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HomeMy WebLinkAbout0438 CAP'N LIJAH'S ROAD - Health 438 CAP'N LIJAH'S RD., CENTERVILLE A= 194 033 �?IfLCCtLG® =J �y�, UPC 12543 o.63LOR ttast�r,as, n�v No. ` Fee$5 0 _ 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS Application for Mtop Sal 6p$tem Cow6truction Permit Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 438 Capt Lijahs Wy Owner's Name,Address and Tel.No. Paul L'Archevesq e Assessor'sMap/Parcel Centerville, MA 1282 Highland Ave / r� � L Fall River MA 02720 Installer's Name,Address,and Tel.No. 7 7 5_8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Sry PO Box 1089, Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(xn)o Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) T i t l e 5 T_.e a ch i n Cl r-nn s i s t i n g of four H-20 stonepacked infiltrators. 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 by t is B and of Heal Signed r Datef Application Approved - Date o� 1� � Application Disapproved for the following reasons ZZ Permit No. . -- Date Issued No. / ' / � � Fee $5 0.00 tK THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLId�HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for M �oosIal *pztem Conotruction Permit Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4 3 8 Capt Li}ahs Wy Owner's Name,Address and Tel.No. Paul L'ArCheVASQ e Assessor'sMap/Parcel Centerville, MA 1282 Highland Ave / 9 - ,COS'/ Fall River MA 02720 Installer's Name,Address,and Tel.No. 7 7 5-.8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Sry PO Box 1089, Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 4 Lot Shse sq.ft. Garbage Grinder(Xrlo #. Other Type of Building 1)ToZo�Fe lolls Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description 20 oil sand v Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching consisting of foam H-20 stonepacked infiltrators. J ? : -= I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal sy)tern in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Cifi- cate of Compliance has been issued by t 's Board of Heal Signed Date Application Approved b Date/A7."/l9 Application Disapproved for the following reasons Permit No. ,- Date Issued ----------- —1------------------------- HMMON���EALTH OF MASSACHUSETTS � _� - BAR TABLE, MASSACHUSETTS L'Archevesque Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (XX)Upgraded( ) Abandoned( )by at 438 Ca t Lijahs Way, Centerville has been constructed in accords ce with the provisions of Title 5 and the for Disposal System Construction Permit No. 2f WA09 dated Installer Wm E Robinson St Sept Sry Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 'S 7 Inspector ————————————————————— ————————————————— No.�11 ' Fee $50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS L"Archevesque Migpozar *pztem Conkruction Permit Permission is hereby granted to Construct( )Repair(X4 Upgrade( )Abandon l System located at 438 Cant T. j aha Way" Centerville Installer Wm E Robinson Sr Septic Sry and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to s comply with Title 5 and the following local provisions or special conditions. Provided:Construction /must be completed within three years of the date of thi it. Date: Approved �G% TOWN OF BARNSTABLE LCC.,A- ION C-004 i_s, AA s SEWAGE # '7'C 6 6 V11,LAGE an+ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. bAJ t Rab(m ol) T!76 SEPTIC TANK CAPACITY 1600 LEACHING FACILITY: (type) y 17)Ae i i?i t 5 (size) a J+ NO.OF BEDROOMS 4 BUILDER OR OWNER L- if Arch caues tJ 2. PERMITDATE: i 1 13 19-) COMPLIANCE DATE: m 13 -1-7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well 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 of leaching facility) Feet Furnished by _ _ __ _ __ a � A ,�� `� � ,� � n 5��,�, Y � �3/� ,� TOWN OF BARNSTABLE LOCATION Lw��A4 SEWAGE # CI.7'C�s VIITIGE ��1"}' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. r i Ql n'1 ° (Mon SEP'I'IC'TANK CAPACITY LEACHING FACILITY: (type) y Al wi im i7 t/S (size) JE 4' i NO;.'Oh`BEDROOMS BMPER OR OWNER PEitIviTT DATE: i 1 r 3)� COMPLIANCE DATE: /1 -/3 -'�7 Separation Distance Between the: Maxitnum Adjusted Groundwater Table and Bottom of Leaching Facility Feet priyafe Water Supply Well and Leaching Facility (If any wells exist Feet -on:9ite or within 200 feet of leaching facility) Edge:of Wetland and Leaching Facility(i.f any wetlands exist Feet within 300 feet of leaching facility) Fuir islied by n V3.6 Y y i TROY WILLIAMS , t, SEPTIC INSPECTIONS 41 �cF�Il e Certified by MA Department of Environmental Protection y�o�eg9 99J N 508) 385-1300 19 Hummel Drive WH4F2getr South Dennis,MA 0266CU 0 00MMONWEALTH OF MASSACHUSETTS S -V �. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION �J ONE WINTER STREET, BOSTON, MA 02109 617-292.5500 WILLIAM F.WELD �✓ TRUDY CORE Govemor Secrctan- ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION Pr Add y 3�' C"t' } �' ` S �c f. C c yr ftw;f(c Property f l Address of Owner:Date off Address:Inspection: 7 (If different) Name of Inspector: Troy Williams 1 am a DEP approved system inspector pursuant to Section 15.340 of Title S (310 CMR 1S.000) Company Name: Troy Will ldmS $ePt1C IF1SDeCt10nS — - Mailing Address: _19 HLmmPI I)rivP , SWIth f)Pnnis , MA 02660 0.27.20 Telephone Number: T5 0 8) 3 8 5-13 0 0 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: J Date: _11 /7 /9 The System Inspector shall submit a copy 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, 8, C, or D: A] SYSTEM PASSES: k/�4 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. COMMENTS: BI 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. Indicate yes,no,or not determined (Y, N,or ND). Describe basis of determination in all instances. If'not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or no( metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, 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. (refixed 04/23/97) !.q• 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A t, CERTIFICATION (continued) Property Address: 4/38 C",o 4'. L , - 'I,, Rrf Owner: P,J i L /A Date of Inspection: it /7 /q 7 BJ SYSTEM CONDITIONALLY PASSES (continued) V �/�► 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). Describe observations: 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 pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed q 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) "' o.... ..• n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 33 C"`Y L f d G, Owner: I�� ( L 19. Date of Inspection: D] SYSTEM FAILS: XmYou st indicate ei;,.er "Yes" or "No" as to each of the following: 1 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. Yes No 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 eesspeel 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 times 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. N�q Any portion of a cesspool or privy is within 50 feet of a private water supply well. NLM 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. EJ LARGE SYSTEM FAILS: 1`1 14 You must indicate either "Yes" or "No" as to each of the following: 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: 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 11 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 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (raviaad 04/25/91) a Daq• 3 0[ 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B C/ ?? CHECKLIST Property Address: /J 8 C,p �—. L 1-J,_i, S Owner: wu L 14 Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or / as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. V/. _ The system does not receive non-sanitary or industrial waste flow. J _ The 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 construction, 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: The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. ✓ _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (raviaad 04/25/97) a Paga 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: L/ 8 C�� L t J c-- Owner: �� L 4 Date of Inspection: f I f 7 7 FLOW CONDITIONS RESIDENTIAL: Design flow: 9 Y—()--g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no): /VO Laundry connected to system (yes or no): Seasonal use (yes or no): A/y Water meter readings, if available (last two (2)year usage (gpd): �6 = yS,OJu g A//u`. s Sump p Pum (yes or no): 1�i0 Last date of occupancy: 0 c ✓e COMMERCIAUINDUSTRIAL• Type of establishment: Design flow: eallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title S 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: l �7 `AD Jw. 1 R A ft U.,T Il c.r✓l S !)L,, )h 1t I rc. 4-M t AA,vi lT System pumped as part of inspection: (yes or no) n/a If yes, volume pumped: Qallons Reason for pumping: TYPE QF 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) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Qr—' ­: t + 7. --� Sewage odors detected when arriving at the site: (yes or no) Nd (r.vi..d 04/25/97) Page 5 of 10 • r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ? SYSTEM INFORMATION (continued) Property Address: 3 C," k L ; Owner: '��v ' L , Date of Inspection: /.� /9 7 BUILDING SEWER: n f /19 (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _ other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance —(Yes/No) Dimensions:_ �' �/ ,� o Uo Sludge depth:_ 1p Distance from top of sludge to bottom of outlet tee or baffle: 02 Scum thickness:_ /— Distance from top of scum to top of outlet tee or baffle: `Q"/ Distance from bottom of scum to bottom of outlet tee or baffle: / How dimensions were determined: /--�ry b e Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) e-s w Z!! '„- �t ;,, ��c N t� /I/o s; s- V G� ✓ V/ ,`[�`�Hn n� ✓i 4 O o c-A s d l.—I-t 1 GREASE TRAP: IV/4 (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) I (revised 04/25/97) a Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 4./ SYSTEM INFORMATION (continued) Property Address: 7 3 S �"r J ,-L, S )Z,,k Owner: L ' 4, Date of Inspection: I / .7 TIGHT OR HOLDING TANKA/ (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; _ No Date of previous pumping: 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: Comments: (note if level an distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) y v r.df �e 5: A 4 f v ,Z-/ __ G--N—, A �, G fC✓ K t T S O I C � / 4✓',i v(/G✓ G..L— It / 6GL..G ✓✓J s. PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) Alamo in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: /��J L Date of Inspection: I � ' /� , SOIL ABSORPTION SYSTEM (SAS): V11- (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: _OM G �X6 t�� w {(s S �, G ss✓�• rtc{c.�,(. leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of getation, etc.) C. to / �.�,.c / r ✓ T �.--/ u. W c� ✓'Y J w p r L I ti Ar I.c.4 17 J.� 6 i W i.✓ct 5 I✓'C �°o./ /GN 0 7�r,)rJ 6�,'. _L C�U G✓h CESSPOOLS: s 7"N L S 1✓✓U V h ,H G �o ; l mil - a (locate on site plan) U-�^ A S 0.41✓ W a �-� ✓ T� �h e -�� o f' S 7 6 H�-, I`7• s Number and configuration: 5 °�✓� P' w s Depth-top of liquid to inlet invert: / r-�, !3r: 5 ti , ti /J., - J— 4v Depth of solids layer: 4, `' ) �..x f•0 J S t L c�✓e.�.Depth of scum layer: Dimensions of cesspool: G .� ✓h,, t r r C. ry 6u✓ o< « Uh ��ti,� o [✓viL✓. 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:_N/A (locate on site plan) Materials of construction: Dimensions. Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised O4/25/97) Page ! of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �/ SYSTEM INFORMATION (continued) Property Address: L7 3 �� 4' L Owner: P- I L � �✓Gc� eUc. syv� Date of Inspection: I I /7 / y 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water s pply comes into house) I �o � POOL i ��oUyglCo� , 5r y � 7,6 a-jo x 1� G 'x6 L«,t, (rovisod 04/25/97) Pag• 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: Depth to Groundwater _ Feet i adjusted high groundwater level Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) L d t 0 f a h G ✓,< o �t cloy. Lu/ � Sc �7-**' c. �o<�J�,� ��{✓c �-ro , 7Dv�d w� �t �� vt h✓ f w� ��,� lcv�� ro�,�J wcJfi Q✓ t��( /3v �—f s �.. �.v4, (raviead 04/25/97) Page 10 of 10 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. MA 02108 617-292-5500 WILLIAM F.WELD TRUDY CORE Governor Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: 438 Capt Lij ahs Wy, Centervil)kddress of Owner: Paul L'Archevesque Date of Inspection: i/~ 9 3 — 9 �7 (If different) 1 282 Highland Ave Name of Inspector: Wm E Robinson Sr Faa �0)River, MA 02720 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15 Company Name: Wm E Robinson Septic Service— Mailing Address: PO Box 1089 Cpnt-Prvi 1 1 e- AAA 02632 ��/�� Telephone Number, 5 0 8 ', 7 7 5—R 7 7 ti 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: 4 Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: c_.v i. Date: s " The System Inspector shall submit a copy 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: AI SYSTEM PASSES: A 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. C MMENTS: 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. Indi to yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, 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 04/25/97) Page 1 of 10 DEP on the World Wide Web: http://www.magnet.state.ma.us/dep C'j Printed on Recycled Paper r � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 438 Capt Lij ahs Wy, Centerville Owner: L'Archevesque Date of Inspection: J/ e�;R- B] 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). Describe observations: 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 pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] F THER 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 ublic health, safety and the environment. 1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER HICH 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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. Method used to determine distance (approximation not valid). 3) THER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 438 Capt Lij ahs Wy, Centerville Owner: L'Archevesque Date of Inspection: o -7 D] SYSTEM FAILS: You must indicate ei; .er "Yes" or "No" as to each of the following: 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. Yes No 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 112 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the 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] LA E SYSTEM FAILS: You m t indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: he system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to ublic health and safety and the environment because one or more of the following conditions exist: \ Yes o 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 ow er or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program require ents of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 438 Capt Lij ahs Wy, Centerville Owner: L'Archevesque Date of Inspection: -1 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and:the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or / as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. W- _ 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 construction, 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 438 Capt Lij ahs Wy, Centerville Owner: L'Archevesque Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:41,4VIC0 g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: G' Garbage grinder (yes or no): -4 Laundry connected to system (yes or no): Seasonal use (yes or no)/ 4 Water meter readings, if available (last two (2)-year usage (gpd): 1995 - 70, 000q Sump Pump (yes or no): 11'o Q 1996 - 45, 000g Last date of occupancy: �^0 C MERCIAUINDUSTRIAL: Type establishment: Design low: gallons/day Grease t p present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanit ry waste discharged to the Title 5 system: (yes or no)_ Water me er readings, if available: Last dt(Describe) cupancy: OTHE Last dcupancy: GENERAL INFORMATION PUMPING RECOR S an source of information: System p ped as part of inspection: (yes or no)__V&,S If yes, vo de pumped10-6-10 gallons Reason for pumping: - c c5 6 S Si`z'` /�7 L` TYPE O 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: ,//�/'s Sewage odors detected when arriving at the site: (yes or no) 1 0 (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Capt Lij ahs Wy, Centerville Owner: L'Archevesque Date of Inspection: %/ 3 9 -j B ILDING SEWER: (Loc to on site plan) Dept below grade: Mater I of construction: _cast iron _40 PVC _other (explain) Dist nce from private water supply well or suction line Di eter C ments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grader Material of construction: Zoncrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: C �� Sludge depth:_____ �� Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness:_ ' J Distance from top of scum to top of outlet tee or baffle:_ , Distance from bottom of scum to bottom of outlet tee or baffle:/(J How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and utlet tees or ffles, depth of liq id IeveJn relation to outle�invert, structural integrity, evidence of I kage, etc.) �d ss- `�.� A-, t-'' ` 6 � C�t,J so z 1 GR SE TRAP: (locat on site plan) Depth below grade: Mater al of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Di ensions: Scu thickness: Dista a from top of scum to top of outlet tee or baffle: Distan a from bottom of scum to bottom of outlet tee or baffle: Date o last pumping: Com ents: , (reco mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural int rity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 d � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Capt Lijahs Wy, Centerville Owner: L'Archevesque Date of Inspection: 6/—/:F 7 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (loca on site plan) Depth low grade: Materia of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dim lions: Cap city: gallons D ign flow: gallons/day Ala level: Alarm in working order _ Yes; _ No Date of previous pumping: Com ents: (cond tion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) ,off Depth of liquid level above outlet invert: L/ Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) r PUM CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarm in working order (Yes or No) Com ents: (not condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Capt Lijahs Wy, Centerville Owner: L.'Archevesque Date of Inspection: -7 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note.condition f soil,, signs of ydraulic failure,jkyell of gpnding condition of vegetation, etc.) C SSPOOLS: _ (lo to on site plan) Num er and configuration: Depth op of liquid to inlet invert: Depth f solids layer: Depth f scum layer: Dimensi ns of cesspool: Material of construction: Indicati of groundwater: inflow (cesspool must be pumped as part of inspection) Com ents: (not condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate n site plan) Materia of construction: Dimensions: Depth f solids--- Comm nts: (note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) ?age 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Capt Lijahs Wy, Centerville Owner: L'Archevesque Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) � A v a� (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Capt Lij ahs Wy, Centerville Owner: L'Archevesque Date of Inspection: „�3. cj 4- Depth to Groundwater 70 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions L,e"'Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers 1//Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) r © va �L i �L sl 14 �7 (revised 04 25 97) Page 10 of 10 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated I I- 1', — � I , concerning the property located at 438 Capt Lijahs Way, Centerville, MA, meets all of the following criteria: * `(here are no wetlands within 100 feet of the proposed leaching facility. * t1Sere are no private wells within 150 feet of the proposed septic system. *LW ere is no increase in flow and/or change in use proposed. *`There are no variances requested or needed. tIf he proposed leaching facility will be located with 250 feet of any wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division GG.�.--I..S. map) f B)Observed Groundwater Table Evaluation jaccording to HealtVDiv�ision well map) SIGNED:,/ DATE/,k-J 3 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER-Q (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). i 1 i v r m , I I6� I I 'IJ i I J O 0 �� TOWN OF BARNSTABLE LOCATION L� V C'`'-!O 2/- Z- �/ S SEWAGE # VILLAGE � � ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACrrY / b 6 d LEACHING FACT ITY: (type) fi (size) 2 ,5 NO.OF BEDROOMS �7 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist + within 300 feet of leaching facility) l Feet Furnished by--7. LJ r 1 ✓ Poo L I 2.5 SENDER: :o ■c-mplete items 1 and/or 2 for additional services. I also wish to receive the y ■complete items 3,4a,and 4b. following services(for an '4) ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. m ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 4. permit. d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2,❑ Restricted Delivery to «' ■The Return Receipt will show to whom the article was delivered'and the date a o delivered. Consult postmaster for fee. 3.AAcle Addr sed to: 4a.Article Number E 4b.Service Type m r° ❑ Registered ® Certified d" rn CO) ❑ Express Mail ❑ Insured y al: ❑ Return Receipt for Merchandise ❑ COD 7.Date of Deli ery ° z o p 5.Received By:(Print Name) 8.A dr s ee's A ress Only if requested W and f e is pai ) t 6.Signs ure res,ee or Agent) o rn .� PS Form 3 11, December 1994 Y r 9 Domestic Return Receipt M UNITED STATES POSTAL SERVICEai j ?0 F_a amt,No.G-ib'-'— • Print your name, a r <and ZIP OWein'this-box--w—'--- Health Department Town of 6amstable P0,ft w i yannis,Massachusft OW Fax(508)775-3344 Phone(508)790-6265 ti'!?!tliil£fltlil?1!?'fi11�{!£3F�9�I?9�1?ii4?it?�Itiiill9l1l11 Z ��i48 6511 024 Receipt for Certified Mail No Insurance Coverage Provided URrrED STATES Do not use for International Mail POSTAL SERVICE (See Reverse) Sant to • �� Of LS et and No. 2 L CIS P.O. 'at CPos age co E Certified Fee O q V- Special Delivery Fee N a fi�stYict`�&t D,e1{7V q cif { rfldYrS'A��'��t5� to Whom&Date Delivered Return Receipt Showing to.Whe4zn Date,and Addressee's Addre�s.94 TOTAL Postage &Fees Postmark or Da �� �i STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address' 12 leaving the receipt attached and present the article at a post office service window or hand it to .your rural carrier(no extra charge). 2.01f you do not'want this receipt postmarked,stick the gummed stub to the right of the return Cl) address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 00 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If t1 return receipt is requested,check the applicable blocks in item 1 of Form 3811. a 6. Save this receipt and present it if you make inquiry. 105603-93-B-0218 TOWN OF BARNSTABLE BAR-W 451 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager %� � Address of Offender %3� [. -J 4,/,1, MV/MB Reg.# Village/State/Zip Gry QJ 6,3„a v Business Name J�� ,gym pm, on Business Addressk Signature of Enforcing Officer Village/State/Zip 1 Location of Offense 1/_1�- Cor4 Enforcing Dept/Division Offense NulsawV Facts a P*_ na,A e eA )i ndQts- rl- Lege JY9,n r UJ0, rs Acknu sSlrea° so)a, 07` J v��-.� AAA Gi-� i�-- This will serve only a�warning.' At this tim& no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary. compliance. Subsequent violations will result in appropriate legal action by the Town. ' 1 TOWN'gOF BARNSTABLE BAR-W 451 Y' :... Ordinance or Regulation WARNING NOTICE Name of Offender/Manager . dii 1 1") F—Va Address of Offender MV/MB Reg.# Village/State/Zip C' '1 1P.*y/ �r ko 0j 6 ) Business Name _Yff ,am"/pm, on 43 19 Business Address . 14, 2 &a4 Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense ' 1-oryy -- Facts A Pt. n aA,. /,,4 b r►d-rtr h- n��,n�:�!f � uu&b buy 1 f, k>ot-/ 1awh, d'2 ©n4-n e CV 1144'j- 'i sc t29 v41 ddi i--4 ra -�A This will serve only as a warning." At this time no legal action h1as been taken. t It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary. compliance. Subsequent violations will result In appropriate legal action b the Town f 1 TOWN OF BARNSTABLE BAR-W 41 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender Ad MV/MB Reg.# Village/State/Zip (.'fit"� rtrP (r !fits !wI __i _' Business Name / .z axWpm, on // s' 19 Business Address 1` fir, : • , . Signature of Enforcing Officer Village/State/Zip PP Location of Offense "�' J �"'.th�, � - � �!,• 1' ' '� P� 'i Enforcing Dept/Division Offense ./t11 .. ;, s r r�, , ,�--,( /Ait �/ + Facts .y i r. r F {u 1ilitJi Ova,- t�d1Lx✓ /•yRl Its yRl:4 w tt"� 7., 'rr / ° . --j- �J11 t" .Ai�(F J,•LRtJf r+7 i ya,-i ,ts l Iof tJ"JO / This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result 'in -`i appropriate legalf action by the Town. y A2 d - f t,«f G..�G✓r LIU X. TOWN"OF BARNSTABLE BAR-W 376 Ordinance or Regulation WARNING NOTICE Name of Off ender/Manager /�" t•- (y� �� E ve n Address of Offender y 3g- [,oaf L( o ail S A MV/MB Reg.# Village/State/Zip 024-5,t/i/tQ Business Name /pm; on d 19 ys- Business Address A %��6i�aM91C, /0- Signature of Enforcing Offlicer Village/State/Zip Location of Of fense Enforcing Dept/Division Offense IL9S ejZ2 4110. 40,-� M41n44ecP%" 4--eers t 6o-Ybkgf I -f✓�J�7GJ' Facts 1 Jule1-,.of p e-ekf-e Y-,rvk ' y-ew ai1 1,L4u&,e . T i-zs �wu._t'l pl j rt'&-Ce p f I � U id a- e�► c� �r� l�-�� e�,� U4- l,4u� e, "ute days This will serve only,(fld a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. - ;a TOWN OF BARNSTABLE BAR-W �f Ordinance or Regulation WARNING NOTICE Name of Of fender/Manager /��,lr lJ w Y►�"v►�9 E ye n Address of Offender_ Y 39- MV/MB Reg.# Village/State/Zip f 4-ek-Vi Q'� Business Name am)/pm; on ..S ,J O 19 , Business Address Signature of Enforcing Officer Village/State/Zip Location. of Offense3.Sr `, # 1 ►r,. h If ! Gft`4i-f-r6 Enforcing Dept/Division Offense 1111ty'r)'" 04 A—ec-r l- --ene Facts beik W � This will serve onlyj&67 a warning. At this time no legal action has been taken It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in , appropriate legal action by the Town. , TOWN OF BARNSTABLE BAR-W 37 Ordinance or Regulation t WARNING NOTICE Name of Offender/Manager / � s- ' ,�.. -) L Vr r) Address of Offender / 3 )a MV/MB Reg.# Village/State/Zip f .!4+ j ,^ Business Name /a Wpm, on 19 Business Address kPA r J" "t r_ 4 r. Signature of Enforcing Offlicer Village/State/Zip Location of Offense ' Enforcing Dept/Division Offense Facts f�/! r�:... .i. .SU,r 1•�p �r * {�. r 1�f rt: ,/r tlf �cca�t r~fi S K �z This will serve only (as a warning. At this time no legal action has been taken. J It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. 1"( N44-_ 093 LOCATION SEWAGE PERMIT NO. VILLAGE 7Z) INSTALLER'S NAME ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED b6 PI - s' ` �s 41 — SAPP 11G O S� `