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HomeMy WebLinkAbout0095 BARNICLE DRIVE - Health ( 95 6ar,ni.cle Drive Marstons Mills r P A '087 061 v - Town of Barnstable T Regulatory Services oFr Thomas F.Geiler,,Director Building Division >i�itNSTASIX, - v nrnss. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fa a : 08-790-6230 Approved: (::� Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: �'l�Ti�l�= /if)f= �',. ��-/—C�� i�� Phone f Name of Business: /S(O /` Type of Business: /,���1� /=c���/r�Map/Lot: 0 w 1 �-r— INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by.such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • . No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant:z����4'�A ti —Date: Homeoc.doc Rev.5/30/03 tz YOU WISH TO OPEN A BUSINESS? 1 For Your Information: Business certificates(coat$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, V FL., 367. `ow) Main Street, Hyannis, MA 02601 (Town Hall) DATE: r Fill in please: . APPLICANT'S YOUR NAME: BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS LLB TYPE OF USINESSaz:l�i�, 5111 IS THIS A HOME OCCUPATIQN? YES NQ Have you been given approval.from the building.division? 'YES NO c� ADDRESS OF BUSINESS. _ MAP/PARCEL NUMBER_ �J Q& When'starting a new business.there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -.(corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM NER'S OFFICE This individ al h s en m m f any permit requirements that pertain to this type of business. A thori a nature* COMMENTS: ` ^� 2. BOARD OF HEALTH This individual has b en infor d o the permit requirements that pertain to this type of business. Authorized Signature** / COMMENTS: /L Z . At r rliY, 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature**. COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: iI'/S�G G O'GtJ a'ErzGA✓ BUSINESS LOCATION: �/ .elli�o4�'1�d��OLII ,/J7/��,�r INVENTORY MAILING ADDRESS: rrxa20 TOTAL AMOUNT: TELEPHONE NUMBER: -5:-ag =�r211l CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: r„QrnE MSDS ON SITE? TYPE OF BUSINESS:?—/=Lc>.� .��_ l/�� INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive �f f} NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) T " Spot removers &cleaning fluids 09 (dry cleaners) - L Other cleaning solvents. Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS f: . r j COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION M F z y MP aW PARCEL LOT ' TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 3 t Property Address: 95 BARNACLE DR MARSTONS MILLS,MA 02648 Owner's Name: MARY CRENON Owner's Address: 95 BARNACLE DR MARSTONS MILLS,MA 02648 JUN 14 2002 Date of Inspection: 5/20/02 TOWN OF BARNSTABLE HEALTH DEPT. Name of Inspector: (please print),,, =1- JOHN GRACI \ Company Name: ` SEPTIC INSPECTIONS Mailing Address: Pb. BOX 2119 TEATICKET, MA.02536 i Telephone Number: 508-564-681'3 FAX 508-564-7270 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 the time of the inspection.The inspection was performed based on my training and experience in the proper function and-maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340'.(jf Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Pass _ Needs Further uation by the Local Approving Authority Fails Inspector's Signature: Date: 5/20/02 The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti n. If the system is a shared system or has a design flow of 10,000 gpd or greater,tl�e inspector and the system owner°sh`all'submit the report to the appropriate regional'office of the DEP. The original should be sent to the system owner and copies;sent to the buyer, if applicable, and the approving authority. Notes and Comments THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. • *age 2 of I I "4 ' ' t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 95 BARNACLE DR MARSTONS MILLS,MA 02648 Owner: MARY CRENON ` Date of Inspection: 5/20/02 Inspection Summary: Check A,B,C,D or E/AA LWAYS complete all of Section D A. System Passes: X 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: THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or�,repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a 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 oritank 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 backuj'or`Break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ 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 the Board of Health): broken pipe(s)are replaced _obstruction is removed r;r ND explain: n/a psi � ?age,3 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 95 BARNACLE DR MARSTONS MILLS, MA 02648 Owner: MARY CRENON < ' Date of Inspection: 5/20/02 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. , t 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a,manner which will protect public health,safety and tale environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50'f et of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board.of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank.,;I d 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 I 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 n/a **This system passes,if the`well water'halysis, performed at a DEP certified laboratory, for coliform bacteria and r,a. volatile organic compounds indicates,that the well is free from pollution from that facility and the presence of armnonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 9 n/a 1� 1 �Ic , { Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM „ PART A CERTIFICATION(continued) Property Address: 95 BARNACLE DR MARSTONS MILLS,MA 02648 Owner: MARY CRENON Date of Inspection: 5/20/02 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 or system 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 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 volurne is less than '/z day flow X Required pumping more,than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NOT IN LAST YEAR. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy'is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool 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 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 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 to this form.) , (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 systemlfails.4The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no",to--ach of the following: �S (The following criteria apply to large sy{stems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply ` •i X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen'sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Secliun D above (lie Ia;ge sysielu hu;; liiiled. 'I'lie owner or operator orally I,uge system cun:;itlad a!Jg1lif icaill di eill 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. d Page,5 of 11 t OFFICIAL INSPEC;TION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 95 BARNACLE DR MARSTONS MILLS,MA 02648 Owner: MARY CRENON Date of Inspection: 5/20/02 Check if the following have been done 3You must indicate"yes" or"no"as to each of the following: i 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 ? 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 irispected for signs of sewage back up {4 11 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 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 ? X _ 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: 'a Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the f eld'(if any of thelailure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] ,,l e: Page-6,of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 95 BARNACLE DR MARSTONS MILLS,MA 02648 Owner: MARY CRENON Date of Inspection: 5/20/02 ,FLOW CONDITIONS RESIDENTIAL 3 Number of bedrooms(design): 5 Nu'mber of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 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 Seasonal use: (yes or no): YES Water meter readings, if available(last 2 years usage(gpd)):aLw b() _ Ci i, C) Sump pump(yes or no): NO Ol I Iw$�11 GD0 Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15i.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO 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: n/a Last date of occupancy/use: n/a OTHER(describe): n/a y GENERAL INFORMATION Pumping Records Source of information: NOT IN LAST YEAR Was system pumped as part of the in (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 box, soil'absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology,Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1985 BY ON1'NEIi Were sewage odors detected when arriving at the site(yes or no): NO t: Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 BARNACLE DR MARSTONS MILLS,MA 02648 Owner: MARY CRENON Date of Inspection: 5/20/02 BUILDING SEWER(locate on site`plan) Depth below grade: 22" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 14" Material of construction: Xconcrete_metal fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a l9iage confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7" W,4`10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined'MEASUERD Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage;etc:): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal 'fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to tope 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 recommendati'ons,•inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):, n/a { ''d) ;s Page 8 of I 1 rt . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 BARNACLE DR MARSTONS MILLS, MA 02648 Owner: MARY CRENON Date of Inspection: 5/20/02 TIGHT or HOLDING TANK: (tank must be 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 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 C DISTRIBUTION BOX: X(if presenv must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): VIDEO INSPECTED-APPEARS TO BE FUNCTIONING PROPERLY AND IS STRUCTURALLY SOUND. 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 t� di, Of t R Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 BARNACLE DR MARSTONS MILLS,MA 02648 Owner: MARY CRENON Date of Inspection: 5/20/02 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a a Type 1000 GAL 6' X 6' leaching pits, number: 2 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 n/a overflow cesspool, number: n/a n/a ;ti, innovative/alternative system Type/name of technology: n/a n Comments(note condition of soil,signs-of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PITS HAD 2' OF WATER IN THEM AT TIME OF INSPECTION. BOTTOM AT 8' 6" 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.): n/a PRIVY: (locate on site plan) ." y 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 1, 9 Page 10 of I I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 6 Property Address: 95 BARNACLE vii MA ISTONS MILLS, MA 02648 Owner: MARY CRENON Date of Inspection: 5/20/02 1; SKETCH OF SEWAGE DISPOSAL SYSTEM including ties to at least two permanent reference landmarks or benchmarks. Provide a sketch of the sewage disposal system Locate all wells within 100 feet. Locate',where public water supply enters the building. ,9 S I v I 4. 1 S 'j 1{ 01 - 4A a A P 3X E � �-7 Page 11 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 BARNACLE DR MARSTONS MILLS,MA 02648 Owner: MARY CRENON { Date of Inspection: 5/20/02 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+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 excava'torsjnstallers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER DETERMINED BY AUGER- IT NO WATER ENCOUNTERED t. �t 11 TOWN OF BBA�RNSTABLE LOCATION "IS ��Ir�i,C�tQ,.Q IiJ( ��L_ SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 0S-7b(0l" 5 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY D Jo �n LEACHING FACILITY: (type) CJ _i"Y rVcam`1�T (size) i NO. OF BEDROOMS BUILDER OR OWNER J n� 0 ,[C4 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility)-:T 1r Feet Furnished by �� 1 Q 51 Z0) OZ RPM c � q AC. NC C L=C- C AT I ON SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NA E A ADDRESS B U I L D E RJ OR OWNER D-ATE PERMIT ISSUED 11 3 DAT E COMPLIANCE ISSUED 3 f WNW boo w No.................. Fps .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN BARNSTABLE ............ .........................OF....................................... Appliration for Disposal Workii Tnnitrnrtinn Prrmit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: Lot 65 ................_................................................................................. .................-................................................................................ mrs. Mary L'r n-Address Barnicl2 Roa(y Lot No. ...................._........_.......... = .................................. ..........--...................................................................................... Owner Address W IM3YStQC1S.M111S...........................................•..... Installer Address 25,004 UType of Building Size Lot...........................S feet �. Dwelling—No. 'of Bedrooms....................5.._._.........._......Expansion Attic ( ) Garbage Grinder (no) - `•� Other—Type of Building .............. No. of persons.........._................. Showers — Cafeteria dOther fixtures ................................ ................................... .................................................. W Design Flow.............55 ............................... per person per day. Total daily flow..........55.0.._...._....._......_._....gallons. WSeptic Tank—Liquid capacity.1500-gallons Length10'.-6"_ Width5.'_-8."�._. Diameter................ Depths_'_- ��._.. x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No...........2---_.... Diameter......10I._...._. Depth below inlet....5&7'._-__ Total leaching area..... 14-......sq. ft. - Z Other Distribution box (X ) Dosing tank ( ) '-' Percolation Test Results Performed by...._ ?LJe.. _Survey-•;Consultants____ Date.....-11 211 Test Pit No. 1........ .....minutes per inch Depth of Test Pit-•-__12�_....... Depth to ground water_. .... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water �q�•..�s.TE,t'kIEN 'y� P4 .........................•---•------•-••................................................•-•-----------;----••-•-•••-•---•-•------- . ...... .....ArVN O Description of Soil......?';'-_-#1•l___ 7;LK� h nus; 12"-36"� compacted subsoil• ® WILSON x 36 -144",..Poorly graded median sand, �9� � TEs�O c.� -------------•----• ----.....-•--•---•••......_..... ------. � -•-•-•---•-------------------------•----•-----------------------------------------•----•----•-•--...----• •-••----------------------------•--------••----•-•--------------.......•• ° o U Nature of Repairs or Alterations—Answer when applicable............................................................... ......................................................................... ........................................................•--•-•-••-----•----------.....-----------•------....--•-•-.......-•---•--------•---------..............._....._... •... ...C...;'T Agreement: _ —S'* The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be by the r f h . igned-• ` .rd�� n Date jApliQion Appro By.. •--•-- l.! .v?.� 1( Date Application Disapproved for the following reasons-..........................................:................................................................... ...------•-----------•-----•-----•--•.............•--•••-----...•---•••--••-------••-••-•--•---••--•----•..--•-•-----•---•----•---•-------•-•-•.....••••------•••--•••••---•-----• - •-•-------- Date Permit No........ 9 -f la: .-_._.. Issued---.._.._.�...' 3 -•-•- -4 •-•-----•-• ----------------•- .............. Date No.. ................... FITs.......................... . . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...----T�iaN... ... ..............OF.....BAFTt`�B...ICE_......................................................... Appliratiun for Disposal Works Tonsirnrtiun Vprrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ................_..............-`=-............................................................ .............................Lot 65 Location-Address r Lot No. • -r=3rs. Mary.crehar� --•------------------------------- •---------.. .ch Roar Owner Address W ---•-•--....- slaem"� l---•------•-••____________________•------•-----__-__-.a .. -• ' Installer Address 2 Type of Building Size Lot.._`5.004..........Sq. feet U Dwelling No. of Bedrooms.................... .Expansion Attic Garbage Grinder /n p, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures .-------•------------------------------------•••-- W Design Flow.....:__._____55.........................gallons per person per day. Total daily flow.......... 50...........................gallons. WSeptic Tank—Liquid capacitY..j.5Q®_gallons Length 1Q_!.-..6". Width.5_!_.-$!!... Diameter................ Depths.!.-l}`!.__. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------2........ Diameter......101....... Depth below inlet._.5,677 _. Total leaching area....53-4......sq. ft. Z Other Distribution box (g) Dosing tank ( ) `-' Percolation Test Results Performed by..... .. __ ��r. *� ,,_:.. Date.......IJ 91/a ,aa Test Pit No. I.........2.....minutes per inch Depth of Test Pit.....12._}........ Depth to ground water.-_ -OF Test Pit No. 2................minutes per inch. ±Depth of Test Pit................... Depth to ground water . . .............. O STEPHNG ........... ;a............................................................................ 5E --•-- (j - iLLN'- O � Y escriptonoo •-••• x � . WtSF 7 r a - c --Ik .ar. 1�. ----------•----•--------------•.--- +Q- 0.39246 �i �4 ................................................ -•-•-•......---••--•••-•-•••.... .•-•••••--•-•--•----••-••-•••-------------------•--------••••......--•---•••------•----••- FS U Nature of Repairs or Alterations—Answer when applicable___________________________________________________________________________ _ pN _�► .... Agreement: The,'undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accorda e wing the provisions of TIT?:,. 5 of the State Sanitary Co The u r ' ned her agrees not to place the system in operatio t until a Certificate of Compliance has bed ue y e b ar lth Signed-•- ---•-•-••-•---••--. ApplicationApproved By... -•••-•••-••••••••••-•••........•--•••••••...............•----••-•--......•••••-•--•••••-••• ......................................... Date Application Disapproved for the following reasons:--------------------------------------------------------------•-----------------•-------------••--•--••••-_---•- .....................................................---•-------•---•--.....------------....-------------•-•-••---•---•••-•--•--•-•-••--•-•-----•••--------••-•--•--•••-•...-••----•••-•......••-••--•- .-,o,,�� Date l Permit No........I? -__11 a 3 --------------------- Issued.......... . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... �rr#ifirtt#le of f�unt�rli�nr�e TFjIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed 'l ) or Repaired ( ) by......i---b�---- - fi iPl --------------- - s at...........=..................................................................................................................................................................................... has been installed in accordance with the provisions of TIi'IL jjqf -TP(f 66 Sanitary Cod'e•�Cs l{�s ii bcd in the application for Disposal Works Construction Permit No......................................... dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM WILJ-7 UNCTIO SATISFACTORY. DATE . .. .. ... ....................•-••--_--_. Inspector_•••-----•-•- -•- ••-•-•••... -------• ---•••-••------•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF............................................................................... ...... � 4 No......................... FEE........................ Disposal Works T-Nunstrnrtion rrntit Permission is e.reb granted_... - -------------------------• -------------------.........................._-........ to Construe-gtor_�a��'r"( ) a i�Ii�l �• a e Dispo f n atNo................................................................................................------------- --••- •-- as shown on the application for Disposal Works Construction er tTs._.__ r___� te��i ............ ...................:......'+ -------------------------------------•-------•------------------------------------•••-•-•...•••....•-••- Board of Health DATE... .. ..1_..._.. 5 FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ""' } k.• TEST PIT DA TA DATE 01 TESTING: _ REVISIONS: DATE -�L N° /yam PERC. TEST DATA SEPTI C TANK DETAIL SIZE ray :� 1`G�.: _ DIST. BOX DETAIL LEACHING FACILITY DETAIL: TEST BY: ,4-- Mi�Ea,v1�wI - r. P. e W/TNESSED BY: .TA��„�= DATE OF TESTING,° ,z Novi :� l�j{ _;° TANK TO CONFORM TO TITLE 5 REOUiREMENTS. TO CONFORM TO TITLE 5 REQU/REMENTS �C^��'D' �Y 4 v/a G / �t /s+�row e' .TEST BY: NO. OF OUTLETS 5 WITNESSED BY: sTt. A c o r > 1` '`ti �.�:�,_�.� — -- a .�,. .r. [� 4�Un � v i�-ice �12 ii.//3'i%��/i�'/�/ Y�a - .—�v.T_� � � �r�3��- RFMOIEABLE COVER 4 cornP cnc� E� g�'a s MANHO BROUGHT TO ° _�- o iLQ4MAF/LL l2 MAX. '.... .. �,., ....:.' ,. �. . ,: FINISH ::BADE. e,. 2"PEASTOJR� .. ' 3 CL EAR 3 CLEAR ° -- -- .,--r DEPTH r-1' OUTLET PIPES - T OF rES7r' 6„MIN. �- 2"MIN 6„MIN AS REQUIRED I RATE: T►- fkll a ►,�, nicH lD MIN D/ST. noo t T"`----- INLET TEE -- . OUTLET TEE b �I BOx \ I I Y > — 4 G/. /000- GAL. d 1 GqA p INLET AND OUTLET 4`O" MINIMUM OUTLET TEE DEPTH: t� I �'¢ TEES r0 BE CAST L/OUID DEPTH /4"AT LIQUID OEPTrI of 4` 2" 6`" , SEPTIC TA w I . P ECAST DR BLa MAti!' UAW R /" CONCRETE r I SEEPAGE P/T IRON SCNED. 40 : 19., " •` •` �� 5` .° M ED 1 M DEPTH OF TEST: P.V.C. OR CAST IN P4 6` . e . . . v o . �: CONSTRUCTION /O' SAN RATE PLACE CONCRETE29 CONCRETE , 34" •- " 8` BOTTOM ON LEVEL STABL£BASE MIN. I cONsrRucTiDN �• I i (WATERT/GHT) d INLET TEE PROVIDED WHERE SLOPE a:• . ., . �, ,,.,. a ,,..,'.r.•►: FOUNDATION w 1, ..r;,'.. .,.,e .. ---- .,., OF INLET PIPE EXCEEDS O.58 % OR ---------- f TANK TA LOADING UN TO WITHSTAND IN A PUMPED SYSTEM. ' / /- BOTTOM OF TANK ON LEVEL STABLE BASE H-IOLOAO/NG UNLESS UNDER 20 M1N. �/�' WiOSHED STONE I PAVEMENT OR IN DRIVE.H-20 I I L OA D/NG UNDER PAVEMENT OR I DRIVE /Q' I I PLAN VIEW INVERT ELEVATONS. /. THIS PLAN/S FOR THE DESIGN AND CONSTRUCTION OF THE SEWAGE ` DISPOSAL FAcl- I T Y ONLY. SCALE : I "•= 24 /NV, AT BUILDING 9�,7 2. ALL CON.�TRucrlcN METHODS AND NATERIALS SW L CONFORM TO /NV. AT SEPTIC TA/VK(/N) MASS. rO.E,p.E. - TITGE 5 AND THE. ��wuSsa-�,�,�- B4�dR0 OF --/NV. At TANK(GUT) �..:.2�_— ,, � 'Y " �''�''FN HEALrH REGULATIONS. /1L l F r, 5. "i"SS W N WATirr., �5 AvA i L- ►BL•V 7,:s THIS Lor.. c. /s r 3A /NV. AT D/ST. BOX(/N) 4° ncssRc�nrT MQr�>:s S AV IC E-0 Der TOWN 1NATCR� { �V / .:1'1 INV. AT D/ST. BOX(AUT) AT LEACHING FAC/L/rY, 9i.a Y• I .i e' BOSTON, MASS. WORCESTER, MASS. AT BOTTOM OF P/T- HALIFAX, MASS. NORWELL, MASS. I r BEDFORD, MASS. LEXINGTON, MASS. r` 'y ���S HYANNIS, MASS. MANSFIELD, MASS. CRANSTON, R.I. DERRY, N.H. 96 — r 1 / i B C _ 9 y .— w _ - ......, .,.. - r... ., :.c. ... _„_ «'i _ _ '�' �. vim+• k � -- _ S F r LO -� o Al DESIGN DATA DESIGN FLOW, _ I � _ t N� . REQUIRED SEPTIC TANK: `'7o = c'r,, ` GAL. .� SEPTIC TANK PROVIDED = ('� c, v, GAL. CAPE COD SURVEY CONSULTANTS r REQUIRED SIZE LEACHING FACILITY: • k � ! � ��, '' _----- _- ----- -- - :� �- lvlA/�/ ATE' ��": �. S -. '� :-� ,. .-- - ----— �-- ,;.,,,.-` —- -- `' t;G- — — .4-- /�a't :.".`tu.�ti J1��L f-r cam',�• 20 ---- - low : -- ---- - DIVISION OF BOSTON SURVEY CONSULTANTS INC. _ iENGINEERING • SURVEYING • PLANNING SIZE OF LEACHING FAC/L/T Y PROV/DED _ . I o R � `•' :''� ___- .,,____ -'� � TYPE OF SYSTEM + y1. TITLE: -- IN, 141 �, > t;c _ • � � ice_. '` - , '� ` �• '. ----- 4,4 �, .-�. i -- - T, N 'e�e r tin : 7 rt C x G H L r'R t 7`T G F c ,�; � �� � ' '� ,, `� _ S� ; D SEWAGE DISPOSAL SYSTEM DESIGN J Ip tox. ON —-- _. - -- -- L O to 8,41 FAI Ce E R o A LOCUS PLAN • N /L S, O D — . a��—� FOR: y[ -� SCALE: AS SHOWN a c�a�� { L 0 7-6 s- METERS FEET 0 /O PO vo (5 33 DATE: NON. e91 /9B3 i' COMP./DESIGN: CHECK: O. F• IN R.P.I'Y). DATUM' DRAWN: T. T;• A SS Utr 6-D FIELD: Fi'L H T, 7. Y ` ZOI✓E R F FILE NO: SE`T Qss�n 34 =/5=/5 DWG. NO:(PIS JOB NO: C- 143V �1,/ r. SHEET: I OF: I y r . . r , TOP FNDN. AT EL. 62.1 SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN 6' of FINISH GRADE LISA LYONS, RS /-- ACCESS COVER (WATERTIGHT) TO ENGINEER: MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 53.0' D. DESMARAIS, RS WITNESS: 2" DOUBLE WASHED PEASTONE 8/15/05 �- •` ELEV. 56.8' RUN PIPE LEVEL f DATE: FOR FIRST 2' 3' MAX. PERC. RATE _ < 2 MIN INCH DORY EXISTING �QQ0 GALLON SEPTIC * 50.0' o 55.4 f jT'EE CLASS I SOILS P# 11049TANK (H- 10GAS 49.30' pppp O pppp %RE-USE BAFFLE 49.47' c 49.17' pppp p p p p p o $ ", 6" CRUSHED STONE OR MECHANICAL $o pppp p p p p p COMPACTION. (15.221 [2]) ,$ 2' pppp L7 p p Cl p o 47.17' i ELEV. z DEPTH OF FLOW = '4' 12 1 % SLOPE) „ 0"" Q 53.5' �" Q 53.8' � NEB WAY '. ( % SLOPE) ( Lo ) 3/4 TO 1 1/2 DOUBLE WASHED STONE A A u TEE SIZES: INLET DEPTH = 10 7//LS UNSUIT. UNSUIT. 14" 5" 10YR 4 3 3" �/'zl 0YR 4 3 OUTLET DEPTH / / LOCATION MAP NTS B B 50' D' ' LEACHING �SL UNSUIT. /SL UNSUIT. ASSESSORS MAP 76 PARCEL 45 FOUNDATION BOX 14 EXIST. SEPTIC TANK FACILITY 4.37' 28" 1OYR 5/4 30" 1OYR 5/4 'THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTIU11ES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION Cl Cl OF SEPTIC SYSTEM - THE INSTALLER SHALL CONFIRM MIN. SEPTIC TANK 35't /oSL SL uNsulr. SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR UNSUIT. RE-USE 42.8' S5„ 10YR 6/2 60„ 1OYR 6/2 48.9' 48.8' -I- WATER EXPECTED AT ELEV. PERC C2 PERC C2 12't PER TOWN z x GROUNDWATER MAP MS MS 2.5Y 6/4 2.5Y 6/4 5' REMOVAL OF UNSUITABLE SOIL 128" 130" 42.9' REQUIRED AROUND PERIMETER OF 42.8 L=1 1 8.1 6 `` LEACHING FACILITY, DOWN TO NO GROUNDWATER ENCOUNTERED NOTES: R=1 30.00 SUITABLE SOIL LAYER. REPLACE WITH CLEAN MED. SAND. SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 1. DATUM IS APF'ROX. NGVD EXISTING �� DESIGN FLOW: 4_ BEDROOMS (110 GPD) = 440 GPD 2. MUNICIPAL WATER IS USE A 440 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 10 R� 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-10 C,/RC SEPTIC TANK: 440 GPD ( 2 ) = 880 5. PIPE JOINTS TO BE MADE WATERTIGHT. / s1 ss �� / o 110" �F USE A 000 GALLON SEPTIC TANK (RE-USE EXIST.) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. h p c'9S WALK T 1 0 K 7 OAK �\ -- ENVIRONMENTAL CODE TITLE V. CO'�o' �i a LEACHING: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 'I x 3 2' 5 5 < r SIDES: 2(40 + 10) 2 (.74) = 148 TO BE USED FOR ANY OTHER PURPOSE. �. 59.81 1 10" OAK R SS' = 296 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. EXIST. s55. 2L �'68 BOTTOM: 40 x 10 (.74) 9.87 DWELL. s » 39 10" OAK 8� 600 444 9• COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT TOP FNDN 1 PIN 1 TOTAL: S.F. GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 62.1 7 USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. u EQUAL) WITH 2.6' STONE AT SIDES, 4' AT ENDS AND 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PIT 0 57.51 > I53.09 \ 24 EX T. N 3.25' BETWEEN UNITS \ DECK g 72 DOUBLE 12' \ MAPLE 54.95 \\\ \1. , ° 59 LOT 47 LEGEND TITLE 5 SITE PLAN \ 61.00 FAILED 52,172 SF \ / ASS 0 LEACH PIT 1 OO.O _ PROPOSED SPOT ELEVATION OF \ 6,.43 0 C. 62 BARNICLE DRIVE 1 61.3 a&6 .30 5 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: a 0 5 . 100 PROPOSED CONTOUR o (MARSTONS MILLS) BARNSTABLE AQ / 6 .2s QP/ s 3 so.o1 ow 100 EXISTING CONTOUR PREPARED FOR: gORTOLOTTi g� 0.22� r 61.46 .3So.i6 CONSTRUCTION/MacDONALD BENCHMARK: USE DECK 30 0 30 60 90 CORNER AT ELEV. 62.4' BOARD OF HEALTH \ MA SCALE: 1" = 30' DATE: AUGUST 16, 2005 APPROVED DATE 0 �s N O ��• off 508-362-4541 fax 508 362-9880 down cape engineering, inc. rA NIE yN o ARNEOJACIVIL ENGINEERS H. Vl� � oALAo. 307 2 .o N g' LAND SURVEYORS �a���Ol %o �5- 179 939 main st. yarmouth, ma 02675 oiA , P.L.S. DATE