HomeMy WebLinkAbout0225 MOCKINGBIRD LANE - Health E= 0291019
KINGBIRD LANE,M. MILLS
J 'r- _
�J,,TOWN OF BARNSTABLE
LGATION �/�s ��' SEWAGE#
VILLAGE /"l A-L• S ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO. ✓� t L o
SEPTIC TANK CAPACITY
LEACHING FACEL=: (type) ;dl� % (size)
NO.OF BEDROOMS
.— q—
BUILDER OR OWNER �— v 4-
PERMPTDATE: .3 COMPLIANCE DATE: q 12 Z 3
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 Wetland and Leaching Facility(If any wetlands exist
within 300 feet_o sac facility) r Feet
Furnished by J •6` ' ( '— '� f �,.2 g—
16
33 �y
L ! CO-
TROY WILLIAMS ':19\
SEPTIC INSPECTIONS
' J U
y Lr
so
Certified by MA Department of Environmental Protection (508) 760-1819
40 Old Bass River Road
South Dennis,MA 02660
Commonwealth of Massachusetts o U
coo
Executive Office of Environmental Affairs
Department of
Environmental Protection
WBNam F.Weld Trudy Coxe
GoMMM escnuy
Argeo Paul Ceilucai David B.Struhs
LL Gmemor conwisel rrr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
i
'
M ctr S A0..5 —/'
Property Address:s S /'/o C. { „%y 6,vat L N • I S. Address of Owner. /?j c, u✓cA a,.J Z �`oc
Date of Inspection: 6 I tll/Cf(, / (If different) �'— [
Name of Inspec I G T - e-� J
Company Name,Address&y �I �Nu17 mber.pony add Telephone Number.
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date:
The System Inspector shall submit a.oa y of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority:
INSPECTION SUMMARY:
Check A,B,C,or D:
A) SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B SYSTEM CONDITIONALLY PASSES:
r N
/4
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection.
Indicate yes,no,or not determined 6, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
_ The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or enfiltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
/CERTIFICATION (oontinued)
Property Addreem a�2 s / " c� ,�; ►-.y Ej;r
Owner. —� .�-rya-U 4-
Date of Inspection:
6 /ay /q e
BI SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pans
inspection if(with approval of the Board of Health):
broken.pipe(s) are replaced
obstruction is removed
C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT-
- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis 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.
S) OTHER
(revised 11/03/95) 2
ill
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner.
Date of Inspection:
C / `
i D] SYSTEM FAILS: //�/may q
`
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
— Backup of sewage into facility or system component due to an 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 1/2 day flow.
— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of tunes pumped
— Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
— Any portion of a 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 I of a public well.
— Any portion of a cesspool or privy is within 50 feet of a private water supply well.
— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS: Al/j9
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
— 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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CUR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11/03/95) 3
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Paperer Address: ?,7 /Ll o ,.. 6;rd
Owner. / -✓ ��v '
Date of Inspeetion: 6 /Tay
Check if the following have been done:
Pumping information was requested of the owner,occupant, and Board of Health.
Zone 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.
ZAs built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
I/The system does not receive non-sanitary or industrial waste flow
_ZThe site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, 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 baffles or
tees, material of constriction, dimensions, depth of liquid, depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on existing 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 Sub-
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE
CTION FORM
PART C
7 ^, SYSTEM INFORMATION
Property Address: aaZ S /,(o c.�(. G. �j.✓�
Owner. / L
Date of Inspection:
6 �aN �5�
RESIDENTIAL FLOW CONDITIONS
Design flow: ons
Number of bedrooms:
Number of current residents: .3
Garbage grinder(yes or no):,A(o
Laundry connected to system(yes or no):�GS
Seasonal use(yes or no):_,A(0
Water meter readings, if available: C/ s = 7 o o
_ c. o �. S
Last date of occupancy: Q c. v.o " e c�
COMMERCIAL/INDUSTRIAL•
Type of establishment:
Design flow:_--Pllons/day
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)
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
s �>
ystem pumped part of m2one �no)
�lb ,
If yes, volume pumped: gallons
Reason for pumping:
TYPE QF SYSTEM
septic taak/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 pOmponents, date installed(if known)and source of information: 7j--in S -�r' 126 /c 3
Sewage odors detected when arriving at the site: (yes or no)L V
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/ SYSTEM INFfORMATION(continued)
Property Address: p�� s AO C,/f-�
Owner. Z,T LYG V /
Date of Inspection: 7'
SEPTIC TANK
(locate on site plan)
Depth below grade: �
Material of construction: Vconcrete_metal_FRP—other(explain)
Dimensions: S 9 Y Ca C UOri G C-0
Sludge depth:,_
Distance from top of au a�/dge to bottom of outlet tee or baffle:
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:
Comments:
(recommendation for pumping, condition of inlet and outlet or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidences of leakage, etc.7 /t L S c✓ T�v a I. C-% 6«JI, a,, s o rCf v Ill o
w T N 6- — c, H L.e— ii a ,C /J✓vy,./J, h t ca
GREASE TRAP:H114P
(locate on site plan)
Depth below grade:
Material of construction: _concrete_metal_FRP—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:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baIDes, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: 0 144 <^g lb:/'ok
Owner.
Date of Inspeotion: Q r 0-``v +4-
` /02y
TIGHT OR HOLDING TANK: /V/'
(locate on site plan)
Depth below grade:
Material of constriction:_ooncrete_metal_FRP_other(explain)
Dimensions:
Capacity:- ¢allons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX
(locate on site plan)
Depth of liquid level above outlet invert:I�Lk//
Comments:
(note ' level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 11/03/95) 7
l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address:
Owner. /
Date of Inspection. r tU v
40 /-Z
SOIL ABSORPTION SYSTEM (SA91
(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:
8 Pits, number: C�vl` y
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number,dimensions:
overflow cesspool, number:
Comments: (note condition of/pOil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) o i
R i w � �� �LrL e t ✓7✓GSCN t o2 Q�
CESSPOOLS: W/IQ
(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(cesspool must be pumped as-
Part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:_A111
(locate on site plan)
Materials of construction:
Depth of solids:
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: o�a2 S �oc�t.; b;r� Lin .
Owner.
Date of inspection: e'4-r`
G
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
ay ' l8 �
3� aye
✓0 0X
0
w; K, a
DEPTH TO GROUNDWATER
Depth to groundwater: -- feet ----adjusted high groundwater level -
method of determination or approximation:— /- ,_04
9
LJ CAT ION EWAGE PERMIT NO•
/ - kor .3
VILLAGE
o �q - off
INSTALL R'S NA i ADDRESS
N UILDE R OR OWN Eft
c � �
DATE PERMIT ISSUED ,� ''�'
DATE COMPLIANCE ISSUED � �3
I .... Y
M �V
------
I
No.._ ✓._... _ .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Applira#iuu for Disposal Works Toustrurtiun 1hrmit
Application is hereby made for a Permit to Construct ("-<or Repair ( ) an In Sewage Disposal
System at:
. ..- Location-Address or Lot No.
......................_. ../ :.�. -..Blew.��...... o_e?----------------------�Q x �1..�......� --
Owner .............................. Address
W ------------------------------ t t t� �a ���........ ... 4.
Installer Address 3sV
Type of Building Size Lot... __t____________.....Sq. feet
Dwelling—No. of Bedrooms_._._.---...............•..........Expansion Attic ( Garbage Grinder (A, (o
'4 Other—Type of Building No. of persons............................ Showers — Cafeteria
C4 YP g P ( ) ( )
a4 Other fixtures ..___.
W Design Flow........................5 ......gallons per person per day. Total daily flow............... 2..-0.............gallons.
04 W Septic Tank—Liquid capacity/,60-..$allons 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 ( ) �^�� 1
�" Percolation Test Resul s Performed by_______________________ t � Fw .............. Date........( .._.��y� ............
aTest Pit No. 1..� .mmutes per inch Depth of Test Pit_.._._..r.__ _..._ Depth to ground w ter-------
(i, Test Pit No. 2....__.........minutes per inch Depth of Test Pit.................... Depth to ground water____-_-.
----.............................................................................•------- ...
.._..-----------------------.------------`-----------
p �QFt s
Descriptionof Soil..................................... f-�.......�....---•- ------t --�/--�=t---•------/-J-------R--•--------...---...........-----
V ................�_ �r_�+' �.._.—:.._...__ ✓1. 11S!'t `__,`Ie� i!l...w1�1�!�!.____EC.!_�[ ..�.� _ ...___
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 AI`:IE �5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board o ealth-
ned_ .. ...... . ......................•-••• ••-• ...
Zffollowing
G ✓,
Approved B /rt
-----
Applicationpp y
Date
Application Disapproved f reasons--------------------------------------------------------------------------------------------------------------.
.................................•--........--------------------------------------------•----------------'------------------------------------------------------------------------...-•------••••--_•.••-
Date
PermitNo......................................................... Issued.----------------------------------------------._......
Date
• No... .... ' Fizic ................
THE COMMONWEALTH OF MASSACHUSETTS
�._ BOARD OF HEALTH
r /'� 1�✓ !�'✓ OF..............5A � f�` � r //7 t ��°�.....__.......
: _....•................
Appliration for R.5poiittl Works Tonstrur#ion ramit
Application is hereby made for a Permit to Construct (r )' or Repair ( ) an Individual Sewage Disposal
System at: �•-�- P ,--._ t
------.... � f.. .;... l... �l.►` fit_
Location y--Address ff / /- or Lot
......................_....._..._. / _., 4.... ?t`...t ._...t_ /.
•..
Owner Address
Installer Address .v
Q Type of Building Size Lot.........:.................Sq. feet
Dwelling—No. of Bedrooms..... "..............................Expansion Attic (X-)5 Garbage Grinder (str)
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures . ------------------•--- .
W Design Flow................ .•------.�`----........_gallons per person per day. Total daily flow....._....._ ..............................gallons.
f� Septic Tank—Liquid capacityr .2.tgallons Length................ Width................ Diameter................ Depth................
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...........................�� �'2...�O �w rr
-- ---• Date f
aTest Pit No. l.4:i'y% '..minutes per inch Depth of Test Pit........ ._' %`... Depth to ground wa ,r--___..�_
Test Pit No. 2_.''.�I?`4...minutes per inch Depth of Test Pit........ ...... Depth to ground water..._.
.......................................... ............................... ........................................................... ic f.r -
........ ........_.r.......
Description of Soil.....................................0_-` .a.v..1 ::...... .. _.wt '�,'..5 o''!('
.
1(� '--........^.----••-------------•-----------'_.----...-------_'.-^---==.... ...t........._._. ... -------------- ------
W ..........--•-•................................. ..1r_--•a{ — ................. _w: _.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:I':IEZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of-health,
f Igned ....................................... .........•---•-------.......... ..._� l ......--• •.
Application Approved By---
all
.......................................
Da Application Disapproved r e following reasons:............................................---•------•----•-------------------------------D- a.t.e.---........--
...............•---•---•----•-•-•-------------•••...-•-•--------•---•-•••....••-----•----------•----...--------._....-•••••••-•••-•--•-•-----•-•---••••-•--•-----••-•--•••----•.....----•------.......--
Date
PermitNo--------------------------------------------------------- Issued----------•------•-•---------••------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
..-..•
BOARD OF HEALTH
^
(9rdif iratr of Tomplianrr
THIS IS-TO CERTIFY, That the Individual Sewage Disposal System constructed 4-'`°r or Repaired ( )
by....................... ......................... ��' "c �_ r.�------------------------------------------------- ........--------......-----.............----------......
�- stiller � } f,�,.�. it r•
at........................ '= ............... Sr^'----------- fl ------------- ��� ,7�f ..............................f��'1ft;......._S W f t( a
has been installed in accordance with the provisions of TI�Iy 5io The State Sanitary Cod s escribed in the
application for Disposal Works Construction Permit No---- � ---_�-_------_--•--. dated_..'_ : .
THE ISSII NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE
SYSTEMWill F CTION SATISFACTORY.
i
DATE.- 121 --0----•.................. Inspector..._.. ------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................................
No.. FEE ......................
Disposal lWorka Tons rmt.ion rrutit
,,�-,.,*,s'
Permission is hereby granted ....••••--------•-• -:.��a •.t
to Construct) or Repair ( ) an Individual Sewage Disposal Sys -•
�`. ✓ ,-ti .. L �' it /t��✓S
at No.--------•................� -t' i .%'Z•�.-r �' ,/f�r- , ,r am
;..... ....................:-.......--•--• ---••-------...........r----• ---- -----r---------------- --••--•-- ............
" Street
as shown Xtheli tion for Disposal Works Construction Permit No.. __....... ted�...,.:..._�........................
�!. �and of Health
DATE ---•-----•------.-----
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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EDGE OF P,9VCMkiv r
—,onto _ — — — — — `0�x5
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p®��resr 2 _ MIN.FRONT &B. 30ft-
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3ARRY& MRUREN MAC PHEE
LEGEND ?x -)E2s7 CERTIFIED PLOT PLAN
EXISTING SPOT ELEVATION OxO
EXISTING CONTOUR --- O
FINISHED SPOT ELEVATION g LANE PH IP. p�
g JV ti. LOT /38 / //gyp OCKlNG13JRB MR(ZSTONS 1 ill LLS
FINISHED CONTOUR 0 w1G IN
366
APPROVED BOARD OF HEALTH ^ Tµ(`:' ya' .�1 ,I�� S•���
NAL�:'
DATE AGENT ` SCALE$ I 3o' DATE, J4N l9'�
"L®R?EDGE EA GINVEERIA- CQ lAt� CLIENT I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED . JOB NO. 1100? BUILDING. SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING LAWS
ENGIPIEER RV DR.BY ;.ADD OF BARNSTABLE $ �ASS.-,':..
712 MAi N STREET. CN. 13Yt...
H YA N N I S, MA3S. SMEET-2- OF 2 DATE TjtEG. LAND SURVEYOR
n T:C
NOTE
4 20 AT M//V. -1 i'_Ei4C+.!l:vj P/T ARE ./+?pRc TN.q,`/ /2"gELCiv
/p RT M/N. f �.eROE! �i 24 'O/AME.TER COyC,Pc?-c CCYE�'
:iJ•IALL BF BROUGHT TO G.4,4 OE. '- v r , a .
Q"—VC P/PL {
CONCRerL NE.4YY CAS T i.k, Cam:/=.?
VEyt/A Y �� � C✓
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