HomeMy WebLinkAbout0417 LAKESIDE DRIVE WEST - Health EA�
eside..5rive (West), Centerville
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Commonwealth of Massachusetts g
Executive Office of Environmental Affairs �1+
Department of 4. s..
Environmental Protection �ECENEO
William F.Weld F E B_2 6 199
Trudy Coxe
Sec,„ry,ECEA ki 6
David B. Struhs
Commrssroner -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Lf�'fDe. Q�ktVe cwe^S�
Property Address: +J 7 Lakz S�c�r• iJr��N fN"c:Y Ccnre(-vier Address of Owner.
Date of Inspection: a fL4197 (If different)
Name of Inspector: 9,'aA zr LO t'A rop
Company Name, Address and Telephone Number: AI G� S�P►-r�C �nS�.
20 LoAg yr�w PrrrC., O'rle.?ns"
CERTIFICATION STATEMENT 24-O-�27
I certify that I have personaliv inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper funcoon and
maintenance of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date: 1. it-!a7
The Svstem Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspecnion. If the system is a sharea system or has a design flow of i0.000 gpd or greater, the inspector and the systeem owner shall submit
the repo^ to the aopropnate regional office of the Deoartment of Environmental Protection.
Tne oneinai snouid oe seni :c :ne stem owner ana cop,f, ser:. to the bu,er, if applicable and the appro rig authony.
INSPECTION SUMMARY: t
Check A, B, C, or D
A] SYSTEM PASSES:
�I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B1. SYSTEM CONDITIONALLY PASSES:
EV& One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not)
_ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
1
trev:sed 8/15/95,
One Winter Street a Boston, Massachusetts 02108 a FAX(617) 5-1&1049 a Telephone (617) 292-5500
Pnnred on Racyded Pope
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:4-i7 Lake W-
Owner: p, ray for
Date of inspection:21z11-197
Bj SYSTEM CONDITIONALLY PASSES (continued)
_ Sewage backup or breakout or high Static water level observed in the distribution box is due to broken or bstru t he
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C] �FU�RTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
►V//} Cond bons ex st which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
—T— public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESSTHE
BOARD
A MANONER HEALTH
THAT PROTECT PUBLIC
THE PUBLIC HEALTH AND SAFETY AND D EERMINES THAT
THE SYSTEM IS FUNCTIONING IN
ENVIRONMENT:
_ The system has a septic tank ano soil absorption system and is within 100 leer to a surface water supply or tributary to a
surface water supply. well.
_ The syste�, hay a septic tank and soil absorption system and is within a Zone I of a public water supply
_ The system has a septic tank and soil absorption system and is within SO feet of a private water supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5
ppm.
D] SYSTEM FAILS:
1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The
T basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
_ Backup of sewage into facility or system component due to an overloaded or dogged 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.
2
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:,+17 "ke 5U)e dr;K—.
Owner: P 'raj/for
Date of Inspection: 4124-/97
Dj SYSTEM FAILS (continued):
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
_ Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
_ Any portion of a cesspool or privy is within a Zone I 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 SO feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design floe of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a
public water supply well
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
3
(revised 8/15/95)
r.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: `t-17 L2k-d Sides drllve tA/
Owner: A 75y br
Date of Inspection: e—IZ4-19.
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
built plans have been obtained and examined. Note if they are not available with N/A.
1/fhe facility or dwelling was inspected for signs of sewage back-up.
t'The system does not receive non-sanitary or industrial waste flow
✓The site was inspected for signs of breakout.
✓AII system components, excluding the Soil Absorption System, have been located on the site.
!/•The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
L_ The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
_✓(he facility o%sner (and occupants, if dirferent from owner! were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 8/15/951 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: +J7 Lake S•11' d I'VV
Owner: �, r2�I'ar
Date of Inspection: ZIZ4-197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 3.30 gallons 4-
Number of bedrooms: 3
Number of current residents: Z
Garbage grinder (yes or no):4-9!S
Laundry connected to system (yes or no):�/
Seasonal use (yes or no): NO
Water meter readings, if available:
Last date of occupancy:
COMMERCIAUINDUSTRIAL: �(J
Type of establishment:
Design flow:_gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title S system: (yes or no),_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of information:
cv'
System pumped as part of inspection: (yes or no) e
If yes, volume pumped gallons
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)
Other (explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information: 19 98 zS �as�y c.zrr
Sewage odors detected when arriving at the site: (yes or no) 1 d
(revised 8/15/95) 5
�9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: +)-7 §3e drive h/.
Owner: ppec, %ar f o /
Date of Instion: Z )7
SEPTIC TANK: P—'
(locate on site plan)
Depth below grade: g qr1dC - 6 ;r"r C'� j d t� o�� -t2A�
Material of construction: ZIC-Oncrete _metal _FRP —other(explain)
Dimensions: 17r060 Q�1•
Sludge depth: 3`r fr
n from to of sludge to bottom of outlet tee or baffle: 3 f
Distance p g
Scum thickness:
Distance from top of scum to top of outlet tee or baffler_
Distance from bottom of scum to bottom of outlet tee or baffle: 11 t 4
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,.structural
in(egrity, evidence of leakage, etc.)
0
GREASE TRAP:
(locate on site plan)
Depth below grade.
material of construction: _concrete _metal _FRP other(explain)
Dimensions:
Scum thickness:
Distance from too of scum to too of outlet tee or baffle:
Di<_tance from bottom ni «urn t^ bottom of outlet tee or baffle-
Comments:
(recommendation for pumping• condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
Integrity, evidence of leakaee. etc.(
6
(revised 8/15/95)
I_
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 447 LA_, SiG�C !J G
Owner. 17, "TzIV jor
Date of Inspection: Z1L�f-�H7
TIGHT OR HOLDING TANK:AAA
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP —other(explain)
Dimensions:
Capacity: _________gallons
Design flow: Rallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: Per as �rWyrs-
(locate on site plan)
/�O [l'9Lvt/c'�'Cci — �Dc1?'C4 v;3�c•Y )P.2i'42d
Depth of liquid level above outlet invert: Pd�k��9 dTrv1,
Comments:
mote ii levei and distnbut,un equal, e%.dcncE of solids carr�o\er, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 8/15/95)
i
SUBSURFACE SEWA
GE DISPOSAL SYSTEM INSPECTION FORM v
PART C
SYSTEM INFORMATION (continued)
Property Address: 417 Lake Srk A-ii'l/le W,
Owner: A %ay/vr-
Date of Inspection: Z�Z4�g7.r
SOIL ABSORPTION SYSTEM (SAS):_✓
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:_
leaching galleries, number:
leaching trenched, number length: ) — G"�Z X Z u/(c�� x
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
Ala a-r sn 3/ dry ti lem`s
CESSPOOLS: WA
(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 (cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: WA-
(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)
(revised 8/15/95) 8
r
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 4-J7 l a/!c St)-
Owner: p,Date of of Inspection: Z./z4-/y7
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
/ W,! quc r
AC- r4,5' 9 C-33
A D-of 8 D--z6,3,
A g�
z/c+ro9Jl.
C
� D
Per desz�x 43 17
L.AKIC,-510E DRIVt'
DEPTH TO GROUNDWATER
Depth to groundwater, �f-' feet
method of determination or approximation: fer _n j*
QYD �.�� i ua ram.- ,•- / L
rCV.
(revised 8/15/95) 9
2
No.._••---•.y••....... ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
_.c ...........OF........#z r-N s / I-- X/e ................
...................................
Appliratiun -fur Dhipo l Workii Cnunitrurtiun Vrrnlit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at: - e
--__.__-
L atign-Addres or Lot
...__..... ` �_.. . =----- ---- ---•--------------------- --------------- ,4 Ile
�----•-- ... ----____..-- ---='._.. ---u----------___----
W e Address
a •---• - - •••-----••••--•----•--•---------•_.... ................. .•-••-•-•--•--------•----
Inst a Address
UType of Building Size Lott --------Sq. feet
Dwelling—No. of Bedrooms_- ................ _-________Expansion Attic ( ) Garbage Grinder (�
pa, Other—Type of Building *� _ __ No. of persons...___���,., ( ) ( )
Showers 1 — Cafeteria
Other fixtures ___--.___--iS _ »i
0 y ----------
W Design Flow................ ..���p_gallons per person per day. Total daily flow------------------------ _�---__-gallons.
USeptic Tank—Liquid capacitv-_-_________gallons Length....... Width......5....... Diameter__-___--__----- Depth------6-_----
x Disposal Trench—No. _______l.......... Width...
...A---------- Total Length-----Y_7.... Total leaching arca___P .�F_e----sq. ft.
Seepage Pit No..................... Diameter____________________ Depth below inlet............_....... Total leaching area._..--_.__-_______sq. ft.
z Other Distribution box (0-7 Dosing t k ( ) t /
Percolation Test Results Performed by-.__-_ _c�.: __ .� I_��.J____ Date.... ._.____.
Test Pit No. L__/tC....minutes per inch Depth of Pest Pit___________________" Depth to ground water_--____--___--_-__-___-.
(s, Test -Pit No. 2................minutes per inch Depth of Test Pit.................... Depth'to ground water-----_-----------------
9 ---------------------- -------------------------------------•-••--•-•-•-------- •-- --- _
O Description ofil
- �-
_ -� �:. -7-- w - -------- ------- -
7 r.Q_v Z� -k -------------
--------------
V Nature of Repairs o teratio —Answ w ap livable-___.------,------ /
ff ---------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be"sued sued by the ar o ealt .
Signe .. 'u�!&.6-4
-------------------- -------------------------------
Date
Application Approved By----- ` 1 - 7 '
Date
Application Disapproved for the following reasons:..........................................................____..................................................
--•-•--"-••--•-------"-•-•-•----------------"----•--••---------..._..-----------•-•---------•-----------•..----"--•-••-----------•-••----•--•-_..__...-------•••-•--------------...----------------•---•-
Date
Permit No. Issued. � 79--
-•-••----•--------••-_..
Date
No....... ....... Fmc..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH j.r.
OF......................................
Appliration -fur Uiopooal Workii Qlotwtrurtiou Vrrmit .
Application is hereby"made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
----------•-------------------------------....................................................... ••--•-....•-••--••--•••••---•---•-•-•--------••---•-•-••------•----••------------•--••--••---•---
Location-Address or Lot No.
•------•---•----•..........................•---....---...-----•---•---------•----••-•-••.......... ..........•...•••..•...............•--••-..............................•••.............-•-••••-•--
Owner Address
W ,
Installer Address
Type of Building Size Lot----------------------------Sq. feet
., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons.-:------- ____-_--_-__-__- Showers ( ) — Cafeteria ( )
A' Other fixtures ------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tunk—Liquid capacity------------gallons Length................ Width.----_----._.- Diameter..........------ Depth.-..------------
x Disposal Trench—No. .................... Width-------------------- Total'Length-----------......... Total leaching area--.-:._-_-_=.T-_-__sq. ft.
Seepage Pit No.---_______________ Diameter.................... Depth beL inlet----------.......... Total leaching area------............sq. ft.
Z Other Distrilintion box ( ) Dosing tank ( )
a Percolation Test Results Performed by ------•------------------- Date...................................
=
,a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to'-round water....___.................
(� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water....---..-_.-_-.--__-::.
--------------------------------------------------------•-----•-----•--------------------••....--•--...................................................
O Description of
x 5 �
t - -
� •� ------ --- --
�r�w + 7 *-
V Nature of Repairs o terati l,—Answ r w n ap licabl _---A-- ------ --------- *.
�e-- -------------
Agreement:
• ' /
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
11 0.
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.be sued by the oar o eal
w
�. Sign
- ................
✓ Date
Application Approved BYf' ---------
Date
Application Disapproved for the f oldozeiing reasons-------------------_-----------------------------------------------------.----•------------------------------
-------••-••-•--------------•-------•-:........--•---------......•......-----------••--••••-•--•--•-•-------------------•--•----••-•-•-•••-•---•••--•-------------------- •.......-------•---•--
Date
PermitNo-------------------------•-•----•---•................... Issued....................... - ----------------------•---•
Date
.a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
(9rrtif irdr of f�nm1t�rirr
T IS IS . 0 CERTIFY, That the Individual sewage Disposal System constructed �) or Repairefl ( )
by---- -- •--
-
at.._`.------ T. --- ���.---- ........................
has been installed in rlccordance.with the provisions of Ar ' e XI of The State Sanitar Code' as described in the
1
application for Disposal Vorks Construction Permit N __ '.��................... dated'..r _=, _ 'l��r`................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FgNCTION SATISFACTORY.
DATE-------. ...........•- 7- . Inspector.-- -------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
7
NO............. ......... FEE. ..............
i� uo kq' Tooitrurtion Vrrmit.
Permissio i hereby granted--- L ,...
to Co uct Repa' ( ) an I vi al Se a e Sp '.Sal Sy m
at No. }a�} " ------------- -
Street
as shown on the application for Disposal Works;Construction e mit o.._______ �y
-------- Dated...
._........................
oard of th
DATE........--.......................................................................
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FORM 1255 HOBBS IN WARREN: INC.. PUBLISHERS
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;•� ` , .LEGEND � ;..
EX14tING SPOT E:LEVAT`ION `XO `f CERTIFIED PLOT L:AN
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EVSTING CONTOUR -�- p - � �sRQ�)L"T- �o k .;IPA- 757FFVE
TWIS,HED - SPOT IELEVA.TION. ,.. 0 Yv` �
`#lN1,3HED CONTOUR 0 - - - -------.
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��ROVED = BOARD '' OF: HEALTH !' ,'�.�ti�.�a
E AGENT . SCALE 2,0 DATE '/?. T
4 L DREa6E ENGINEERING CO /N CLIENT TA YL
CERTIFY THAT THE PROPOSED
EGISTERE REGISTE�2E0 JOB N0. -771 BUILDING`'SHOWN; ON THIS PLAN
CiYIL "' LAN CONFORMS TO THE ZONINQ LAWS
DR..BY .A,
ENGINEER SURVEYOR OF BARNSTA E MASS
N0; 'MAIN ST ' :` 712- MAIN: ST.
SO YARMOUTH, ]t]js�s HYANNIS, MASS: SH:EfT OF DATE REG.. _LA.ND SURVEYOR
TOWNZ BAR.NSD LE
L%W.ATION �� SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT -23 -a 3
INSTALLER'S NAME&PHONE NO. r
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: 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) Veet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
e 7
L0 1T � � SEWAGE PERMIT NO.
( VILLAGE
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INSTA LLER'S NAME & ADDRESS
Ag cga� 4�,l
B U I'L D E R OR OWNER
f 2F,N/9 2 T f y 1e6L..
DATE PERMIT ISSUED _.4 �1
OAT E COMPLIANCE ISSUED
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,`, ,. LEGEND'
aEX13''�1NG SPOT ELEVATION 'CxO > �/< CERTIFIED PLOT "P`L.AN°
_EX1'9T_INQ' CONTOIIR_- = 0.-
`FINISHED. CONTOUR 0 �n_�JC)lr �o Q h�}lC�- .���. » .
w FfNi$HEO SPOT iELEVATION 0 N� -
Chit• Tf-=J2. /C�E
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�PPROVED`t BOARD OF HEALTH
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flATE AGENT . SCALEt l l.C) DATE , �d ?`
11L DREDGE ENGINEERING CO. IN a "?
I , ----------- _ CLIENT T�/2 I CERTIFY THAT THE PROPOSED
ri Ea1STERE REGISTERS JOB N0:'7'I BUILDING''. SHOWN ON THIS:,PLAN
CIVIL LAN CONFORMS TO THE ZONINQ LAWS
ENGINEER .,:SURVEYOR DR BY OF BARNSTAS E MASS.
33' NO. MAIN ST 712 MAIN ST. CH. BY: RIP ]`ate /fi t
SO. YARMOUTH, MASS. HYANNIS, MASS. SKEET- /,OF -2- V DATEr��� , .REG.- LAND SURVEYOR
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