HomeMy WebLinkAbout0310 PLUM STREET - Health 310 PLUM ST46Gl"
WEST BARNSTABLE
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No.-----__---------7 Fee.: -------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applicat ion for Well Construction Permit
Application is hereby made for a permit to Construct (w�r, Alter ( ), of Repair ( )an individual Well at:
�— Location — Address Assessors Map and Parcel
Owner Address
------------- ------------ -------------
Installer — Driller Address
Type of Building
Dwelling --- --- ------
Other - Type of Building---- ------- No. of
Type of Well S —' � �� Capacity- ----
Purpose of Well---r�aT7$i�31 �- /��-��—
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until Certificate Compliance has been issued by the Board of Health.
Signed — -— w
date
Application Approved By d -
date
Application Disapproved for the following reasons:
- ------- ---------------- date-- _
Permit No. � 7�GTl f^3� -- Issued
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Comphance
THIS IS T CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( )
by-- --
Installer
at— //> �LGI vT—1/Y iyS /� 1 --- ---
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well P otec ion
Regulation as described in the application for Well Construction Permit No. �---��Dated�_( 3 -�1_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector--------- --- —_�--____
\1-
GJ 2WU 1 -17 Fee..:S- -----------
BOARD OF HEALTH ' a.,3
TOWN OF BARNSTAB\LE' `
Applirat ion,forVell Cootruction Permit
Application is ereby made for a permit to Construct (voT, Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel ^ —
L &/Q
Owner Address
/7 —7,4C
Installer — Driller Address
Type of Building
Dwelling _---- -- ----- -- i;
Other,- Type of Building-- ------ No. of Persons------------------------_---
Type of Well - 4Ca�pacity--Z-----
---
Purpose of Well-----
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a•Certificate .of, Compliance has been issued by the Board of Health.
Signed - — — -�� T 2,01
,..... date
Application Approved By -------- ✓7-7 C I -
date
Application Disapproved for the following reasons: ---------- ----------- --
date--
GJ ?.girl i-3-7
Permit No. - -- Issued----- --- =- --- - -----
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
11 C ertif irate Of ComPhance
THIS IS TO CERTIFY, That the Individual Well Constructed (''), Altered ( ), or Repaired ( )
by--- ------------- -------__------
Installer
aller
at
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pr e tion
Regulation as described in the application for Well Construction Permit No. -��`—J �-3�-Dated-� ? Q�--
} THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- Inspector-------_--------------- -------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ivell con5truct ion Permit
Fee ----------
Permission is hereby granted
to Construct (✓), Alter ( ), or Repair ( ) an Individual Well at:
No. .3/0 L 77916
Street
as shown on the application for a Well Construction Permit
w210Vt- 3 -7 3-/zr
No.- ---_ Dated--- - -----------------------------------------
— -_ - --— - ------------------------
33 -Z 3 G Board of Health
DATE __-_ _____
1 k1
E TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE �J• {(�� �.�`� ASSESSOR'S MAP & LOT/Pb- d
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY %500 0 Zo�
LEACHING FACILITY:(type) ���� (size)
NO. OF BEDROOMS PRIVATE WELL R PUBLIC WATER
BUILDER OR OWNERj1��,(�•
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: /
VARIANCE GRANTED: Yes No
1
��� 15
ASSESSORS MAP NO;_L_..._--.--
PARGELK
No................-.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiuu fur Di-iripuuttl Works Cfumitrur#iun rami#
Application is hereby made for a Permit to Construct ( ;�4 or Repair ( ) an Individual Sewage Disposal
System at:
� •Locationv Addr�s or t o — . (-
�I ..� — a{t l....AIl Il Eg2��.._..--•--•. ----��--I0-----=--"l1K/(-•-•-•----•-, 3 � .4� �1`�Ttlg1 g�
®r Installer C&Oi JX•I&d�i 7O'® Address
d Type of Building Size Lot--- +_.Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
'k bther—Type of Building No. of persons____________________________ Showers — Cafeteria
Q' Other fixtures ------------------------------------
W Design Flow..........)- _____________________•__--gallons per p ry pert day. Total dAily ow-----.....'�_`�.. ..._._.._.-_--_--__--gal�ons.�l
WSeptic Ta>�E� iqu>d capacity.15Fgallor 46I ezngth_ + _` ��i h_ Z�I �_ Diameter................ Depth___.... .
x
Disposal -13—No. ---------I--------- h____________________�o�igth______.__...___----- Total leaching area_—_, 7----___sq. ft.
Seepage Pit No_____________________ Diameter____-...____._-_____ Depth below inlet.................... Total leaching area.................. q.
Z Other Distribution box (V) Dosirtg tangy(. )
12
'—' Percolation Test Results Per _��Per-formed by____________________ . t_" !"� ____ Date.............. .«__q
Test Pit No. 1----------------minutes per inch Depth of Test Pit---- .... Depth to ground water.._._..b�E d....
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
� �`_ _..Lc�S �.....��---c---- S ------
O Description of Soil------'�"- ------- ----------------•--••-----...------------------------------------- -----------.......... .....
...... �.:.---
x
c.,
W - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
UNature 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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance s b n is y e b of lth. 3
Signed . ......... ..............I.......................... ......................
...........:......
Application Approved jj✓�------------------ --------------------- --t�-�---...:._-----------���i
Date
Application Disapproved for the following reasons: .......................................... ..................................
............... ........................................................ ............................ ..................
Permit No. ......../....t'... .. � .... Issued � - ----...._G`�?............
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration f or Diiipwml Worlm Tonotrnrtion ramit
Application is hereby made for a Permit to Construct ()',I or Repair ( ) an Individual Sewage Disposal
System at
r:_G� f t-y.,�•z� ��►��...._!...... ��7 2
Location-Addres or Lot No.
........................................H� I la r✓�?� ��� I�i �r.lt i _:_ 41 �c-
l .................................. ............................................... ._.............. .......................J
Owner Add•ess
gI Qr 7`e Z—O 7!1'/ Installer C `�J J`r�/� /O�/ ' Address
d Type of Building Size Lot_ s�±.Sq. feet
- -----------
Dwelling—No. of Bedrooms............r}..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ---------------------------------- -----------------�ooNl
Design Flow......__..)_ ......................•...gallons per per--san per, day. Total daily flow_._____.._` ` '_........._____._....gallons.
W • ISM d _� cl ," S ' -Y 'I
W Septic Tank'EL capacity._____ _.gallop Aq Length t� __�4;.��i Width- Z.s._� Diameter................ Depth_...............
x Disposal gncla—No. .........I......_.. �rek-h_``.................. Tot-al�ength__.___.....'..'... Total leaching area__a�2.......sq. ft.
Seepage Pit No--_---------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank ( )
Percolation Test Results Performed b ! ..��? =.. '`h'ti "'.`�..... Date....... I `�"
Y
aTest Pit No. I................minutes per inch Depth of Test Pit.... `.L'_.�.... Depth to ground water-------t'+J E.A7.. tee l
44 Test Pit No. 2................minutes per inch Depth of Test Pit................. Depth to ground water........................
-------------------------------•-•••---- ---------•---•••••......--•-••• :............ ---...
D Description of Soil......-1�-- .......................... 4�6 L�....L e,G S .. .. �'i� A C Lb/mot j�� (I)-/�'- I -------�•d�....._..
_ _
� I
.............. ..•---------..............-------•------..•-•--------•------......--...........--•--•----•---•-------------------..........-----•-----•......... ......................................
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
ti ._ .
Agreement: `
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental 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.,
Signed ...... ../�`5/ �'!i ' ?�_�jTr.-/.......................................
Date
1.
Application Approved B�-- - -.... :........... ; - -- --- -- ---... . -----. .. .... -....................................
Date
Application Disapproved for the following reasons: ........--. . ....................................... .. ..... .........................
......... . ..............................�......._. ........ . . . .............. . ........................................
42 Date t
Permit No. ...... �'�� - Issued `A"..k_ .' .�"'.,_ ...........
-f''�- " - ....
Date
---- --------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Ileztifi ate of (IJampliance
THIS IS T,0 CERTIFY That the Individual Sewage.Disposal System constructed ( a� ) or Repaired ( i )
by , . a
... 4. . .......
%jf,
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
�'._ r....A ..._.` .: .. ?_. ra �c.
the application for Disposal Works Construction Permit No. d-. date �-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE:CONSTRUEA AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ... ....- - :. ---------------------- Inspector...., .......... ..............
---------------- --------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
---� ' TOWN OF BARNSTABLE
No P ' . . rrr FEE................... �.
Diopooal Workii amit
Permission is hereby granted........ .......I --If-- - --- ------ ...........................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
............................................................. ....................................................
Street -1 1 � .t� ��
as shown on the application for Disposal Works Construction Permit-No'`..__�1,/1.:�.�i' Dated... ;
Board of Health
DATE =:�.� •-' -'---.....----•-••----
FORM 36508 HOBBS&WARREN,INC..PUBLISHERS
LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTALLER'S „ NA ME i ADDRESS
Cam '
-112
, -4 7b-,r-t4,,i ten 21&
--+ID ORS, -OWNER
181
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ..- /:- ��`'
r :
bs �,
i
No.... .- Fes$.......` ..... .
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® r0F HEALTH
-------------- OF...-..--...................-.._._..
Nlipliratiun for Uiipuual Workii Tome rnrttun rumAt
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
....3-4.0------�1vM....51................. :Z.._.�..........
Location-Addre s or t No.
.......... 1�►!�_.....1,�.1:� ... �' 1.. --•---.....
Owner Address
aj0 P,-------------------------------------- -----------------------......_.....--------
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms...................•...-._-_____ ___..Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of ersons____________________________ Showers
a YP g -------------•------•-.....- P ( ) — Cafeteria ( )
Otherfixtures ------------------------------•---------------------...•--------------•---------- ....................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ 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--------_-------------
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----_...................
a •-•----•--•-------------•_..•--•••••••••--•--•••-•-••••----..._..----•-•-....--------•-•----•-------........................................................
0 Description of Soil........................................................................................................................................................................
x
U ....--•••••••••-•-•••••-•••-•••••-•-••-.-.....•--•----------•--------------------------------------•._...-----•••--•-•--------------•••--•--•-••-•••--•------...•-••-•••-•-----------------•-•----------
w
-----------------------------••--•----------------••-----------------------------------------------------------_....--------------------------------•-----------------•••••-•---•••••. ------•-
U Nature of Repairs or Alterations—Answer when applicable.____ONvjE .:• ___-_-T4_sZS!.-4.v ........
-----------------------------------------------------------•-------------------------•--....-••---•-•----•-------•----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT?,% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is u.d by t bo r of h I.
Fffollfowinga
Signed -------------- -----••--••-•••......._..._.....
Application Approved By-----•- ------- •- ------ -------......-_------ ----� ----___DateApplication Disapproved fort reasons---------------------------------------------------------------------------------------- ----•---------------
------------------------...------....---•-----------------------------•--------------•----...__._._. ••---------•--
Date
Permit No........... ------------_------- Issued......9--'i 4"9,5......................
Date
-----------------------
�,6
----------------
I)i No------ Fnz..........................
I THE COMMONWEALTH OF MASSACHUSETTS
4 BOARD OF HEALTH
------------------ ......-OF..........................................................................................
,vppftratiou for Uispoiial Workii Tonstrurtion jhrmff
al
�p Construct a
,'Rli�ation is hereby made for a Permit to Const or Rep ir an Individual Sewage Disposal
Sys'
11\ lb ?1QM
.............."F-
ro-�..... #-....�. ------iw ................
a
W or f1p
er Address
.......... .............0......................................................... ..................................................................................................
Installer:,'�`:. Addresi
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..................I .........Expansion Attic .Garbage Grinder.
Other—Type of Building ...................... No. of persons........................___. Showers-11-'( Cafeteria Other fixtures .......................................................I................................. ......................... ................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid capacity............gallons Length................ Width._......._._._._ Diameter._._...._..._._. Depth................
Disposal Trench—No..................... Width.................... Total Length......_............_ Total leaching area....................sq. f t.
Seepage Pit No_____________________ Diameter.__...._.___.__..... Depth below inlet_................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Perfor\med by-------------------------------------------------------------------------- Date........................................
V-4
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.._................._...
............................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
---------------------------- -------------------------- ---------------------------------------------------*--------------------------------------------f-\-----------
------------------------*----------------------------------------------------------------------*--------------OVER-----PoN;F-.--�r..... -------
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 been iVued by 0 Ith.'pard
Signed04h,, ........E ............
---------
Application Approved By ................
............
................... ........................................
Date
Application Disapproved for the following reasons:....................
.........................................................................................
............................................................................................................... . ............................................................D..a..t.e...............
1.4 . PCV5-) 34 ;�, W- p
PermitNo................................. ................. IssueL.......................................................Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF.,".HEALTH
..........................................OF.....................................................................................
(Intifiratp of T-nutphatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed 4 or Repaired
by----------------A-1...1141-e�^..........?..............................................................................................w.........................................ff......
at....................3.W-PLvwL5-jt.................................Install. .er...............................................................................................
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......................................... dated_.....__._..._._..........-.............._......
THE ISSUANCE OF THIS CERTIFICXTE SHALL NOT BE CO STRIKE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............. ................... ................................................... Inspector.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No...................... ...........................................OF......I..".......................................................................... SOO
FEE........................
tdion "pandt
Permissionis hereby granted..........1....................................................................................................................*..............
) or Repair �( X"antJ, osalt3jem
to Construct dual S
atNo............................................./........... ........7.......... ........................ .................
V- e% 7
as shown on the application for Disposal Works Construction Permit o.......... - tated
-----------------
........... . ................ ..........................................................
Board of Health
DATE.................................f..O�----------------------------------------- y
FORM 1255 A. M. SULKIN, INC., BOSTON V
v* / 4,1
TEST HOLE LOGSall
�
a
f_ \ {
r, ENGINEER: N.44E- JjALA
/ io'�' WITNESS: --_____
' ''' DATE: z I�
PERC. RAZE �A t ��
Aa-
°ERC. TEST
`
'OP AND. TOP AND --- ------ --— -----
a SUSSOIL ! SUSSOtL LOCATION MAP (NOT TO SCALE)
- ) I�" I ASSESSORS MAP ice. PARCEL
S V{i 'L A
' _ —
-J� " I P i FLOOD ZONE :�
/ B ! I
�
� 7� + 14� � f(�'�-Imo �.Lk_'��-_-�'
o L 2 IM E
---� _
1 . DATUM IS �,(•�r•\/j�, }t"i�A},-) �� i. -
/ 2. MUNICIPAL WATER !S -- ---_—�lr— _
3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
14 u-o '�z `-__-_� 4. DESIGN LOAD►N, FOR ALL PRECAST UNITS TO � �
+; n F P'P T F I
x - PoI�T a Icy 49 95 t=��'►�� �. � E JOINTS 0 B_ MADE WATERTIGHT.
6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
-Fna r ' T6 i4v 49, ENVIRONMENTAL CODE TITLE V.7.. PROPOSED WORK SHOWN MUST BE STAKED IN FIELD BY THE
DESIGN PROFESSIONAL RESPONSIBLE FOR THIS PLAN TO ASSURE
h� COMPLIANCE W!TH APPLICABLE LAWS. -
` ^ `� •� !� �� S E P rJ,I C PROFILE_ 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40 4" PVC.
1!/'• ��f. 1 1�� j/� '•"'...�I ' �— G ` i N� 0 — (" ------ --� `. {,;.. >I' ['a�' I ,7 1 r v�� -I r''.- � � Y•�r
( T � IF, / '- ,oO L
(� ric`o. -b�� F u� Or. V,pr- n r
u M�'� `T% f:kCr'A S' f,1�p t t�►� 1 T.O.F. AT ELP
"T`.} ,fj i+=�ij,r,,�; �L, * ;, ', �• y 1 sz,44 ✓ - �•'T J rrvv Ev Q�
PROPOSED
, * `�•�'t 'ff1 ►'-i j� �"- d 1 - �C ' ` GA"ON SEP;;c-�/ a t --
�lV '' J~}• i n - - r--.. TANK l .�.p •h
r' S" f ` _. - --.L�_ ;j z •, ,,ol go IY a Ifs „
1 pw xw-H OF Flow �. 4S11 I,+ �i lvrlv"j v.tip'
-f -- ." •Ste.i :3 , � ' `\.._ _ ----v ,
h� �+- TEE S;ZES. 0
INLET OEFTH
x SLOPE OUTLL7 DEPTH 4
+_
' ..- . .
15-
ATIONV�- t LEACHINGFOuN0 AN
L;' D- Fmk" i�lt�I�J'"FAC►L
p' I
L F rzp
4
�ftv�,�. �.,Ia '� - �- .3- �. H'�`� �'vf✓� �1D (� !��'-���! G� (� ��f..l (j'•�� I� T��_�`
SITE ND SEWAGE PION
� .
!, r �►� r t SEPTIC DE -N: (GARBAGE DISPOSER S No* 4�5✓) ./•,U
_ — 1 MLA �P-VI-r142.4 �1D � �I LlY CAM
�!v _ DESIGN FLO'n: BEDROOMS (.L.t. ? GPD) = `� GPD ? U P� .I}./1 �MP-61 ��I CY-'w�T� �;
- \ ' `�' SSE .A �? GPO DFSIr'N FLOW _--_--_ -
�� SEPTIC TANK:_ S-.," GPD*(L) _ GALLOr:; PREPARED FOR: �h✓�p )✓?I { ,r fZ'J p, lTj
USE A _iS4'0 GALLON SEPTIC TANK f-I-{O i4lH-7.0 Tv
- TEACHING_ -T*'1 } J e;1P —4
BREAKOUT w t106, G-,T f�7 + -1744,Z
4 ,lTz t� �tt � % �s 7 N.i 70 {S 0 _
Feet
BOTTOM: --
FIRM a
r—:--
�I SCAU: f 7 DATE:
down cape engineering, Inc. SYSTEM IS _ MOM z. _ f �� „ �.�,�����I��� �%������-_�f�ll�+�i�.�"iPr.S
CIVIL ENGINEERS �/' k 1, Q`. e�
LAND SURVEYORS BOARD of HIaTH
PHONE 508-362-4541 FAX 508-362-9880 n Ptt"'L#•���� V✓ MA �, / —1` --
939 main; s t. yarmouth, ma APPROVED DATE 1' 4 OJA �,�� ` DA TE ,