HomeMy WebLinkAbout0053 BLANID ROAD - Health 53 Blanid load
Osterville
A= 140-047
Apr 19 2019 00:05 HP Fax page 3
t 1110_ Oil�..
Commonwealth of Massachusetts
,V I
Title 5 Official Inspection Form a
M•i
Subsurface SewageI f,
Disposal System Form Not for Voluntary Assessments
53 Blanid Road
Property Address kf
Elaine Markey -
Owner Owners Name
information is OStervllle
required for every MA 02655 4-18-19 :
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the.form.
3 \\��l11111101 F ll4 l 11/
Important:When 0%
A. Inspector Information CC
• filling out forms O�# 35 ny
on the computer, J r = �? •JA M E S G
James D.Sears m use only the tab 3�:
key to move your Name of Inspectorcur H v :ti x
use the
returndo Capewide Enterprises *''
use the return
key. Company Name '.m•�y �Tkr- ��
153 Commercial Street opF 5 INsp�G�o��
—1d1 Company Address -
Mashpee MA 02649
City/Town State Zip Code
508-477-8877 S1623
_r Telephone Number License Number
B. Certification
I certify that: I am`a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system: -
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
0111� 4-18-19
OlKspect&s Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This
his report only describes conditions at the time of Inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
151nsp.doc•rev.7l2612018 Title 5Ofidal M specEon Forn:Subsurface Sewage Disposal System•Page t o118
Apr 19 2019 00:05 HP Fax page 4
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
kv�v Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
53 Blanid Road
Property Address
Elaine Markey
Owner Owners Name
information is required for every Osterville MA 02655 4-18-19
page. City/Town State Zip Code ®ate of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below,
Comments:
The system is a 1500 Gal Tank D Box and two chamber's.
2) System Conditionally Passes:
❑ One or more system components as described in the Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass,
Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
"A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5lnsp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 o1 18
,
Apr 19 2019 00:05 HP Fax page 5
f -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.% 53 Blanid Road
u—
Property Address
Elaine Markey
Owner Owner's Name
requireinformationfor
Osterville MA 02655 4-18-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection K(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass Inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board.of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5inap.doc•rev.712612010 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Apr 19 2019 00:05 HP Fax page 6
Commonwealth of Massachusetts
Title 5 Official Inspection- Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
W.jv
53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
information is Osterville MA 02655 4-18-19
required for every ,
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet.or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other: .
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doe-rev.7f26l2018 Title 6 Official Inspection Form;Subsurface Sewage Disposal System•Page 4 o[19
Apr 19 2019 00:05 HP Fax page 7
Commonwealth of Massachusetts
A t Title 5 Official Inspection Form
C Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,(Y
53 Bland Road
Property Address
Elaine Markey
Owner Owner's Name
iequire io is Osterville MA 02655 4-18-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cant.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in is less than 6"below invert or available volume is less
than '/z day flow X-tRcN'^'4
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portlon of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
r For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area —IWPA)or a mapped Zone II of a public water supply well
t5insp.coc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Apr 19 2019 00:06 HP Fax page 8
Commonwealth of Massachusetts
Y Title, Official5 Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments,
53 Blanid Road
Property Address
Elaine Markey _
Owner Owner's Name
requinform
re ton isd for every Osterville MA 02655 4-18-19
require
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes" to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or "no"for each of the following for all inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components,excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid,depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)(310 CMR 15.302(5))
t5insp.doc rev.7126/2018 Title 5 Mist Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Apr 19 2019 00:06 HP Fax page 9
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
' 53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
information is required for every Osterville MA 02655 4-18-19
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
1500 Gal. Tank D Box two chamber's.
y
Number of current residents: 2
Does residence have a garbage grinder?' ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection Yes ® No
information in this report.)
Laundry system inspected? El Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage 2017-129,000Gal
g ( y g (gpd))" 2018-100,000Gal's
Deta il:
Sump pump? ❑ Yes ® No
Last date of occupancy: Present
Date
I
t5lnsp.doc-rev.W2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Apr 19 2019 00:07 HP Fax page 10
Commonwealth of Massachusetts
: ,. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments.
5
53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
information is
required for every Osterville MA 02655 4-18-19
page. City/Town State Zip Code Date of,Inspection
D. System Information (cont.)
2. Commercialllndustrial Flow Conditions:.
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
• gallons ,
How was quantity pumped determined?
Reason for pumping:
Mnsp.doc•rev.712612018 Title 5 Official Inspectlon form:Subsurface Sewage Disposal System•Page a of 18
Apr 19 2019 00:07 HP Fax page 11
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form •Not for Voluntary Assessments
kgoz:5,40;�
53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
information is required for every Osterville MA 02655 4-18-19
page. cityrrown Slate Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank,distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank_Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components,date installed (if known)and source of information:
2012 Permit #2011 -004.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
"
Depth below grade: 31
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Pipeing is 4" PVC SCH -40.
t5insp.doc•rev.712&2018 Title 5 Orficlar Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Apr 19 2019 00:07 HP Fax page 12
" v
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
53 Blanid Road
Property Address
Elaine Markey
Owner Owners Name
information is psterville
required for every MA 02655 4-18-19
page. Clty/Town State Zip Code Date of Inspection
D. System Information (Cont.)
6, Septic Tank(locate on site plan):
Depth below grade: 21"
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years.
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 Gal, Precast H-10
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle
27"
Scum thickness
1n
Distance from top of scum to top of outlet tee or baffle 6
1.
Distance from bottom of scum to bottom of outlet tee or baffle 17
How were dimensions determined? Asbuilt-Tape
Sludge Judge
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank at working level.Tank at 21"below grade w/both covers at 18". In and outlet tees. No sign of
leakage or over loading.
t5insp.doc-rev.7126/2018 Title 5 Mini Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
Apr 19 2019 00:07 HP Fax page 13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
v
" 53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
infonnabon is
required for every Osterville MA 02655 4-18-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
t
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
B. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain).-
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
15insp.doc•rev.7126l2018 -PUe 5 official Inspection Form:Subauface Sewage Disposal System-Page 11 of 1 a
Apr 19 2019 00:07 HP Fax page 14
Commonwealth of Massachusetts
P Title 5 Official Inspection Form
ff Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
45
53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
information is required for every Osterville MA 02655 4-18-19
page, City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert 0
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D Box is 16"x16"-31"below grade wlcover at 16".Box is clean and solid w/one line out. No sign of
over loading or solid carry over.
t5insp.doc•rev.7/26/2018 Tltle 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 12 of 18
Apr 19 2019 00:07 HP Fax page 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
fs
53 Blanid Road
`V
Property Address
Elaine Markey
Owner Owner's Name
information is required for every Osterville MA 02655 4-18-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cost.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No"
Alarms in working order: ❑ Yes ❑ No"
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on,site plan, excavation not required):
If SAS not located, explain why:
r
Type:
❑ leaching pits number:
® leaching chambers number: 2
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Typetname of technology:
t5insp.doc•rev.712 6120 1 6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of is
Apr 19 2019 00:07 HP Fax page 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
ry 53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
information is required for every Osterville MA 02655 4-18-19
page. CityfTown State Zip Code Date or Inspection
D. System Information (cont.)
11. Soil Absorption System(SAS)(cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching is two 500 Gal, dry well chamber's. Chamber's at 4'below grade. No sign of over
loading or solid carry over."6"water in chamber's wino sign of high stain line.
a
I
12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
15insp.doc-rev.7126/2018 TiBe 5 Baal Inapecfion Forn:Subsurface Sewage Disposed System•Page 14 of 18
Apr 19 2019 00:08 HP Fax page 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
information is required for every Osterville MA 02655 4-18-19
page. City/Town State Zip Code Date of Inspectlon
D. System Information (cont)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
ISlnsp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 1a
Apr 19 2019 00:08 HP Fax page 18
Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
53 Blanid Road
V
Property Address
Elaine Markey
Owner Owners Name
information is
required for every Osteryille MA 02655 4-18-19"
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
44
e � Y
� o
y
03-► 2 3 0
,
)_a_ ,� FRo,vr
33
islnsp.doc-rev.7126/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System-Page 116 of 18
Apr 19 2019 00:08 HP Fax page 19
4!Z�,N Commonwealth of Massachusetts
,� Title 5 Official Inspection Form
r ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
i
53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
information is
required for every OsterviUe MA 02655 4-18-19
page. City(Tovm State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
No
Estimated depth tcifh_�h ground water: 11'+
feet
Please indicate all methods used to determine the high ground water elevation;
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
T.H. 11'no G.W.. Bottom of chamber's at V-6" below grade. Bottom of chamber's at 4'-6" above
T.H. Depth.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc rev.7128=18 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
Apr 19 2019 00:08 HP Fax page 20
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
r w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
53 Blanid Road
Property Address
Elaine Markey
Owner Owner's Name
information is required for every Osterville MA 02655 4-18-19
page, City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
Z B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6 (Checklist)completed
® D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
�R�ar T.u
13 ofir► `L
�N,�mBFRs i�
r H
�1 b
L
Gw
t5insp,coc-rev.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
r
No.i V 06 y Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN_ OF BARNSTABLE, MASSACHUSETTS Yes
Rphratton for �Bigom[ ,&p.5tem Con.5trurtton Vertu
Application for a Permit to Construct(-,)/Repair( ) Upgrade( ) Abandon( ) 2 Complete System ❑Individual Components
Location Address or Lot No. <3 /3[t 4P Owner's Name,Address,and Tel.No.
a 5_r"if I—LA_ InAeY F, s%70 P4V �r,�vs
Assessor's Map/Parcel tve) / d 7 Itt�//�€ ?;,L..a "'z'! /l QW
Installer's Name,Address,and Tel.No. _S 4 4 Designer's Name,Address and Tel.No.u/xfj_,6e 7 165oc-
eVa
Type of Building:
Dwelling No.of Bedrooms -3 Lot Size sq. ft. Garbage Grinder
Other Type of Building "Al No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3M gpd Design flow provided 35-3 gpd
Plan Date /Z � � %� Number of sheets Revision Date
Title r Cf1 o�/o GS%62✓14AW
Size of Septic Tank agaddV-5 Type of S.A.S.
Description of Soil 45 t2"
Nature of Repairs or Alterations(Answer when applicable) -
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Heal
Signed Date 2-
Application Approved by Date
Application.Disapproved Date
for the following reasons
Permit No. 0 o o y Date Issued 3 /
} `fir •-� i 1 "��
w
ar 1 "
-No ,.. f Fee
N `¢ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
i
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
_ Yicottor� for ig ogaY ip rem Cow9truction permit
' Application for a Permit to Construct(V<'Repair( )'' Upgrade'( ) Abandon O Complete System ❑Individual Components
Location Address or Lot No. j�j 1" �9 /•� 1 ' Owner's.Naine,Address,and Tel.No. j
}C� ?A.,2✓s� �r /��i '_Y 'L-5%!1 I l�� VI I) r r.C2 r/57 �
Assessor'sMap/Parcel va < 0-1/`T
G11A:444�4 7/ 660 .
Installer'st�ame,Address,and el.No. 9 4 Designer's Name,Address and Tel.No.
ny�4A1j *9 6
7
Type of Building:
Dwelling No,of Bedrooms 'i Lot Size ' 3�4C sq.ft. Garbage Grinder,(/0)
Other 'Type of Building R�n�WUF No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design°Flow(min.required) 330 gpd Design flow provided -353 gpd
Plan Date 1 Z Ilfi' f Number of sheets Revision Date '
Title -5 t7K -f 5CW%F ¢�tAAI 5?r 1314,u/? 1-96. 6511514 V14405
Size of Septic Tank (�4 Cl?LLOW6. Type of S.A.S.�9 -50 CW— PWc45! UPJa1g ."-°
Description of Soil •1-i .12 9K /aiC^&I
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
.'K'' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed �" � Date Z-
Application Approved by .+� Date 3 1�
Application Disapproved b P. '®"^ ;, Date
for the following reasons
Permit No. Don — o o c/ Date Issued � � 3 1' �
r -..: _ _ -- : _
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
' THIS IS TO CERTIFY,that the On-site Sewa e Disposal System Constructed (I/ ) Repaired ( ) Upgraded ( )
Abandoned( )by a/V e 'at 3L/Mllb a 5 Z97,Q VIL64F has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. D o0 l/ dated /2,
Installer Designer
#bedrooms Approved design flow 3 30 gpd
a The issuance of this permit/s/hall ofb+e�construed as a guarantee that the system will function-as designed.
\ - Date `fA-j � Inspector C--_� --''"�,�
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
Mi.5pont i§v.5teni Construction Permit
Permission is hereby ranted to Construct ( L,' Repair ( ) Upgrade ( ) Abandon
System located at / _j V16 LE
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of thisTentnit`
Date 1 3// Approved by• ✓ �'tnr �f.
'Vown of Barnstabic
Department of Heallh,Safety,and Eitvironrnental Services
s e i 1
""'� � Public Health Division Hate
367 Main Street,I lyannis MA 02601
FLARNFMAOM
KA99.
rEotwc+"' Date Scheduled /2 -1 lme_ ;"� Fee Pd.'-
'A
Soil SuitabilityAssessment for Se f e�Dispo�rrl
Performed By K�I 1 10 Witnessed By: r-
LOCATION & GENERAL INFORMATION /
Location Address Owncr's Name
/D
Z>57v/L Gem Address �E'•` '4zet� s �9
Assessor's Map/Parcel:few _ O 4/ Fatgineer's Name
NEW CONSTRUCTION _ L,"- REPAIR Telephone# � �S�C, j/� J
Land Use _ — ,r Stores(°�") —r Surface Stones _ •_
Distances from: Open Watcr Body _..,fl, t'ussihle.Wet urea .-,. I ,,,fl. Drinking Water Wcll Wiz; RR
G
Drainage Way It ' Property,l,inc',_k_ ` r 141 Other W Il
SKETCH:(Street name.dimensions of lot.exact locations of test holes&perc tests,locate wetlands in proximity to holes)
y
t -71tt
✓� a
. : '
4
Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in IVole`. Weeping from Pit Face
Estimated Seasonal Iligh Groundwater
DETERIMINATiON FOR SEASONAL, lI1lTH WATER TABILE ;
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
Index Well#_ Reading Date:_ Index Well level _ Adj.factor Adj.Groundwater Level
lr _
PERCOLATION TEST mate Timc^
Observation a
1 tole#: Time at 9"
`
k Depth of Pere 8 s 5� .'• � Time at 6"
Start Pre-soak Time @ D Meet Time(9 -6") s
End Pre-soak 8 ern, O Mwij
Rate Min./Inch
Site Suitability Assessment: Site Passed LZ Site Failed: Additional'Testing Needed(YIN)
Original: Public Health Division t Observation Hole Data To Be Completed on Back
Copy: Applicant
E
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil I lorizon Soil Texture Soil Color Soil Aher
Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Bouldcres.
Consistency.° Gravel)
D° &oP^ Seto ``o 4 1? Z _
"121 2.5-y713
DEEP OBSERVATION HOLE LOG Hole #
Depth from I Soil Ilorizon I Soil Texture I Soil Color I Soil Other
Surrace(in.) Mottling (Structae,Stones,Bouldcres.
_ n i t nc ° ravel)_
37,�3 C, 140�7. s+-V
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil I lorizon Soil Texture Sail Color Soil Other
Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Bouldcres.
onsistency.%Gravel
---Gs * 2. 1r 13_ --- — ...----------
DEEP OBSERVATION-HOLE LAG Hole#
Depth froin Soil I lorizon Soil'texture�— Soil Color Soil t O!lier
Surface(in.) (USDA) r. (Munscll) Mottling (Structure,Stones,Bouldcres.
Consistencv." Gravel)
6 - Iat boy
G - 3 tog" s
39-13z s Z,S 7lz
Flood Insurance Rate Man; /
Above 500 year flood boundary No. Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perlip at
eria.1 exist in all areas observed throughout the
area proposed for the soil absorption system? — y
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on -W "b (date) I have passed the soil evaluator examination approved by the
Department of Enviro' me tal Protection and that the above analysis was performed by me consistent with
the required t g,expertise and experience described in 310 CMR 15.017
1 l
Signature _ _� —--- -- Date l_ '
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director.
swsxsrns[.e:.
,,,, Public Health Division
fny Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: 3=- 7_ Sewage Permit# Zo117-eV Assessor's Map/Parcel / p
Installer & Designer Certification Form
Designer: EGc `,�` � � Installer: A)a�zT/,� .�J D ,rJicL;�-UG .
Address: 07 Address: f'a1916Z Q9S
On / 3—Z �z : , ,d4r,lc.�/ :was issued a permit to install a
(date) (installer)
septic system at 53 8 •�/ � b��izz based on a design drawn by
(address)
c.L Arcs--�.trc� dated
esigner)
y/I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stri pout (if required) was inspected and the soils
werehund satisfactory.
i /I certify that<the septic system referenced above was installed with major Chang v es (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. Stripout (if required) was inspected and the`soils
were found satisfactory.
OF MAgsq
cy
iM( talle,�V' Signature). DA�
s . o YER
N0. 1140'
(Designer's Signatur (Affix De e ere)
PLEASE'RETURN TO` ARNSTABLE 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.
gAo�ce formsldesignercertification fonn.doc
TOWN OF BARNSTABLE
LOCATION SEWAGE#
VILLAGE D Sn v u` ASSESSOR'S MAP&PARCEL 1 4t 0 l4 7
INSTALLER'S NAME&PHONE NO. �✓a�n �-�v P�✓�^ti- .3��-9�7'�
SEPTIC TANK CAPACITY /.-va
LEACHING FACILITY:(type�2)S'bd G D-4- w &Lr (size) 3 Z J
NO.OF BEDROOMS 3
OWNER t 6—CAI-O'
PERMIT DATE: / 3 12 Z COMPLIANCE DATE: 41137,
Z
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
3
—
1
a
J-L
Z l �1- Z3 •S
I
... ... 4'-0" - .. .. .. .... .: :.
r.r
o
CA I
r �o
D _
z
3.
0
W
o
o
0 o m�
mV 2" 60'x60 7/8'
W T _
_ y 24410IN 2
k`.
b N � ---
�, N
"
:. .. 72 3/8°x24 5%a" D.
cI
W q3O'..
J n �
.. - mN 7
r �
m Tw 24410-2
T-0" 1/2":
.. ..
N
m i
N..
p
IT
° A o BILL 4 ELAINE I"IARKEY BAYSIDE BUILDING, INC.
m 05TERV I LL:E,. MA _
m
3 BAYBERRY SQUARE,CENTERVI_L JE MA OWW
w F o PLAN PHONE:SM771.10140 FAX:SOB"7750155
m.
4'-O" 24'-0"
m O
D 0F71 F70
r ,r w
rn
30 1/8'x60.7/5" .�,D N
—
TH
N 24410: m�m
r 89 7/8'X60 7/8'
TW 2.4410-3
61 (DI
Z
3
Z D
.. 30 1/8'x6o 7/8"
TW 24410; X
- ro.
w p
til .. .W N N 30 I/8"x60 7/8°: .
_ ..TW 2 _
Z' � � 4410'
3: 3'-9wp : Z 9'-4 1/2" I x . jo
Aal
N
-- 13=I l/2
_ .r.
m
a
0 lJ
n I
0 30 1/8'x60 7/8" 1 r , s
TW 24410 ... m p ...
oT
iS
F�
N .
Z N O C 235:. N
.. ... .. ... .L." N I . O: I3
a I i
- _
O TW 24410
4> .(a
I
- I
. -- — —
w
I I
I I .
x a_ .. A
fl " .. ...�. ... I
TW 24410 e c J 13 72'Xe3°
z�'I
D j j.:' K A'° :( I:.
� i
a W12x35 STEEL 6EAM —-
o 03
-G i) C,q). .
:.
I I
_ I
I
1/8"x60 7/8" .. .._ .. .. p
TW 24410 __-
--- 5 0-
O '
di
7x9' O.H. DOOR 7'x9' O.H. DOOR.'
W/ TRANSOM W/TRANSOM
N.m
1 tq e 0
� 2'-6" 2'_9-
.. .. - ..
q.
m BILL ELAINE MARKEY BAYSIDE BUILDING, INC•
z � . 53 BLAN I D RD.
in OSTERVILLE, MA
m . 3 BAYBERRYSQUARE9 CEN Jt GRVILLEj'M V�i
o •' m
F o PLAN PHONE:SM771-1 040 FAX W&7750 f 55
'I
O
=o®
I D
/� zz r
_ rn
o �n
r
r
i
..
LIH
mi
.. ........... ....
}
° A QILLLAINE :MARKY BAYSIDE BUILDIN INC@m F
53.BLANID RD.
Z _ OSTERV I LLE,: MA
o "
m 3 BAYBERRY SQUARE,CENTERWLLE,MA 02E32
W F oNt
ELEVATIONS PHONE:50077 •1040 FAM SM7750155
N :. .. ..
c
V �,j
-TZ
�1
g INSTALL RISERS COVERS TO PIFi5 TO BE LAID LEVEL FOR
WITHIN G" OF FINISH GRADE 2' DUT OF DISTRIBUTION BOX
� w J (SEE PLAN VIEW FOR LOCATIONS) 2" LAYER OF PEASTONE OVER
Lu
WI'TER TEST D-BOX FOR
U 1- ELNE55 * FLOW 3/4" _ I %2" DOUBLE WASHED
EQUALIZATION STONE ALL AROUND
rL
0
EL. 32.0
LOCUS _ T.O.F. @ EL. 32.0 - - - - - - - - - EL. 32.5-
O � EL. 33.0 4" SCH 40 PVC 4+5cH TOP @ EL. 29.7
40 PVC
� CD Q 4"5CIj 40 PVC
I O" 14„
Q (2) 500 GALLON PRECAST DRYWELLS
`30.00 29.75
_I INSTALL GAS BAFFLE 29.40
29.23 BOTTOM @ EL 27.00
O 29.00
IN OUTLET TEE 29 rJo
� � :k 1 D5.-5
N
W INSTALL TANK* D-BOX 51
¢ p
O ON 6" LAYER OF CRUSHED
1 500 GALLON PRECAST STONE
5EPTIC TANK
BOTTOM TEST HOLE #4 @ EL. 22.00
32 -
\ 5EPTIC 5Y5TEM PROFILE
\ DE51GN DATA
\ DAILY FLOW: (3) 5EDR001v15 x I 10 GPD = 330 GPD
\ 5EPTIC TANK: 330 GPD x 4'=% = GGO GPD DEEP 0155ERVATION HOLE LOGS
U5E: 1 500 GAL. PRECA5T 5E.PTIC TANK DATE: 12-07-201 1 P- 13494
,S DISTRIBUTION BOX: D13-5 WITNESS: D. DESMARIAS,CHEALTH ASENT
S 501L A550RPTION 5Y5TEM: PERC RATE: < 2 MIN./INCH
J gsd USE: (2) 500 GAL. PRECA5T DRYWELL5 LINED W/4'
" DEEDEOBSERVATION HOLE#I EL. 34.2
Of DOUBLE WASHED`STONE
SOIL SOIL SOIL COLOR SOIL
/ LOT 8
CAPACITY: SfROM HORIZON TEXTURE (MUN5ELL) MOTTLING OTHER
_ i _ A LOAMY SAND I OYR3/2
/''/� /� F 51DEWALL AREA: 7G x �? x 0.74 = 112.5 GPD °' 8 s
/ 1 5 G 4 6 .4 5. 1 I - - �`` 8"-37" B LOAMY SAND I OYR4/6
BOTTOM AREA: 13 x 2 5' x 0.74 = 240.5 GPD 37"- 1 32" C MEDIUM SAND 2.5Y7/3
/ PROP05ED (3) BDRM. 30 TOTAL CAPACITY: 353.0 GPD
DWELLING r T�Oj=,
EL. 33.0 j \`♦ / DEEP OBSERVATION HOLE#2 EL. 34.0
DEPTH SOIL SOIL SOIL COLOR 501L
/ ' ` F F FCC FROM HORIZON TEXTURE (MUN5ELL) MOTTLING OTHER
I / ``� GENERAL N OTf-5 SU°FABI A LOAMY SAND I 0YR3/2 PERCOLATION
I �,
!`� //' ` 8"-37" B LOAMY SAND I 0YR4/G TEST (off 38"
\ tSCRE, i ,�-� �� `� 37"- I32" C MEDIUM SAND 2.5Y7/3 24 GAL. < 15 MIN
P EN/ ` '
�.. I . SEPTIC 5Y5TEM 15 TO BE IN5TALLED IN ACCORDANCE WITH
N --� --- GARAGE 3 10 CMR 1 5.00: TITLE V.
/ DEEP OBSERVATION HOLE#3 EL. 34.0
o \ EXISTING 2. TH15 5EPTIC 5Y5TEM 15 NOT DE51GNED FOR THE U5E OF A DEPTH
SLAB `` ' GARBAGE D15PO5AL. FROM HORIZON TEXTURE 501L 501L SOIL COLOR SOIL OTHER
OCESSPOOL /�` .� \ EL. 2@ r,/ SURF C (MUN5ELL) MOTTLING
\ / `3 5 /' 3. TH15 PLAN 15 NOT TO BE 05ED FU-R PROPERTY LINE DETERMINATION. 0"-G. A LOAMY SAND IOYR3/2
G"-38" B LOAMY SAND I 0YR4/G
/ 4. CONTRACTOR SHALL PROVIDE,48 HOUR NOTICE TO DE51GN 38"- 132 C MEDIUM SAND 2.5Y7/3
/ ENGINEER FOR ANY REQUIRED ;N5PECTION5.
10.1 / / ?O�s - _ y' ( 5. CONTRACTOR TO BE RE5PON5iBLE FOR THE LOCATION OF ANY
/ UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION DEEP
EXISTING EXISTING' �� i 33.0
,/ CESSPOOL ; OR CONSTRUCTION. DEPTH OBSERVAT
ION
5 HOLE#4 EL.
SOIL SOIL1L
. SOIL COLOR SOIL
DWELLING � '� /' _- _ % FROM HORIZON TEXTURE (MUNSELL) MOTTLING OTHER
-Y G. EXISTING CESSPOOLS TO BE PJMPED DRY, CRUSHED IN, SURFACE
(TO BE PRpp /' / O"-G" A LOAMY SAND I OYR3/2 PERCOLATION
/ 30 Q FILLED WITH CLEAN SAND.
DEMOLI511ED) //SFRv°��E� �/ 35"-38" 5 LOAMY SAND I
C MEDIUM SAND 2O5Y7/3 24 GALT Q 15 MIN
10.51 / - ;/� O NOTE: NO GROUNDWATER ENCOUNTERED IN ANY OBSERVATION HOLE
51TF --- 5EWAGE FLAN
• • / - �.., � Q F O R
53 ELAN I D ROAD 05TEKV1 LLE, MA
�f4 - '' Q PREPARED FOR
104=�- _ •/ #31 WILLIAM * ELAINE MARKEY
\ O OF SCALE: DATE: DRAWN BY:
3 2 V,�\ MASs
l I '7-�- zl 4 o Mew �`�' 20' 1 2-05-20 1 1 TMW
l I #I I No 35791 H �q� DARR€N y�
GARAGE _10.9 L �\ i EY M. � JOB NUMBER: REVISION: SHEET NUMBER:
(TO BE .. su 0 1 1 -045 5P-
34
DEMOLISHED) 100% GISTS WELLFR *- A550CIATE5,
� �
Fn ' TBM = EL. 34.3
EXPANSION i 1SANITAR�A�
+4.5 AREA u i ; TOP OF CONC. BND. I G45 FALMOUTH RD., SUITE 4C -�- P.O. BOX 417 CENTERVILLE, MA 02G32
2 WINDY WAY, #232 NANTUCKET, MA 02554
TELEPHONE * FAX: (505) 775-0735
5G.8I, i EMAIL: trl5wcIIer@comca5t.net
34
REGISTERED LAND 5URVEYOR5 * ENVIRONMENTAL CON5ULTANT5
Traverse PC