HomeMy WebLinkAbout0065 RICHARDSON ROAD - Health 65 Richardson Road
Centerville
A = 210 - 189
/// 5 M E A D
Na 2.15xm
UPC M4
anad mm • Oak to USA
Town of Barnstable
° Regulatory Services
s a Richard V. Scali,Interim Director
a s
• BABNSTABLE, +
TA Public Health Division
n►��" Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date:9 in Sewage Permit# dl Assessor's Map\Parcel
Designer: � U Installer:
Address: &� 644OUG1 Address: C a1 (b l
Moto
On (�J� was issued a permit to install a
(date) (installer)
septic system at ��� based on a design drawn by
(address)
dated ) �®
/ (designer)
V I certify that the,septic system referenced above was installed substantially according to
Y Y g
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
were f and satisfactory.
I cert fY tha he system referenced above was constructe ce with the terms
t p oval letters (if applicable) �Q��N F Rss
o� DAgVID 9cy�
' MASON rn
s Signature) a No.1066 'y
9�G/STEPeo
e ' Signature) (Affix Designer amp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
QASeptic\Designer Certification Form Rev 8-14-13.doc
TOWN OF BARNSTABLE
LOCATION� ,'!��4®SG� �, SEWAGE# ®/
VILLA61�P .�,a/tom ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.r Q>,�✓Q C {�n s, x / .C�:_f 19<�
SEPTIC TANK CAPACITY il_X0
LEACHING FACILITY:(typo'" e 61/11s size) `®X .�
NO.OF BEDROOMS S >
OWNER 11 Z- /e,,I1V F1'lee� 1�4WVOAJ
PERMIT DATE: Z.$ /'i COMPLIANCE DATE: /O 3 S"
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
4 _ i
� 7 �
blAh ,
L,J n�
No. l i Fee V t� .�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Application for a Permit to Construct( ) Repair( Upgrade( Abandon( ) ❑Complete System ❑Individual Components
Ioc d HI or Lot ' G V/ Owner's Name,Address,andf,T�l.I,to. Q
Assessor's Map/Parcel ��d j er,L`9`t A®" ' f P� CI�'
Installer's Name,Address,and el.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 1113 Lot Size f�/ sq.ft. Garbage Grinder( )
Other Type of Building)j&� ^c/ 4 L7 No.of Persons le,7— Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.re q ired) gpd Design flow provided gpd
Plan Date 26 WO I Number of sheets Revision Date
Title L t>%W,
Size of Septic Tank 100D ( FYQ! c I Type of S.A.S. w
Description of Soil �J_ j01(_, lz!)<A?
Nature of Repairs Alte ations(Answer when applicable) �Epbl >t--
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 of the Environmental Code and not to place t e system in operation until a Certificate of
Compliance has been issued by this Boa of Health.
Signed Date
Application Approved by Date
4.
Application Disapproved by Date
for the following reasons
-
Permit No. - ,� - 2 Date Issued
Fee V C.) .�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION4 TOWN OF BARNSTABLE, MASSACHUSETTS f
2pplitation for -Misposaf *pstrm ConstriUtion Permit
Application for a Permit to Construct( ) Repair( Upgrade( "Abandon( ) [:]Complete System ❑Individual Components
Locatio Address or Lot No. Owner's Name,Address,and Tee 1.No.
(05'1�11}fParc!l , G GJ7 ZVI GG . Ol(,Z� hu,)Z I £ Z 1IRE1 LiL
Assessor'sMap/Parcel Zip �
Installer's Name,Address,and fel.No. Designer's Name,Address,and Tel.No.
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.req fired) gpd Design flow provided �c gpd
Plan Date Za 2� Number of sheets ( Revision Date
Title '>IT1
Size of Septic Tank I 00D t��?�]�11n,,f�l Type of S.A.S. Z
Description of Soil
fir.�•
Nature of Repairs of 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 t e system in operation until a Certificate of
Compliance has been issued by this Bo of Health.
R Signed Date cd 7-44
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No.` �2 f Date Issued /
----------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
CPrtifitate of CompYiantr
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( y�Upgraded
Abandoned( )by o,�)rQ�.Dwjw"
at � R\6-HA( u# RK:M(/A� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.
^20 ((5\—/�2")dated b J-
Installer �_ so�p W � �- --A45—. Designer DDA LiJ --E>:> i
#bedrooms_� Approved design flow, �!� and
The issuance of Tspe Tit shall not be construed as a guarantee that the system ill fun ion,as designe .Date ( Inspector , it
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal *pstrm Construction permit
Permission is hereby granted to Construct( ) Repair( Upgrade((-< Abandon( )
System located at `J � G M
and as described in the 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:Construction1must b completed within three years of the date of this permit.
Date J / ' Approved by �J►.
Town of Barnstable P# 1AJ O
r
xp� 4 Department of Regulatory Services
. .AP.Nff,Br.E : Public Health Division Date Zb
p
200 Main Street,Hyannis MA 02601
sLoO �"r't
Date Scheduled Time () _ _ Fee Pd.
Soil Suitability Assessment for Se ge Disposa r
Performed By: tt/,`(V 1 0 Witnessed
LOCATION&GENERAL INFORMATION
Location Address jam, �1/t ly�(�(� p�q t--� Owner's Name
t a
�JG (/ptJM�i/����1ccc� t�-til�'p� Address
Assessor's Map/Parcel: 'Z`(,/�6t) Engineer's Name�t
NEW CONSTRUCTION REPAIR Telephone# �f
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions oflot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
l
i
Parent material(geologic) Depth to Bedrock
Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date Time
Observation I
Hole# Time at 9"
Depth of Perc �!� Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak V/ 1
l
Rate MmAnch �,* �^ b/
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100'of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC n
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color- Soil Other
Surface(in.) P/ (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
I Consistency.%Gravel)
rr
,Z
41 AA An
tr
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) - (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistences%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
Flood Insurance Rate Mao: /
Above 500 year flood boundary No //Yes r
Within 500 year boundary No_ '
Within 100 year flood boundary No Yes
Death of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perv.o s erial exist in all areas observed throughout the
area proposed for the soil ab rp ton system.
If not,what is the depth of n lly occurring pe ious material?
Certification p
I certify that on t l (date)I have passed the sod evaluator examination approved by the
Department of Enviro e l Protection and that the above analysis was performed by me consistent with
the required training,expe 'se ea eri nce described in 310 CMR 15.017.
Signature Date
Q:\SEPTICPERCFORM.DOC ,
LOCATION SEWAGE PERMIT NO.
VILLAc
INSTA LLER'S NAME i ADDRESS ,
OF,TD`2 A3 r v
e UILDER OR OWNER `
u- S All Y
DATE PERMIT I S S U E D
DATE COMPLIANCE ISSUED > S _ s �
� " lz/ -'' -
No. ..s.! ate..'?. F>$.��..........................
o 1 UE COMMONWEALTH OF MASSACH U SETTS
BOAR® OF HEALTH
....................OF........ ...... ...
41�Appftrativu for 11hipas al Works Tanstrnrttnn Prruat
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
............. . . ........................ ............................................... ....... ..........................................
� rn &cation�ddress T� or Lot No.
........ ..................................
.............
......... ...._._..........-- M.:_... ......._
O er S Address
Installer Address
Type of Building Size Lot....� ,�.�.g?....Sq. feet
Dwelling—No. of Bedrooms.............�L.........................Expansion Attic (Nd) Garbage Grinder (1Va)
p, Other—Type of Building ............................ No. of persons.......--..--.............-- Showers ( ) — Cafeteria ( )
a' Other fixtures ------------••• •---••...............•---•---
Design Flow...............��\P•---------gallons per person per day. Total daily flow....._..._3 3 0.....................gallons.
Septic Tank—Liquid capacity\�QQ.gallons Length................ Width................ Diameter--------.------. Depth................
Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area.---......_.......__sq. ft.
x
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tpk
~' Percolation Test Results Performed by....... _6AJ .�.eA.....`&.... ... ......... Date.. '�,a._� .�............
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water............:...........
fq Test Pit No. 2................minutes per inch Depth of Test Pit..----.............. Depth to ground water.----.-----..........--.
9 .....•--•-•-•••-•................... .•----•------------•-•---•-••-•-•-----•-•---...--•----•------•.........................................................
O Description of Soil........... 2 ........jw.sa n.......�5 ......... --•--------••---•--•-•------•-------••-•--•---
O\A
U ---------•-•............... --a --—�-'----------- ,-•-•-----• - .............-
W a
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health. {��
Signed----. ....... �...... '`..-•--•-•-•-•.--_.. �.`
Application Approved By..........- .lQ___.. ..._ P&'f•......--
Date
Application Disapproved for the following reasons:-----••----------•------------------•--•----•---------------....------•-••••--....... -•-•••-••-••.............
..................................................
-------------------------------------------------------
-----------------------------
Date
PermitNo......................................................... Issued--------------------------.............................
Date
No......0 Finc
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... ................OF........`1t M.... ........... _....
ApplirFatiou for Uispaa al Works Toatotrurtiou Prrutit
Application is hereby made for a Permit to Construct ( V) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
. ............................................... ._... —----------------•----------....._..Address.-Owner Installer Address
Type of Building Size Lot..__.\�_:0.()_b._..Sq. feet
�., Dwelling—No. of Bedrooms___..._..... .........................Expansion Attic (NU_) Garbage Grinder (Qo)
Other—T e of Building No. of ersons....•____________________ Showers
a Other—Type g --•------------------------- P --- ( )..— Cafeteria ( )
Otherfixtures ......................... ----------•--••-------------.•-----••-•----••-•. ••-•-•......••--••......•.<._._•-- ......._..
W Design Flow.......... '.......�\t�..........gallons per person per day. Total daily flow--------.---:_:�.`.....................gallons.
WSeptic Tank—Liquid capacityV!_2 .gallons 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 ( )
1.4 Percolation Test Results Performed by...__.. .RAJ :. _ __.._`e____. _-=�A-- ............ Date_. :__ ..:. .\............
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-._-_-_______•__-_--___.
G74 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •---------...4...............•---•................--•-•--•-••••••-•-•-•--•.......................___.........................................................
0 Description of Soil...........LD•= '- ...._._Q_ '_ rn.........
•-•-•.0 \0 S L�t ...............................................................
V ............•.............................................................. eta n ..1
-••------------•---------•---- -•----•-•-••--••-••-------•••••......................•--•---•--•-••-•-•-----•------•--•-------•••••-•••--.....----•-•---•-•--•--• =--------------------•-
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
--------•--------------------------••------•-------------------•----------•------------.......----•----------------------------------------------------•-------------------------•.••-••-•--•-----••---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
SSigned .1.�� ------------ �1-:. r`�...
g ---••••.......... ,-•-•-
Date
Application Approved By--•••. .... ..--�✓/ e3
' ate 1 ---------
Application Disapproved for the following reasons:---•----•--•----------------------------•-----•-•-••--•---•------------------------•--.........................
............................................•------...--•---••----•---•----------•--------------•---.......-•-------------------------------------....................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ ...............OF...........J) n \ 1�. ,
Trdifirat a of Toutplitturr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (4 or Repaired ( )
by = ..................•----..........-•--•-----•----•---------------------------•--..................................---.-._._........
Installer
at ------------•--------------------------••----------------------------- --•--------------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. _1..,_.. ................ dated---------------------_..........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................... Z P 81..... ..... Inspector !� -•----•-•-------•......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...............OF............-�..... :... .. -. s,� .�.=-.......................
................... FEE ....
Disposal Vorkv TyMns#rurtion lerutit
Permission is hereby granted......... �_ .: 1 .�?..........:� . 0 ��`. a`n°
to Construct ( t/y or Repair ( )�an Individual Sewage Disposal System
at No......... .........................................' � , 'fir, L-,A-=�-` `�-� �' � ( `�_c'��•e 1� �� ''
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated...•......................................
....... rC a-,. •:,• - ----------------•-----------------
/^ �/ Board a
DATE........ 3--••-----••---------•-•-•-•......-•-•-------•-•-•--•••••,
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
V1,1'P' �3'�
� i..10 (�At"GT4tAE� E..jGI 1.1L'��SZ �� I �
I�dl t_�f ; taw z. t to -
� 1-tC -1"�v lk� = 3�t� t (r7C % • GL��?�.F?D. .h 16773xi
_ j �W
pos,&L_PIT Usi~- t 0� Get_,
` P.D.
8CT 1 t7Ni ALE'A c �j0 Sr--. ? a 'ov t✓ +. a rack• c
A t .a
ToT,&t_ Lac-��IG►J = 1�25 G.t?�. zo'-� P�aP
P•r ,yy
w to bra ppg
j._ - -'e. -
00
20 A-t,
I
I
p l6f To;n rru:i
7
s V.
LOAMsefnc
I Sv'�vt�.. �rpv� �: $--- Irv. �,�.�. 9�'•3 ,,.;
INV.
I t700 i W v
C.rat,. 9d.7 9d,
tT
r- f _
'' -- - L b CA T I U t-I CMG��V�/t�•�►
tZ ._ t to SG/1Sr. GC.AI.Y= j1- A-T'r--,
�k o W'4 TM
c U IZ T I V, -r T;4 far 'r k c-_ 014-c>pxta t �;ii�,v Pt t .t R t= P i_+,j��`=
1-iZA-Y M-01J C0M Pt_l!S `.V i'1 t- Ti-i` �t l�C.t_i:-ir.• ,
��ja -�ETt_ nct! G'r•-C t�cAA&wTy oi= . 'ra�tr
i3j =L_!Ufj.`rt=. _ f_t-- M {.! p B/ ,h-i-- 1�'., r�.
. G
ti�{st"��:1:✓1C=1.1;' ;U{'_�lt=�' TttL, tJF=1=��i Sri �llf�l�ltl� `pr-)t t iC.At—i-T� 1
t•��r i?�c-_ ur', � TIC) 1-)r_-:rc.i��.t1�t �.o�c- i_Ii� �M .� � v� c�S VIA tom?
ASSESSORS MAP : �'���------------- _-----------___.____._._ TEST HOLE LOGS
I!� q _
� PARCEL: � �� / ;
— ------ ---- - ---- - _ 1) 'I�lie installation shall co1ntAl�y with Title V un:) 'To�Vn of ' (��!� 1loard of
i w►� r� GI�� ' �kv1 rJ M g
FLOOD ZONE: ti/c�% SOIL EVALUATOR :f� I lealth Re ulalions.
- -..----- ------- . . _ _ WITNESS : I YyJ1 ' al 2) The installer shall verily the location of utilities, sewer inverts and septic
REFERENCE:
DATE: ( components prior to installation and selling base eleva(ions.
- ---
PERCOLAT ION RATE: 3) All gravity septic piping to be 4 inch Sch 40 I'VC at 1/8" per foot. The first
Oil= �� k _ TT r --- / 9 two leet out of the d-box to the teaching shall be level.
TH_ t 4) This plan is not to be utilized for property line determination nor a other
TH_2 ny purpose other than the proposed system installation.
0V—ggqI( 1 �i 0244o IL 5) All septic components must meet 'title V specifications.
6) Parking shall not be constructed over 1110 septic components.
7) The property is bounded by property corners and property lines.
?� �p0 8) I he property owner sliall review design considerations to approve of total
LOCATION MAP / J" design flow and number of bedrooms to be considered for design. Receipt
of payment for the plan and installation based o❑ the plan shall be deemed
approval of the design flow by the owner.
9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall
+ be removed along with contaminated soil and replaced with clean sand per
,1 +� Title V specs.
1 p
)System components to be 10 feet (coin water line. Sewer !Ines crossing the
water line sball be sleeved with 4 inch SCI140 PVC with ends grouted if
applicable. The proposed SAS is being installed below the water service
�T line. The line is to be sleeved as aforementioned and maintained in place.
SEPTIC SYSTEM DES I GN 11) If a garbage grinder exists it is to be removed and is the responsibility of the
j owner to ensure such.
FLOW ESTIMATE 12)`l he installer is to take caution in excavation around the gas line if such
exists.
j l ';`'. BEDROOMS AT 1 ID GAL/DAY/BEDROOM - �GAL/DAY l3)"fne installer shall verify the location, quantity and elevation of the sewer
o �7y �T, ' lines exiting the dwelling"rior to the installation.
SEPTIC TANK 14)'I-Iiis plan is representative only
that a system can fit on a property meeting
"Title V requirements.
-Q +
GAL/DAY x 2 DAYS - GAL
USE 11 )� GALLON SEPTIC TANK I�
i
N - 6;
IS, m W SOIL AI3S0RPT I ON SYSTEM _
•
oFi
q 1
'�� .IjAvl�. 9�
SDE AREA: 1z- a .�
n
_ BOTTOM AREA: �`o � 1���7� .. .x..�,,7 Zv�.�� � NIASON yl�
\p T No.1066 G~
h ,
�,�,� y' 0
i
S-E- ?T I C SYSTEM SECT I ON v =� '
_fir �� -
,ray, .T,�j
J,
f�,
"l
=AL
D
GAL tea ' I
IF
SEPTIC TANK I Z� I —
L cy,I�VJLV T� 2v� x
7
/
1�t .
31TE AND SEWAGE PLAN
0
LOCATION : -44957
7 ,
_5G 2 — — PREPARED FOR : �ykLDIMV�, CM��"C�,�1
0
O
SCALE:
W
a _ --� DAV I D• B . MASON R5 DATE:
s DBC ENVIRONMENTAL DESIGNS
z EAST SANDWICH . MA
DATE HEALTH AGENT
( 508 ) 833- 2177 .