HomeMy WebLinkAbout0093 BLUEBERRY LANE - Health ii3 BIuenerry Lane
p- Marstons Mills
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1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r
93 Blueberry Lane
V
Property Address h..�
Anthony Volk
Owner Owner's Name
information is '
required for every Marstons Mills Ma. 02648 7/9/2018 r-
page. Cityrrown 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.
Important:When filling out forms A. General Information S/#� r3/ ::�-j
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Sean M. Jones
use the return Name of Inspector
key.
S.M.Jones Title V Septic Inspection
Company Name
74 Beldan Lane
Company Address
Centerville Ma 02632
Cityrrown State Zip Code
774-248-4850 smjonestitle5@gmail.com S14522
Telephone Number License Number
B. Certification
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 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
7/9/2018
Inspector'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 should be sent to the system owner and copies sent to the
buyer, if applicable, aid the approving authority.
****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.
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
xL
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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:.
The dwelling located at 93 Blueberry Lane Marstons Mills is served by a Title V septic system
consisting of a 1500 gallon septic tank, distribution box and 4 precast leaching chambers. The system
was found to be in proper working condition at the 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 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):
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
< Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
93 Blueberry Lane
`J Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ 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):
❑ 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):
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.
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 the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. City/Town State Zip Code Date of Inspection
B. Certification (cent.)
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 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.
3. Other:
D) 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
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the 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 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 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 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.
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.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
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
If you have answered"yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. 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.
t5ins.doc•rev.Bit 6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
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)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ® Yes ❑ No
Water meter readings, if available (last 2 years,usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/industrial 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
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ 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):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�e} Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�r
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owners Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
system installed 4/18/2002
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
12"
Depth below grade: 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.):
Joints ok, no leaks , vented through roof
Septic Tank(locate on site plan):
Depth below grade: 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 gallons
Sludge depth:
6"
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Offidiail Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 3
Scum thickness
0"
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
10"
How were dimensions determined? opened covers and took
measurements
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 does not need to be cleaned now but should be done soon and again every 2 years for proper
maintenance. Water level was even with outlet, tank was not leaking and was structurally sound.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete 1] metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
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
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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
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
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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.):
Distribution box was in good condition, no major rot, water level was even with 2 outlet inverts.
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.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is Marstons Mills Ma. 02648 7/9/2018
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 4
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching facility consists of 4 leaching chambers in a 37'x8'x2' trench. Chambers were video
inspected from d-box and were found dry with no stain lines.
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
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
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.):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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
PC
k 0 1
0
z
2�
Z 2�
Z 31
A 3 26
63 3-/
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12+
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:
Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
93 Blueberry Lane
Property Address
Anthony Volk
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 7/9/2018
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates(cost$40.00 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.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office,.1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: Fill in please:.
APPLICANT'S YOUR NAME/S: 1 O L
BUSINESS YOUR HOME ADDRESS:
G
TELEPHONE # Home Telephone Number
NAME 4]F CORPORATION Si�.:�s
NAME OFNEW BUSINESS ' S S TYPE'OF BUSINESS
4 ,
IS THISA;HOME OCCUPATIOiV9 S N0
ADDRESS;OF BUSINES. [ " / MAP
PARCEL NUMBER:`. (Assessing)
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 COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
2. BOARD OF HEALTH
- This individual has bpen informed of the permit requirements that pertain to this type of business.
Au horized Si ture*
COMMENTS: !�11 S 1'((-+'(�(' I CQ Dill �\l
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
TOWN OF BARNSTABLE
LOCATION SEWAGE #
%VILLAbE 4/15AT __ ASSESSOR'S MAP & LOT 10 '� oZ
`INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY i Sid 64C
LEACHING FACIL=: (type) yO6 C►L Cla,?`.-s Cx) (size) '% X37"A
is
NO. OF BEDROOMS
BUILDER OR WNER
PERMITDATE: COMPLIANCE DATE: U;!
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S� Feei
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feel
Edge of Wetlan�td Leaching Facility (If any wetlands exist
within 300 f�;t of leaching facility) Feel
Furnished by Cv/.e
TOWNOFBARNSTABLE
LOCATION SEWAGE #
'/U—L,AGE ASSESSOR'S MAP & LOT
,y
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACM=: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: 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 fecf'..leaching facility) Feet
Furnished by
9tit
�bolc
i'
TOWN OF BARNSTABLE
OCATION 9.3 131ae Lnp Z.,) SEWAGE # aM2-1f6
VILLAGE ASSESSOR'S MAP & LOT 1U 2 ._1I X
INSTALLER'S NAME&PHONE NO. Qa4l a/ VC
w
SEPTIC TANK CAPACITY /S'Go G,qC
LEACHING FACIL=: (type) �_oaG�.� (size) X3°71 '
NO. OF BEDROOMS 3
BUILDER OR C R��d�ft
PERMPTDATE: U•id-dam COMPLIANCE DATE: Ua
a
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility rf 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 �w A/ C vl e
9hL
96h Syr %h6
/®Z_
No. V'D 2—l) b ' Fee s(
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I/
Yes
PUBLIC HEALTH DIVISION - TOWN OF'BARNSTABLE., MASSACHUSETTS
2pplication for �Diopool bpg;tem Con!gtructton Permit
Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) Y Complete System ❑Individual Components
Location Address or Lot No. Ale
H Owner's Nameddr/ d Tel.No.
Assessor's Map/Parcel
Installer's Napi�,Address,.an�].No Designer's Npei Address �No.
Type of Building:
Dwelling No.of Bedrooms Lot Size �0 sq.ft. Garbage Grinder( )
Other Type of Building of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 0 gallons per day. Calculated daily flow 313e gallons.
Plan Date Nu er of she is Revis'on Date
Title ® l
Size of Septic Tank Type of S.A.S.
Description of Soil je,0�9 70.5
7 S3 it`Z
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 Certifi-
cate of Compliance has been issued b s d ea
Signed Date
Application Approved by Date U
Application Disapproved for the following reasons
Permit No. a 0o a Date Issued y 6 U Z
t
NI.A)Vo 2—1 l7 + ` 't.-x(g� .__s4�:�,,e ..-
�^ ` ,�, Fee:
THE COMMONWEALTH OF',MASSACHUSETTS Entered in computer:
Yes
' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
0[pprication for Zigpool *pgteml'Congtruction Permit
141
Application for a Permit to Construct( )Repair( )Upgrade(/Abandon(� mplete System D Individual Components
Location Address or Lot No. uP `p/', /n Owner's Nam , dd�e�KdTel.No.
Assessor's.Map/Parcel ,la/'s -7D��c. VV/
i. �7 / / `�
Installer's Mype,Address and el.No. Designer's ame,Address and Tel.Ijp.
p�7�v1�. ) Go�s1` Dunn , sue,
Type•of Building:
Dwelling No.of Bedrooms Lot Size sq.ft., Garb ge`G der( )
Other Type of Building % L®A,?&o.of Persons Showers
Other Fixtures
Design Flow /D, gallons per day. Calculated daily flow gallons.
Plan Date OZ Nunjber of sheets ! Revis'on Date
Title )` )` P �'!? ' �?4 D 3 _ // .r .
Size of Septic Tank J,5-010 110-4p .r e Type of S.A.S.
Description of Soil C � 'r.5 7 . 7 83X,?
Nature of Repairs or Alterations(Answer when applicable) /x � /�
Date.la 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 b t"'s B v
ea
Signed 4� �' --• Date
Application Approved by A� � Date y 1 6�
Application Disapproved for the following reasons
Permit No. a 0 v a —/S6 Date Issued �� U Z''l
------------------------ ---------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO TIM, that th On-site Sewage Disposal System Constructed( )Repaired( )Upgraded
Abandoned( )-by)-bvi Ao r �
at &141&6aZ1 Y O. ZJ1 11-S has been construct d } accordance
with the provisions of Title 5 and a for Disposal System Construction Permit No. c t)o;z—/i 6 dated
Installer Designer
-, The issuance of is p rmit shall not be construed as a guarantee that the syst6m`wi_lbfunction as d t ned
Date q 1 tU Inspector �2 l 1\).
---------------------------------------
No. )0U?— / ��j Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
30i5po5ar *pgtem Construction Permit
Permission is hereby granted to Cons ct( )Repair( )Upgrade( bandon( )
System located at 3 ��N�4/A/� �I9 ��/�9�4JRS
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: Construction must be comple-ed within three years of the date of this permitJ
Date: 0 Approved by_
,�i
a
e
TOWN OF BARATABLE
j LOCATION '93 131 of -1= Lam! SEWAGE # 4?eW'/fG
V LLAGE /4-I,111 ASSESSOR'S MAP & LOT 10
INSTALLER'S NAME&PHONE NO. da4ldl`Xi
SEPTIC TANK CAPACITY /Y-ve 64C
LEACHING FACILITY: (type) (size) X37/A!:7 '
NO.OF BEDROOMS
BUILDER OR�WNEER� eft
PERMITDATE: COMPLIANCE DATE: �(!?
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �f 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 Dow 1-77I�r+-i�9
�-3
3y6..
TOWN OF BARNSTABLE Au l o`, f i :)-
LOCATION 1 3 z1v c pey V' �.t SEWAGE #_ f
VILLAGE ASSESSOR'S MAP 6: LOT ��
INSTALLER'S NAME & PHONE NO. ��
v 6eV
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) ftc C 06T pl r (size)I (
NO. OF BEDROOMS- PRIVATE WELL O UB CIL WA R
BUILDER OR OWNER `''
s
DATE PERMIT ISSUED: Li D j 7'
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
r
0�' 3
_ K
�lF� iDBv��pl►ow
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
IN ....OF......... .ln.u...t� ................................
Appliratiun for Dispnsttl Works Tanstrurtiun Frrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System
..._........ � `..�. _ � .-1 -:. ------•-------------1'�n.::... 1�: .�� ....................._............_
L tion-Address or Lot No.
�lrl- 2 --`� '�.......----�°• ............ ..................A!�...lE .t. .-------- .....---... ---------•---........_........
O� b ---... .--•------Address
Installer Address
Type of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms.... ` _.•.........................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ------------------ -----•......_. ..._..
WW Design Flow............6--- .........gallons per person per day. Total daily flow............a_-A.0................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length_....._._....... Total leaching area...................sq. ft.
3 Seepage Pit No........1.__......... Diameter...... ._.... Depth below inlet......�Q.._....... Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
`" Percolation Test Results Performed.by-•--------••-----------------•............................................ Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W4 ------------------------------------------------ ------------------•-•-••-----...........--•---.........................................................
0 Description of Soil........................................................................................................................................................................
W .
----------•--------------•-------... .........................................................
W •-•---•----•--••••---•------••----•••---- ----••-•----------••.._...---•-----------------•---•--------------•--------------•-•---------•-------------•••..._•-•-------•-------.. _.-.-•------•--
V Nature of Repairs or Alterations ' Answer when applicable.......1 __..�...............!�'`e-......fit 2 ..............�'.........
.. .......� -- --....... -------•-------------------------------•------.....---•----------------•-------------------------------...........-- ......---•----.....--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITL L . 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by a board of health.
Signed.. --. •--------------- •••. ....
Date
Application Approved By.................... Qi �,-�..` .. .�►�*�+���...�} ......
Date
Application Disapproved for the following reasons:...............:...........................................................................................___
---•-•--•--------------------•-------...........-----....-----------------•---••-------------...--•...------••-------------------------......--------------------------------------------•--••.......................................................
ec��
Date
.Permit No..----�� -��-?=- - ...----•--•-•-••.....:... - Issued...........................................
............... ......
Date
a A Vr..
ell-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f
Appliration for Disposal Works Cfonstrurtion throb#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
6�13............. ..?_.......12-(! — ?_ : ... - -- . ...
. :-.��.c---------------------—_....._..__._..
Location-Address or Lot No.
....._._..i�Yl 1 ...........y�==�-• "�::---•--------- ......................... !!t 1 ... ........._._....------......................
Address
Installer S 1 [ Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms........ �1;1__---------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building _________ ________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures -------------------------------• -
W Design Flow..._..._....>!�'__:�_________________gallons per person per day. Total daily flow________._'ra_..�_c._.........._..__gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal-Trench—No ____________________ Width.................... Total Length..................... Total leaching area...................sq. ft.
f
3 Seepage Pit No.......I............ Diameter._____.X._U__---- Depth below inlet......�V......... Total leaching area..................sq. ft.
Z \Other Distribution box ( ) Dosing tank ( )
~-' Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gi. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�+ ------------
••--•-------
•....................... ..•-------...............
-----------------------••------------------------------........_...-•--------•---
0 `Description of Soil_...----•-------••......................................••-•------..._..---•---•--------:.__...-•---....._............_..--••-----...-------•••••-----••-----•-----__...
W ----------------------------------------------------
_--•-------------------------------
_--------------------------------------
•----------
_-----------
-----•--••-------- -•---•-•------
........................................................ --•------------•-----•••---•................................•--•-------•-•-------•...._.__...---•-- ________
UNature of R airs or Alterations-Answer when applicable_______il�_a_ _____..____Q w`L._..__. __..__�...!................
... e1-- --•-••--``r= --------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The,undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI'PIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health. �r
Signed
............
�t.......
7 ..................
Date
Application Approved By.... ............. y -� ..��.,r..,.. :�� ..._...... ...... Dace ..,...
Application Disapproved for the following reasons:...............•..........................................................................................-__
••-•----------•-•--------------------------------------------------------------------------••-------..._.-------.....---------------------•-•---...------------------------------•-.....--•-.._....-.--
�-/ Date
Permit No. /� 7 7 T Issued.....----•-•---•-•-----••----••---•----------........L...7-- --. r....... ....._.. Date _
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C�IA iw Imo . a.••s, ,�,�'{ L�.E'.................................
Trr#ifiratr of Toutplittnrr s�
THIS IS TO CERTIE ,•-That the Individual Sewage Disposal System constructed ( ) or Repaired ( L.Y'
by......................ram....-•--•-.....1ti!,�� � r...---------•---------------•---........---•------•---••---...._....._..._........._..._........-----•---•--. ........_
fir- � ..
Installer r r
at.................... ---•---- d.t '�----- k✓ r=a�........ / ---------------EC�!�.c.._�tii_{ `_.? .............................................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._______ __'7_-.__ 7 ....... dated..................................:.............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
'DATE--..................-L-a=-------'-•-------��----�•-------------------------- Inspector.............. . ._..............................................................
_ _---------r- --•-�� --,if�l - k- : �_'1 -----------�-lJ f{ r ---------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
77..-_. w\�.........,OF _:P
No.'7....... FzE. ..:....:..
Disposal Works Tonstrurtion Prrmit
Permission is hereby granted.............. -•---•------.=== __..r �r----------------•----------------------..................-•-•---•----._
to Construct ( ) or Repair (t---)-an Individual Sewage Disposal System
Street
as shown on the application for Disposal Works Construction Permit No7 !� :_ Dated..........................................
Aoanl of Health
DATE........... !'= 'rz r�k=aa----••..............................
,
i
SYSTEM PROFILE TEST HOLE LOGS
TOP FND N. AT EL. 89.0 (NU
T T CALE)
ACCESS COVER T� WITHIN 6 OF FIN. GRADE p 0 S
ACCESS ENGIN R•COVER (WATERTIGHT) TO AH OJALA, PE
EE
/87.0 MINIMUM •75' OF COVER OVER PRECAST /` WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 87.0 DAVE STANTON t.A►cf SIDE DR.
WITNESS:
2' DOUBLE WASHED PEASTON
2 26 02
I
Locus
D AT
z E: � f
RUN PIPE LEVEL �
\85.2:_ - FOR FIRST 2' 3' MAX. _ < 2 MIN/INCH g
I PERC. RATE
013
(EXIST) PROPOSED 1500 I
GALLON SEPTIC 84.75' 84.0
85.0 _ CLASS SQILS P# 10177
TANK (H- lO ) GAS
n-- r!5QOQ Q Q BAFFLE a' -84.0o M8 .17 Q Q, AROUNp3 Q Q Q Q Q Q y5Q QQ l� Q Q QC
CA o ELEV.
I � (._/. SLOPE) , 6' CRUSHED STONE OR MECHANICAL
or
C❑MPACTI❑N. (15.221 123) ft� 2 q a 81.17
87.4
DEPTH OF FLOW = 4' ( 7.5% SLOPE) ( 4 % SLOPE) 3/4' TO 1 1/2' DOUBLE WASHED STONE A
TEE SIZES,
INLET DEPTH = 10" SL
„ g" 10YR 3/1
OUTLET DEPTH = 14 L❑CATION MAP NTS
B
10' SEPTIC TANK-
LEACHING ASSESSORS MAP 102 PARCEL 112
10' DFOUNDATION- FACI4._ITY
SL
(MAX) 5
1OYR 6 4
/
51" 83.15'
REQUIRED
VA F UNSUITABLE SOIL R
5' REMO LQU OE
C
AROUND PERIMETER OF LEACHING FACILITY,
DOWN TO SUITABLE SOIL LAYER. REPLACE 6.17'*
7
WITH CLEAN MED. SAND. ENGINEER TO
INSPECT AND CERTIFY REMOVAL ANY DRYWELLS MUST BE
GREATER THAN 25' TO LEACH MED/COS
I_ FACILITY (RE-LOCATE AS NEC.) *CONFIRM SUITABLE SOILS FOR 5 BENEATH
LEACHING FACILITY AT TIME OF
NSTALLATION 10YR 7/4
+ 87.8
+ 87.5 LO
IL
100.00 ^ 00 85.0
+ �9
o TH I 120" 77.4'
4" HOLLY I LOT 93 �� 1 BENCH MARK - GAS SHUT OFF
J , NO WATER ENCOUNTERED
I 10,400t SO. FT. / 1, I VALVE. EL = 85.1 NOTES:
+ •5 1 184.6 -
t 1 1 SEPTIC DESIGN: {GARBAGE DISPOSER IS NOT ALLOWED > 1. DATUM IS APPROXIMATED FROM QUAD MAP
III ; NOTE: 2 CESSPOOLS I 86.7 SHELL a r, - - :•, 1
THIS AREA (ONLY I. Ou VE Ir -- - `' - - r�
] I3 i _� . ' • ;- „ u� 2 MUNICIPAL WATER I5 �T
ONE FOUND) 20•2 7.1 1 USE A 330 GPD DESIGN FLOW 3• MINIMUM PIPE PITCH TO BE 1/8' PER f❑DT•
G G
I + s5. 8�.6 :SEPTIC TANK: 330 GPD ( 2 ). = 660
+ .e 4, DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 .
'
o -
5• PIPE
J❑INTS TO'
D EBE MADE WATER
TIGHT,EXIST.DECK USE A -500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCOR
DA
NCE WITH MAS
S.
DECK
rF aao' LEACHING:. ENVIRONMENTAL CODE TITLE V.
18„ OAK -
o - 132
7 74 7. THIS PLAN I F PR
1 2(3 + 7.8� 2 (. ) L S OR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
rA SIDES
o TO BE USED FOR ANY OTHER PURPOSE.
i 89.0 `- I BOTTOM: 37 x 7.83_(.74� - 214 8, PIPE FOR SEPTIC SYSTEM TO SCH, 40-4' PVC.
p �v
' TOTAL 469 SF 347 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
I INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
+ 86.1
�, USE (4) H-10 500 GAL, LEACHING CHAMBERS (ACME
`� 1"-w + a. I FROM BOARD OF HEALTH.
OR EQUAL WITH 1.5 STONE ALL AROUND
I � )
AK P REMOVE
+ a.9 18" 0 � 10 PUMP & (OR FILL W/CLEAN SAND) EXISTING CESSPOOLS
81.0 11. WATER-TEST D'BOX FOR LEVELNESS
QQ
b
+ 85.6 a5 I L N D TITLE 5 SITE PLAN
+ 85.2
100,0 PROPOSED SPOT ELEVATION OF
93 BERRY LANE
100.00
•9
BLUE
ti
100x0 EXISTING SPOT ELEVATION
78.22 1
�b O IN THE TOWN OF:
00
PROPOSED CONTOUR
( MARSTONSMILLS BARNSTAB E
a
g -- 100 EXISTING CONTOUR -
+ 819' PREPARED FOR: VOLK
c' 84
3
20 0 20 40 60
+ .3
ce BOARD OF HEALTH
_. MA SCALE: 1" = 20' DATE: MARCH 4, 2002
AP R` V AT P .1 ED DATE
- - a
off 508 362 45 1
fux 8 3 -50 62 9880
s
Oiue•" � M
IN OF hygJ•, �� "9l'
P
� y
yti Al H.
ARNE
d wn ern cope en ineiInc. , � s
0 p 9 9� �
o � OJALA
H. CIVIL -'
CIVIL ENGINEERS OJALA N
No.26348Is
LAND SURVEYORS
� 02_-
939 rain st, yarrlouth, ma 02675
ARNE H. OJALA, P.E., P.L.S. DATE
02--022