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HomeMy WebLinkAbout0492 ELLIOTT ROAD - Health ti. f 492 Elliott Road , Centerville A= 210-040 llll LIPC 12543 h10 R HASTINGS, 89N TA COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON. MA 02108 617-292-5500 'V (•. a 1 5�•` 0 WILLIAM F.WELD TRUDY CORE Governor IIf �d Secretary ARGEO PAUL CELLUCCI Co tII`FD S ID B.STRUHS Lt.Governor SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPE ION FORM/ e Jr Commissioner _JI PART A. 1�9`Q dar , 3 CERTIFICATION �fF TO 6tAHNS�, Ar >� Scr^I e� ter. Property Address: �� lllO dP . Centerv�i�le Address of Owner. �,6ter Frecli Date of Inspection. 9 (If different) Name of Inspector: WM E Robinson Sr ((;an 021 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: tim E Robinson Septic Service Mailing Address: PO BOX 1089 , Cent_Pryi 1 1 e_ MA 02632 Telephone Number- S O 8 � 7 7 5—A 7 7 6 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 sew a disposal systems. The system: _ Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails / Q Inspector's Signature: Date: 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: AI SYSTEM PASSES: _e� 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 YSTEM 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)'year5 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:Nwww.magnet.state.ma.usldep �'j Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A f CERTIFICATION (continued) Property Address: 482 Elliot Rd., Centerville Owner: Frechette Date of Inspection: i1""6--9 B YSTEM CONDITIONALLY PASSES (continued) _ er level observed in the distribution box is due to broken or obstructed 3�;Sewage backup or breakout or high static wat 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] FUR T ER 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) 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) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT HE 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) Page 2 of 10 w , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 482 Elliot .Rd.,Centerville Owner: Frechette Date of Inspection: D] SYSTEM FAILS: You"Rust 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 o Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of 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. EJ LARGE S STEM FAILS: You must i dicate either "Yes" or "No" as to each of the following: T e following criteria apply to large systems in addition to the criteria above: T e 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 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 owne or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirem nts 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 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address. 482 Elliot Rd., Centerville Owner: F.rechette Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes i 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. _ 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)] (revised 04/25/97) Page 4 of 10 SUBSURFAC ,.vE�r„SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 482 Elliot Rd. Centerville Owner: Frechette Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:, 330 g.p.d./bedroom for S.A.S. Number of bedrooms:, Number of current residents: 0 Garbage grinder (yes or no): Laundry connected to system (yes or no): Seasonal use (yes or no):-)&S Water meter readings, if available (last two (2) year usage (gpd): 1st 6 mos 1998 —0— Sump Pump (yes or no)Ald 1997 - 11 , 000gais 1998 31, 000gals Last date of occupancy: CO . ERCIAL/INDUS RIAL: Type o establishment: Design low: gallons/day Grease rap present: (yes or no)_ F Industr al Waste Holding Tank present: (yes or no)_ Non-s nitary waste discharged to the Title 5 system: (yes or no)— Watel meter readings, if available: Las date of occupancy: OT we (Describe) Last e of occupancy: GENERAL INFORMATION PUMPING RECORDS a d source of information: System p ped as part of inspection: (yes or no)_A If yes, volume pumped: gallons Reason for pumping: TYPE OF STEM 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: D� Sewage odors detected when arriving at the site: (yes or no)�L (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 482 Elliot Rd.Ti Centerville Owner: Frechette Date of Inspection:j7`s $� B DING SEWER: (Coca on site plan) Depth low grade: Materi I of construction: _cast iron _40 PVC_other (explain) Distan a from private water supply well or suction line Diam ter Com ents: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) Depth below grader � Material of construction: L t`.oncrete _metal _Fiberglass _Polyethylene _other(explain) If lank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) L ► � Dimensions: Sludge depth: Distance from totp�of sludge to bottom of outlet tee or baffler Scum thickness:/_ & t Distance from top of scum to top of outlet tee or baffle:_ t ► Distance from bottom of scum to bottom of outlet tee or baffle:�y"� How dimensions were determined: !'S �/—�i Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet in ert, structural integrity, evidence of leakage, etc.) 7 b 8 Cl y� "^ l c,, GREASE RAP: (locate on site plan) Depth bel w grade: Material o construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensi s: Scum thickness: Distance rom top of scum to top of outlet tee or baffle: Distance m bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommen ation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, idence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) -Property Address: 482 Elliot Rd., Centerville Owner: Frechette Date of Inspection: 9/S TI HT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (Iota a on site plan) Dept below grade: Mate ial of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dim sions: Cape ity: gallons Desi flow: gallons/day Alarm level: Alarm in working order_Yes; _ No Date f previous pumping: Com ents. (cond tion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_v (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of olids carryover, evidence of leakage into or out of box, etc.) 6 Z2 f3 r ��► PUMP C AMBER:_ (locate o site plan) Pumps ir working order: (Yes or No) Alarms it working order (Yes or No) Commen s: (note cor dition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 482 Elliot Rd., Centedvill'e Owner: Fr e hette Date of Inspection: 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 of soil, signs of hydraulic failure, level of ponding, condition of v gelation, et _ e CE POOLS: _ (Iota on site plan) Num and configuration: Depth-t p of liquid to inlet invert: Depth o solids layer: Depth o scum layer: Dimensi ns of cesspool: Material of construction: Indicatio of groundwater: inflow (cesspool must be pumped as part of inspection) Com nts: (not ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRI _ (locate on site plan) Materi Is of construction: Dimensions:. Depth f solids: Comm nts: (note ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 482 Elliot Rd. Centerville Owner: Frechette Date of Inspection: J� 9 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) J J 3b S- A i 1 (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 482 Elliot Rd., Centerville Owner: Frechette Date of Inspection: Depth to Groundwater);� 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 Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your qwn words how you established the High Groundwater Elevation. (Must be completed) + J (revived 04/25/97) Page 10 of 10 j .Olt No.��..3...... /- Fs� . THE COMMONWEALTH OF MASSACHUSETTS ­� t BOARD .OF HEALTH Appliration for Disposal Works Tontrurtioit rrrmit Applicatio hereby made for a Permit to Constr c ( ) or Repair ( ) an Indi idual Sewage Disposal ystesn at: �rr—Crij HS� C�AA l � 3�0 t`--P j^ CA9. S��6 ....... G 4l ...T .. .. ................................... . . ...........................;-. .. ......._......................_...._.... Locat'on-Addr s or Lot No. .....G� J .�. ..n r.r�.............................. ---•- ......Address ...... -................. ... WcSc.... . ............................. ......................................---.............•--............_....................... M Installer Address Q7i Type of BuildinS,,,— Size Lot.,73,,.�?�Sq. feet V Dwelling-L'No. of Bedrooms...... ..............................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures W Design Flow.........//...........................gallons per person per day. Total daily flow.._.,�J92...............................gallons. WSeptic Tank—Liquid capacity/.' gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No............... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No....../............ Di eter...�..:....... Depth below inlet....:........ Total leaching area.................sq. ft. Z Other Distribution box (�n Dosing tank ( ) aPercolation Test Results Performed by.......................•••--•-•---•--••-••••-•...........--...-•-•--...... Date....................................... Test Pit No. 1....:Z.......minutes per inch Depth of Test Pit...l.Z........ Depth to ground water....,!! _.. G4 Test Pit No. 2......G'/..minutes per inch Depth of Test Pit.....f.s........... Depth to ground water......2............... a ••••-•-••--•....v......-•------------ ......•--^J------------- - ...... -------- Description of Soil..•-•-••••• ... ...- U ..............••-•-...--•••...... --......----•-••-•--•----.............---•----.....................----•----...-•--•---......•----•----••----------......._......----•-- W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------•---........---..................---......................---•-•-----..........-------•-•--------------------........----....-----•--•---...............-••-•-•----.............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with. the provisions of iITLL 5 of the State Sanitary Code he undersigned fur her agrees not to place the system in operation until a Certificate of Compliance has been i ue by th ard of i th. igned.._. ,.. ..• :... .. • -•• . ........................ ..... . �.. D Application Approved BY ::. .............•--............-•---------••-•-----••-•........_. .t'f.'.��1. 1..- Date Application Disapproved r e following reasons----------------•-•--•--------•-••-----...................--•-----.....................---•.....-•-••-.....___ ........ ..-••• ..........--•-•---....-^-•------•---....................................•---•---••....--•••--••--••.........._ - ••-•---••---Dam ^ PermitNo...................................................___ issued......................................................^ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......................................................................................... Applutttion for Disposal Works Tonstrudion fermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................... ........................_4L. ~ ».........................._...._-- - Location-Addresses or Lot No. .....`... ..: ".. ':". ........ ...........•............................... ..».......................................... Owner - - Address W •--•---•---•.................................Iastaller.......-----------•--........_.......... ......-------•--...........................—Address�--...................:...-•---...------•-• Type of Building/'" Size Lot.: ,'.. EZ Sq. feet V Dwelling No. of Bedrooms........ .............................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building ............ No. of persons............................ Showers — Cafeteria 04 Other fixtures _ W pr�n w._........ �F-'�......................De gallons per person per day. Total daily flow.... ......................gallons. Gd e W t Liquid capacity/ gallons Length................ Width................ Diameter................ Depth................ i osal Trench—No..................... Width.................... Total Length.................... Total leaching arm...................sq. ft. Seepage Pit No......Peg /---------._ Diameter...c.:;:�........... Depth below inlet...ic'.'-:-.-.-.---.. Total leaching area................sq. ft. Z Other Distribution box (,,�/' Dosing tank ( ) 1.-0 Percolation Test Results.- Performed by.......................................................................... Date........................................ 1.4 Test Pit No. 1.....f..._...minutes per inch Depth of Test Pit.....1 7........ Depth to ground water.... 44 Test Pit-No. 2.....2 ..minutes per inch Depth of Test Pit......:............. Depth to ground water.......::............... O Description of Soil..._3_..._.. � .-:.. `.:.�.. .....r... ... ......f...�./y-�.................. ....j.<�.����....................... W , U --------------• ------ ...... .-• ------- -.......... ----------- ----------- .-..-....... .... --------- -------------------- ... ....... •................... .--------•------ W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ...............................................................•-••--...........--••--••-------...---------•-•---•----------....-----•-••-•-----....---•------------........-----..........0............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. gned. -•••-••.......................................•-•---..........-•----••..•.... ........... .....».... Da ApplicationApproved By...... .• '. x .............................................................. ..... . ........... Date Application Disapproved r t f ollouring reasons:...........................................................................................................--- ..............................................................•--...........----•-•-•---....-•---------............----•---.......................--------..............------------................_..» Date PermitNo...................................................»»» Issued_.......................................--------....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF............................0........................................................ (9trfifirate of Toutplianu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed Leel"or Repaired ( ) ...................... ..................----------------•..............._..... ._.... Install w ;7. ... k -'" -------------•••-•....--.•••. ............... . -. ..... has been i stalled in at.. t accordance with t e provisions of T IE j Hof he State Sanitary Code a 11de 'bed in the application for Disposal Works Construction Permit No. _. _,. - �.............. dated.. . THE ISSUANCE OF THIS CERTIFICATE SHALL OT BE CONSTRUED AS A GA16 TEETHAT.THE SYSTEM WI XL F)JNCTION SATISFACTORY. DATE..... ..L .- � ..................................................... Inspector..... e__ .. ....... ........-........• -....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N "" pl.... OF...........................................................17 _ . ......................... F>aa .........---.. Disposal Works Ton,�� ion Vermif Permissio is r�5y an •*;......... rG �� to Const an In( e D�sal Systemdr ... ....._»».. atNo... a��, •.............. ....... ..- ' ..................................................._..._ ` Street as shown on the application for Disposal Works Construction Per o..................... Dated..,f ................ ...•. Board of Health DATE.., / FORM C-1255 CITY& TOWN FORMS, INC. 369-9708 T TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STO GE SYSTEMS e NAME (%c-7 GS/6 ADDRESS L�v� VILLAGE LOCATION OF TANKS. �"-' t �0 3 CAPACITY: TYPE OF FUEL AGE: TYPE: Zr s�Gl<�.c OR CHEMICAL �'�n 'r ;�IGI�[ S /D�— 2 % �l�E✓ C2- I// (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS bd eF. VJFj �D+ N tD v m O b � o eF � O � C] to O C W m O GQ lv µ O U OCATIO 6H SEWAGE PERMIT NO. I Zo VILLAGE INST Ll 'S NAME i AWORESS j i U rL O E R oR OWIjEft GATE PERMIT ISS:UEa I' BATE C ® MPLIANCE `ISSUED _ 1 n � S/ , A 111 0 CAT 10 6 �a3 SEWA PERMIT NO. ©/ oZ"d- V I L L A G E w�e,�f,r•ae/ . S , I N S T ll 'S NAME D AO#DRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1 n si . O:�OK. 1 f t• rats.4ta .. Ifrf �t Z :c•''Tod ,3a s r 8 .3 �. / <94L . k } H 7 ALAN 1 1C7fdES 64 4. `w, r 70 IJ 57 Ile • '' �/.�`"' _ I:s"4�Y/�.�'- _4 V iks,iP'•¢, K-'s"�;t�' _ J� �. o,; • '' - '!. �''�,��"`/,�`i�"'+ '7'fsfd'?"". �"'�f�';�e:��'L�'.t�? ��h� , ���'s��:�'����� '"f .,.4.�st•r"« .�.5�, '�•�r", x`��i _f""-.