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HomeMy WebLinkAbout0495 SHOOTFLYING HILL RD - Health 495 Shootflying Mill Road Centerville A = 213 002 lllt J�OYC{E0� 1111 UPC 10259 �. No.H_ 630R NASTINOS YN i. w Town of Barnstable Barnstable 'THE T�ti Regulatory Services Department i erieaC'1 SrAUM "`" ' Public Health Division i679• �� m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8483 February 7, 2017—2ND NOTICE { Barbara Doherty 495 Shootflying Hill Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 495 Shootflying Hill Road, Centerville,MA was inspected on 12/29/2016 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date 7 you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health x _ QASEPTIC\Letters Septic Inspection Failures or Future Evl\495 Shootflying Hill Road Centerville 2nd notice-Copy.doc �tKE r� Town of Barnstable Barnstable .�ti Regulatory Services Department 1 mical0 j .AxivseABM �m 91639. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847. 8377 January 12, 2017 BARBARA C. DOHERTY 54 GERALDINE LN BRAINTREE, MA 02184 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 495 Shootflying Hill Road, Centerville,MA was inspected on 12/29/2016 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. '' Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH OARD OF HEALTH cKean, CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\495 Shootflying Hill Road Centerville.doc r NAME OF OFFENDER 13 A R- j /) (L ,/,� �••� �y 't�' E ,.�r 777]BAR 80000 TOWN OF ADDRESS OF OFFENDER / `T r tJ V G tv. DAR�S'I ADLE CITY,STAT ZIP CODE - - pf I E► . „ HARNSIABLE. LJ MASS. ire CD LU TIME AND DATE OF VIOLATION ,�; V. LOCATION OF VIOLATION { �A � Z NOTICE OF (I (A.M./ P,M,)ON AVQ V 0 ,20 01 Lo-5 5#00'l�€h W'(1 i�f t I lVt1 � SIGNATURE OF ENFORCIN PERSON ENFORCING DEPT. �'�' BADGE NO. N f VIOLATION `L �,..7` Pc, ( ��, �/ o OF TOWN r- I,,HEREBY ACKNULEDGE RECEIPT OF CITATION X. a ORDINANCE R�Qnable to obtain signature of offender. THE NONCRIMINAL FINE FOR THIS OFFS SE IS S �p ov Date mailed W W OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION a (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, W before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.Q.Box 2430, d Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to,pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature arc - 3y- b93 SgNDER:'COMPLETE THIS SECTION • • ON DELIVERY ■ Complete items 1;2,and.3.Also complete Aylkgnature bovm item 4 if Restricted Delivery Is desired. ❑Ag nt . E ■ Print your name and address on the reverse ElAddressee so that we can return the card to you. B. Received by(Printed Name) C. date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. I 1.Article Addressed to: D. Is delivery address different from item 1? []Yes If YE r address below* I Ns Barbara Doherty a �p� Z 2���', I 54 Geraldine Lane �`o6 = Braintree, MA 02184 3.pl�"�Type Q CO pressQ etum Rece dise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number i 7 0 0 5 116 0 0 0 0 0; 0191 10 7 51' f Cb (Transfer from service label) ' _ PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 I UNITED STATES POSTAL SERVICE ' First9ass Mail � • Sender: Please print your name, address,- iT21?-�Mfk� oz Town of Barnstable { j f Health Division 200 Main Street Hyannis, MA 02601 1113i'!11141 11jldl!!1!!!!11l1lt1113 f��it�ll,ft�li'ilii!!!l!1!}!f 1iealth Master Detail Page 1 of 1 cii i.: ;4. I lvaN;•✓zrrirtt« a tifc3a Application Center Parcel Lookup Selection Ite€-s Parcel eptic erc T Well 'ue T nk' I Parcel: 213-001 Location: 495 SHOOTFLYING HILL RD, CENTERVILLE Owner: DOHERTY, BARBARA O Business name:yy Business phone 1 ... .._. __. _._._.... _. . F___ i Rental property: Deed restricted: Number of bedrooms Contaminant released: l Fuel storage tank permit: I Sage Parcel Changes Return to Lookip _... _.....,_. _....._. _.__. _ ......... ___.... ._. Parcel Info Parcel ID: 213-001 Developer lot:LOTS 4A K 5 Location:495 SHOOTFLYING HILL RD Primary frontage: 180 Secondary road: Secondary frontage: Village:CENTERVILLE Fire district:C-O-MM Sewer acct: Road index: 1484 0: Asbuilt Septic Scan: 213001 1 Interactive map: r GP (Groundwater Protection OverlayTown zone of contribution: State zone of contribution:IN District) Owner Info Owner: DOHERTY, BARBARA C Co-Owner: Streetl: 54 GERALDINE LN Street2: MA Zip: 021E34 Cou€ City: BRAINTREE State: USA Deed date: 111/15/1982 Deed reference: 3599/-184 Land Info Acres: 0.52 Use: Single Faro NIDL-01 Zoning: RD-1 Neighborhood: C Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location:Water View 1930 1875Construction Info Bzlldi �rYcar BuR fEctive Area 1 3 Bedroom Full + 1H Buildings value:$162,700.00 Extra features: $0.00 Land value: $222,4C6.00 t http://issql/intranet/healtbMaster/HealthMasterDetall.aspx?ID=213001 7/10/2009 �. tapeCodRentalxom Page 1 of 2 _ RINLIN GMJ MA rote ,� OV R RWE flt y visit; www+a.kintingrover. Cape Card Real Estate Business Search Cape Cod Classifieds On-Cape MyCa Account Login Members Search LSaved Searches Saved.Ads ji My Listings. I My lnfoHelp. List Your Rental Ad Detail Florida Rentals Return to Results 1 Back i Houses yearly, 3 Bedrooms, 1 Full Bath, 1 Partial Bath capecod Centerville REAL STATE.Com advertise your $1 ,800 / business • • Information KINLINGMAC ;+ti Seaport Village Realty �BCfitlOtli Uent11s y! A UUMM-MMUM OCEAN RESORTJudith Notz Call For More Info a' 8 Listin s i Website Request More Informatic Save Ad Email Friend Print Brochure mad L1M1rrayrealeshate,caln Details Photos 800-326-2114 Rent: $1,800/ Bedrooms 3 Full Baths 1 Partial Baths: Square Feet N/A Lot Size(Sq. Ft.): Address 495 Shootflying Hill Road Barnstable,Centerville Description http://capecodrent.re.adicio.com/properties/search/detail.php?gBackToSearch=gTerms%3... 7/10/2009 'CapeCodRental.com Page 2 of 2 Watch the sun rise and set from this 3 bedroom, 1.5 bath furnished home steps from Lake This home features front and back enclosed porches.One used as a sleeping porch for exti the other used to entertain while enjoying the views of the Lake. Barbecue on your spaciou look out at the Lake or walk across the street to swim and kayak.This home has a fireplac( livingroom,A/C and more. To view all our rentals including vacation and winter rentals please visit us on our website; www.seaportvillagerealty.com g / Return to Results . r alloiclo For technical support issues contact CapeCodRental.com CapeCodRental.com -Copyright© 2008 capecodONLINE.com. All rights rese http://capecodrent.re.adicio.com/properties/search/detail.php?gBackToSearch=gTerms%3... 7/10/2009 Town of Barnstable Regulatory Services samstable �p THE Tp� � a ti�P� ti� Thomas F. Geiler, Director Public Health Division 9BABMASS BLE,�o* Thomas McKean, Director � ,1 $Ar ib39. a`� 200 Main Street FD MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 2, 2009 Barbara Doherty 54 Geraldine Lane Braintree, MA 02184 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 495 Shootflying Hill Road, Centerville. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.m.a.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2009 fees included. This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free,to call 508-862-4644. Thank you in advance for your cooperation. Timothy B. O'Connell, R.S. Health Inspector Health Division Direct#508-862-4646 Violation History AcctNo 253095 Doherty,Barbara 01-06-2010 54 Geraldine Lane Braintree Issue Date BAR No Fine Date Paid Amt Paid Dlsp Total Due Notice2 Final Hearing Arraign Offense 11-10-2009 8000 100.00 11-25-2009 100.00 Paid 0.00' 12-01-2009 Failure to register rental property per town of TOB ordinance 100.00 100.00 0.00 No.._ I THE COMMONWEALTH OF MASSACHUSETTS fL /'r B AR® OF HEALTH S DG . ..... ......OF.... � - ----=-----M--------------- Allp iratiun for Diipuoal Works To union Pawit Application is hereby made for a Permit to Construct ( ) r Repair ( ) an Individual Sewage Disposal System at: '10 I_S€ # � � .. Locatio •Add No. ... - ...Y...._� /?E- ------------------ . .................. caner Address ................................................ ,---------------------------------------------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedroom ___ _________________________________Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—Type-of Building __________________ No. of ersons.__.____._._________________ Showers g ---------- ----------------------------P ( ) — Cafeteria ( ) Otherfixtures _____________________ -•••-•••--•--•--._...-••-••...•---------...---•--•--••-•=•-•-•-•••-•_...---••--•-•--••-•-•-_•-•••- 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._I. �90_t)__. Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( -) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2............. ' iinuteF per inch Depth of Test Pit____________________ Depth to ground water........................ Q+' --•----•------------------•-••---------------___--•-••-----•-----_...--......................................................... 0 Description of Soil...................... .__.._..•---•------••-•--•••---••--•-•--•••--•---------------•--•---•••------•-•-•••-•_••-••••-•-•----•--•---•-__....------••-•-- x x ------ •-----------------•- U Nature of Repairs or Alterations—Answer when applicable______ ___ __ __ ----•--••--••---------•-----•-----------•-•---.•-----•-•-•...................--..................................---------•-----•-••---------•---•------••------•-•-•----•--•-•••••••......_..----•••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL U 5 of the State Sanita Cod — The and gned further agrees not to place the system in operation until a Certificate of Compliance ha bee the o health. Signe -- ...... ... .. - --•-- ................................ . � to Application Approved By....... ---•-•• -7 .L 2— � 7 -- •- '-•------•-•-•••-•-•----•--•--•-••------------••-•••--------•---Date Application Disapproved for the following reasons__________________ __________ ---_---------_ - •-•..............•-•-•-•••----•----------._...-------------•-•-------•-----------•--------•---•••--••••--•;-••-••-----------------•--•--------------••••------•-____------•--__-_••---- Date PermitNo......................................................... Issued....................................................... Date `yt Not? ._ja F�s....� �:..... THE COMMONWEALTH OF MASSACHUSETTS B ARD OF HEALTH ... "�.�t'{ Z' .V iratiou for Uispoii al Works Can nr#ion rprmit Application is, hereby•made for a Permit to Construct ( ) r Repair ) an Individual Sewage Disposal System at P0. 0., . Locati Add e No. W. QJm caner �' t dress W �� l r<• �-- --------- --------------•-----•-------_ .. -ii� 4)1W_. 1. j.. a ............................... Installer Address Type of Building Size Lot............................ q.•feet Dwelling—No. of Bedroom ;_ .. ................. ..........Expansion Attic ( ) Garbage Grinder ( ) 114 Other—Type of Building ............................ No. of persons•----- _.__________________ Showers ( ) — Cafeteria ( ) Pa 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 are'a...................:. ft. Seepage Pit No: .. Diameter.................... Depth below inlet____________________ Total leaching area................... ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results :Performed by---`................ ......................--------------•---------------. .Date....................................... Test Pit No. I..............:xriinutes.per inch Depth of. Test Pit______-.____-_____-• Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to.groundwater........................ Descriptionof Soil.......................................................................................................................................................-................ V ........................................................-------------------•----..............................................................................................................=........ W ---••-•-•--•.......-........................................................................................... -- V Nature of Repairs or Alterations—Answer when applicable...___ _ -':�-----� ,r'`' --- -•- --------•------•--•----•-•----•--••-----------•-......._--••-- Agreement: The undersigned agrees to install the aforedescribed Individual.Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanit y Co —The un gned further agrees not to place the system in, operation until a Certificate of Compliance ha be th health. Sign, ' ,-- • ----------•-•--•---•--•••....... - . e Application Approved By...... .. •-----•-•------•-•------•-- - --�---• _�•1_ __ .. . Date Application Disapproved for the following reasons-------------- - ------------------------------------•-------------------•--------------•-------........_ . --- ..................................-.................................................----•-••-----------...------------------------------------------------------------ ...............--................. Date PermitNo................................................... .... Issued....................................................... r.• Date THE COMMONWEALTH; OF MASSACHUSETTS BOARD QF HEALTH ........OF. TrrfifirFatr of TompliFanrr THIS IS T CE F ]�a ndividual Sewage Disposal System constructed ( ) or Repaired ( ) by......................... --f: t - .................----.................................................................................................... In aller ---------------------------------------------------------------------------------------- has been installed in accordance with the provisions of T r 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ........... dated_-.._ ___ * " `" •-• -------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT.BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,'.BATE...!/ ........Y..............7.... ........... Inspector..... ._.-•jA_ .._. _-_--_ -_---•-•-------••-- THE COMMONWEALTH OF MASSACHUSETTS :eyT ........ .., .. :..: . ........ OFRD HEALTH r4/� • ..... ................:........ FEE .: ............ �t hors • nr ' �itn tr io autit Permission is her nted...... to Construct, ( Re a an Indivl al Serge sposal S r Street as shown on the' apglication for Disposal Works ConstructioAe ' o. ,�................................. ate .. t -•--•-------•-•••-•-_-••-- + Board of Health DATE..... ----- �'"". -- ---_---•- FORM 1255 HOBBS &,WARREN. INC.. PUBLISHERS a - No.-----.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ...........0 F. .................. Apphration -for lhtipooat Worko Tott,15trurtion Vrrutft Application is hereby made for a Permit to Construct or Repair ()-'T an Individual Sewage Disposal System at: ........... ......... ------------------------------------------------------------------------------ cc ti •Add ess' or 01 0 ............. .. .......... --------------------------------------- Owner d ress�..... .. .. ........... . .. ....... ... ...... ...................................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons.........._....._......._.__ Showers Cafeteria ( ) Otherfixtures ----------------------------------------------------- ----------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity------------gallons Length................ Width.._._.._........ Diameter_-.__...-...__-_ Depth._..---__-._..-. Disposal Trench—No. .................... Width--__-_-.-_-_-.---_-_ Total Length_................... Total leaching area....................sq. f t. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area------------------sq. f t. 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_--------------------- Test Pit No. 2----------------minutesper inch Depth of Test Pit..._................ Depth to ground water_-.__-_-___.___.--_--. �; ..............•--------I............................................ ....................................................................................... 0 Description of Soil..... ............. 4L.- �4 _-L-A�_ __ ----------------------------- ----------- ---------------------- -kP---)4C?Z)V..._-%,� U ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .......................... U Nature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------- ---------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- -------------------- Agreement: . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be ss d by the boar)ljf he th. I Sig d- ..... I ....... lgp)2d.-. - ----- -------------------- -------------Gam•-------------- 2 Application Approved By-------- -e-- -- ------ ...... /---ale, 3 Date Application Disapproved for the following reasons:................................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................... ............................ Date ----------- i9 No....... 3= . F>�>�1?..1 r� �...... THE COMMONWEALTH OF MASSACHUSETTS u BOARD OF HEALTH Application -fur Di,ipu,ial Workii TouMrurtiou Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (vf an Individual Sewage Disposal System at: C�7 / ocat�grn Add ess p or Lot No. -- ••---•--•-- -- r_.----•— •- Ow er Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- 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 ( ) aPercolation Test Results Performed by--------------------------------------------------------•---------------- Date-.----------------------- --------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit...---__.___.-__---. Depth to ground water........................ (X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--._.-__---.---_...-. lX --•-•-•----------- ----------------- ---------•-..................................................----'----- ------•---.---- G Description of Soil =` /. Q "/ � ,�,?l!'�� ,�" x --------- -_7n_ Z --—-------------------- x ------••----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------------------------------_ • ------------------••••--••------------•----•---------•-••-----------------•-•--•-- --------------------•--------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been/issued by the board of health. Sig ed. /=-/� t, i ��-� , . h f ` Date Application Approved BY .... C ! 1.�'1i1-.'+'�.> '`. G ' 7 ----- / Date Application Disapproved for the following reasons:.--------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------•------•--'-••-----.......•-••---•-------------...............------------•-•--•---------------•---•------------•------ Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......Irv, .7 ...........OF..: •r•r1f�7 t� .-��.,........................... (Irrtifiratr of feoutplitture THIS IS TO CER, IFY, That the Indio}'dual Sewa DisposaI System constructed ( ) or Repaired (d_T !/(...r Inst ller -- -----•-•------ •• ,-_------------- - at_... -t 1 / l�__� .:......% f, _ 1- t�� - /�J%( t' 1�/�o© f _ has been installed in accordance with the provisions d A E �of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.- _ --------e__/.�'__--__-.-_-. dated-.-.- ---7-6 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WIL UNCTION SATISFA RY. DATE-------- --........ ---'-------- ....... Inspector-----.�:7--- -------•• - ----••----------•----•••----------------------- ) a THE COMMONWEALTH OF MASSACHUSE TS BOARDS, OF HEALTH loll J.............OF.. - No.............2---•-- ........... p.. . FEE�-:---��-�'=�-•-•- DinVupttl ark �omitrurtiou Prrutit Permission is hereby granted_. _._.! . IJ� �7�' • --------.-•------------------•..........---..---- to Construct ( ) or Re air (, " an Individual�rwage Disposal System a at No._M���J-�!_.�-�-1�....r. P/ 1 �. /! 1?xr l/_.!/ >__ ?��/`�Q._ 6)' '1 2� 'i7fl f j Street/ as shown on the application for Disposal Works Construction P n)it'No____ ________ __- Dated...lJy:7� _C'7•L__-_..__---- DATE----- _ ' v�-�---------�- -7----------------------------------------- Board of Health � FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS OC l,.T IOI ' -IS-42- IT'S SEW C,E PERMIT 1.1 O. ��sz.7- .�L�!PLC_ :.��1�.L-- �12- — — • iNSTA�-LER•5 I.1�ME E AD�JRESS �: BUILDER •5 tJ At.AE ADORE SS - - -- -- - - ' �J� 1-T ISSUED ' -T'E PERK 'p.TE COMPLI lit ! :r f ' _ N , L S L O'C A T-rO`N-- 5 S E W A E PERMIT NO. ILLA6E INSTA LLER'S NAME & ADDRESS yo- B UILC R 44 OWNER DATE PER,,MIT. ISSUED HATE COMPLIANCE ISSUED a 1 v J I D M TOWN F BARNSTABLE t� --. 1 pp LO'CATION �(!S SfOM- f�l��r'1� 1, �� --- SEWAGE # �lQ' al VILLAGE 2 0 0 kYVt.It u ASSESSOR'S MAP & LOT - -INSTALLER'S NAME&PHONE NO. P I `� C ��� C_• I. SEPTIC TANK CAPACITY �,,, �� 11 LEACHING FACILITY: (type) 2 c,-Q i �TS(size) . `I�cS E-AC` -11— w. NO. OF BEDROOMS BUILDER OR OWNER PERMI I DATE: I~Z�o I� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet —Piivate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � S ....... d _._ � _. FLy �ti G- �-F.__ Cz_ �� 3� �J� s, ��� -� -� N CATION SEWA E PERMIT NO. ILLAGE i3 - 001 Z—lqll 7cn t, INSTA LLER'S NAME & ADDRESS B U I'L DE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��z�iv� � N9