HomeMy WebLinkAbout0028 MINTON LANE - Health 28 Minton Lane ;
W. Barnstable
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■ Print our name and address on the reverse 1rt�,7z�`
so that we can return the card to you. ❑Addressee
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or on the front if space permits. C<h a C�
1 `Article Addressed to: D. Is delivery address different from item 1? ❑ es 11
If YES,enter delivery address below: ❑ o
e H`u'tc�hinson & Luanne Drelick
<Luanne:.Drelick
,G%veland-MA 01834
3. Service Type
❑Certlfled Mall® O Priority Mall Express"'
❑Registered ❑Return Receipt for Merchandise
❑Insured Mall Cl Collect on Delivery
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number
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7015 1520 00oai 1971'i 7033
PS Form 3811.July 2013
Domestic Return Receipt
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Irene Hutchinson & Luanne Drelick
RI % Luanne Drelick
Groveland, MA 01834
{
Town of Barnstable Barnstable
: .�.. Regulatory Services Department
4 b 9. �� Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7015 1520 0000 1971 7033
November 10, 2015
Irene Hutchinson& Luanne Drelick
%Luanne Drelick
Groveland, MA 01834
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 28 Minton Lane,West Barnstable,MA was last inspected
on Oct 21,2015,by John P. Graci Sr, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Conditionally Passes"
under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Must replace distribution box
You are ordered to repair or replace the distribution box and repair the leaking septic tank
and components within one (1) year from the date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE ARD OF HEALTH
g mas cKean, R.S., CHO
Agent of the Board of Health
QALetters Septic Inspection Failures or Further Evl\28 Minton Ln W.Bam Nov 2015
I�
Parcel Detail : Page 1 of 3
�mF,
Logged In As: Pa rice I Detail Monday, November 9 2015
Parcel Lookup
Parcel Info
Parcel ID�174-031 �l Developer 24 ... w
Lot
Location 5 MINTON LANE I Pri Frontage I
Sec Road k �.._,_.. �......._.�....�.�_ ._, Sec _ �I
Frontage
Village{WEST BARNSTABLE Fire DistrictBARNSTABLE �
Town sewer exists at this address No I Road Index 2048 m _ I
Interactive
p
- Owner Info
Owner HUTCHINSON, IRENE& DRELICK, LUANNE Tj Co-Owner SASH, CARLA
Streetl !C/O DRELICK, LUANNE I Street2 774 SALEM STREET
City;GROVELAND I State MA zip,018�� 34 Country
- Land Info
Acres f1.00 __ use,Single Fam MDL-01 zoning RF I Nghbd 0105
Topography i evel ) Road Paved
utilities iPublic Water,Gas,Septic I Location, �� )
Construction Info _
Building 1 of 1
Year$1984 _ _A' Roof e/Hip �`I Ext'Wood Shingle
Built Struct= Wall
Living Roof
11467 Cover fAsph/F GIs/Cmp AC'None 4
Type
Style'Cape Cod .J Wall Vywall�,�... r.�,,:I Rooms' Bedrooms J Z.;,uni z d T BA`� e
s
Int
Model ResidentialBath -- gas
Floor ICarpet I Rooms 2 Full-0 Half
14. io
Grade=Average { Type Hot Air— I Rooms 7 Rooms TotalM
Aj
Stories 1 3/4 Stories Heat A"" Found '""""""
I I Fuel ;Gas I ation JPoured Conc.
Gross3320 w
Area
Permit History.
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12214 11/9/2015
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Town of Barnstable
i r
+ SARN3fABLF,
MASS
1639, ,�' Regulatory Services. Department
lfD MA'S�
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Richard Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 7/6/15
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An"x"marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
ONE (1)YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑Any portion of the cesspool within a Zone 1 to a public well
❑Any.portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis.(This system passes if the water analysis
indicates the well is free from pollution).
TWO (2)YEAR DEADLINE CRITERIA.
❑ Single Cesspool
❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
❑,Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code
§360-9.1)
OTHER
Repair deadline: jp U
Q:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc
i 11
' Commonwealth of Massachusetts
W Title 5 Official Inspection orm
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 28 MINTON AVEME
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE ='
Owner Owner's Name t°
information is WEST BARNSTABLE MA 02668 10/21/2015i
required for every -`-='
page. City/Town State Zip Code Date of Inspection
t+L;�
Inspection results must be submitted on this form. Inspection forms may not be altered in and
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer, O
use only the tab 1. Inspector:
key to move your
cursor-do not JOHN P GRACI SR
use the return Name of Inspector
key.
GRACI SEPTIC INSPECTIONS LLC
rQ Company Name
PO BOX 2119
Company Address
TEATICKET MA 02649
City/Town State Zip Code
508-641-6694 S 1468
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
❑ Passes ® Conditionally Passes ❑ Fails
❑ Needs Further aluation by the Local Approving Authority
10/21/2015
Inspector's Signature Date
The system inspec shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) in 30 days of completing this inspection. If the system is a shared system or
has a design flow o 0,000 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.
****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.
400 �5
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
. Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is WEST BARNSTABLE MA 02668 10/21/2015
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
NA
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
NA
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 1.7
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 MINTON AVENUE
M
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
® Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ® N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below):
® distribution box is leveled or replaced ❑ Y ® N ❑ ND (Explain below):
DISTRIBUTION BOX IS ROTTED AND FULL OF SAND NEEDS TO BE REPLACED.
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
NA
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
° M 28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is WEST BARNSTABLE MA 02668 10/21/2015
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance: NA
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
NA
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped: .
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 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 Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
1000 GALLON SEPTIC TANK 1000 GALLON LEACH PIT DISTRIBUTION BOX WHICH NEEDS
TO BE REPLACED
Number of current residents: VACANT
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d TOWN
9 ( Y 9 (gp ))�
Detail:
2012 25000 2013 19000 2014 ZERO
Sump pump? ❑ Yes ® No
Last date of occupancy: VACANTDate
Commercial/Industrial Flow Conditions:
Type of Establishment: NA
Design flow(based on 310 CMR 15.203): NA
Gaiions per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.): NA
Grease trap present? ❑ Yes ® No
I
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available: NA
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: NA
Date
Other(describe below):
NA
General Information
Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ❑ No
If yes, volume pumped: NA
gallons
How was quantity pumped determined? NA
Reason for pumping: NA
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
° 28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
1984
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
(16) SIXTEEN INCHES
Depth below grade: feet
Material of construction:
❑ cast iron ❑ 40 PVC ® other(explain):
Distance from private water supply well or suction line: GREATER THAN 10+ FEETfeet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
Depth below grade: feet
1 ONE FOOT
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1000 GALLON SEPTIC TANK AT TIME OF INSPECTION APPEARS TO BE STRUCTURALLY
SOUND AND FUNCTIONING PROPERLY. UNABLE TO INSPECT UNDER NORMAL USEAGE.
If tank is metal, list age: NA
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 GALLON TANK
Sludge depth: (8) EIGHT INCHES
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle (26) TWENTY SIX INCHES
Scum thickness ZERO
Distance from top of scum to top of outlet tee or baffle (6) SIX INCHES
Distance from bottom of scum to bottom of outlet tee or baffle ZERO
How were dimensions determined? MEASURED
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
1000 GALLON SEPTIC TANK APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING
PROPERLY AT TIME OF INSPECTION. UNABLE TO INSPECT UNDER NORMAL USEAGE.
RECOMMEND PUMPING EVERY TWO YEARS
Grease Trap (locate on site plan):
Depth below grade: NA
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
NA
Dimensions: NA
Scum thickness NA
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee or baffle NA
Date of last pumping: NA
Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
NA
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: NA
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
NA
Dimensions: NA
Capacity: NA
gallons
Design Flow: NAgallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: NA Alarm in working order: ❑ Yes ❑ No
Date of last pumping: NA
Date
Comments (condition of alarm and float switches, etc.):
NA
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. Citylfown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert NA
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
DISTRIBUTION BOX NEEDS TO BE REPLACED
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ® No*
Alarms in working order: ❑ Yes ® No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
NA
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
NA
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 12 of 17
f
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
1000 GALLON LEACH PIT WAS EMPTY AT TIME OF INSPECTION STAIN LINES NEVER MORE
THAN (2)TWO FEET. SYSTEM APPEARS TO BE STRUCTUARLLY SOUND AND FUNCTIONING
PROPERLY AT TIME OF INSPECTION. UNABLE TO INSPECT UNDER NORMAL USEAGE.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration NA
Depth—top of liquid to inlet invert NA
Depth of solids layer NA
Depth of scum layer NA
Dimensions of cesspool NA
Materials of construction NA
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
NA
Privy (locate on site plan):
Materials of construction: NA
Dimensions NA
Depth of solids NA
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
NA
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
L
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
(�Al2
AP A74 BA 14 0 1(Dtb CoIton ST
66 3®`l (q 1P 13 o
�
0
aC3 U_ 0 C
pD 3qAn.f 31
o ® i0bbC0110n LP
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
r ' Commonwealth of Massachusetts
w Title 5, Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c,M 28 MINTON NJENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow-wells
12+
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
HAND AUGER
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
i
. Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 28 MINTON AVENUE
Property Address
HUTCHINSON IRENE AND DRELICK LUANNE
Owner Owner's Name
information is required for every WEST BARNSTABLE MA 02668 10/21/2015
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
I
1
No. C; `�/ Fee 0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftpIication for Vsposal *pstem Construction i3ermit
IPr-pl�e, D-13o�
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.g g Owner's Name,Address,and Tel.No.
1,'�� ' �RG�f �Fc�rcye'hsoh
Assessor's Map/Parcel Gv rviS !L ��(
Installer's Name,A�lress,and Tel.No.,5a— Yga-47.T Designer's Name,Address,and Tel.No.
Joseph
p
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
i
Nature of Repairs or Alterations(Answer when applicable) Rr-T cry�&X £ Pif/= 70 11"e� ,r
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 Certificate of
Compliance has been issued by this Board of He
Si ed Date 1122
Application Approved by Date lJ
Application Disapproved by Date
for the following reasons
Permit No. �j " .J1 L Date Issued 1 '
1
No. ! _ Fee
THE COMMONWEAUKOF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN bF BARNSTABLE, MASSACHUSETTS Yes
ftprication for Nsposar *pstern Construction Permit .
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components
Location Address or Lot No_; G /41 b'1 Tv'l 14015 Owner's Name,Address,and Tel.No.
Assessor's Ma P/Parcel r 13R
Gt/• `1�75 l9 �-
Installer's Name,Address,and Tel.No.{c>. -412e)-97 3 Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms I Lot Size sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) �j gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)�/�1)114,/' g, T ki.j
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 Certificate of
Compliance has been issued by this Board of He"--,--,-
Sigged Y Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. j / 3Pj Date Issued
---------------- ------ ------------------------------------ ------- ----------------------------------------------
Q� THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASS�AC SETTS
Certificate o�'`7tomPilaure
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by JDS � � Z/e 15,4., a,;
at !22 &ia; je 4oy�&? ul, //5 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No- )�j dated
Installer .G d Designer
#bedrooms Approved desig ow �� gpd
The issuance of th' pe it shall not be construed as a guarantee that the system will nctio qs esigned
Date Inspector I
---------------------------------------------------------------------------------------------------------------------------------------
Noy— I C Fee U
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal 4stem ene-I uction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at :2 1� �TOO Za w.5
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must b completed within three years of the date of this Fpermit. —
Date I /5 n Approved
LOCATION SEWAGE PERMIT NO.
PILLAGE
INST LLE 'S NA i ADDRESS
B UILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
ti
a
NY - 03l
THE COMMONWEALTH OF MASSACHUSETTS ,
'g
BOARD OF HEALTH
TOAI.M.........OF.............�ghq�c.�.r� ��....--.............._...........
A iration for Dispaiial Workii Tonstrnr#ion thrutit
Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sew isposal
System at:
t0 ...1............. - ? .. £.. ........
--•--- _..
Location-Address --.or Lot No.
.............................�. .�.......... .(� _ ' ................. ..-....•...............................................
Owner / /F Address
a ........................................................ �.o'� .t'.;--...............P1 �i./ ............................-•-------••--------
Installer Address
d Type of Building Size Lot...` ::3/� .:C.Sq. feet
U Dwelling—No. of Bedrooms................ ......................Expansion Attic ( ) Garbage Grinder
GL
Other—Type of Building persons............................ Showers g ...............•----------•• No. of P ( ) — Cafeteria ( )
a Other fixtures ................................. -
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 (,t) Dosing tank (
aPercolation Test Results Performed by......................3r Depth to D,.� Test Pit No. 1................minutes per inch Depth of Test Pit................... De p ground water........................
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...........
------.--_-_.
----•-•----------------------------•----••.........�.... �/.............. ....-•----. ....._.._.
`� --•-
O Description of Soil...............•-......----••---.........---•--.........IC?.......__.... .01 -� !_5 •-- ..
-----------------------------------------------•-------------------------------•-------------.....-----.....----------------- �)
V Nature of Repairs or Alterations—Answer when applicable..................................... �-.............
r .
.........................................
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 agree to place the system in
operation until a Certificate of Compliance has been issue he board of eal h.
Signed---................. 4 .......... ... ... _. _. ................. ...... Vf
D�
Application Approved By..... ._ ..... ?•--•----0��.,........................ ........ 6�1 R -
Date
Application Disapproved for the following reasons:......... --•----------------------•--............--•--•------••----------------•._.............----..........•.
-•-•----...-•............................••-•---•----------.........-----........--•.._..............................----•-•--•-.................................... ......---... ............-
Date
PermitNo.............................................•-•••-..... Issued........................................................
Date
..........:.. ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.... !/'!
ljio . C r !ems
- ..........,..,�'.Y:h-... ...........OF............. .✓. .. ...6. .... ------.......------.....................
Appliration for Uiiipnntti Work,5 Totea.rttr#inn "truth
Application is hereby made for a Permit to Construct (ra' ) or Repair ( ) an Individual Sewage -isposal
System at:
............................................... ....................................... ...................................................�..yft✓' ......--
Location-A4�ress or Lot No.
......................__.............................
C:� a ....................... .......
��)f `!'— ..........._......
. -- ---.. --.
Owner r f!j! Address
a .. ..................
Installer .T._.•------------- I
Address
Q Type of Building Size Lot.....`? "?,/c A �'Sq. feet
Dwelling—No. of Bedrooms..............'J� Expansion Attic ( ) Garbage Grinder 1, -�
aOther—Type of Building ---------------------�--- No. of persons............................ Showers ( ) — Cafeteria ( )
POther fixtures............................•---•-------••-----------•-------..............--------...----•-.........------••---------........-•------.............
WDesign Flow........................ ................gallons per person per day. Total daily flow__..........�.� _0...............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.
Other Distribution box (�) Dosing tank ( )
Percolation Test Results Performed by......... � y � f��f--- Date-----..... ~/. � -
Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water......................_.
4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................
P4 ............................................................ .................
` O Description of Soil--- ... . .
U � :,�.5�= �`
x --------••------••......---•-• ------------•----••--•-•-------------------------
C^ >
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 of to place the system in
operation until a Certificate of Compliance has been issue he board of Veaiffi.
..... ..... ......./ /e/
Application Approved By......c.—, --t, ...F:r_.._f.................................................) ' j .`�.:f_....
•....--- --
Date
Application Disapproved for the following reasons----------------------:..---•-•--.....-----------------...----------------------....--•----: ....................
..................................... .......••----•••-•--•---------•.......--------.......------.........---...........------------......•.............-----_.... ..-•---... . .................
Date
PermitNo......................................................... Issued....................................................---
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA�,lLT�H;�
................ . .�°"�'`''+.......OF..................� .f`. �f?!.�fi`� '" -r.---..............
Tntifiratr of Tompt.iatto
THIS IS TO CERTIFY, That the Individual Sewag Dis osal S m constructed { or Repaired ( )
ie
...................:...... y... . ------....... .......
by............................... .5..
Insta er P f. d
at.................................................................I v ......... - ----------- -ezel ......��°�A ........................
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 .............. dated_.....�.�,ff�.� Rw'�r__..:_....._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........................................? f� Inspector......._. :[ _..........................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH-
...... r�
�. i �'......OF.........................�.:� !v ' �(............
No.........................
FEE........................
Dinpoiial Workii Tonn#r iott it
Permission s hereby granted---------------•--•-••--- ,A1.�1-. 1 ....... i.� .............................................................
to Construct ( Y.) or Repair ( ) an Individual jSSvvage Di osal S stem
at No.. -•--...---•--------------------•-•• Via: { .. y:!'�........ � ;. ---........t,./ .1/../_CL. _u ir ie! .'G'".._.... `r._._.......
as shown on the application for Disposal Works Construction Permit:No._.. :...._....._ Dated......._,,�.,...:...................:...
G^.• c i.i07,
-•..................•---•.............---:...---••......._...-•---.......------.............-_....._.....
Board of Health
DATE..................................................................................
FORM 1255 A. M. SULKIN, INC., BOSTON
.�O FT. MlAI. N07rE //s E "HL�A'
i7 _ THE SEATIG TiAMK ,0R'.: _*
LJEi4.Ct//iv6. P/T .+N& M®Rts TNA.N �aN.��l®�V
a® Pr At-W. .�sRAD®F� 1 .'p/.QA9F7".�R CONG'.�*ETBf
SWALL &� SQPtdMT rD 6.�-4 00- V F,XT�A a,
GO/VCRLaTE q"PYC P/Pe 1iE.4vy CAST/ROA/ Co i/�/� SHALL 9.E USE®
mf.,V. PJTCN
COYE/?S IPA.419rr. /F /N OR/VEJVA y
Ca/YCR'E TE
2•� 141m. a c9 i�E R
C31wE CZ A .SAIYO
a BA.CkF'/LL-
.�• 1.IQU/® LEt�EL - •>.- _ •, �LAYER _ • 1
Q� ST Cam.•�'o. - I'.• p oQ
•• ' /dJ/ PITCH IO O U G/1L. • / • • • • • a e • p s+ 'WA ST2'JNE M
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yr: ZZ(• X S s
. . pRELi45T SEe4GE
fe e • e • e • •• • ® B O/TOR EVI!/V.
/7, G4:f�e4 Ci7-1/. G 7 fj q,*L-IAO"+ • B LEL /O Z t7
/NYEI+ET AT Szl/"/R/6 FT. c 3' f
II4/LE7 . TIIC T.4A/K. . IQ.,SFT• 12 FT. O/AJW. OWE btu�sTrOw� I
"7,LEr SEPTIC Ti4NK / 7 o r3 FT
/ 0 9 OFT G ROVAIV W.47, T TAOL.E
/AoLF�'A/STIR/ IOM BOX �CTeO/V �F'
O�172,ETl�l9TR®gd/'TYON�eJr l� �Fa ,
/aLET LgACKrIvrG *ir !o oFp �'� o4G� O/S'I�ASA SY.ST�/�ll TA4jW4 ..4'T/DIV
L EACHI/VG I0/7' D�MfNsIOeV 5 ITT
SCALE �4� s / -,O~
DESI6N CAA T'R/A D/PyAW51O N �--�--�`T• j
Nt/.�l9ER OF®tE�00MS 3
.4 G.EA/SPOSAL UNIT �� SOIL. LOG
_ ,SOIL TEST.
T0TA4 BSTr/►�ATEG FLOI4/ 3 3 v G.�c./DAy SO/L TEST 0/ SOIL S7-e02
NUMBER CIFACXl .oils / FLEV, /08.8 E�CEY. GATE OF SOJL TEST
S/OF LLACHING AEe4 PJT Z2(f Sg PT. �0- 3 ! ' RESULTS iq/!T/VESSED BY
Z
s s.~
L� Chl.
BOTTOM L,fy4G'M/NG PER P/T I ! 3 S4• FT LoR- 1-7
� RERCOLAT/OJv R�4TE�/ M ryy
rM
TOTAL LEACH/i1'G AREA3 sp. FT Sv3 5v r� A�RCOt�T'/oN RAVE 2 M/r/�I�NCH
RESERt�E LE,4lHJ/V6 ARE/ 3 SQ. F T. /LTST _
H Of At s �N OF M.4S �r iv L D T z4 /"I//t/ Ton/ L t1 Al t
�2 ROBERT 2�
sou�€ A<BERT yG C�=/✓%E/�. ��L L
.� _., �
!o ELDRFD(
j
/ � No. Ej.D RED 4S&EIVGINAVRI'V(G C46�I#YO.
Civi
7J2 MAIN Sr., N7/ANN19, MASS-
h'p su%,q �fsS10NRk.c•
® NO GROUNv yY,4TER EIyCOUivTER�O CcJ.EN�� „�3 �z D,ITE Z.s
GR O UNO yvsa TEMP AT EL L�j! .JOB /ViO..
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OFA44SO
CERTIFIED PLOT PLAN
RJ[3Gki r>!z o? ALBERT. ya L�-7 Z4 ���/✓Tv�/ A�E
BRUCE-
` ECDREDGsg N
'PFCfl✓/5�4;; � N
9 GrST�
s E SUSpFFSSlONA1- r.At •i�A� � •••�14 , .�! �,.'•�wJ:J r
�4 .. ,k,�"
s SCALE r i—. 'DATE 7
tl.KD—R-EDGE ENGINEERING llV
CLIENT.------ I CERTIFY THAT THE PROPOSED
EGISTERE REGLSTEREO J08;P10.°Q3.Z .Q BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING LAWS �
ENGINEER R �3:q; MAY':Y' A = OF �ARNSTABLE MASS.
712 M A I N STREET ' & CHI S.Y� ` 8 _7AA�
HYANNIS MAS$. w Z -,�
SH. ET 0F' "DAY E REG. L ND SURVEYOR
. - '. s j�� =i v +F do��>r5•y"�'c�' ..