HomeMy WebLinkAbout0186 LAKE ELIZABETH DRIVE - Health 186 Lake Elizabeth Drive
Craigville Conference Center/Mass Coference of UCC
226-184 Centerville
a gig 25 2016 20:17 Jim The Inspector Man 5085349919 page 1
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Commonwealth of Massachusetts aa 8�
% = Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments m
"ID
w r 186 Lake Elizabeth Drive �+
Property Address
Craigville Conf. Center(Dawn Hammond CFO) 3>
Owner Owner's Name —
information is
required for every Centerville MA 02632 8-25-16
page. City/Town CA
State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms �t��tnntrrprr�
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use the return .lames D.Sears = JAMES :m>
key. Name of Inspector y
Ca ewide Enterprises, LLC
Company Name
!*
153 Commercial Street �', s ilvsP�o�•��`��`
Company
Address
I Mash pee MA
02649
City/Town State Zip Code
508-477-8877 S 1623
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
8-25-16
�hspectsure Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system 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 DEP. The original should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority.
_—This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform' in the future under
the same or different conditions of use.
t5ins.doc'-rev.6/16 Title 5 Official Inspection Forth:Subsurface Disposal Sewage Dis g p System•Page 1 of 17
�d V
Aug 25 2016 20:17 Jim The Inspector Man 5085349919 page 2
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
186 Lake Elizabeth Drive
Property Address _
Craigville Conf. Center(Dawn Hammond CFO)
owner Owners Name
information is
required for every Centerville MA 02632 8-25-16
page. Clty'T own State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The system is a 1500 Gal Tank-shared tank#2  Pump chamber and leaching
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
"A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5ins.doc•rev:6r18 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslem•Page 2 of 17
Aug 25 2016 20:17 Jim The Inspector Man 5085349919 page 3
Commonweafth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
186 Lake Elizabeth Drive
Property Address
Craigville Conf. Center(Dawn Hammond CFO)
Owner Owners Name ---
information is
required for eve ryCenterville MA 02632 8-25-16
page. City/rows State Zip Code Dale of Inspection
B. Certification (Cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health).-
El broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
I. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins.doc•rev.6/16
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Aug 25 2016 20:17 Jim The Inspector Man 5085349919 page 4
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
186 Lake Elizabeth Drive
Property Address
Craigville Conf. Center (Dawn Hammond CFO)
Owner information is Owners Name
required for every Centerville MA 02632 8-25-16
page. CityfTown State Zip Code , Date of Inspection
B, Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
V El ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in is less than 6" below invert or available volume is less
than '/z day flow
t5ins.doe•rev.6/16
TIIIe 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Aug 25 2016 20:17 Jim The Inspector Man 5085349919 page 5
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
7
186 Lake Elizabeth Drive _
Property Address
Crai ville Conf. Center Dawn Hammond CFO
Owner Owner's Name
information is
required for every Centerville MA 02632 8-25-16
page. City/Town Stale Zip Code Date of Inspection
B. Certification (cont.)
Yes No
® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
System y passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins.doc•rev.6i16
Title 5 Oftfcial Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17
Aug 25 2016 20:17 Jim The Inspector Man 5085349919 page 6
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r 186 Lake Elizabeth Drive
Property Address
_Craigville Conf. Center(Dawn Hammond CFO)
Owner Owner's Name
information is
required for every Centerville MA 02632 8-25-16
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to.each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as NIA)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out)
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® Was the facility owner (and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): NA Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins.doc•red.6/16
Title 5 official Inspection Form:Subsurface Sewage Disposal System.Page 6 of 17
Aug 25 2016 20:17 Jim The Inspector Man 5085349919 page 7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
186 Lake Elizabeth Drive
Property Address
Craigyille Conf. Center(Dawn Hammond CFO)
Owner information is Owners Name
required for every Centerville MA 02632 8-25-16
page. City/Town Stale Zip Code Dale of Inspection
D. System Information
Description:
The system is a 1500 Gal. Tank-shared tank#2 + #3 Pump chamber and leaching
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use?
❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)): 2013-39,000Gals
2014-49,000Gal's
Detail:
Sump pump?
❑ Yes ® No
Last date of occupancy: NA
Date
L
Commerciallindustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present?
❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
ISns.doc-rev.6116 TIDe 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Aug 25 2016 20:17 Jim The Inspector Man 5085349919 page 8
Commonwealth of Massachusetts
Title. 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
186 Lake Elizabeth Drive
Property Address
Craigville Conf. Center(Dawn Hammond CFO)
Owner Owners Name
information is
required for every Centerville MA 02632 8-25-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
® Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
® Other(describe):
Pump Chamber
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sysban•Page 8 of 17
i
Aug 25 2016 20:18 Jim The Inspector Man 5085349919 page 9
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
186 Lake Elizabeth Drive
1W -
Property Address
Craigville Conf. Center (Dawn Hammond CFO)
Owner Owners Name
information is
required for every Centerville MA 02632 8-25-16
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
NA
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 28"
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line:
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Pipeing is 4" PVC SCH 40.
Septic Tank (locate on site plan):
Depth below grade:
18"
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene
❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 Gal. Precast H-10
Sludge depth: 2"
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Aug 25 2016 20:18 Jim The Inspector Man 5085349919 page 10
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
186 Lake Elizabeth Drive
Property Address
Craigville Conf. Center(Dawn Hammond CFO)
Owner Owner's Name
information is
required for every Centerville MA 02632 8-25-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont,)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
28"
Scum thickness 1
it
Distance from top of scum to top of outlet tee or baffle
12"
Distance from bottom of scum to bottom of outlet tee or baffle
17
How were dimensions determined? Asbuilt-Tape- Plan
Sludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank at working level. Tank at 18"below grade inlet baffle outlet tee
---------------
Grease Trap (locate on site plan).-
Depth below grade:
feet
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:
Date
15in5.doo rev.6/16 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 10 of 17
Aug 25 2016 20:18 Jim The Inspector Man 5085349919 page 11
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r 186 Lake Elizabeth Drive
Property Address
Crai ville Conf. Center(Dawn Hammond CFO)
Owner Owner's Name
information is Centerville required for every MA 02632 8-25-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene
y ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping:
Date
Comments (condition of alarm and float switches, etc.)!
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins.doc--ev.3/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 at 17
Aug 25 2016 20:18 Jim The Inspector Man 5085349919 page 12
Commonwealth of Massachusetts
t= Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,
186 Lake Elizabeth Drive
Property Address
Craigville Conf. Center(Dawn Hammond CFO)
Owner Owner's Name
information is Centerville
required for every MA 02632 8-25-16
page. CityrTown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert No Box
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
• 1
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins doc•rev.6/16 Title 5 Official Inspection Form:Subsuriaoe Sewage Disposal System-Page 12 of 17
i
Aug 25 2016 20:18 Jim The Inspector Man 5085349919 page 13
4
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
186 Lake Elizabeth Drive
Property Address
Craigville Conf. Center(Dawn Hammond CFO)
Owner Owner's Name
information is
required for every Centerville MA 02632 8-25-16
page. Cityrrown Stale Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
® leaching galleries number: 33
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology.-
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of
vegetation, etc.):
Leaching in a shared system w/dining hall and other unit's. Leaching is 2 rows-33 galleys each
row w/2'stone. No sign of over loading
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Aug 25 2016 20:18 Jim The Inspector Man 5085349919 page 14
Commonwealth of Massachusetts
Title. 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
" 186 Lake Elizabeth Drive
Property Address
Craigville Conf. Center(Dawn Hammond CFO)
Owner Owner's Name
information is
required for every Centerville MA 02632 8-25-16
page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)-.
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids 1
i
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
I
t5ins.doc-rev,6116 Tift 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Aug 25 2016 20:18 Jim The Inspector Man 5085349919 page 15
Commonwealth of Massachusetts
- Title- 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
186 Lake Elizabeth Drive
Property Address ,
Craigville Conf. Center(Dawn Hammond CFO) s
Owner Owners Name
information ry Centerville t
required for eve MA 02632 B-25-16
page. Cltylfown State Zip Code Date of Inspection
D. System Information (cont)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
I
t5ins-doc-rev.W16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Aug 25 2016 20:19 Jim The Inspector Man 5085349919 page 16
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
r 186 Lake Elizabeth Drive
Property Address
Craigville Conf. Center(Dawn Hammond CFO) 4
Owner Owners Name
information is
required for every Centerville MA 02632 8-25-16 •
page. City[Town State Zip Code Date of Inspection Y
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑. Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 20'+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database- explain:
You must describe how you established the high ground water elevation:
Ck area and abutting property. Leaching area is high
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc-rev.6116 Title 5 Official Inspection Form,Subsurface Sewage Disposal System-Page 16 of 17
Aug 25 2016 20:19 Jim The Inspector Man 5085349919 page 17
Commonwealth of Massachusetts
fi
_ - Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
186 Lake Elizabeth Drive
Property Address
Craigville Conf. Center(Dawn Hammond CFO)
Owner Owners name
information is
required for eery Centerville MA 02632 8-25-16
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
i
t5lns.doc•rev,6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:—�
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppf ration for Mispo8al bpstrm Construction Pffmit
Application for a Permit to Construct( ) Repair(V Upgrade( ) Abandon 00 ❑Complete System [Individual Components
Location Address or Lot No. i g(p LAKie CL(?A Owner's Name,Address,and Tel.No.
CAmrgJl"C— ¢ONE
Assessor's Map/Parcel C V l e-4
Installer's Name,Address,and Tel.No. OS'tf"►T— �T ( Designer's Name,Address,and Tel.No.
C.A &Vwc- �vvtcc DQisc S [,44-
i5 c r 5 r M=45Nt� (41A
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Sig Date
Application Approved by Date lr _?-VApplication Disapproved by Date
for the following reasons
Permit No. oo (D "� t'ip Date Issued
No. �-^C/ 1 �i' . Fee �( J /�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:: /
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZippliCatlon for Disposal 6pstrm Construction Permit
Application for a Permit to Construct( ) Repair)� Upgrade( ) Abandon( ❑Complete System [Individual Components
Location Address or Lot No. 19(p LAKE 6(-(7 4$6Tr1 pk Owner's me Na ,Address,and Tel.No.
C`Ylc.C.0 cR4rF�victE cofjF�cnCC TEX.
Assessor's Map/Parcel aa(c,� " I F(o L^46 GU2A&G74 tip, cpAl45tlr
Installer's Name,Address.and Tel.No. Designer's Name,Address,and Tel.No.
0-AP6 vcoC FviovlsG s CILCI
Type of Building:
I� Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ,/` gpd Design flow provided �l gpd
r
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
'W
Nature of Repairs or Alterations(Answer when applicable)
,L18,�N�ant LAs*�t-f tj6x T� T
CGL-'�tzy ��� �SEs�r✓ �5���',1'dG ZJ4�1(�
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Sign Date !`!�
Application Approved4y Date l/�?0 t16
Application Disapproved by Date
for the following reasons
Permit No. Ziy' / ' �a ( Date Issued ( to
---------------------------------------------------------:--------------------------------------------------------------------------°
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(1() Upgraded( )
Abandoned(X)by QAp&(, 1 vE CQ i7m pse;5 c� L L<Z
at /2ro Uk8 ELIZ46CMI ]DQJ U& C IV(c.cg has been constructed in accordance ,
with the provisions of Title 5 and the for Disposal System Construction Permit No.7 6 _ 78f dated k.11 ( 7DI(n
Installer (2AP&k.)f 06 G- tZ�dhus(5S LLQ— Designer WA
#bedrooms 4` - Approved design flow and
The issuance of this pe it shall not be construed as a guarantee that the system will fun'tion s de i ied.
Date 7 , Inspector
------------------------- - _
- -------------------------------------------- -
No. ? �S I Fee ZS cv
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
33isposal 6pstrm (Construction Permit
Permission is hereby granted to Construct( ) Repair()0 Upgrade( ) Abandon
System located at 1 2(0 LA411: L I !M�!-if l mt U C, JEE T y I U-.1r
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Co stru tion must be completed within three years of the date of this permit.
Date Approved by
d Li ' f
C
v TOWN OF BARNSTABLE
CI�
'0 BOARD OF HEALTH
ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
Date _oqa, - (;�0 V4'-'-a
Owner Tenant /
Address Address /
Complionce Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities as
C �
3. Bathroom Facilities
4. Water Supply 01
5. Hot Water Facilities /
6. Heating Facilities
i
7. Lighting and Electrical Facilities I
8. Ventilation
9. Installation and Maintenance of Facilities j
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements j
14. Insects and Rodents 0 Mr, COO �
GOAOL
15. Garbage and Rubbish Storage and Disposal n
WA
16. Sewage Disposal
17. Temporary Housing
PART II
7 Placardin of Condemned Dwelling;3 g 9- s 1 ' i 08�5
Removal of Occupants; Demolition
P jA)
I
Person(s) Interviewed Inspector
If Public Building such as Store or Hotel/Motel specify here
HOBBS&WARREN,INC.
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
6f
DateI(V6 0' �0'-r4enant
Owner �n6 1.- Q
Address Address
Compliance Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents r v6s) C�
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal J Sf9
1640 L"--
WA
17. Temporary Housing
PART 11
37. Placarding of Condemned Dwelling; O
Removal of Occupants; Demolition
G a
Person(s)Interviewed Inspector
If Public Building such as Store or Hotel/, otel specify here
HOBBS&WARREN,INC.
TOWN OF BARNSTABLE
BOARD OF HEALTH
a
ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION
i
Date � / n
Owner /�/ ( �`�-` Tenant
Address Address
Compliance Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water FacilitiesV �Q 0
Ell
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11.. Space and Use
12. Exits y
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents c0j) P65 j
01/
15. Garbage and Rubbish Storage and Disposal �' C -
v J
16. Sewage Disposal j J
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demoli 'on
0 a
Person(s) Interviewed Inspector V
If Public Building such as Store or Hotel/Motel specify here
HOBBS&WARREN,INC.
1
r
a
C"P � OWN OF BARNSTABLE
CPO BOARD OF HEALTH
ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION
Datei
Owner Tenant I �-d` A (�Y V --C�����'
Address Address
Compliance Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities Jur
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and DisposalA3
i��
16. Sewage Disposal 0 WIET:e;EC-1- WE`
17. Temporary Housing Sr
PART II 6AIW ---W
37. Placarding of Condemned Dwelling; fyv
,F�(
Removal of Occupants; Demolition !! �\
Person(s) Interviewed Inspector )
If Public Building such as Store or Hotel/Motel specify here
HOBBS IN WARREN.INC.
COW,
C ( c 1� C"-C
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
Date Q
Owner Tenant n
Address Address
Comp i9cce Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water SupplyA P
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents J)%
15. Garbage and Rubbish Storage and DisposalbA A U)/Q
�!L
16. Sewage Disposal
17. Temporary Housing
PART II ��
37. Placarding of Condemned Dwelling; vD��
Removal of Occupants; Demolition
�V
Person(s) Interviewed u"rInspector ✓V
If Public Building such as Store or Hotel/Motel specify here
HOBBS&WARREN,INC.
�THElOI.._Qn Town ®f Barnstable
Department of Health, Safety, and Environmental Services
+ BARNSTA11M •
MAW Public Health Division
1639•
AIFDA 367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
SEATING 160 ANNUAL x SEASONAL
ASSESSORS MAP AND PARCEL NO. Map (--266 #97 DATE T)PrPmher 1 1007
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
Massachusetts conference of the United Church of Christ
FULL NAME OF APPLICANT At Cra i giri 1 1 a C'nnferenre renter
NAME OF FOOD ESTABLISHMENT INN DINING ROOM at C,raigville Conference Center
ADDRESS OF FOOD ESTABLISHMENT 208 Lake Elizabeth Drive-CraigviIle, MA 02636
TELEPHONE NUMBER 508-775-126S
TYPE OF ESTABLISHMENT: X FOOD SERVICE RETAIL FOOD
BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD
TOBACCO SALES FROZEN DESSERT CATERING
SOLE OWNER: YES NO
IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 042-104-697
STATE OF INCORPORATION Massachusetts
FULL NAME AND HOME ADDRESS OF:
PRESIDENT The Rev. Bennie F. Whi ten, jr - P n Rnx ??46 - Framingham, MA n1710
TREASURER Mr. David Shumway it ITit
CLERK Ms loan Vander V1 i et IT 11 it
O (Director)
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS 39 14oso-,4v�-Craigville, rJA 02636
HOME TELEPHONE# 508-775-1265
foodest/db/q
*°tr�l�e—. .:+�"� , �rear�: .. --- :_ - ., ..:^•a-={ ..+,. .,,..�,�, �,'G- a.s: � - ;�.. y
: w ev�its`�.,,,7..d.�y,�7'�k� r .1• '�-�iy°"'�x+...:.n'"� "�.r��u'�ra wxn:'k��Pii� s`y;•} iy+r��� y.�'aM s-++•+i r.saT.�'F
C
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION
Date /9C
Owner Tenant
Address Address J Q,�
Compliance Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities VOL f
3. Bathroom Facilities ,b
4. Water Supply
Y,
5. Hot Water FacilitiesQNt)u v�
L
6, Heating Facilitiesok
7. Lighting and Electrical Facilities v,
t.
8. Ventilation till-
9. Installation and Maintenance of Facilities ff
10. Curtailment of Service v
�.Gi'Ge u
11. Space and Use _ S
12. Exits !.@y Y l ¢ 6U
13. Installation and Maintenance of Structural 46 e Ao-f G•V b
Elements (,
14. Insects and Rodents V ✓U Lll� I
15. Garbage and Rubbish Storage and Disposal -7 C41 /Cy � !
16. Sewage Disposal
17. Temporary Housing ✓ ' /a �� _
PART II
(`r5
37. Placarding of Condemned Dwelling; �J � 1/e�-�J
Removal of Occupants; Demolition cJ
U
Persons)Interview kVk
Ins�or
tl I << • �h
If Public Building such as Store or Hotel/Motel specify here /Zf
HOBBS&WARREN.INC. a /
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owner Tenant
Address Address
Comp iance Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities or, P-100W
3. Bathroom Facilities v44A
4. Water Supply ce)V-e-- (w 04
5. Hot Water Facilities
6. Heating Facilities 4-
7.1 Lighting and Electrical Facilities KA
IA 0 lam"
8. Ventilation
i. 4o-it pejq-a ylitzme;
9. Installation and Maintenance of Facilities -4e—t porce) (-w 5-ujt,7.4, (u o'
r 7
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART 11
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
n Person(s) Interviewed 1A - Inspector
If Public Building such as Store or Hotel/Motel specify here
Hoaas&WARREN,INC.
1
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION
Date b'0
L
yea ,l �/� U� /�� 1 n '
Owner /„/� l�Oh�', G� U!'!/�G� l C�l�zfjLTenant �Uoci12.
Address, 9 F /w )4Ue, e-flr-1 Ulf t Address -3 r/
Complionce Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities /
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal (�
16. Sewage Disposal ✓
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s)Interviewed Inspector /* �✓
l
If Public Building such as Store or Hotel/Motel specify here
HOBBS&WARREN.INC.
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owner ,4 6 Uh/74 `"� Tenant
CA A--6f
Address _ F-yS,�'ra �leY'i/P Address /!/7"r /' /P `� :� (l/z '
Complionce Remarks or
Regulation# Yes No Recommendations
it
2. Kitchen Facilities
3. Bathroom Facilities V I'l 4, ire w' d T n D
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities Wi#� iwt]kn w ��
�- J~0 U►
10. Curtailment of Service
11. Space and Use
12. Exits L-r
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal v
is 17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
" /2Person(s) Interviewed Inspector
If Public Building such as Store or Hotel/Motel specify here
HOBBS&WARREN,INC.
TOWN OF BARNSTABLE
BOARD OF HEALTH
Q ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION
Date / / E
Owner
AA Coft t 64 Vh 44) o f &$-"',(/Tenant
c� ,�,
Address 3 / �Y� 7 � Address �/ (.'!i'� �� ✓�-�� iS. (Jj�C�
/
Compliance Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition f� 1
h'
00 l
Person(s) Interviewed Try Inspector //
If Public Building such as Store or Hotel/Motel specify here
HOBBS&WARREN,INC.
Ill
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owner �h7� 0 6f Tenant V �d V�'� /�✓U t��
Address Ale Address
Compliance Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
i
8. Ventilation
9. Installation and Maintenance of Facilities / Q0,1 1t s�
Cl ✓�-.
10. Curtailment of Service
i
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
i 14. Insects and Rodents /
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s)Interviewed ! Inspector
If Public Building such as Store or Hotel/Motel specify here
HOBBS&WARREN.INC.
117
TOWN OF BARNSTABLE /
BOARD OF HEALTH V •
�--� ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owner' /4 Ael � � � tom:s��M✓� ��0/J/yfenant t1q,I41
Address Z ,el �`4&e %ri`;�'Address
Compfiance V Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities V
3. Bathroom Facilities - A - l,2
4. Water Supply �- M f rx'6z,;''I-z�/ "` s ! T
5. Hot Water Facilities
6. Heating Facilities C J11 V �
7. Lighting and Electrical Facilities "
8. Ventilation \ 4/
9. Installation and Maintenance of Facilities
10. Curtailment of Service 1/ i Y
11. Space and Use J` 4
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal/ ?` ti .�l?� .� ✓
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
r
Person -►s) Interviewed � ��4A` ��� �.Q�� IC4 Inspector-" e4�`""i..�J�l/�.
1
If Public Building such as Store or Hotel/Motel specify here 1
HoBBs✓jC WARREN.INC. !,f
TOWN OF BARNSTABLE
_ BOARD OF HEALTH
-^ ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION
Date f
Owner (�/� /� Tenant
Address � C ..� Address
Compliance Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
c
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service �Jr�
11. Space and Use
12. Exits 41
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition /
1 1
Person(s)Interviewed_- � Inspector
7Piq J i
If Public Building such as Store or Hotel/Motel specify here
HOBBS&WARREN,INC.
TOWN OF BARNSTABLE �' 'r ��
BOARD OF HEALTH �7
/ ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
Date / .�... /�J �
Owner /r/.G� `: Z� �� �� /i/ an"t , a ti►� w�� _� �
Address �` Address ,Yr� �
p� Complionce 0 Remarks or
Regulation# Yes No Recommendations
2. Kitchen Facilities /^
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities , j
a
10. Curtailment of Service
11. Space and Use k1
/7
12. Exits
4 ,� �..
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal (=J 7 .,� �t
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s)Interviewed --r ? Inspector
If Public Building such-as-Store or Hotel/Motel specify here
HoBBs&WARREN,INC.
TOWN OF BARNSTABLE
ov
BOARD OF HEALTH
ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owners 4 Y tof 00 `r,a" e ?.
Address ' //i Address
4
Complionce Remarks or z
Regulation# ( Yes No Recommendations
Facili
ties i 2. Kitchen act es
3. Bathroom Facilities / 1
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
N
y _ C
7. Lighting and Electrical Facilities
8. Ventilation s !9
9. Installation and Maintenance of Facilities c
10. Curtailment of Service 11- 1 z r
11. Space and Use ,l Q'f �16 ;L---777
12: Exits ' ` /
1.3. Installation and Maintenance of Structural
Elements l'.�.I f-� /,`�,�• �l�ct�r ..
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal 12 hl <%/,/ ,/ 7+ Z F J- 7
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Interviewed Inspector /fei1 .E r1
If Public Building such as Store or Hotel/Motel specify here
HOBBS&WARREN.INC.
�69 ."�7� 3
TOWN OF BARNSTABLE
f BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date ....�-- -------------------------------
Owner �42-_�'`v� Tenant
- -- -----------
Address -------------14�p------------ Address
----------------------------�- -
Re
Compliance ;i arks or
Regulation # " I Yes No Recommendations
i
2. Kitchen Facilities i I�
3. Bathroom Facilities I� v �I ���� _ :�✓"�"`— �'y�"
4. Water Supply ,r•-� I� V,
5. Hot Water Facilities
6. Heating Facilities � 5 �77
7. Lighting and Electrial Facilities t�
8. Ventilation
i
9. Installation and Maintenance of Facilities
10. Curtailment of Service /I �4 _5 f��� f�
11. Space and Use �✓ 1 r
12. Exits
13. Installation and Maintenance of Structural /
Elements Y
I
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Interviewea. , Inspector ------------------------------------------
- - - - - -
If
- �/✓ L �J�
Public Building such as Store or Hotel/Motel specify here ___ __-.-______-._____.._____-_.-________________..___.______
HONDO d WARREN, INC.
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE 11: MINIMUM STANDARDS FOR HUMAN HABITATION
Date _r!`.._ t_
Owner
_. 1- /l�l. -� � il Tenant iLll
Address ---- 'L--,---- C—----- ---- ----------�J--------g(�� �v', � -�s��'�%L 7
----------- Address _�O� �-----�---------
----
i Compliance ; Remarks or
Regulation # (/ ! Yes Pfo I' Recommendations
2. Kitchen Facilities j
3. Bathroom Facilities ! \
4. Water Supply ��.�€'Y1 I an 1I�,��?*���E�••=�> �---�/�
5. Hot Water Facilities
6. Heating Facilities CA
7. Lighting and Electrial Facilities J
I j
8. Ventilation
9. Installation and Maintenance of Facilities I
10. Curtailment of Service
11. Space and Use /
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal �,�
17. Temporary Housing A
PART II �
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Interviewed 1_ ------------- _______________ _____ Inspector " 6 "c _ /_ J� `�
— -
If Public Building such as Store or Hotel/Motel specify here .._____.______ ._____________________________.,___.____-__.------- -------.-___-.__-__
M 013138&WARREN• INC.
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date e.�
Owner -16--!/ Tenant __^ _
Address -''' �-L�rs, lI/gip - Address �J -------------
Compliance ;; R marks or `
Regulation # I Yes No 11 Recommendations
i
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supplyn/ I (�
5. Hot Water Facilities �'I— I V.
6. Heating Facilities 6.4 5 , i
7. Lighting and Electrial Facilities I wa,
8. Ventilation I (�
—i
9. Installation and Maintenance of Facilities I V
10. Curtailment of Service
11. Space and Use (/
12. Exits v5X
13. Installation and Maintenance of Structural r�
Elements t�
I
I
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling; 1
Removal of Occupants; Demolition
I I
Person(s) Interviewed ____.- `__) I -_- -___-_____ Ins ector
�1
v
If Public Building such as Store or Hotel/Motel specify here .._____._.._..__....___ -----------------------------------------------------------------------...._
NORD*d WARREN. INC.
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date - ----
Owner ------------------------ ----------------------------------------------------- Tenant -------------------------------------—------ --------------------
Address --- /1 Of----------- ---- - -- ! C--------------- Address
Compliance i; j` Remarks or
Reoulotion r II Yes No �� Recommendations
2. Kitchen Facilities II III_
3. Bathroom Facilities
4. Water Supply II
=5. Hot Water Facilities
b. Heating Facilities
�I
7. Lighting and Elecirial Facilities
8. Ventilation II '
i9. Installation and Maintenance of Facilities I ;
' � I
10. Curtailment of Service
I
11. Space and Use I i'
12_ Exits I a
I
13. Installation and Maintenance of Structural
Elements • r v ��� , `�SS iP ) ��� r�a.
14. Insects and Rodents
15. Garbage and Rubbish Storage. and Disposal
16. Sewage Disposal
17. Temporary Housing
_PART II -
37. Plocarding of Condemned Dwelling;
Removal of Occupants; Demolition
Persons) Interviewed/a=(_ �'i'��� __ Inspector---- �_� l - _
If,Public Building such as Store or Hotel/Motel specify here
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date - ------ �
Owner ------------------------------------------------------------------------- Tenant -------------------------------------------------------------------
Occ
Address ---- - ----------- -- Address - ---- - - -- -------------------------
-
Compliance d Remarks or
Reaulotion �r Yes No 1i Recommendations
2. Kitchen Facilities II II
I
3. Bathroom. Facilities II di_ jG��ti'»cd n61
r,?
4. Water Supply I fly II
5. Hot Water Facilities
i
6. Heating Facilities I '✓/ -
7. Lighting and Elecirial Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
'10. Curtailment of Service I I�
11. Space and Use
12. Exits I .�
13. Installation and Maintenance of Structural
Elements r
14. Insects and Rodents
15. Rubbish Storage Garbage and Rubb a and Disposal
g � g p
16. Sewage Disposal C-
T
17. Temporary Housing I1
_PART II
37. Plocarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) �Interview e" �., .._ _,� nspect or _----
6%—Z%%-C.-• � s-:-- �" �-�'= I -
If,Public Building•such as Store or Hotel/Motel specify here
a
TOWN OF BARNSTABLE
' BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owner ---- -�7 b-----( ------e,__ >_r1 `A_� Tenant --------------
Address .� �4 _ ______!=_C� Address
---------- ----------
:! Compliance ii Remarks or
RegulationYes No 11 Recommendations '
2. Kitchen Facilities C �
3. Bathroom Facilities I I
A. Water Supply ( II <<
5. Hof'Water'Facilities - -
i f
6.. Heating Facilities II
7. Lighting and. Electrial Facilities II
i
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service I I
I
11. Space and Use I
- r
12. Exits j.
t
13. Installation and Maintenance of Structural x -)Q-CA
Elements
J 1
14. Insects and Rodents
15. Garbage and Rubbish Storage: and Disposal I1 l
16: Sewage Disposal -
17. Temporary Housing I) _
_PART II
37. Plocarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Intervtewe Inspector
If,Public Building such as Store or Hotel%Motel specify here
TOWN OF BARNSTABLE
BOARD OF HEALTH
f
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date t s v y
Owner ,. ' � "�'" ^'��'' Tenant
Al
Address' Address
Compliance Remarks or
Regulation # Yes No Recommendations f'J
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
b. Heating Facilities
7. Lighting and Electrial Facilities
8. Ventilation
O�
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural f
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Interviewed = - - - spector
If Public Building such as Store or Hotel;Motel specify here ---------------------------------------------------.__-------_-----.--_-__--------_.---_-------
TOWN OF BARNSTABLE
BO RD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date �e
Owner ��°" 7/^�' �` rr^ Tenant
of �
Address �~ '''�` "'� Address
Compliance Remarks or
Regulation # Yes No Recommendations
2. Kitchen Facilities
i
3. Bathroom Facilities - �,r.�� . cp l ✓
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrial Facilities -'
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use ,
12. Exits `
13. Installation and Maintenance of Structural
Elements ,
14. Insects and Rodents � l
9"
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal ��� •� �- � �r��
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
-
Person(s) Interviewed ---- Inspect f/
- i
If Public Building such as Store or Hotel;Motel specify here ---------------------------------------------------- --------_-------------------------__
ti TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION y
Date ��0
Owner Tenant
1r
Address �"�f-' f Address
Compliance Remarks or
Regulation # Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities 4
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities /
7. Lighting and Electrial Facilities
8. Ventilation
9. Installation and Maintenance of Facilities ,
10. Curtailment of Service
11. Space and Use ~
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II `-
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Interviewed ----------------------------------- Inspector ---
-----
If Public Building such as Store or Hotel./Motel specify here -----------------------------------------------------____.._---------------------------___-_---_-_
Mr. Rnn Gifford FROM Richard H. Eggers, Jr., Director
TO Board of Health WIGIJILLIo cm'rp'u,.0 ce
TOM-of Rarngtahlp Craiville,, Massachusetts 026.20
367 Main Street
Hyannis, MA 02601
SUBJECT: Groves House - Septic System DATE: January 13, 1984
FOLD rnnfirming nur telephone conversation today, the Conference Center will install an
anceptable septic system for Groves House this spring We have already discussed this
matter__ and have received a Quote from the Robert B. Our Oman• the same organization that
instal-led-the main septic Aystem for the Tnn- Tbie work will be started as soon as weather
Hopefully' thin will he he T.aST septic system we'll have to deal with. Thanks for
your, belp and enoppratinn.
PLEASE REPLY TO SIGNED4115�4 , LOP
DATE SIGNED
GRAYARC CO.,INC..BROOKLYN,N.Y.11292 THIS COPY FOR PERSON ADDRESSED
S
Mr. Ron Gifford TO Richard H. Eggers, Jr., Director
FROM Board of Health
Town nf Barnstable
367 Main Street
SUBJECT: Groves House — Septic Systm DATE: January 13, 198
FOLD
Confirming our telephone conversation today, the Conference Center will install .an
as table septic system for Groves House this Miring, We have already discussed this
natter and have received a tl'ote from the Robert B. Our Q=any, :ihe Same or $at�i.on that I 4
J t`
Installed the main map ti ry a3mtem for the I=. Th4 a work will be started as soon as weather
.conditions Dermit.
Homey, this will be the T AST septic system wee 11 have to deal Stith. Thanks for
Your he3jj and co=eration- 1 � f
—.
R E T U R'N T O -� SIGNED �` .1-.a'• > [�G, c.`'/ ""`` j
i
DATE SIGNED
I
GRAYARC CO.,INC..BROOKLYN.N.Y.11232 PERSON ADDRESSED RETURN THIS COPY TO SENDER
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owner i /�� (l. , , r��. _ Tenant
Address >> v 1. f' Address _
Compliance Remarks or
Regulation .# Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
el
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrial Facilities r"lMr
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural `
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal I
1 ,
16. Sewage Disposal
17. Temporary Housing
PART II
i
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Interviewed __._..__._ ___________ Inspector ___
-
-------------------------
IfPublic Building such as Store or Hotel/Motel specify here _____________________________________-_________--__-.._-_.______________.._..________________...._
TOWN OF BAR TABLE
NS
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date�a �0� �-f
Owner ��� . ,�- r. Tenant
Address `i �. :gym as 'Address _
Compliance Remarks or
Regulation # Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply 7
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrial Facilities : `"
8. Ventilation
9. Installation and Maintenance of Facilities , sir-otM• '�
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition I
t i
Person(s) Interviewed -------_. --- ---------- --------- Inspector
r\ -------------------- ----- -
U
If Public Building such as Store or Hotel./Motel specify here -----------------------------------------------------..____--___-_----___._.--______.-___-_--.._
TOWN OF BARNSTABLE
j
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owner ' �p C 44, Tenant
�d
Address �.17� .a� n. Address
Compliance Remarks or
Regulation �} Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities �,,' ✓ - S +,
4. Water Supply '
5. Hot Water Facilities
b. Heating Facilities
7. Lighting and Electrial Facilities
8. Ventilation
9. Installation and Maintenance of Facilities `
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition f
o G7" ' ! r
Person(s) Interviewed __...__.__ __--_-_-- Inspector ____--'_________________________________
�y----------------------- - ----------------------------�
If Public Building such as Store or Hotel;Motel specify here ______________________________..______-_____--_-____-_..__-.._-______-_-___._.__-_____..__-----___
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owner �.n ��. �...� Tenant
id
Address _ / � w ' Address
Compliance Remarks or
Regulation # Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply -
r
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrial Facilities 1
8. Ventilation
9. Installation and Maintenance of Facilities ..
10. Curtailment of Service
Gv,rs�r... C:�� s2a ram.
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
f
Person(s) Interviewed ----------- Inspector
If Public Building such as Store or Hotel;Motel specify here _--_--_.----------------------____--__-----_-------_..--_.---_--_-------.._-------_.-_----
ga.tJ, fo,z 1�F:,1gn c-4:,oci at,,' _qnc.
28 Bam tagle woad
o7tJarcnis, db(og 02601
5081790-g686
Sax 50&/771-i&66
May 7 , 1990
Board of Health
Town of Barnstable
367 Main Street
Hyannis , MA 02601
ATTN: Dr . Grover C . M . Farrish , Chairman
RE: Christian Camp Meeting Association
Craigville Beach Road
Centerville Map 225 Parcel 001
Dear Dr . Farrish:
On May 3rd and May 4th , I inspected the installation of the
subject sewage disposal system . The system was installed in
accordance with the submitted plan dated February 26 , 1990 . The
owner is aware that the system shall be pumped at least once
every three years .
Mgss9c Very truly yours ,
R. G
i GREGORY /
TAYL'OR -1
NO. 27770 N
` Gregor aylo P .E .
«TEP�,��� residen
CC' Mr . Herb Cahoon
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date l ��
Own r- Tenant
Address--7"'C`'`/'ti`t'� Address
Compliance Remarks or
Regulation # Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrial Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Interviewed -------------------------------------------------------------- Inspector =------------- ---------------------------------------------
If Public Building such as Store or Hotel;Motel specify here -------.----- - - -�L�'
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date /
OwnerU� '2 Tenant
Address Address
i
Compliance Remarks or
Regulation # Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
i 6. Heating Facilities
7. Lighting and Electrial Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal ,
r-1/s, o0-
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Person(s) Interviewed -------------------------------------------------------------- Inspector ------------
--------------------------------------------------------------
If Public Building such as Store or Hotel;Motel specify here -_-_-------------------------------------------------------------------------------------------
TOWN OF BARNSTABLE
BOARD OF HEALTH
/J ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date
Owner """ n Tenant
.<</LGA VL r
Address Address _
Compliance Remarks or
Regulation # Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7 Lighting and Electrial Facilities es
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
JL-
Person(s) Interviewed -------------------------- -------- Inspec r ` -t ! -t -
If Public Building such as Store or Hotel,/Motel specify here -- --- --- ---- ---------------------------------------------_--__ --------------------
TOWN OF BARNSTABLE
BOARD OF HEALTH
66 ARTICLE 11: MINIMUM STANDARDS FOR HUMAN HABITATION
G
Date , G
Owner - `�-/�j Tenant
Addre
1 �r 6�% '� -C.2 tn-C-s--• Address
i
l
Compliance Remarks or
Regulation # Yes No Recommendations
2. Kitchen Facilities
3. Bathroom Facilities _
4. Water Supply
5. Hot Water Facilities
b. Heating Facilities
7. Lighting and Electrial Facilities
8.. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
` JPerson(s) Interviewed _______________ - Ins e -'/�-
-----------------------------------------------
If Public Building such as Store or Hotel;Motel specify h e -___-__ __ !
I
No... d.-Ao G FEB ... _
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............. ..........................OF..........................................................................................
Appliration for Disposal Works Tontrttr tort rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
stem at: �eu�cc. �,
..............._... ... ...................__.......r... � -•-•-•r- .................•-••----•---•-----•-----•---__.................. ..........-y-•Location-Addres Lot No.. _....... � ...................................... .. .... .......... -------•--•
Owne Address
a ' ........... ...... --.......
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.......��................................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
WOther fixtures --------------- ------------------------------ - --------- ---- ------- ------
W
Design Flow..... ...:....... ...........................gallons per person per day. Total daily flow....5 _.............._....._.__gallons.
WSeptic Tank—Liquid capacity gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No-------------------- Diameter....A.......... Depth below inlet.....:45Z,:s Total leaching area.��'O'2e.'.Sq�t
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date----------- ............................
a
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+' •---•-•-----------------------------------------------------------------------------•--•-•.....---•-.........................................................
0 Description of Soil........................................................................................................................................................................
x
V ---------------------------------------•------•..............-•------••-•-•••.....---••------------------•-----------------------•-------------------------------------•-----------•-...---------------
W '
--------------------------------------------------------------------------------------------------------------------- --- --- ---- ........ ---
U Nature of Repairs or Alterations—Answer when applicable � -� /���ti' -� 'Jam.` .....
.--
-----------------------------------------------------•--•.
Agreement:
The_undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en issued he?board of health.
Signed ............................fie. - (� 1-' °/
ate /
Application Approved ............�"P�_
........................................ Date
Application Disapproved for the following reasons--------------------------------------------------------------------------------•---------------------••---------
••..........................•----••---------------....-------------------•...----•--•------------....----
Date
PermitNo....................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............OF......... ......................................
Trrtifirtttr of Tontplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
Installer
at............... ...... ---- ......----------------------------------------------.........._....------------------------------.
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...._..60._-....G_Z6....... dated---- .............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. -_. ....----................-••••-•••--_.._.. Inspector....................................................................................
No:_ ..... FEs............. :...._......_
THE COMMONWEALTH OF MASSACHUSETTS.:
"�
°BO oe'RD.!OF HEALTH
F. ....................................
Appliratinn for Disposal arks Tonstr inn permit
--.Application is hereby made-for a Permit to"Construct ( ) or Repair ( ) an Individual Sewage Disposal
stein at: / :
& a
tv"lL e �.'1 tG a r
f
Location-Addre§�� ` g � -Wa ),,,,or
or L'
ot No.am.... . .... ... , ......O I......... ..........•-•-------•-.......................---•--.wn j Address
....... ............................................. ---••-•-----•------•-•--..........------•••-•---•----•••....----....•--•----------••-•--•-•---_...---•---------------------
� Installer Address
UType of Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms.._..-X7...............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------•--•••----------••••----------.•••-----•--•......----------•-•---••------ s......
W Design Flow•.....:..:..............................•_.gallons per person per day. Total daily flow.:=: ✓.__.__._.._...._..._.__:::gallons.
Septic Tank—Liquid capacity:0Q.gallons Length................ Width................ Diameter................ Depth................
W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No------- ---------- Diameter---.A .. Depth below inlet---.. _ aTotal leaching area.611114
Z Other Distribution box ( ) Dosing tank ( )
0.4 Percolation Test Results Performed by.......................................................................... Date........................................
1.4
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ---•-----•-•--------•--------•--•.....•-•--••••--------••--•---•---•-•...............••••-•--•.........----•-------------------•------•------•---...........
0 Description of Soil........................................................................................................................................................................
V ......................••----••--•------•------------•--•-..........-•-------...................-----•......--------•------------•-•----•------•-••----------•---------••---------•--------••---•-------
W
-------------------------------------------•-----------------------•--------------------------------------------------- ------------------------------••-•-------.-- --, ---------------------------
U Nature of Repairs or Alterations—Answer when applicable_____r#ti_ '% ... ....f_?.c_c r ` r. ;z: +5 ,
----------------------------------------------•-----•-•-----------------•-----------.....-------•-•-----••---------------------------------------------•--------------------------------•------•-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance haseen issued by)the board of health fi
Si ned.rC'd s' ..�d?......
Date
Application Approved By... rr� = i -•�!-� --•-••
Date
Application Disapproved for the following reasons:-------•-------•--------------------------------------•-------•-----------------••--•-•--••-----••-•--.....-----
.........-•---....--•.....................•-----••-•-•-•----...----------•---••--•--...----•----...•-----••----------------------••---••-----•------------••-----------••-------------------•-----•---•-
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD /OFF HEALTH
..... .....................OF........ ! .aQ-!-+,�Y ,.......................................
Trrtif iratr of fanmplianrr
THIS IS TO CER IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (I )
: 2
Installer
at-------------- . ....... .......�_ ..
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----- o.......¢ef....... dated--.f 11. —,V_',d.................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............•- --------------------------------------------- Inspector...................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
FEE.........................
Disposal Iforks Cr3anstrndUan firrmit
Permission is hereby granted----.---- .-.... ......-------------------------------------••----------•-•--•----•--...---...............
to Construct ) o,; ReAe
pair ( &o'`an Individual Sewage Disposal System
at
--------------------------------------------------
Street
as shown on the application for Disposal Works Construct
i rmit No..................... Datedd:: I�..- 3 0 -
.--.
DATE..................................
..............................................
Board of tlr
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS c
I
Craf&f le Conference Center
�nn,.a' xnor, 1::ni?$E,aYLi1
Craigville (Cape Cod) Massachusetts 02636
Telephone (617) 775-1265
OPERATED BY THE MASSACHUSETTS CONFERENCE OF THE UNITED CHURCH OF CHRIST THE INN
FOR ALL PEOPLE WHO ENJOY PLEASANT AND CONGENIAL SURROUNDINGS
January 26, 1980
Board of Health, Town of Barnstable
397 Main Street
Hyannis, MA. 02601
Dear Mr. Childs, Dr. Mandelstam, Mrs. Eshbaugh and Mr. Kelly:
Thank you for your letter of January 14, 1980, in response to my
appearance before the Board of Health in December.
At its winter meeting today the Board of Directors of the Christian
Camp Meeting Association, owners of the property doing business as
Craigville Conference Center, voted unanimously to reaffirm the need
to build a small addition to the Craigville Lodge, and to meet the
provision you set.
We agree, therefore, to upgrade the on-site sewage system to conform
to Title 5, State Environmental Code and Town of Barnstable Health
regulations by December 1, 1982, and submit engineering plans for
approval prior to that date. If problems occur immediate action will
be taken since this provision would be invalidated.
You are aware that over a year ago we commissioned an engineering
plan. ' Today we also created a committee charged with examining the
improvement of other on-site sewer systems besides the Lodge. We
will take a careful look at creating a system that can serve several
buildings in the same area, and even at costs and implications of
having a small plant that could service the entire village. We are
well aware that ours is a problem area that could become serious
within our lifetime, and we want to address our problems as fully
as possible.
I hope that this letter will serve as sufficient evidence of our
commitment, and that we will be able to secure a building permit
as soon as possible.
Yours sincerely,
4 � ' - AWA
William F. Hobbs,
Director
Our Private Craigville Beach House with Dressing Rooms and Lockers on the Warm Southern Shore of Cape Cod
,. January -14, t1980
Rev. W1;lliain F. .Hobbs • ' ' S
Craigville conference Center
Craigville - 14A.. ,
Dear Rev. Hobbs:
Thank7y0u• for appearing before the Hoard of Health in December
regarding'•an addit on 'to . the Craig'ville Lodge.
• TheB f
oa ha rd s` rec n o s'd�. er d e u . .o r request
'y' r qu st and will allow an ,
aaa ixon �to• thetodg
e
Prov d ed
you• certify,
t ify, in writing, , that
you will upgrade the .on-»site sewage system to conform to
•Title 5'0 "State .Environmental,` Code and Town of Barnstable! Health
regulations ,by December 1, 1.9820 and submit engineering plans
for .approval, prior to that date, R,
If problems occ%ir, this agreement is invalid-.and you will be .-
D r'equized to `install..;a new separate system immediately that con-
forms► •to 'Title 5, state Environmental Code, ,afid Town of Barn-
stable Health Itegultnns. A
r
Ver truly yours LL
Ro ert L. Milds,w Cha .rman
'yrwrtwfirnrrr,rr.r.r.+rr.r-irrrr _ fi - -
A., W - Mandelstam, M. D.
e -
Ann ''ane shbaug r F r
HOARD OF HEALTH
TOWN, 'OF .BARNSTABLE '``'
November 23,- 1979
Mr Dexter T* Bliss
q Site Manager
Craigville Conference Center
Cra gville, MA.
Dea B : ...
Mr. li s
Thank you for appearing before the Board of Health on` November 21
^ regarding an addition to the Craigville Lodge.
The. Board of Health;Will 'allow an- addition t.o the lodge provided'
-you certifys �in.writing; that you will upgrade the on�site sewage
system to, conform to Title 5, State Environmerital, 'Code and Town
of Barnstable Health regulations by December , 191310 and submit
eng 1'
ineering plans. for approval prior to that date.
" if problems occur this� -.• agreement will' be invalid and. you will be
required to immediately install' a new separate system`.that' con-;
t❑ forms to Title 5, State Environmental Code, and Town of Barnstable
Health Regulations..
very rely yours, , .
Ro rt L Childs, Chairman
A * Mandelstam M.- D
00
Ailri ,
Jane E
au' h
.. BARD OF HEALTH
r. TOWN OF BARNSTA.BLE'
JMK%nau
Craf&file Conf erence Center
,.f
Pipit,Armor, 31:1obge,anb Cottages r
Craigville (Cape Cod) Massachusetts 02636
Telephone (617) 775-1265 a
OPERATED BY THE MASSACHUSETTS CONFERENCE OF THE UNITED CHURCH OF CHRIST THE INN
FOR ALL PEOPLE WHO ENJOY PLEASANT AND CONGENIAL SURROUNDINGS
t
November 21, 1979
TO: The Barnstable Board of Health
Barnstable Town Hall
Hyannis, Massachusetts
SUBJECT: Request For Waiver
q To Allow Addition to"The Craigville Lodge"
The Craigville Conference Center-United Church of Christ and the Christian
Camp Meeting Association respectfully request that we be allowed to increase
the size-.of The Craigville Lodge Prospect Ave., Craigville, to allow for a
more functional dining room and a permanent year-round office. Under no cir-
cumstances will we expand the present capacity of 75 persons in the dining
room or the size of the kitchen. The office staff will also not be expanded.
Although our present sanitary disposal system does not meet todays requir- t
ments it is an adequately functioning system that was upgraded in 1967.
During the last year we have also taken several specific steps to decrease
the load on the system;
1) All showers now have 2gpm shower nozzles reducing consumption 50-75%.
2) All toilets have been modified with water dams to reduce each
flush by 1-2 gals.
3) Our in house laundry service has been reduced to almost nothing with sheets and towels now being sent out to a commercial laundry.
(The implementation of these items has provided approximately a 50% reduction
in effluent from this building)
4) We have established a regular theraputic type pumping system in
both the Spring and Fall.
Sanitary Disposal Syetem Craigville Lodge
Existing System New Requirments
800g+- Grease Trap 1500g
3600g+-(pools) Septic Tank 5588g
3000g+- Leaching pits 4002g
The size of the existing system is an.estimate based on pumping, measurements,
and consultation with Joe MacComber, Ed Lacey and Bruce Lawson. The new
requirments were provided by Baxter and Nye.
Res
Ms tted,
Dext Bliss
Site Manager
Our Private Craigville Beach House with Dressing Rooms and Lockers on the Warm Southern Shore of Cape Cod
,.. � '
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ti ®SENDEP,: Complete items 1,2,and 3.
-st Add your address in the"RETURN TO"space on
reverse.
1 The following service is requested(check one.)
Show to whom and date delivered............
❑ Show to whom,date and address of delivery...�Q
❑ RESTRICTED DELIVERY
o Show to whom and date delivered............_¢
❑ RESTRICTED DELIVERY.
Show to whom,date,and address of delivery.$_
(CONSULT POSTMASTER FOR FEES)
2. ARTICLE ADDRESSED TO:
m Mr. William F. Hobbs -
c Craigville Conference Cente
z Craigville, Ma. 02632
M
m 3. ARTICLE DESCRIPTION:
m REGiSTERED NO. I CERTIFIED NO. INSURED NO.
0019 746
G) (Always obtain signature of addressee or agent)
rn
I have received the article describe above.
rr
mFSIGN,ATURE OAddressee uth ed a nt
Z
cSDATE OF DELIVERY TMARK
m v
D
Z 5. ADDRESS(Complete only if requested)
0m
6
A
� 6. UNABLE TO DELIVER BECAUSE: � CLERK'S
p IGII�IA S
D
*GPO: 9.288-848
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C$300
LFUNITED STATES POSTAL SERVICEOFFICIAL BUSINESS
PENALTY SENDER INSTRUCTIONS USE To AVPrint your name,address,and ZIP Code in the space below. of v , uComplete items 1,2,and 3 on the reverse. UAttach to front of article if space permits,
otherwise affix to back of article. O
I
• Endorse article"Return Receipt Requested"
I adjacent to number.
RETURN
TO
BOARD OF HEALTH
(Name of Sender)
TOWN OF BARNSTABLE
P. 0. Box 534 0
(Street or P.O.Box)
HYANNIS MA 02601
(City,State,and ZIP Code)
oFTHETo TOWN OF BARNSTABLE Copy
OFFICE OF
i BAB E,
MA56. Ft,i BOARD OF HEALTH
y A68.
°°ArE26 .
O MAC a��0 367 MAIN STREET
HYANNIS, MASS. 02601
August 8, 1980
Mr. William F. Hobbs, Director
Craigville Conference Center
Centerville, Ma. 02632
NOTICE OF .VIO.LATION _OF -31-0. .CMR -15-.0.0. .THE STATE ENVIRONMENTAL CODE,
TITLE 5 MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY
SEWAGE
The property known as "The Lodge" at the Craigville Conference Center,
was inspected on August 8, 1980, by Ronald Gifford, Health Inspector
for the Town of Barnstable, because of a complaint. The following
violation of 310 CMR 15.00, The State Environmental Code, Title 5,
Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,
was found:
REGULATION 15.02 (20) : Septage from sewage disposal system serving
The Lodge discharging onto the ground on West side of the building.
This system must immediately be pumped and kept pumped until a new
system can be installed.
You are directed to submit engineering plans to this office showing
the up-grading of this system within seven days after receipt of this
order and have this system upgraded to comply with the State Environ-
mental Code, Title 51 by September 1, 1980.
You may request a hearing before the Board of Health if written
petition requesting same is received seven ( 7) days after the date
order served. ,
Non-compliance could result in a fine of up to $500. Each day' s
failure to comply with an order shall constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
John M. Kelly
Director of Public Health
JMK mm
encl. 2 '��'G` � "�'"/ S' •
Craigbilre Conference Center
�Jnn, Annar, XvbSE,anb
Craigville (Cape Cod) Massachusetts 02636
Telephone (617) 775-1265
OPERATED BY THE MASSACHUSETTS CONFERENCE OF THE UNITED CHURCH OF CHRIST THE INN
FOR ALL PEOPLE WHO ENJOY PLEASANT AND CONGENIAL SURROUNDINGS
August 13, 1980
Mr. John Kelly
Director of Public Health
367 Main Street
Hyannis, MA. 02601
Dear Mr. Kelly:
We have received your letter of August 8, and have acted on it.
Plans have already been delivered to the Board of Health for the
improvement of our septic system in compliance with existing laws.
We will continue to pump our system as there is need--just as we
have consistently done.
It is humanly impossible to meet the September 1 deadline. But
we will continue to work on the problem through bidding and con-
struction stages as quickly as we can.9 and will depend upon the
Board of Health to understand dealys over which we have no control.
Yours sincerely.,
e 4j4
William F. Hobbs.,
Director
Our Private Craigville Beach House with Dressing Rooms and Lockers on the Warm Southern Shore of Cape Cod
4 r
L SCAT I�N /� �/ SEWAGE PERMIT N0.
VILLAGE a.�
Ce-n/ f e--
INST LLER'S NAME 6 ADDRESS
® U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
�C:55
L -Qs� Lit'z ��
....�.... ....... F>s.........'....................
THE COMMONWEALTH OF MASSACHUSETTS SUBJECT TO
A���
BOARD O F HEALTH BARNSTABLECONIN�CONSERIVA`
-- 1--�cr''` . ........OF.... ................... SSiON
Appi ation for Disposal Works Tomitrurtion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:` pp //
--Z.
_.... tio'-Sd3dress /...` �....o I-�. --..---- ..... .........
�a Owner Address
Inst er In! Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons---------------------------- Showers — Cafeteria
a' Other fixtures .................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid"capacity------------gallons. Length................ Width---------------- Diameter......---------- Depth------.---.-----
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No--_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.----------------.-- Depth to ground water-.---.-----..---_.-._...
f.� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-------------
0 Description of Soil.�Q'?...a(...-0. ...... - - ........ --
w ' ---- - ---------- .�� .
.............. --------------- -
--------------- -------------------------- --
V 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 TITLL 5 of the State Sanitary Code— The undersigned further agrees.not to place the system in
operation until a Certificate of Compliance has bM issued by board of health.
Signe _.. 7 6,7
Date
Application Approved By..........� ...................... ------ �:--
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------....................................
................................•------....--•---•------•---•----•--•••••-----•--•---........•--•------••-----------•--------•--•••---------•-----------------------------•---•-•••----•--•---....._....
Date
PermitNo..........-�--�-�------------------------------- Issued-.......................................................
Date
No 5,504.)..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
y..........................................OF........:.::"
........................I....................................................
Appliration for Disposal Works Tonotrurtion "rrmit
V
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at-"
t
........................................... ....................4....... .........O..i5•0.1.4..........7*"--------------------------
Address r t
Z)
43W -----------------------
-------------------- --------------------------- ------
ner AddZy, ?,/.e
.. . .......................................... ..................................................................................................
............... .............................. Address
Type of Building Size Lot----i......................Sq. feet
U
Dwelling No. of Bedrooms............................................Expansion Attic Garbage Grinder
P4 Other—Type of Building ............................ No. of persons_...................._______ Showers Cafeteria
PL4Other fixtures ......................................................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity............gallons Length................ Width.......__._..... Diameter_____._......... Depth............__..
Disposal Trench—No..................... Width..............._._.. Total Length___......_..--._.... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.__................. Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I----------------minutes per inch Depth of Test Pit_._..........._._... Depth to ground water........................
�14 Test Pit No. 2................minutes per inch Depth of Test Pit...____.........._.. Depth to ground water......___..........._...
............................. ..........**'*'*---------*.........1_1*11------------------*
, 0411-0 Description of Soil.....__ ....2-0 .0 ................<Z......... ..........................................................................................................
............................ . . .............. .......
.......................... ......................... ........... ....... ......... .. ..........
U ------------
----------
-Answer when apflitable_*5/�------------- ........................
--------------------*------*-------------*----------X----------
Nature of Repairs or Alterations
................................................................................................................................................................................................ ......
Agreement:
The Undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE:, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b en issued by/he board of health. I f
.." '6_ 0�- 4�1_c e
Sign . . ....... ........................
............. F.. ........ .
. -----
..
.14 `7-- -------------------
ApplicationApproved By........ .................................... ........................................
Date
Application Disapproved for the following reasons:..............................................................................................................
........................................................................................................................................................................................................
Date
Permit No. -::U1............................... Issued.................................. ..........
............ ...
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... ..........OF........4?*a4`1�. ........................................................... ... ........ .......
Tntifirate of Toutpliattrr
THI,�IS TO CeRTIFY, That the Individual Sewage Disposal System constructed or Repaired,,,(
........by...........
I--n-s-t-a--l-e--r
---------nte------------------------------------------------------------------------------
at.......... ................................................. ----------- -----------*---------------------------------------- -----------------*---------------
has been installed in accordance with the Wovisions of TITLE 5 of The State Sanitary Code as �escribed in the
....*....
application for Disposal Works Construction Permit No------- ...... ............. dated.............. -;r..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL RINCTION SATISFACTORY.
0 CC
DATE..................X. •IC'..7.....>.. ...................... Inspector......../............. ........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD,OF HEALTH
....OF.....! ..........................................................
........ ............
No..... .0'—, '04 FEE........................
Disposal Works Tomitrurtion "Pumit
Permission is ------- ----------
hereby granted. ........I.........................................................................
to Construct or Repair Kan IndividualSe Tage Dispo Syslem
6
at No..... ......... ..................../.....r C'-�I Y-A..................... . .....
Street
.. ........ '/7"
as shown on the application for Disposal,Wo s Construction Permit No --- Pated...... ........ . ....
.........................A.....C.,------- ....
Board of Health ........
DATE-----------------fl -.2f......................................
FORM 1255 HOBBS &WARREN. INC., PUBLISHERS
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Hancor, Inc.
P. 0. Box 726 Union Station
100 Latourette Lane
Endicott, New York 13760
pacesetter in plastic drainage products Phone(607)748 7336
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L0CATI N SEWAGE PERMIT NO.
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DAT E COMPLIANCE ISSUED
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OF THE
a BnaaST"LE, 8 TOWN OF BARNSTABLE, MRCPS.
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SEWAGE DISPOSAL PERMIT
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Health Officer.,
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SEWAGE DISPOSAL PERMIT f
Permission is granted to --�-a---g____ _____ ____ �_______ to construct �_`°_� �� ��' ---
Upon the Premises of � 'ate 0 kz..4 04—e-u4d41 Sketch
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Health Officer.
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10 feet from property I'ne �• 'h•f t�ri �° $> aS
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P�OF7HETO�y OFFICE OF THE BOARD OF HEALTH
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BAHHSTAU % TOWN OF BARNSTABLE, MASS.
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SEWAGE DISP®SAL PERMIT
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MASS.
SEWAGE DISPOSAL ' 6MIT
Permission is granted to
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Upon,the Premises of
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