HomeMy WebLinkAbout0171 SEABROOK ROAD - Health (2) 171 Seabrook Road
Hyannis F/R OVA, ,
A = 307 207
1 i
1
No. OL I3 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitatlon for bisposal *pstrm ConstCUttion 3dErmit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon X ❑Complete System ❑Individual Components
Location Address or Lot No.171 k—,0ee1 OX✓n 's Name,Address,and Tel.No. mpg-S<tf.3--.2ScJ6
Assessor's Map/Parcel 30 o'?
n f),'-S /GPM l�t.rr e-* 10 r�Ti RBI
taller's Name,Address,and Tel. o. e5M— 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.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
e
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental t to place the system in operation until a Certificate of
1 Compliance has been issued by this Board of Hea
Signe ----.Date
Application Approved by Date l5,
Application Disapproved by Date
for the following reasons
Permit No. ;?o 0 Date Issued P_
No. cI 565
� Fee .
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
v _1
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplitation for bisposar 6pstem Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ❑Complete System ❑Individual Components
Location Address or Lot No:/7/0�1� k O ner's Name,,Address,and Tel.No.
/ � Gtnr�i'$ '�1'7cP!".ry rr�Ff- !7 P;neTree j?cl
Assessor's Map/Parcel 307 �o2G7 yQ,y1�/,(� vas
taller's Name,Address arid Tel.�o. '�9 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
ll
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
:c
r -
Nature of Repairs or Alterations(Answer when applicable)
�4
d
Date last inspected: ,'`
Agreement: ( '
hF,
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-arid not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health'')
�.
Sign�d�, �._,.--` --- Date g
Application Approved by Date
Application Disapproved by Date
for the following reasons
n
Permit No. Via(3 — Date Issued
...� - --------------.------------.-------------------------------------.------------_,------.-----_.______.,_,____,__._-______._____.-____-______________� ,4:.. �.. .
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO C IFY,)ha tthhfOn-sit? wage,Dis�pos4l system C
on
structed( ) Repaired( ) Upgraded( )
Abandoned�y /�Jl� ��d�✓ e /kllGC_llDyq
at/ has been constructed in accordance ..
with the provisions of Title 5 and the for Disposal System Construction Permit No.�)0/3-56 S dated `
Installer Designer
vlq#bedrooms Approved design flow gpd
The issuance of this permit hall not be onstrued as a guarantee that the systen will functio as Igned.
Date �� Inspector
I
-z. ---- - -9G-----50 - - ----- -------------•- - -------- -----•---------------
-----------------------------------------------
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstrm Construction Vermit
Permission is hereby granted to Construct(/) Repair( ) Upgrade(' ) Abandon
System located at / —21 �Ql�°
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:Cons tion nwst be co pleted within three years of the date of this permit.-
Date Approved by
TM THE COMMONWEALTH OF MASSACHUSETTS
FORM 30 �x�w HOBRS 8 WARREN
BOARD OF HEI& I TH
CITY/T WN
W '
DEPARTMENT
ADDRESS
�M
TELEPHONE
Address I I r --Occupant " '" ✓e
Floor Apartment o. No.of Occupants
No.of Habitable Rooms_ No.Sleeping Rooms__ _
No.dwelling or rooming unitt—_ No Stories
Name and address of owner _
6 02 3 arks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 11220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
i
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
StAcks, Flues,Ven Safeties:
Kitchen Facilities ink
e
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub: -
Infestation Rats, Mice, Roaches or Other.-
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPO SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJUR .
INSPECTOR TITLE
M.
DATE _��0 o TIME
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety,and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns,shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or corditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503,B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
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d
.41
THE COMMONWEALTH OF MASSACHUSETTS
FORM 30 C&W HOBBS&WARREN
BOARD OF HE TH
CITY/TOWN ,
DEPARTMENT
ADDRESS /
-
TELEPHONE
Address A * " - - Occupant
Floor Apartment o. No.of Occupants
No.of Habitable Rooms No.Sleeping Rooms_
No.dwelling or rooming unit No Storie
Name and address of owner
6 7 a 3 � r� emarks Reg. Vio.
YARD Out Bld s.: Fences:
} Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M I Doors,Windows: /►
Roof /
Gutters, Drains:
Walls:
Foundation:
Chimney: Ll
BASEMENT Gen.Sanitation: ,
Dampness: v
Stairs: '
Li htin : A "�—
STRUCTURE INT. Hall,Stairway: 1 T
'yObst'n:
Hall, Floor,Wall,Ceiling:
i Hall Lighting:
i Hall Windows
HEATING Chimneys: i
Central 1p Y ❑ N Equip. Repair
t TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen:Cond. Distrib. Box:
f Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1 ov-14
i
Bedroom 2 I �{
Bedroom 3
Bedroom 4 j
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: �' 1
Stacks, Flues,Ven s Safeties: r
f
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
-
Wash Basin er',-Showor Tub:'
Infestation_ Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
I General Building Posted -T- /)
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH.OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF .THE CODE .OR THE
AUTHORIZED INSPECTOR. (See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY:"
INSPECTOR TITLE t`f
! .. A.M.
DATE 2 O TIME P:
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water suffic ent in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B) and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 4.10.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns,shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting,or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
+ TOWN OF BARNSTABLE
LOCATION I �� � /�t`S Z()o I c f� l� SEWAGE #
V _LAGEy/_/ ASSESSOR'S MAP & LOT D
IN."STALLER'S NAME&PHONE NO.,%Z/Ck* 17zl
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 500 &4io* l ck"w5 (size) .3 oZ X1.3
NO. OF BEDROOMS__
BUILDER OR OWNER _"Yb-400$ QRltra
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
ANAW *0Wr4ft6
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) IV IA- Feet
Furnished by
wbN��
a3
A � a
B3
No. 'v Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes
2pplication for Migogal bpgtem Congtruction Permit
Application for a Pen-nit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.)7 1 S FAZ Ttco h R D Owner's Name,Address and Tel.No.
�QU6-E[.k + '0,4XuNF�7z/Z:/G
Assessor's Map/Parcel -7 D2-v , `
Installer's Name,Address,and Tel.No. I Designer's Name,Address and Tel.No. �j o- 3
1104N,9r,> M c Kji-c�r_n NU I D ,$off E 5 Ewz!.v CH
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder T--T—
Other Type of Building 1 2 No.of Persons Showers�9- _) Cafeteria-(—)—
Other Fixtures
Design Flow gallons per day. Calculated daily flow `f l gallons.
Plan Date ber of heets f Revision Date
Title S
Size of Septic Tank L-L Type of S.A.S. 3 F'C S U� ��.
Description of Soil
1 _ /I e All ARo v' �
0. lK
Nature of Repairs or Alterations(Answer when applicable) A S Z5;n1ZE
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 y is of th.
Signed C _ Date//S
Application Approved by AV Date
Application Disapproved for the following reasons
Permit No. Date Issued
.., 3.•�� , .
' No. ��,� Fee 0
y
if THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: Yes
r P�UB.LIC HEALTH.DIVIS_I,ON.-TOWN OF BARNSTABLES MASSACHUSETTS
' Application for Miq#ogal *p!gtem Congtruction Permit
Application for a Permit to Construct( )Repair(�/)Upgrade.(-. )Abandon( ) ❑Complete System O Individual Components
Location Address or Lot No.'1 71 Owner's Name,Address and Tel.No.t
Assessor's,Map/Parcel
Installer's Name,Address,and Tel.No. "�- Designer's Name,Address and Tel. o •J` a1 f
RqNft_D mcf J,>u 1 D U) Ct
Type of Building.
Dwelling No of Bedroom s'`Y Lot Size sq.ft. Garbage Grinder("'T
Other- Type of Building 4 No.of Persons Showers Cafeteria{---)
Other Fixtures
r,
Design Flow 440 a gallons per day. Calculated daily flow l gallons.
Plan/Date, Z I her of Sheets J Revision Date
Title S I± r
Size of Septic Tank J00 14 Type of S.A.S. 3 ?/Tti
c.e.1 s Y-v e 4//A Ro v 0
Description of Soil I.e 014G r G
y
Nature of Repairs or Alterations(Answer when applicable) S,�P�OV�
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 y ,is of • th. r�
Signed /t A C Y� Date�`J� j
Application Approved by U a Date
Application Disapproved for the following reasons l
1
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
4 ,t
Certificate of Compliance °
THIS IS TO CE�FY�,tfh�trthe O ite Sewage ispoosal'S tern Constructed( )Repaired(�)Upgraded( )
Abandoned( )by l�l L.l�#0�r�� 1 ('. ► f
at has risonstructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No ;,bated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the sy a will unction a desig ed.
Date Inspector 4r4 S
—L— — —— — —
v --
No � r ��� --- -- ----- ------- Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
)0i2;pogar *pgte Construction Permit
Permission is hereby granted to Construct( )Repair(7 Upgrade( )Abandon( ),
System located at ��
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Constn' tion must be completed within three years of the date of this4peermiitt.
Date: 1 i — 13•r Approved by
TOWN OF BARNSTABLE �.
LOCATION j �Fa` ZnoK SEWAGE # a0oa'S3S�
VILLAGE y ASSESSOR'S MAP & LOT
392A6Z
INSTALLER'S NAME&PHONE NO.2/C�ft
SEPTIC TANK CAPACITY 5-00 -rA
LEACHING FACILITY:
�00 (y�ii�Hl Gi�l�ii� $,_ ) 3
(type) (size o -3
NO.OF BEDROOMS
BUILDER OR OWNER �'bkoWE !L'10
PERMITDATE: 0 COMPLIANCE DATE:
Separation Distance Between the: Rrsaua CN9*00MM4�
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Feet
Private Water Supply Well and Leaching Facility (If any wells exist Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist N /A Feet
within 300 feet of leaching facility)
g
Furnished by
i
AJu- 30' ALex
02's" A. o�
Jhat 3C`
bar
!B3 Of
A4
$S`= 37' `�
'i
.Y +
` t
FFFSMI
I'OMMONWEALTH OF MASSACHUSETTS
EXECUTIVE'OFFICE OF ENVIRONMENTALDEPARTMENT OF ENVIRONMENTAL PRLE
a i
W
FAILED INSPECTION
�e �.t:a s Yo..
TITLE 5
OFFICIAL INSPECTION:FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFAC
E SEWAGE DISPOSAL SYSTEM FORM
.,
ti.4 s PART A
CERTIFICATION
J(Ji 2 J�7
Property Address: 171 SEABROOK RD HYANNIS,MA 02601 %{
Owner's Name: ANGELA DEMAKE ` .
1
Owner's Address: 26 MODOC ST WORCESTER MA 01604
Date of Inspection: 8/19/02COP
s.. m
Name of Inspector: (pleas.6,Rrint) t JOHN GRACI
Company Name: SEPTIC INSPECTIONS
Mailing Address: (. P.O: BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX 508-564-7270
f
CERTIFICATION STATEMENT
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 th'etime 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. ;..:!
Co4r&
ses
_ Nealuation by the Local Approving Authority
X FaInspector's Signature: Date: 8/19/02
The system inspector shall su 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 now 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 an ifopies sent t(�%t e buyer, if applicable,and the approving authority.
No
Notes and Comments 4i, _' "i
CESSPOOL IS IN HYDRAULIC FAILURE.OVERFLOW WAS
SYSTEM FAILED TITLE V.I..NSPECTION.OVERFLOW
FULL AT TIME OF INSPECTION!,MAINCESSPOOL NEEDS TO BE UPGRADED.
****'I't►is report only dEscrfues'Cpnditions al the time of inspection and mjder the conditions of use at that time.This
inspection does not address, t(oV the.system will perform in the future under the same or different conditions of use.
,�st, .�a "•s
Titla 5 IncnPrfinn Form h/1 S/')f1f 1t1
1
Page 2 of
f.
OFFICIAL INSPEC,T,ION,FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
'.' CERTIFICATION (continued)
Property Address: 171 SEABROO(RD`HYANNIS,MA 02601
Owner: ANGELA DEMAKE
Date of Inspection: 8/19/02
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:
SYSTEM FAILED TITLE V INSPECTION.CESSPOOL WAS FULL AT TIME OF INSPECTION.
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 rep I acenjent#.jrepair,,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.
't
n/a The septic tank is metal and over 2'0,years old* or the septic tank(whether metal or not) is structurally unsound,exhibits
substantial infiltration or exfiltration`�r 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: n/a
n/a 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): ''' t" lit
5'ibrokenYpipe(s)are replaced
_ obstruction is removed
distribution'box is leveled or replaced
ND explain: n/a
>;
n/a 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 th�efBoard of Health):
_broken pipe(s)are replaced
_obstruction is removed
NT)explain: n/a
t'
�ON,
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Page 3 of 11
f .
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
C°ERTIFICATION(continued)
Property Address: 171 SEABROOK RD HYANNIS, MA 02601
Owner: ANGELA DEMAKE
Date of Inspection: 8/19/02
C. Further Evaluation is Re_quired,by the Board of Health:
_ Conditions exist which requii*61furttier evaluation by the Board of Health in order 6 determine if the system is failing to
protect public health, safety or th'e%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 mannWwhich will protect public health,safety and the environment:
_ Cesspool or privy is whioim,,Wfeet,of a surface water.
_ Cesspool or privy is within.56.feet of a bordering vegetated wetland or a salt marsh
1.. .
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2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines th
at 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 wa ersupply.
_ 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 tarik acid SAS`and the SAS is within 50 feet of a private water supply well.
_ The system has a septic,^tank and fSAS and the SAS is less than 100 feet but 50 feet or more from a private water
supply well". Method u'sed'to"deterrniihe distance n/a
"This system passes if the well water analysis,performed at a DEP certified laboratory, 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, provided that no other failure criteria are triggered.A copy
of the analysis must be.attached!io th6-form.
3. Others
n/a ,$
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Page 4 of 1 I
s
OFFI
4
CIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM
, ; PART A
E CERTIFICATION(continued)
Property Address: 171 SEABROOK RD HYANNIS,MA 02601
Owner: ANGELA DEMAKE., ,..,� Y', '.
Date of Inspection: 8/19/02
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X _ Backup of sewage into facility-ors ystem component due to overloaded or clogged SAS or cesspool
_ X Discharge or ponding of effluent to.,the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool`Yf
_ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
_ X Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow
X Required pumping moreAhan 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped 7 YF.ARS•RY OWNER.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool of. privy is within 100 feet of a surface water supply or tributary to a surface water supply.
_ X Any portion of a cessppol,or privy is within a Zone I of a public well.
X Any portion of a cesspool or privy is>within 50 feet of a private water supply well.
_ X Any portion of a cesspool or privy is iless 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'colifor m,bacteria and volatile organic compounds indicates that the well is free
from pollution from thaYfacility*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.]'- I
X _ (Yes/No)The system fails.1•have determined that one or more of the above failure criteria exist as described in 310
CMR 15.303,therefore the system fails:?'Tlie 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 now of 10,000 gpd to 15,000 gpd.
You must indicate either"yes't'or"no"to each of the following:
(The following criteria apply to large systems'in addition to the criteria above)
yes X the system is within 40&feet of asurface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
`a nitr gen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped
X the system is,located m'
Zone 11 of a public water'�supplyLL we'lL
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"Yes" in Section D Rbove.t1w I'll- sN sien>hAs foiled: 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.
z
d
Page 5 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 171 SEA•BROOK RD HX.ANNIS,MA 02601
Owner: ANGELA DEMAKE
Date of Inspection: 8/19/02
.. r.
Check if the following have been done„You must indicate"yes"or"no" as to,each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
_ X Were any of the system'components'pumped out in the previous two weeks
Ilk
_ X Has the system received normal flows in the previous two week period?
_ X Have large volumes of water.been introduced to the system recently or as part of this inspection '?
_ X Were as built plans of the,system;obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling'inspecte I for signs of sewage back up?
X _ Was the site inspected for-signs of break out?
X _ Were all system components,excluding the SAS, located on site?
X _ Were the septic tan °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?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems?
J
The size and location of the,Soil.Absorption System (SAS)on the site has been determined based on:
Yes no
X _ Existing information. For example,a plan at the Board of Health.
X _ Determined in the field(if•any?oftheifailure criteria related to Part C is at issue approximation of distance is
unacceptable)[310 CMR 15.302(3)(b)]_,
4tC I,
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Page 6 of I I �E
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACkSEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 171 SEABROOK RD HYANNIS,MA 02601
Owner: ANGELA DEMAKE ;s::: z s
Date of Inspection: 8/19/02
FLOW CONDITIONS
RESIDENTIAL y ' ^
Number of bedrooms(design): 4 NurAl r of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15:203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: n/a
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes.or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO: z?
Seasonal use: (yes or no): NO ", r S
Water meter readings, if available(last 2 year§.usage(gpd)):,W* _ ®u
Sump pump(yes or no): NO -Y.
Last date of occupancy: 8/20/02_,, '
f IDgS
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a i?e+>., t
Design flow(based on 31.0.CMR 1 :203): n/agpd
Basis of design flow(seats/persons/sqf:etc.): n/a
Grease trap present(yes or no):''NO , - i.
Industrial waste holding tank.present(.yes or no): NO
Non-sanitary waste discharged to,`the'+Title 5 system(yes or no):NO '
Water meter readings, if available.n7a
Last date of occupancy/use: n/a $i:
OTHER(describe): n/a �n u
GENERAL INFORMATION
Pumping Records
Source of information: 7 YEARS BY'OWNER
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons'--How was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution lion,•soil absorption'system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes�attach,prey ous 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,of5the DEP approval
Other(describe): n/a
Approximate age of all components s date installed(if known)and source of information:
35 YEARS BY OWNER
Were sewage odors detected when a.rriv14at the site(yes or no): NO
ca
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PErge 7 of 11
v�r.g
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 171 SEABR,OOK,RD HYANNIS,MA 02601
Owner: ANGELA DEMAKE
Date of Inspection: 8/19/02,i I,
BUILDING SEWER(locate ontsite plan)E
Depth below grade: 22"
Materials of construction:_cast iron:_40TVC other(explain): n/a
Distance from private water supply well or suction line: n/a
Continents(on condition of joints,venting,'evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site--plan)
Depth below grade: 16" art '
Material of construction: Xconcrete, metal fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age donifi'rmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 6'X 6' BLOCK CESSPOOL"
Sludge depth: 4"
Distance from top of sludge to bottom of,outlet tee or baffle:30"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 0"
Distance from bottom of scum toz bottom.of outlet tee or baffle:0"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
r
to outlet invert,evidence of leakage,etc.):
MAIN CESSPOOL IS STRUCTURALLY`-SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING
EVERY TWO YEARS TO PR6LONG4HE SYSTEM'S USEFUL LIFE. MAIN CESSPOOL NEEDS TO BE
UPGRADED.
GREASE TRAP: _(locate on site
Depth below grade: n/a
Material of construction: concrete'nietal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet,tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendatibns, m.la and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert,evidence of leakage;-1etc`):
n/a
rE,
'st ;
Page 8 of 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 171 SEABROOK RD HYANNIS, MA 02601
Owner: ANGELA DEMAKE,ti_ ::';t;,• ,
Date of Inspection: 8/19/02
'i
TIGHT or HOLDING TANK: (tank must lie pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a ;lt *,{ i1
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a '
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:;_(if present t4ust,be o.pened)(locate on site plan)
Depth of liquid level above outlet invert n/a
Comments(note if box is level and distributionito outlets equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
PUMP CHAMBER:_(locate on site plan),.
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a -
}
S '!.N0,
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 171 SEABROOK RD HYANNIS,MA 02601
Owner: ANGELA DEMAKE
Date of Inspection: 8/19/02
SOIL ABSORPTION SYSTEM(SAS): X jlocate on site plan,excavation not required)
If SAS not located explain why:
n/a
ape n t=. ' leaching pits, number: 0
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a # leaching fields, number: n/a
6' X 6 BLOCK CESSPOOL overflow cesspool, number: 1
n/a (;', innovative/alternative system
�TyRe/name of technology: n/a
cs
Comments(note condition of soil,signs'of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
LIQUID LEVEL IS FULL,OVERFLOW IS IN HYDRAULIC FAILURE. SAS NEEDS TO BE UPGRADED.
BOTTOM IS AT 9 FT.
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: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): 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: n/a
Depth of solids: n/a ;
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
Li
4
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 171 SEABROOK RD HYANNIS,MA 02601
Owner: ANGELA DEMAKE
Date of Inspection: 8/19/02
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system,including ties tout least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet. Locate where public water supply enters the building.
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Page I 1 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 171 SEABROOK RD HYANNIS,MA 02601
Owner: ANGELA DEMAKE
Date of Inspection: 8/19/02
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 10+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local exca`vdors;`installers-(attach documentation)
NO Accessed USGS database-explain: n/a
r
You must describe how you established,tne Ziigh ground water elevation:
HAND AUGER- 10+FT.
UNITED STATE t � RtCEg
• Sender: Please print your name, address, and ZIP+4 in this box •
I
Town of Barnstable i
6SRIEW Health Division
200 Main Street r
Hyannis, MA 02601 1
I
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
I ® Complete items 1,2,and 3.Also complete A. Si
item 4 if Restricted Delivery is desired. ❑ ent
E Print your name and address on the reverse ❑"Addressee
I so that we can return the card to you. B. ReceivAd by(Print a e) C. to\11) �f I' ry
■ Attach this card to the back of the mailpiece, IICX\
I or on the front if space permits.
16
D. Is delivery address different from item 1? Yes
1. Article Addressed to: Y
If YES,enter delivery addfess below: ❑No
�• ��� / Cn
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to 3 7 a
f tit 3. SSe�Type
I f I O;L 5 8
q 130Certifled Mail ❑Wress Mail
M ❑Registered [3tetum Receipt for Merchandise
I ❑Insured Mail ❑C.O.D.
M 4. Restricted Delivery?(Extra Fee) ❑Yes
I 2. Article Number 7006 2150 � 0002 1042 0637 /v)
(Transfer from service label)
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M 1540
>4:
ASSESSORS MAP :
`_--��---- ---- ----__ __-__ __ .__---------- TEST HOLE LOGS-
PARCEL:
_ �•T��-- ----__ __ ____y..___ __ _ _ _. _ _____.----r__.�_______ _.
SOIL EVALUATOR
FLOOD ZONE: H l ( GjT � CAW (�,_ �Lqp(-J WITNESS : bT
� REFERENCE: � _.___. .____ ___ DATE:
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jarPERCOLATIONRATE:
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FLOW ESTIMATE -----.-W..,.. __ ...
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—'� �� BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY
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SITE AND SEWAGE PLAN
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DA VID B . MA 1�5
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EAST SANDW
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W ATE C/HEALTI-rAGENT
( 508 ) 833- 2I77
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ASSESSORS MAP :
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PERCOLATION PATE .G
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SYSTEM DESIGNi+►�.IG-{
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GAL/DAY
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SCALE
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DAV i D B . MASON19S DATE:
DBC ENVIRONMENTAL DESIGNS
° EAST SANDWICH . MA
W DATE HEALTH AGENT
( 508 ) 833- 2177