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HomeMy WebLinkAbout0180 GLENEAGLE DRIVE - Health 180 GLEN EAGLE DRIVE, CENTERVILL. A= 191 150 -------------------- ------ I �s P I f UPC 12534 . No. 2-153LOR HASTINGS,MN Date: C)l 1900 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: CL_CS`r "ANC—R_ BUSINESS LOCATION: W QCtiC-PA(_ �� - C& fVV'1 IP , M MAILINGADDRESS: SRMe Mail To: TELEPHONE NUMBER: Sob k) - 3 Sb D • / 4/ ho r Board of HealthTown of Barnstable CONTACTPERSON: jf P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 771-1 M CQi _-zgA) _C'y"-� Hyannis, MA 02601 TYPEOFBUSINESS: Qdean lnaA Sinps'S Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES ✓ NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids , `(dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS No. J Fee T,HE COMMONWEALTH OF MASSACHUSETTS; PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for XDigpogal *r5tem Construction Permit Application is hereby made for a Permit to Construct( )or Repair(�)an On-site Sewage Disposal System at: Location Address or Lot No. Y Address and Tel.No. .qn/ ,- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3g ,�aS�4 cam. �r-�.�+s✓�rS Type of Building: Dwelling No.of Bedrooms Garbage Grinder(Alp 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 Description of Soil Nature of Re airs or Alterations(Answer when applicable) 0 O vJ 1 k b®l Nk-w%) L& -N PtN- W 71 S lb-J`i rz *CS/�17✓[ �rfRm - Date last inspected: 9�+ 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 lace the system in operation until a Certifi- cate P Y P of Compliance has been issued by this oard of Health. Signe d�_ ,--A !,.%, Date ry Application Approved by Application Disapproved for the following reasons 6 3- /` �r Permit No. � CP_3 Date Issued � �� G ——————————————————————————————————————— No. ! _ Fee T}iq COMMONWEALTH OF MASSACHUSETTS.; PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppItcatton for Xhgpozaf *potem Com5tructton Vermtt Application is hereby made for a Permit to Construct( )or Repair(,\,,)an Oti-site`Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 10o GL�v.��At,L� 7�6 %/K ,COT- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3� �S�r2`► C... f-Fs1a-�wc� l-1 ST ^7 7 I V I?B Type of Building: Dwelling No.of Bedrooms Garbage Grinder(,✓P 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 Description of Soil. 0- 2 Nature of Re airs or Alterations(Answer when applicable)��� OvJ f, — 1`Oob G/lit uH1 L A W S t bvj, Date last inspected: PN►JC_ 9S 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 this oard of Health. Signe o--k4 Date 4 S Application Approved by Application.,Disapproved for the following reasons i Permit No. .` S_` f 60P'3 Date Issued P G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certiftcate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(L-<on by N 6mASe' for ©u,ov v4— k`ao C WrYT a+ So J e U N has been construc ed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. b P_-3 dated `f 6 "A_r . Use of this system is conditioned on compliance with the provisions set forth below: a� No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Xt,5Po!6a1 *p5tem Cougtructton Vermtt Permission is hereby granted to tAkCVA--�tI CONS ►� to construct( )repair( loKa-n On-site Sewage System located at 1 $D 4=L.X !J-^cLca Q!Q, .,Q V11 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: d" /4 4. Approved by ` 1 CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at 116 Q C`LlaO E.& Le meets all of the following criteria: • There are no wetlands within 300 feet of-the proposed septic system • There are no private wells within 150 feet of the proposed septic system NV • The observed groundwater table is 14 feet or greater below the bottom of th eaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: \� �_— �_ DATE: g� rt V LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. _ - - . 7tCi� �� :may/ � �' � �� � �� 0 off'o��D . . aN heln 5 1999 COMMONWEALTH OF MA USEM EXECUTIVE OFFICE OF ENV T S John Grad DEPARTMENT OF ENVIRONMENT ® DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 180 GLENEAGLE DR. CENTERVILLE 0A - 15 L Name of Owner BILL PIRANI Address of Owner: SAME Date of Inspection: 6/21/99 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: n/a Mailing Address: n/a Telephone Number: n/a 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: X Passes The inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is _ Needs Further Evaluation By the Local Approving Authority performing at the time of the inspection.My inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:6/22/99 The System Inspector shal submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:6/21/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: nLa 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. Wa 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 complying septic tank as approved by the Board of Health. Wa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced _ obstruction is removed distribution box is levelled or replaced Wa 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:6/21/99 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 the public health,safety and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of 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 ANY)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 of 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 nla..(approximation not valid). 3) OTHER Wa revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:5/21/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described 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 X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Wa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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 ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone Ii of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:6/21/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X 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. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X 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: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:5/21/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-0 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):3 Total DESIGN flow: 3M Number of current residents:.1 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): Wa Sump Pump(yes or no): NO Last date of occupancy: nLa COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: n&gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):DLO Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) nla Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM HAS NOT BEEN PUMPED IN 4 YEARS. System pumped as part of inspection:(yes or no):NO If yes,volume pumped n&- gallons Reason for pumping: nLa TYPE OF SYSTEM XSeptic 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.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: THE ORIGINAL SYSTEM IS 25 YRS.WITH A NEW PIT INSTALLED IN 95 Sewage odors detected when arriving at the site:(yes or no) NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:5/21/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 1'C Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n(a Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: 1' Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO nta Dimensions: L 8'6"H 5'7"W 4'10" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 3E Scum thickness:3" Distance from top of scum to top of outlet tee or baffle:6 Distance from bottom of scum to bottom of outlet tee or baffle: 1E How dimensions were determined: MEASURED 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.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM NOW AND THEN MAINTAINED EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Wa Dimensions: nLa Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:111a Distance from bottom of scum to bottom of outlet tee or baffle nLa Date of last pumping: n& 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.) D& revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:6/21/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n1a Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) Wa Dimensions: nta Capacity: Wa gallons Design flow: Wa gallons/day Alarm present: MQ Alarm level:jiL& Alarm in working order:Yes_No_ NQ Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n1a DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:n& Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) I]La PUMP CHAMBER: MQ. (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:6/21/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Wa Type: leaching pits,number: 2-1000 GALLON LEACH PITS leaching chambers,number: _nLa leaching galleries,number: -n& leaching trenches,number,length: n& leaching fields,number,dimensions: nla overflow cesspool,number: n& Alternative system: nLa Name of Technology: _nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE NEW PIT HAS NOT HAD MORE THAN 1'OF WATER IN IT CESSPOOLS: _ (locate on site plan) Number and configuration: nLa Depth-top of liquid to inlet invert: Wit Depth of solids layer: nLa Depth of scum layer. nta Dimensions of cesspool: n& Materials of construction: n& Indication of groundwater: Wa inflow(cesspool must be pumped as part of inspection)WA Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n& PRIVY: _ (locate on site plan) Materials of construction:Wa Dimensions:WA Depth of solids: n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) D& revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:5/21/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a (�AC� deck � A C- A �K yb a� ac gC �6 revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 180 GLENEAGLE DR.CENTERVILLE Owner: BILL PIRANI Date of Inspection:6/21/99 NRCSReportname: nLa Soil Type: n& Typical depth to groundwater: n& USGS Date website visited: n& Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health _ Checked FEMA Maps Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET revised 9/2198 Page 11 of 11 Z (348 i648 631 Receipt for Certified Mail No Insurance Coverage Provided IMITED ST11TE5 Do not use for International Mail OOSTIIL SERVICE See Reverse) _ 0) S a n i to 0) o� Stree nd No. Cd P. tate Code Postage s M E Certified Fee O � Special Delivery Fee a' R"es�iict�d'Ne`1iVrrV I 1Rettifn"Rt�cufi�}rSlioUiiii�r 1 D to Whom&Date Delivered Return Receipt Shoving'to'VVhom, Date,and Addre see's Addr0r s TOTAL Postage f &Fees i'n'j Postmark of Dater .. 1 STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). m 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). CC 2. If 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. rn 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 co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 0 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, 4" endorse RESTRICTED DELIVERY on the front of the article. E o 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL t return receipt is requested,check the applicable blocks in item 1 of Form 3811. to n. 8. Sa.e this receipt and-y«se;,-it-if you make inquiry. 105603-93-B-0219 SENDER: y • Complete items 1 and/or 2 for additional services. I also wish to receive the y • Complete items 3,and 4a&b. following services (for an extra 4) H • Print your name and address on the reverse of this form so that we can V 0) return this card to you. fee): ` m • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address N does not permit. t • Write"Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery C • The Return Receipt will show to whom the article was delivered and the date m C delivered. Consult postmaster for fee. V � .3. Article Addressed to- 4a. Article Number � Z c CL 4b. Service Type Co /��a `/�yy�,� El Registered ❑ Insured V "CCUU1lll Certified El COD 5 W `fir/y ❑ Express Mail ❑ Return Receipt for f Merchandised G C J 7. Date of Delivery w Q o z5. Signat (Address 8. Addressee's Address(Only if requested .x and fee is paid) c H � s R 6. Signature (Agent) ~ 0 PS Form 3811, December 1991 *U.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE I i Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT ' OF POSTAGE,s300 r, II Print your name, address and ZIP Code here { Health Department Town of Bamstabie p 0.Box 534 Hyannis,Massachusetts 0260 Fax(508)775-3344 Phone(508)790-6265 .P Town of Barnstable • • Department of Health, Safety, and Environmental Services B"MOB Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health August 14, 1995 Rose Bechard 180 Gleneagle Drive Centerville, MA 02632 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 180 Gleneagle Drive, Centerville was inspected on August 2, 1995 by Robert Bortolotti a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Wastewater liquid depth pit 6" in leaching pit. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. P HE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health t [Installer letter] TO: 3'0" (Date)"' ' J ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. &"5r" The septic system owned by. you located % *as inspected on by �a�-, Viassachusett licensed septic inspector. ' The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: 11 t s..Ow _ ` P t� 4 4-A/ You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable 't BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM T . Address Prop Date of Inspec}�a M / rarcej� Owns CHECK IF THE FOLLOWING HAVE BEEN DONE: PART A — CHECKLIST 9 iir PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND 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 COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO /THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. v 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 SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,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 SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR /APPROXIMATED BY NON-INTRUSIVE METHODS. THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL �� No of Bedrooms No of Current Residents /✓0 Garbage Grinder Laundry Connected to System YV Seasonal Use NON RESIDENTIAL: . Calculated flow WATER METER READINGS,IF AVAILABLE: GALLONS Pumping Records and Source of Information: o u inn �e/W5 �l� Vic. SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF SYSTEM: Septic.tank/distribution box/soil absorption system Single:Cesspool Overflow Cesspool Privy Shared:system:(if-yes,attach previous inspection records, if any) Other.(explain).. c���, Approximate age of all components. Date i wied,If known. Source of information. / . SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? Ile SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC Depth below grade- C, /�e Dimensions: Material of construction: . oncrete Metal FRP r Other) Sludge Depth �� Distance from top of gl i9ge to bottom of outlet tee or baffle Scum Thickness Distance from Top of Scum to top of outlet tee or baffle �7 �dam/` TO Distance from bottom of Scum to bottom of outlet tee or baffle u�� Co ants: 7 Q: /000 a I77 /7 O19, DI TRIBLMON BOX: IVO DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: MPCHAMBER: Pumps in Working order? Comments: SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE: — OdD O O Comments: � K2 zi /'� CESSPOOLS: Number and configuration Depth—top of liquid to Inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool " " Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: Materials of construction Dimensions: Depth of solids Comments: - ,fix.'. kd _ •. I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — USTEM INFORMATION (Continued,) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' • • 5 au DEPTH TO GROUNDWATER DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: / r c.' fr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA . •� 4 ku'r d - y e(indica4 Y u.yw N" no ND not determined.Describe basis,of determhmMon.If not determined•,explain why not) v Backup of Sewage into Facility's k y Discharge or ponding of effluent to the surface of the ground or surface waters? 14 Static ligwd level in the districution box above outlet invert? jc4c. ` 1 Liquid depth in'.. 6 below invert or available volume, 1/2 day flow? /t/ Required pumping 4<times or more in the last year? Number of times pumped /v Septic tank is"Mmetal7 cracked' structurally unsound?substantial infiltration?substantial exfiftmtion? tank failure-imminent? - - - is any portion of the SAS,cesspool or privy,below the high groundwater elevation? /1� Within 50 feet of a surface water? Vlfithin_100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? 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 col'iform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION INSPECTOR O '.ROBERTJ.B_RTOLOTTI ADDRESS: 765 WAKEBY ROAD,MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508)771-9399 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND.MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. CHECK ONE I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED AREAS STATED JN TWFAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR.15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA'SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(If applicable),APPROVING AUTHORITY ,4 �x- l SS{�'''S5S,.'�' r ak-.,�311 ,�s t 1 Iz :'-"f'd �f.i�}f S � i a st r �•j� �a � - s i t 4•* ' �5 ' ,q .3 �3� 'R .1;+p1."rse 5-� s yr-{�E 3��`r °•, ,''q !` .. ,�•p, , a�' � !P'z� x'�d � y'!,2^ y r ,4�S� . dt 1 � . _� � � �� er-A. u-..' � srq, «L s.• 1 c '�'�'K *m •;�-,thr., x _y„�,y� _ f�ti���y.. 4; } a f i• pier - qk r. ,^ TOWN OF BARNSTABLE LOCATION J a .a- "` SEWAGE # VILLAGE a7., �-i ASSESSOR'S MAP&LOT '9 `457t3 INSTALLER'S NAME&PHONE NO.'�`7'Glor SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) NO.OF BEDROOMS BUILDER OR OWNER fF-'4rZLW PERMITDATE: 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) x I o Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of.leaching facility) Feet Furnished by "" � I o Or l�vt!�a4��if y LOCATION ( � SEWAGE PERMIT N0. V, VILLAGE S5, INSTA LLER'S NAME & ADDRESS 5 d L- T �0'� 1,(-, ;T, rrL B UI*LDE R OR OWNER ass ctl- If / DATE P RMIT ISSUED DATE COMPLIANCE ISSUED L>� / No.. ... ...... Fmic.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH' ....... .. .. ..........OF.............................................1-1-11.....I.,......... ......... Appliration -for Maposal Worko Tonstrurtion Vrrnift ,App1,j* ion is hereby'ma, for a Permit it to Cor)§truct or Repair an Individual Sewage Disposal system :V Y- 7 90 ....... ...... .... ......... .... 'A ocation- ress- t 1 :0 -- - --- ------ ....... .. .. ......................... .. .....A---------- .... .. .... .......... Address . . . . .. . ..... .. .. ......................... ................... .... .. .. ............................... ------------- Installer Address Ty of Building Size Lot_/57_4-------------Sq. feet Dwelling—No. of Bedrooms___________________________________________Expansion Attic Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons...._.__.._..._.__..__....__ Showers Cafeteria ( ) Otherfixtures .............................................................................. ................ -------- ---------------------------------- Design Flow......_. ..................:.....gallons per per-son per day. Total daily flow_______ _40--------------------------gallons. Septic '17,,.iiki-'I-iqtiid capacitv-j.&6gallons Length________________ Width.__-.._...-._.. Diameter___.__....____. Deptl i---------------- Disposal Trench—No_ -------------------- - Width._.______....__.__._ Total Length__._______._______.. Total leaching area....................sq. ft. Seepage Pit N-.16...6--6----- Diameter____________________ Depth below inlet____._______________ Total leaching area---------------_sq. f t. Z Other Distribution box ( ) .Dosing tank ( ) 0 j�- /V& - :Z- .2 2 - 7 7 Percolation Test Results Performed by----------I---------------------------------------------------------------- Date---_-----------_--------------------._.. Test Pit No. I----------------minutesperinch Depth of Test Pit_.-_______________-. Depth to ground water---------- -------- Test Pit No. 2--------_------minutes per inch Depth of Test Pit._._.__._.._._._____ Depth to ground water------------------------ ---------------------- 0 Description of Soil---- XAI ------ ----- ------------ U - ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable_----------------------------------------------------------------------------------- --------- ---------------------------------------------- ----------------------------------------------------------------------- ------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary ode—The undersigned fur er agrees not to place the system in operation until a Certificate of,Compliance has�,ee-jlsued by Yte ,o of h ----- ............. ... ..._g SiL led.-- ---------- - ------- ------ Vate Application Approved By---- - --- Y---—----------------------- ---- ----—--7.7--------- Date Application Disapproved for the following realons:................................................................................................................ ............................I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Permit No. ........................... Issued...... 77..Date....... ... ............... ..... Date No. /5 _--•_.. Fps....` ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... -- .OF........' ................................................... Appliration -for Dig o,ittl Oorkii Trimtrurtion Pumit Appli motion is hereby'ma�e for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a, 6' i" ` - l 'r - ----------- - - ocation ress r t / jt's _ of No. *�` '�•'4 d A f l O , / Addre s ``' I �+ Installer Address �v UTye of Building Size Lot_ _�� ------------ feet Dwelling—No. of Bedrooms.___ .....................................Expansion Attic ( ) Garbage Grinder ( ) Other—a Type of Building ............................ No. ofpersons �e sons__-___-----_____---.-___.-_ Sh owers � — Cafeteria Other fixtures -------------------------------- -•---------• -------- ---------- -- - ( ) -------------- ----------------------------- W Design Flow--------- .;... ---__________________gallons per person per day. Total daily flow....... _—-_-_--_-_.-._-.-..gallons. P4 Septic T;:nk-A-�iquid capacity_/-&-6gallons Length---------------- Width..........------ Diameter-----.---------- Depth-------......... xDisposal Trench , No..................... Width-------------------- Total Length------------_------- Total leaching area--------------------sq. ft. Seepage Pit No./b--- A----- Diameter____________________ Depth below inlet.................... Total leachin are.._...__......____sq. ft. z Other Distribution box ( ) Dosing tank ( ) p� • PC � - 2 - 2a - � 7 '-, Percolation Test Results Performed by------------------------------------------------------------------------- Date--------------------------------------- Test Pit No. I................minutes per inch Depth of Test Pit._-_---_._--__--- Depth to ground water-..-__.__-_-----..___.- tq Test Pit No. 2----------------minutes per inch Depth of "Pest Pit----------------_- Depth to ground water--------------.--------- -------------------- x ` - --•-------------- ` " �escrttion o Soil--. -- a V --------------•fir•--...-•..l- ................V?_- ^`f = --- W x --------------------- --------------------------------------------------------------------------------------- ------------------------------------------------- -------------------------------------- U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------.-------------------------------------------------- . -------------•---------•---••--------------------------------------------------------------------.••----•-------------------------•-•---------------•---------•--------•---------------------------•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State SanitarPCVe— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has 6esued by tlye orb oth ",,,. .^.�' Signed---/J Date Application Approved B U ' L-'Z `--....................... ... '- Date Application Disapproved for the following reasons_-----------------_------------------------------------------------------------------------------ -------------- -------------•--•-••-•------•-------•-••-----------------------••--------•---------------------•--------------------------------•-•--•-----•------•---------------------•-----------. -• ------------- Date PermitNo......................................................... Issued........... ------ ..................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ lY�- 'T........OF..... f r G�-2.�?� (9rrtifiratr of f.1ampliana T ISMS TO C-ERTI I�, That the Individual Sewage Disposal System constructed (�or Repaired ( ) by s' Installer vi at.. . := _... - -- ?'t - •-------•-•-•-•----------••-•-------------------------•------- has been installed in accordance with the provisions of A:1 leJ XL of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.�_.Al ................... dated..-_ -: ' _____'7_ 7.....___._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 7 . DATE----. •--�"`---'� ..-----•--�•-----............................ Inspector.------- ` "_ __... THE COMMONWEALTH OF MASSACHUSETTS BOARD /OF HEAL�H�„ i ............a....! ''...........O F........v.�r..`"y' 'v t.f� .1......................... . d. No......................... FEE.....-•----............. Di>spos W rkii noit rurtioii Vrrmit Permission is hereby granted-----------ems'••-•- - --------�� to Construct) Repair ( ) a I iv al Sewage oral System ,. at No._--•---•- --- !- ';r'►1...... ...... ..r= -- `- Street e as shown on the application for Disposal Works Construction Perrait-_�No___ __ _____------/Ipated----- ..'` __ _7-_7---------- - -------------------- DATE................................................................................ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS c.Z3. MOON AWE X �± a 'k r 76 5 V \ - - I1� O /45 23 `V - LO T 40 'ZDlv/NG CLI-?5s'. -= R W ea 20 ' A2on/T YARD �V /© i Y APR O pa°�Y.� 'si 0�j\ A.—_ C 7IV OfiEi� N � "�jt •7s `� ,, "`� CERTIFIED PLOT R!AN //V A- s. Ln T 1' �/ ^NE r CERT/F Y TfHA T THE �°_��lJ��/C�.�T;G�% R!CkAR D U. 0'14EARid, R L.s., R. S. ,ATUWA ' ON THIS PLAN /S LOCATED /9/ NIA//V ST. (RTE. 2�) ON THE GROUND AS INDICATED AND WEST DEAW 15" , MASS . 0�=i sr 134 MAs 5. >A N A 4,- z /% �— JOB A10._�J .� C°L/E!�/T- C=aiNn� c� i o.grE ,�/' REG. LA Avo suqvE✓o ®/?. F� Y: f?lC1i S/-/FE T OF