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HomeMy WebLinkAbout0023 GRISTMILL PATH - Health 3 Gristmill Path Marstons Mills _ _ -- A= 064—020 Y TOWN OF BARNSTABLE LOCATION� MIL L P0l4'TW SEWAGE# VILLAGE P l•5 l /�e,[lk ASSESSOR'S MAP&LO ©� INSTALLER'S NAME&PHONE NO. 71--Ir�:2360 SEPTIC TANK CAPACITYJC A LEACHING FACILITY:(type' / �T(e o�. 0 7f>S (size) a5" "JC IA rX9f NO.OF BEDROOMS ? P,` BUILDER OR OWNER k)p�—S PERMIT DATE: ( • vl 'U S� COMPLIANCE DATE: Separation Distance Between the: r CA 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 Wetland and Leaching Facility(If any wetlands exist J within 300 feet of leaching facility) / Feet Furnished by 350 Main Street w � > 1 Fee �d VY THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: tOl PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS w �;PZippftcatiou for �Digool bpgtem �Comgtrurtion Vermtt Application for a Permit to Construct( . )Repair(.�pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No..)? (.T jAjSf M1 f A* Owner's Name,Address and Tel.No. Assessor's Map/Parcel Q(a.Zk --_ 00 Installer's Name,Aft,gd& Designer's Name,Add s and Tel.No. 350 Main Street Type of Building: Dwelling No.of Bedrooms__3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 C• gallons per day. Calculated daily flow �3� gallons. Plan Date 7M lr Number of sheets Revision Date Title c)/ f S-__ r--f Size of Septic Tank' d b 60'vc> Type of S.A.S. Description of Soil /"-C r h Nature of Repairs or Alterations(Answer when applicable) LCr 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 t �s Boar o ealth. Sign ! Date Application Approved by Date VIA YZ� Application Disapproved or the following rea Permit No. Date Issued IOW !�' ` � -� ` i o- � .iY' , �. .+a [ fi' • , ` .,`� X ! A00No. f. Fee A ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ,, "t PUBLIC HEALTH DIVISION -.TOWN OF BARNSTABLE, MASSACHUSETTS Z pricatton for Oiopogar bpotem Construction Permit Application for a Permit to Construct( )Repair( -,)rVpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.�)3 6:1';S f `l l"/l Owner's Name,Address and Tel.No. Assessor's Map/Parcel ( �B Installer's Name,Address,and Tell.No. Designer's Name, Ads and Tel.No. 1 peE r �T Type of Building: _ Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) ` Other Fixtures Design Flow 331 . gallons per day. Calculated daily flow �C) gallons. Plan Date Number of sheets Revision Date Title S-/Xe 1�: g s^ Size of Septic Tank /e-x J�> r a y Type of S.A.S. Description ofSoil /"-r r14 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 En ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar of Health. Signe �� Z` C t ca Date Application Approved by Date f Application Disapproved for the following rea r 14 Permit No. Date Issued j THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site ew ge.D�is�osal System Constructed( )Repaired_( -Upgraded( ) Abandoned( )//by / ;UFO O at C�f S A` f has been constructed in accordance with the provisions of Title .,and the for Disposal System Construction Permit No. t dated �" l Installers�',C� Designer r g The issuance of this permit shall not be construed as a guarantee that the s �st 'I'll u t±ction as designed.. P g Y g Date 1 Inspector No.��=— +-�— — ------------.. — ---- Fee I/CJ� THE COMMONWEALTH OF MASSACHUSETTS -' 0 PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Xhopogar *pgtem C_JD-"truction Permit Permission is hereby granted to Construc .( )Repair( �)Upgrade OAbandon( ) System located at c�)]?, 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. j Provided:Construction must be°ompleted within three years of the date of tyip�enmit. Date:_ Approved by y J e V ' 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only . PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM L 'D& hereby certify that the engineered plan signed by me dated concerning the property located at ILL, P -ff �, M����j meets.- all .of the. following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or bus"mess uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Fnmptor method when applicable] Please complete the following: - A) Top of Ground Surface Elevation(using GIS information) /Ud 0 B) G.W.Elevation 5()," +adjustment for high G.W. = lVo C7 W wr� D B A d B AIIA- Zp SIGNED DATE: 7 f 2�/o NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans- q:1Sepric xemp.doc f Town of Barnstable Regulatory Services 5 - -13 q Thomas F. Geiler,Director • sniiivsrA;B�e, �$A ' �0`p Public Health Division lFo ;ra. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 0S Designer: Installer: Address: ,tJ - Address: 350 Main Street 3 On was issued a permit to install a '(date) (installer) e tic system at �!� G�`'�`S based on a design drawn by It (address) C t/( dated Z/c) �J (designer) I certifythat the septic stem referenced above was installed substantially according to � Y Y g the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local R . Plan revision r certified as-built by designer to follow. �H OF M,40S r DA RNX (a"(L(w cy ME ` v taller's Signature) ` 1 400 n G/sTS / V SgNITAR��`a � �J z4M1 sign 's Signature) (Affix Designer's Stamp Here) , PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form l � 7 we n 1 Fz�s... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH b( q ow _- of ... .. --.-----".-".......... Appliratiun for Uiipuual Works ,01owitrurtion Putuit k Application is hereby made for a Permit to Co ruct or Repair an Individual Sew a e Disposal Syst at: . .......�&. L a n-Addres c or Lot No. ei r w d dress ----------- ... . Q ....... :..._._.. 14 Installer Address Q Type of Build,g _ Size Lot--------------_-------------Sq. feet V Dwellingl--No. of Bedrooms------- .........................Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures---- ---------c----------P----P----------P------------------------------------------------ Design - -----�"-------g---------- ons er W p Flow -- - P Y allons Len r lon er da VVidtlTotal dail flow Diameter________________ Depth-- allons. D sposal T ench tic Tank L-Liquid c. ac.. Width_____________ __ _ otal Length. ...... ........ Total 1 clung area....................sq. ft. Seepage Pit No....�._.......... Diameter.)` ._ ept o i t________ __________ Total leaching area -�..__ sq. ft. Z Otlier Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-__--.-__--_--___-_-_--" LTq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Dept to ground water.-___________________-_. Ix -------------------------------- ------------- O Description of Soil------------------- W 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be t sued by the board of health.n igned----- �t+rzs,7 a D to ----------- Application Approved BY----- � ........... 7 : Da Application Disapproved for the following reasons------------------- - ----- -- ------------------------------------------------------------------•----- --------------------------------•-------------------------------•--•---•••-•-------_••••. --------------------------------------------- .. Dat .... e.--•--• Permit No. Issued to 4s No., ' Fimu... ,:... .....�.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH OF.... . - ,f Applirtttion for 43ifiVosal 10orko, C onfitrurtittm Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: • L an•AddressT or Lot No. •__- J- 41% ... _. _ ,�'. ............ ....................................'_--- Address __ -- ' Installe /f Address Type of Build• Size Lot____________________ _____Sq. feet Dweln No. of Bedrooms________ _ _________________________ ___Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............. No. of persons_________________________ Showers — Cafeteria Otherfixtures ................................ - ---------------------------- w Design Flow...................... _._ Ilons per person per day. Total daily flow... ___= ........gallons. W Septic Tank L Liquid ca ac t � Ions Length_______________ ' 1 P q P Y Width Diameter :_. Depth x Disposal Trench—No. .................... Width___ otal Length Total leaching area--------------------sq. ft. e th o `i i Total leaching area... is ft. Seepage Pit No.-- Q Diameter , P F r: g q Z Other Distribution box ( ) Dosing,'tank ( ) Percolation Test Results Performed by.......................................................................... Date............:_.......................... ►.a ,.� 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.................... Dept to ground water------------------------ P --------------------•• --------- O Description of Soil----------------- - '- _.. :..r. x w VNature 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 Article XI 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. igned � l`° . s. •--- -----•---•--------------- k Date A A Application Approved B Y "" f - - Dam*" Application Disapproved for the follow r following reasons_______________________________ ---- --- ................................... rCCC-ee...."----•----- -------•----••-•--••-••--••----••-••-•••---•-••-•-••-•----•-----•-------•--•--------------------•••...---'-------•---------------------••--•••-----•___•••••-..................-•••-----••----------•-•- Permit No. Issued..... � Date 3- D THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH k E - �,� ^k (Intifiratr of (filutplittUrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (.,�9or Repaired ( ) ,� � ' - !. by---------------------------------- . -- ----------------- -- ----------------•----------•---------- s �✓'`'� In)taller E . t pp d at-----•-"__ l t{ -� fie '--! , e° a ..... S_1" ............................ has been installed in accordance with the provisions of Article XI lof The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... _5_ ` _______________________ dated--"__ ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION SATISFACTORY. Inspector ; '>DATE----- 1 y� 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. Permission is hereby granted----------- - ? ,- 4r._ =_A_4- ----------- -- -•--•-..._.................................................. to Construct ( or Repair ( ) an Individual Sewage Disposal System � S at No.- ^ r " � qd ¢ �`'- " 19 =` - -� ;;�, 9 :� f 11 as shown on the application for Disposal Works Construction Per tt o.____ _,ID ted----- _ .___ `------- _____ .. loard of Health DATE --------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Q� 3 Fee-- BOARD OF HEALTH TOWN OF BARNSTABLE Zippricat ion ArWell Cone;truct ion Permit Application is hereby made fora permV to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location.— Address — Assessors Map and Parcel -- - -------------- ---- - -- -3 ,1<'�s � � /.1/Ps •r�/�i/,�' Owner Address -------1�l - - ---- ,�----- -- -------- Installer — Driller Address Type of Building Dwelling------��s�%--i,�--------------------- ----------- Other - Type of Building----------------------------- No. of Persons---------------------------- Type of Well--— y ----------- Capacity---— - --——--- - — Purpose of Well---- f�U------- 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 Ce;tificate .of Compliance has been issued by the Board of Health. Signed - ------ - -- Qp date g Application Approved By '---- `� `/ l 1 date Application Disapproved for the following reasons: -------------------------------------- --- -------- --- ---------------- date — Permit No. -- Issued----- --- - --- ---— — - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individu Well Constructed ( Altered ( ), or Repaired ( ) 'Installer at— - �'!S r Lf 1 1 --—---- ------------ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------Dated----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- Inspector---------------- -- No.------------------ Fee-------------- ----=- y BOARD OF .HEALTH TOWN OF BARNSTABLE Citation ioflftl Con-5tructionPermit App y ,p — r ( ), or Re au (, )an mdividual.Well at: /(J k _� z --- nstruct ( ) Alter------ Z_-_��—------ hcation is hereby,made or a e l to 0 Location •Address,, ! 4 Assessors Map and Parcel Owner Address , Installer — Driller Address Type of Building y Dwelling Other - Type of Building--- --------------- No. of Persons------------__ ------ Type ofiWell— 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 —-- --- — 1 1I y/�A ` date Application Approved By — _ 9 - — s date I Application Disapproved for the following .reasons: —=- — -�=. ---------------— --- date �. I I { Permit No.. Issued---=- -- - = date �ete.9•e•riyt!..,YilGee?iSisse�il3l:.ye.AeG:Jo3oSat6To+Wi7Ci!ealo'SLE3!'elbeuee•e5eeseeLe'afer6eaf!iL'�as n4aliaY43e6leARSsSiSsea2f!CM1�4�ataF8A3!+iE eslSeaei�:.�sfaeYa9eeor�a!i.9a�Yi�1 BOARD OF HEALTH TOWN OF BARN..STABLE �tCertificate Of compliance THIS IS TO CERTIFY, That the Individu Well Constructed ( Altered ( . ), or Repaired ( ) Installer 4 at— -- - - --- ----------- - —�-- ----- T has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection ;Regulation as described in the application for Well,Construction Permit No.==---_------_--Dated----- ---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY: r DATE-----= _- = Inspector-------- —--- ---___ S"•co�i•�!a+.eawGeal+:eo+as�eas!eaecea�c�aaaepss�stcwaraeGvaue�eGeats`seaeaea+h:arasse.c.a*a!se.rbe:ea!aeavaysssr+re+iw:w!:._a�Aea!••..eG!ae�w:vea!i�a"ae:.!a!i!vl;:r�•a!a�:+se BOARD OF HEALTH r TOWN OF BARNSTABLE Veil CongtruttionA3ermit No. -- — . -fee� — _U_4 { Permission ><s hereby granted ., to Construct ( Alt r ( ); or Repair,'.(, ) an Individual Well at: Z Gr cs�-// a-d NO. - -- - --------- Street' — — - as shown on/the appliVj or a Well Construction Permit g No.- ( g _-- --��� _r - ---- -------- ------- Dated— f ' c _� - 1001 -�� - ' Board of Health DATE — I� 1 t I i ASSESSORS MAP TEST HOLE LOGS NOTES: r 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH � o PARCEL: 1 U f } SOIL EVALUATOR D _ me_,- y fzS C' THIS PLAN, 1995 . MASSACHUSETTS TITLE V & TOWN OF FBo FLOOD ZONE : gow PZ � jTi�l"P( BOARD OF HEALTH REGULATIONS. I 9 w� � WITNESS : �t1'� �.(�VitQ-��D , REFERENCE: D ATE:, lu7- L UO51 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, ' DELL 6� PERCOLATION RATE : -� Z M IN IN(,1� SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO INSTALLATION. SottS LTfl12-v•?N 5�a�f�..v TH- I �',,�' ✓I;,T L5 r T!-1-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION of- �� ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE V9' „ ►b��L � DETERMINATION. 4) ALL PIPING TO BE 4 SCHEDULE 40 @ 1/8 / FOOT. (UNLESS !t , �A-�AY ID SPECIFIED OTHERWISE) 1 s�� y0/4 LOCATION MAFP(O-T-5 ,� I Q ,i q 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A � I 11.b1 3Z 13.g?J' GARBAGE DISPOSAL. - Meolum MCOIU`'I 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) G MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON � ,/4 2 V 9 2.3+ A BASE OF 6"OF CRUSHED STONE. t 1 2 25 85,So 7) eP��c,6�-cti PIT To Be- PVAAPtV) CR-OtfED �4 y _ l�2 �o CAW av lea �jw G �r? � _Ft L�L - 7 71-E V. _ w Y..Now►� Pub wEL l w/l 13) v1= 1��op (,eachln�. 92 90 SEPTIC SYSTEM DESIGN 96 94 9) (qu W>'1lGnd5 WViri 1�5) or- Fizop. 1 ALLti1� _ loo 98 102 130.00 f _' " --� �- 1 ' FLOW ESTIMATE la U�kle IArNG�7 FN1 ]TL� D� Tb►�rJ U 3 8Ef)ROOMS AT �I0 GAL/DAY/BEDROOM - 33D GAL/DAY f • ••. v,� ---- TN' sy \ ` It) L+_EPtGN-Itj� (oMpoNepTS 1-o 6r-- 14ZD {,o,q'DEh, r SEPTIC TANK' WELL ° - 12 2) 48 4P Ae"P G6 Pol- UM4, Cc 4 `� m � �4 \ \ Zs' �� 33D GAL/DAY x 2 DAYS 60 GAL USE ICU GALLON SEPT I C TANK-SF_C)0 5fiTc/.N - R-Ee / sw 690 fit , 1 F N'� _ SOIL ABSORPTION- SYSTEM � ; % 1 + u°o, N F1 LTPnL 30SO yNR5 yi 1.3 STONE o^) Fovs ��o N� oN S1 via L. 7_lo x 7 Ill m X o "ADE AREA: L5l�2+(I2)1t�XL \ 92 o m (JoF�OTTOM AREA:- Z 5X I Z X 6 7`{ o T 1 — W ' kn to a -Z G) -� 33 o ' z ; G> 94 SEPT I t. SYSTEM SECT I ON ;� ` � � , IDS✓= �C.c-; )Cara �°IS' °� I -,1 + 4j eL Q lLlN6r CaUEE�eS lv W/1N (o`' �� �i rtlsG► �rc�Pe ) y"t++sP� 10 RIVEWAY footp 1►,sFxll �'�,3 6 S 1 ' _ PAVE[) 4 , ry � --'` ► '=�(I�TI /'ks A -�5 �e 33 �, � GAL g3.Sb WBOX q3IA SEPT I C TANK �ruy ��v��n�55 y p LOT 394 C �A14T_.CRosS E6T7o/U ��.T 5� ' + AREA - 20000 sfi +- `C�c�Tiv� o r% 7��Trt�o�� CL� 02,z 5 Z i'100 98 2" a asAcd SITE AND SEWAGE PLAN 102 „• y LOCATION :130.0 Z�j �-1 STM r l.C. PA'T�+ . ♦-� NIBjl�S nlS /V1 I BLS BENCH MARK ofs� wvti le a" �. PREPARED FOR : TOP OF CONC BOUND M. DARKEN tiG 5 q� WaSk�d ELEVATION = t02.46 o M. s' y12, F us DATUM ASSUMED MEY c�tt" N 1 �� SCALE: / =�0 'Q"a DARREN M. MEYER, R.S. T sTEa� P.O. BOX 981 DATE: 7 Z C Z SANITAR\P� < EAST SANDWICH, MA 02537 J W DATE HEALTH AGENT Ph: (508) 362-2922 3 Z