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HomeMy WebLinkAbout0066 CHUCKLES WAY - Health 66 Chuckles Way, Marstons Mills . . a= 1 f .c �Np COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 'OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 66 Chuckles Way Marston Mills, MA Owner's Name: Michelle&Maurice Mulcahy Owner's Address: Same Map: 101 Date of Inspection: December 27, 2000 Lot. 058 Name of Inspector:(Please Print) James M. Ford FAA F{+qµ_..w Company Name: James M. Ford REC Mailing Address: P.O.Box 49 Osterville:MA 02655-0049 A�1. 1<A.2 0.0 1 Telephone Number: (508)862-9400 TOWN OF Bk-it 1b i tAbL HEALTH 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 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: " Date: January 2, 2001 The system inspector shall su ritapy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design 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,and the approving authority. 'Notes and Comments ****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. - - Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 66 Chuckles Way Marston Mills. AM—- Owner: Michelle&Maurice Muleahy Date of Inspection: December 27, 2000 -"" ` 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: 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. ornt deietrAnsweryes;n m (Y,N,ND),in the. 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. ND explain: Observation-of sewage.backup_or breakout 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: The system required pumping more than 4 times a to year due broken or obstructed i The system will y . . . pipe(s)...._. _...._..._....._...... _..pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 66 Chuckles Way Marston Mills, MA-- Owner: Michelle&Maurice Mulcahy Date of Inspection: December 27, 2000 C. Further Evaluation is Required by the Board of Health: Conditions exist which require ftirther 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 2. System will fail unless the Boaid of Health(and Public-Wa ter'Supoliei,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)*and4h6 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 -**This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compoufids 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. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A A .,CERTIFICATION (continued) Property Address: 66 Chuckles Way ..._. ._ m Marston Mills. IViA t Owner: Michelle&Maurice Mulcahy.. Date of Inspection: December 27, 2000 D. System Failure Criteria applicable to all systems: You must indicate either"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 'h day flow ✓ 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 e 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 certifled 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.] No (Yes/No)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. E. Large System: 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 each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 66 Chuckles Way Marston Mills. Owner: Michelle&Maurice.Mulcahy Date of Inspection: December 27, 2000. .. 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: Yes No ✓ 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(3)(b)]. Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 66 Chuckles Way Marston Mills. Owner: Michelle&Maurice Mulcahy �. Date of Inspection: December 27, 2000 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 2 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): No Water meter readings,if available(last 2 years usage(gpd)): 2000-107 000 gals.; 1999-123,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: _ Design flow(based on,310 CMR 15 203): d Basis of design flow,(seats/persons/sgft,etc.).' Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no), :• R: .. Water meter readings,if available: f r Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 5 years ago-per owner Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval `''Other(describe): ,_._-._.._--------Approximate age of-all components,date.installed.(if known).and.source of information: ____._..._._...._..__ March 29190-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 66 Chuckles Way Marstons Mills, MA Owner: Michelle&Maurice.Mulcahy': .a Date of Inspection: December 27, 2000 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: ` Comments(on condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: -.-. Is age confirmed.by a.Certificate of Compliance(yes or no): (attach a copy,of certificate) x „, Dimensions: 1000 gal. + ! Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 29" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 8" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Both tees wre present The liquid level was even with the outlet invert. There were no signs of leakage. Recommend pumping every 3 years GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete 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: Comments on pumping recommendations._inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C t , : SYS.TEMJNFORMATION (continued) Property Address: 66 Chuckles Way MarstonsMills. Owner: Michelle&Maurice Mulcahy' Date of Inspection: December 27, 2000 :_`_ TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): r ° ✓ (if preserit,must be.gpened)(locate on site plan) ''`DIS.TRIBUTION t BOX : __. _.. , Depth of liquid level above outlet invert: -- 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.): •. The box was not dug up There were no signs of failure in the leach nit PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): . Alarms in working order(yes or no) Comments(note condition"of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C :..• 3 , SYSTEM INFORMATION (continued) Property Address: 66 Chuckles Way Marston Mills. MA Owner: Michelle&Maurice Mulcahy' Date of Inspection: December 27, 2000 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1-6'x 6' leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovativelalternative system, . Type/name of technology:. Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The pit had 4'of water on the bottom.'The scum linimas at the same level:._There were no signs offadure.r The bottom to Qrade was approximately 10' CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM,INFORMATION (continued) Property Address: 66 Chuckles Way Marston Mills, MA Owner: Michelle&Maurice Mulcahy Date of Inspection: December 27, 2000 Map: 101 Lot: 058 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. �r onT 6� .id?� t i,. . ,F..}F' ..t .+t11 ".`I � . _. , ...f c�:..... i +• i.. . .:.1 ,,.... ;ln c .,,:`f cy � f t t� -i 1 .. r. "a " i 4:::4{r�e•rt y �,s, r ,�1 ci Y I 1. t.. � ,, ,{1 � ilk{ .it .�i _ l �'S:'1. Ai - 19 i a . 8 - 39 A 3- 3� f33- 3� 3 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 66 Chuckles Way 4 + :• ; :.` ; .F:3': `' Marston Mills. MA ``�"_� Owner: Michelle&Maurice Midcahy' Date of Inspection: December 27. 2000 W. SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the pit to grade was approximately M Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 40'+/-to groundwater at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 II -t0 A� BORTOLOTTI CONSTRUCTION, INC. MA Y 1 1995 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOB Address Of Property C 11 0G� 5 �/ ✓f/lar�`�o�s 'fi 5 Owner's Name Date Of Inspection 3 PART A CNEC LIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. ✓ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this / inspection. As-Built plans have been obtained and examined. Note if they are not avail- / al: .le 1•Tith N/A. V The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. V All system components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition. of Naffies or teAs, materia' of corstructio:�, dimensions, depth of liquid, depth of sludge, depth of scum. y The size and location of the SAS on the site has been determined based on exist- ing information or. approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential 3 number of bedrooms 3 number of current residents X,0 garbage grinder, yes or no Y6 laundry connected to system, yes or no -VO seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: Last date of occupancy GENERAL INFORMATION Pumping records and source of/information: 5 System pumped as part of inspection, yes or no if yes, volume pumped /d©oy I Reason for pumping: ' Anve wee. Gafer � e ay lve✓ir 4e,4etX5 c.IePlef- B 2 h'-` 4 1 -4- SG i�1vl cP -Yr�u�i�`s 7/7Septic f system tank/distribution box/soil absorption system Single Cesspool Overflow cesspool Privy Shared, system (yes or no) (if yes, attach previous inspection records, if any) Other .(explain) Approximate age of all components. Date installed, if known. Source of information: �� Sewage odors detected.when arriving at the site, yes or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION CONTINUED SEPTIC TANK: V (locate on site plan) depth below grade:—'I L material of construction: V concrete metal FRP other(explain dimensions: /D sludge depth /I distance from top of sludge to bottom of outlet tee or baffle scum thickness 3 distance from top of scum to top of outlet tee or baffle 7 distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage recommendations for repairs, etc. ) r e ill 5 olre e ilISTRIBUTION BOX: ✓ --- ------------ (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leaka e into or ptit of box, recommendation frp repairs, etc. ) PUMP CHAMBER: - (locate on site plan) pumps in working order, yes or no Continents: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs, etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART SYSTEM INFORMATION CONTINUED SOIL ABSORPTION SYSTEM (SAS) :�� (locate on site plan, if possible; excavation not required, but may be approximated .by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number leaching chambers and number _— leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions _ overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) CESSPOOLS (Locate on site plan) :.441/12 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 (cesspool must be pumped as part of inspection) C m)ents (note .condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) PRIVY: ✓ le (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, recommendations for maintenance or repairs, etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION OONTINUED SKETCH OF SEWAGE DISPOSAL SYSTEM; include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 3y i I DEPTH TO GROUNDWATER f depth to groundwater method of determination or approximation: y- I,`/lP✓ 6/oc�Mcri�r�P.^ SUBSURFACE .SEWAGE.DISPOSAL.SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. 141 Backup of sewage into facility? �/ Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6" below invert or available volume, 112 day flow? Required pumping 4 times or more in the last year? number of times pumped /v Septic tank is metal? cracked? structurally unsound? substantial. infiltration? substantial exfiltration? tank failure imminent? /y Is any portion of the SAS, cesspool or privy, / below the high groundwater elevation? /v Within 50 feet of a surface water? N Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? /y Within 50 feet of a private water supply well? A Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, net the SAS)? Less than 100 feet but greater than 50 feet from a private water .supply .well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for'coliform bacteria, volatile organic compounds, amonia nitrogen and nitrate nitrogen. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector: Company Name Company Address Certification Statement I certify, that I have personally inspected the sewage disposal system at .this address and:that the information reported is true, accurate and complete as of he time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance.of on-site sewage disposal systems. Check e• I have not: found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR`15.303. Any failure criteria not evaluated are as stated in the. FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determinimation is provided in the FAILURE CRITERIA section of this form. Inspector's.: Signature Date y� Original to System Owner. Copies .to: Buyer .(If applicable) Approving authority TOWN OF BARNSTABLE LO-kATION lQ(V C�UC E WAy SEWAGE # o p oi" 41 010 VI:hLAGE ✓VI• ✓Y11�IS ASSESSOR'S MAP & LOT !O/- OS$ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) P i (size) &x L' NO.OF BEDROOMS 3 BUILDER OR OWNER Uri IC PERMUDATE: �IaS'I �C1 COMPLIANCE DATE: 3 S 90 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 o leaching faci�ty) Feet Furnished by S L TnSOeXn 1'O/c� ia,/J Ar Al- AA- a3 O O r3a- as, co � a A3- 43- 3q ° ', / O TOWN W OF BARNSTABLE {{{j _. G s �� ®%� �� SEWAGE # M ATTON r rI� k I _ VILLAGE --L<S ASSESSOR'S MAP & LOTo� 7 O � STALLER'S NAME & PHONE NO. e1 C Qra�l. �a 1 • 9�'j��� ;SEPTIC TANK CAPACITY -- 9 LEACHING FACILITY:(type) G.-F-4A ai--- M LCL size) NO.. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER `+ BUILDER O�OR'QVidE�R DATE PERMIT ISSUED: '��✓ 'DATE COLIPLIANCE ISSUED: ` V:ARIANCE GRANTED: Yes No °` r k r E:a: C 93 7 9= 3�` C.`` • Ce � 1 - . Yuic THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliration for Dhipoii al Works Tnnitrurtinn Vanfit Application is hereby made for a Permit to Construct or Repair (_N.� an Individual Sewage Disposal System at: i .......6.�_..._ '. �1�./.�� ......AIA. ..... ......... ®t....._ ..'7.. ........................ Lo ation•Address or Lot No. 4f=►��� ��j --E•J ............................. ....................................................... Address - a .... �!..l_. .� ., -••-••-•-•..................................Installer Address UType of Building Size Lot_/',1.7')....._......Sq. feet Dwelling_=No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder ( ) Other=Type of Building No. of persons� _ a yP g --=--•-•-••................. p :5............... Showers Qj — Cafeteria -(•---•>• d Othe xtures ......................................................---•---------•-•---....._..•----- ---••--•-•-•--••- 4 -- wDesign Flow........, .......................gallons per person e�day. Total daily flow____c ..............................gallons. WSeptic Tank—Liquid capacityle 9_gallons Length.... ......... Width__.,S........ Diameter______ ________ Depth...,........ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 _ O Description of Soil .�•-•-•-P�-Y l t�J-------------------------•----------------------------------...... ------------•--------.........__. x w " ••-•••----••--------------------------------------------------------•----------•-----------------------•---•--•----------------•-----•-------------------•------------------•--••-•---•----••-.......... U Nature of Repairs or Alterations—Answer when applicable___________________________________________•__-_-_____-__-__________••--_--•_--•--••- ---__. ---------------------------------•----•--•---••-•--------•-•-••-------------•--•••-•-•_...---•---•-•-•--••-•.......-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the bo d of health. Signed.... �. - 1 Date Application Approved By__________ Date Application Disapproved for the following reasons-------------•-:= ..............•----•-.....-•-----•••--•....--•-•---•••-••-----••--••-------•--••---..__.....-•------••-•--•-••••------•-•-------•----------------••--------------•-•••••••-----••...••••---••••--------- Permit No,......... ........L-t Dat .....••-__. Issued.-•------•---•-•-•nace---------•-----•-- ....--- �. No.. ............ ./...:. Fps.......2— THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................... ------...........OF...................................... t Appliration for Disposal Works Tonstrnrtiun umi# Application is hereby made for a Permit to Construct ) or Repair (. ) an Individual Sewage Disposal System at: 111 ..-• s_ ..l_...0...................... i ... ..... .............................E...._.......... ...........--......._. �� Location-Address or Lot No. __._.. 1 .. .......-- W Owner / f/ 'l Address ...... -�....._....✓.... -• ......--•.................................••-•------•-...---------..........--�;.------......--- Installer Address 1'� d Type of Building Size Lots___•,-1.':-----1----------Sq. feet Dwelling_=No. of Bedrooms... ...............................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type e of Building No. of persons a YP g ---------------------------• P �---------------- Showers (�)--- Cafeteria (.. ). Othe fixtures Q W Design Flow.......� --•--•:_---------•-__gallons per person per day. Total daily flow...�,..................................gallons. WSeptic Tank—Liquid capacity/a6_U'..gallons Length............ Width-. S---_----_ Diameter................ Depth—T._._._._ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area..__.............__.sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------- ........................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ IX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a DDescription of Soil..... = 5--------P .......... ..A&...-•-•----•-••••--••--•-------•-•••------•••-----••----••••••••••••--•-•••-•--•••••-••-•-•••-•-•--•-••-••-•-••....... x U •••••-••••-••----.......-••••-•-••••---------••-•.............••------•••••••-••••------------•-•----•----•--------•••••-••---••---•-------•••••--•---•••--•--•------••---•---•---••---•-••-•------•-•- W ---------------------------------------------------------------------------------------••-•--------------------------------------------•--------------------•------•--------....._......-•------•-----•- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ .............................................-...............----------------------........-----------------------------------•--------------------------------------_....._........._............---•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the b rd of health. Signed..... �......� �= Date Application Approved By........ f, =^"= � �-��� Y- -` -Cl F'r r� Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------------------••--.......••-- ........................................................•------.........--•----•----....-•-•--------...--'•-•----•--------------------•-•----.._..------------•---------•-•.....-----Date......--.....-•- 7 � PermitNo. =........�._...�....,----•-------•... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF �HEALTH ............OF..... <�... ... : I'�i ........... (9rdif irat a of T,antpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by................ .-------. .. ................................------------------------------••-•------------•------........-----•---•-------...--------.....-------- +� Installer at e::_---r. . 1 .......... ' -`' 0 c=.......... ��..4, Alt i- /Yt,.- -- -------------- has been installed in accordance with the provisions of I'?r, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ _ -__ __r! ------- dated---............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........-�---. ..... `��� �_Inspector --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'r ... ...........OF........... � .,r; �*l!�5 `II _. No._._..... P FEE._....................... Disposal Works Tnn#r ivit prrutit Permission is hereby granted............. f -----------•................ to Construct or Repair ( ) an Individual Sewage Disposal System at No.............. API, sus ca-.: _ 6. ` Street r_ as shown on the application for Disposal Works Construction Ppynut No.-,Y.............el__ Da ed...........................•.............. .._.....---=•--- �`�.s- �,�' -----------•-----•------ Boar of Health DATE...... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOWN OF BARNSTABLE LOCATION ��`/5' eAd4&&,Fj W,4,1 SEWAGE # VILLAGE . 11YAU ASSESSOR'S MAP & LOT /3( INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 106.6 v LEACHING FACILITYArype) (size)— o NO. OF BEDROOMS ' PRIVATE WELL OR BLIC WATER ILDER R OWNER BU -� ��C4D DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: sh If 0 VARIANCE GRANTED: Yes No J �--� ��� cam' . P �� I TOWN OF BARNSTABLE LOCATION SEWAGE SEWAGE# VIl,LAGE �lffl�ST�.�-� ��L� ASSESSOR'S MAP&LOT / � L fir/ NAME&PHONE NO. SEPTIC TANK CAPACITY >aGo LEACHING FACILrrY: (type) (size) Gil NO.OF BEDROOMS 3 RNUMER-OR OWNER —.Z27-- DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 Westland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 3,3'S ,, S YS TEM PROFILE NOT TO SCALE TOP FDN. FINISH GRADE .9-'. EL 99.s :o..,..e. FINISH GRADE O VER FINISH GRADE O VER DIST. BOX FINISH GRADE OVER SEPTIC TANK ss�,o L EACHING PIT 9p 8 0 d .. o: Y2 MAX. o••,p•. o.: .O• O p..4 '�.p 4. O•.O•Q,d•'•�„•b A. .O..'p. ..6 .. A:' 'O'•' ^•6 H. H " i .p ••,• .6,.. . .a. :°.•.• :e .a : �;,�.'a;a:a •p 3 OF 1/8 1/2 12 MAX ASHED PEASTONE ,x--_a. :: _.:.-t•_ PRECAST CONC. OR O 7• ��O OI •:O. s- BRICK 6 MORTAR OUTLET PIPE LEVEL TO 12" BELOW GRADE • • .. O•:Q:.p. Q . _ D64� FOR 2 FT MIN-5 r-- -'- o O•... 0.O /J G CJ `. �o p•.d � a: o: C. I. OR PVC TEES - G a . D•p 0,0.',°1 'O:p'•Q o- e O I o' D .e h� O e� 'v n' •I O. - BS T. •Q'M FLR �1 EL z, � ::a'O _aGALLON �.. IS TRIBU TION BOX •; 4 .': INSTALL ON LEVEL BASE PRECA ST o. o.. .0..0: A:' d •. D: ._� .n. o .0.•b•.•0iO3 •ti Qd % PRECAST TRE 'O.`O,'.b•.'0'.:0'.'.: .e s / D• :WASHL 7 ^e. C O�. CONCR 'TE d•. o .. 0 4'•'. . d'P'.. o' .p. 'O.'• 'o'a': STONE y U .,,.•d,a.,o.o. .o.o A .e,¢ o.,,a;•q .°.d •o a 0,.0 4,. .d.. D,. Q•b.d. H /0 REINFO INSTALL ON L VEL BASE ° NOTE.• EXCAVATE TO ELEV. -,4!_ 'OR • Via'. P'.'•.•fir w' •G•0,.6'• ,p L:: '• r LO�JER TO REMOVE ALL IMPERVIOUS . . . - ,. MA TERIAL BENEA TH THE L EA CHING' , Fi. :�4 2 2 _� .. REPLACE EXCA VA TED MA TERIAL WI TH ' • 6 •_0 „ �. CL EA At, CLA Y FREE SAND • 1 u EFFECTI VE DIAMETER _ �L EA CH.I'NG P GENERAL NO TES PIT .�. ALL ELEVA TIONS SHOdtsN ARE BASED ONASSUMEO INSTAL L ON LEVEL` BASE 2. ALL PIKES IN THE SYSTEM MUST BE GAS T IRON � OR SCHEDULE 40 PVC. .. ` CyB � A TION PIT , 3. THE BOARD OF MEAL TH MUST BE NOTIFIED -- �'� WHEN CONSTRUCTION IS COMPLETE PRIOR PERC TEST NO. P-7388 r �s TO BACKFILLING 'PERGOLA TION `RATE— . 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED 2 MIN./IN. B Y THE BOARD OF HEALTH AND CAPE c� ISLANDS NI TNESSED 'B Y.- O SURVEYING CO., INC. G.DUNNING f 5. MATERIALS AND INSTALLATION SHALL BE IN `� • /� COMPL IANCE #I TH THE STA TE SA NI TAR P BAF.��ls-T—ABLFSRO. OF HEAL TH DESIGN DA TA p �� �/ f f ✓o?�0'�4 CODE — TITLE V — AND LOCAL APPLICABLE DA TE.• ALGA 29,_ _qB.�' b � � RULES AND REGULATIONS NUMBER .OF BEDROOMS 3 6. NORTH ARROW IS FROM RECORD PLANS AND � „ IS NOT TO' BE` USED FOR SOLAR PURPOSES 9s.a GARBAGE DISPOSAL NO 7. FLOOD HAZARD ZONEC aja6—R ZAROL TOPSOIL 6 DAILY FLOW GAL . 8. l�A TER SUPPLY 11z�1�Ll�,�.TER �� SUBSOIL � _ 1 J 36 SEPTIC TANK `REO D. .j000 GAL . ' SEPTIC GAL ti k' �� 5 I000 GA1.LGN E TIC TANK PROVIDED ?000 r 17 / Q` +^ '�� PR CAST CONCRETE L EA CHING REGUIR�ED 330 GPD. S PPTIC TANK 12,�725 S. F. MEDIUM / / � � � � r v <� e-• QQ 'yQ' / SAND � �°'� SIDENALL AREA 188 S.F. o0 1 �Q j68 S. F. X 6/S.F. = 470 GPO S� o / Q BOTTOM AREA = 1,2 S.F. ry <V� LEGEND 79 S. F.X�.1LG/S.F. _ _J�.GPD •J3�� +� \���, r''7v L EA CHING PRO VIDEO _ q�GPD PROPOSED EL EVA TION f 44'°,, NO GROUNDNA TER B� \ —— 9& ---- EXISTING CONTOUR \ SINGLE FA MIL Y RESIDENCE & RECAST CONCRETE OBSERVA TION PIT LEACHING PIT ❑ DISTRIBUTION BOX RICIIRD PROPOSED SEWA GE DISPOSAL S YS TEM JAMES LEACHING PIT o BERTRAND No. 29892 i, PREPARED FOR Q o SEPTIC TANK '�•�� iord�� E SA RNS TA BL E HOL DING CO ,Y LOT 17 CHUCKLES WAY ARP t RESERVE OF MARSTOM MILLS MASS. �� DAVID c 9 so PIPE INVERT ELEVATION HARLES _ .,ANICKI DA TE, �� 71 15>e,9 PLOT PLAN 28085 CAPE AND ISLANDS SURVEY/NG CO., INC SCALE AS NOTED SCALE:• 1 "�.3o i 7 ,�t, !s,���,,u � l3/ SPRING BARS ROAD J, T 1�� ' � E�' P ' 1 r H t� . ,�,° h% 'S PLAN NO. �.��,� AL�rour MA . ". .••r+rn^sw+a.ae.,•r•�,x.+w�+••a>�a ..� t+.rr .zr.•.w«,....•mr+......_.,�m••,.ee•w..n....,�-. r,.m-«.-ww�.:�....�....«..�a4:-�.c...e=>...ffr..�,•...�..a.�aa wrn.,oa-.ers.xrwe.+*....,..+�..,-,.,.,......--..,,_..._..:... ..._::....- .. . f . i _...._ ......._........._,._,....»,._...-..,..,.......-..,.,,....,...._.,.....__.,..:,...m....-.,,�...... .,,-.-,.�.....,••.ten,... 1 s S/ S TEN PROFIL E NOT TO SCALE TOP FDN. FINISH GRADE--Le-o FINISH GRADE OVER EL';. 9�"s" o:•'D:'o: FINISH GRADE OVER DIST. BOX 99-f FINISH GRADE OVER SEPTIC TANK 99.Q LEACHING PITAAN / ?2" MAX.A:. _ o:a. 4. .a.-0. .•° ...®,.,.@.,. 4,, o d a. . ;,. ,@„ •; . . .,@ e• 77 !2" MAX ,,�••d0•.b .'O• p.;e: ''Q.:':0'a.[I:..;•Daw O••�O;'C'. :O.'.'d:0' '.:°': 0 '{j•'o,•p;d D ASHED PEA STONE PRECAST CONC. OR o'; °•:A:: 0 3" OUTLET PIPE LEVEL P TAR BRICK " BELOW GRADE f ','r•: FOR 2 FT. MIN. o'oo pie°. 'orb:4e: a:eo,00.�o.e 0-0 O• 0 ° 0 6p C. I. OR PVC TEES 6.•0 b P.•o. GA N BSMT. FLR .•. X D: —�- DI TRI UTION BO @ I EL . fz, a o': � '• n •o ';4 a INSTALL ON LEVEL BASE 3/4" TO 1-1/2" � o r' PRECAST CONCRETE PRECAST' :'ri:•°-.•o.'o'.•D:o: d .� WASHED.... I . H-- /O REINr�'OR "ED a cRusHEt;J e CONCRETE - ° STONE b. 'o, o' b d"°'"O;b'::o-:o'' D:o'•'A' :o:®:,Q.o:v.:.'d' d 'o.• a o'.'�: o b ,I A ;.a.'o�.o:0,p•,O,•p.o:�o:.Q.:o•,f5••:p:at 0•;Od•.• .d:.'A;.,o•b.•o' \ .°` H-- /0 REINF. n SEPTIC TANK INSTALL ON LEVEL' BASE NO TE.• EXCAVA TE TO EL EV V. 8 u=s'OR a.0 �d . ., ,o : o• :°o _ I L OWER TO REMOVE AL L IMPERVIOUS MA TERIAL BENEA TH THE LEACHING ARE;{ 2 ,-0 " REPLA CE EXCA VA TED MA TERIAL WI TH 6• •—0 " CL EAN CLA Y FREE SAND 10 . 0 „ . E - - _ ;, • EFFECTI VE DIAMETER GN, ' A L NOTES L EA CH.I'l1�G PI T INSTALL ON LEVEL BASE 1. ALL EL EVA TIONS SHOWN ARE BASED ONASSUMED 2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON OR SCHEDULE 40 PVC. OBE:;�. R 11A TION PIT 3. THE BOARD OF HEALTH MUST BE NOTIFIED c l / WHEN CONSTRUCTION IS COMPLETE PRIOR PERC' TEST NO. P-7388 TO BA CKFIL L ING - PERCOLATION RA TE.' f 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED J BY THE BOARD OF HEALTH AND CAPE C ISLANDS WITNESSED BY.' t SURVEYING CO. , INC. G.DUNNING / 5. MATERIALS AND INSTALLATION SHALL BE IN / s COMPLIANCE WITH THE STATE SANITARY BARfS_TA,&F_BRD. OF HEAL TH DESIGN DA TA 'o , % C DATE AUG- 29,.19.8.E i � � � ,, � CODE - TITLE V - AND LOCAL APPLICABLE Q / O !` RULES AND REGULATIONS MBER OF BEDROOMS � 6. NORTH ARROW IS FROM RECORD PLANS AND 0` 98.0 IS NOT TO BE USED FOR SOLAR PURPOSES GARBAGE DISPOSAL N_Q__ p TOPSOIL 6 GAL . f 7. FLOOD HAZARD ZONEC ('jL[=/�AzaRCIi DAILY FLOW .3�Z_ 8. WA TER SUPPLY z0f�n/ WA TFR SUBSOIL SEPTIC TANK REO 'D T. 1 000 GAL . 36 GAL . A. z / SEPTIC TANK PROVIDED 1 000 1000 GALLON - _ LOT 17 / ',�� s PRECAST CONCRETE LEACHING REGlUIRED 330 GPD. T �� X( �� SgPI TIC TANK 12;�725 S. F. MEDIUM SAND SIDEWAL L AREA — 188 S. F. I ;� -� B8 S.F.X 2. 5 G/S. F. _ 1ZOGPD Q o° AN4' BOTTOM AREA —1�Q_S.F. - (vc) LEGEND J_�S.F. X-L-0 G/S. F. ,70 GPD N �2 0�:09 a° gip % v LEACHING PROVIDED 5A,_GPD PROPOSED ELEVA TION 144 NO GROUNOWA TER �� o ,� --- 9� --— EXISTING CONTOUR SINGLE FAMIL Y RESIDENCE & RECAST CONCRETE OBSERVA TION PIT . .�o . LEACHING PIT .��,{ OF ,, O DISTRIBUTION BOX s= PROPOSED SEPIA GE DISPOSAL, S YS TEl�9 RICHARD '� JAMES � BERTRAND rZ�" Lo r` 9 / Q LEACHING PIT a` PREPA RED FOP M1o. 29894 �•. f FFGIST E��� O 01 SEPTIC TANK ` `TONAL ���` BARNS TABLE HOLDING CO LOT 17 CHUCKLES WAY (RP t RESERVE c� , of MAMARS TOM MILL.. — MASS. At PIPE 9� so PIPE INVERT ELEVATION cHnRLEs �^,If SANICKI �:° DA TE.' S� 7 ;� I�-,'?,`� 28085 J CAPE AND ISLANDS SURVEYING CO., INC. 711 PLOT PLAN v 4 41STERN- ��% ' SCALE AS NOTED 131 SPRING BARS ROAD 7- GCS 5t"_ / / /(� �� .SCALE.' 1 �30 ,.�'- —, � PLAN NO. �� ��� �� P � LOT HSF FALMOUTH MASS ii