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Home My WebLink About0448 STRAWBERRY HILL ROAD - Health 448 STRAWBERRY HILL, CENTERVILLE A= UPC 3 No. 53LOR HASTINGS, 4"N DATE: 7 1.4 J P rP 448 St-rawherry 1-1-i-11 Road Center. vine 4b M'�s S 02632 t- 4 c On the above date, I inspected the septic system at the above This system consists of the following: 1-1000 -a]-1-on septic Lank . 2 . 1-1000 ga-1- 1-on -Leaching p:it . Based on my Inrt.nection, I certify the following conditions: 1— 'I'his is a LiLie five sept-ic system . ( 78 Code ) 2 . The septic system is in proper working order at the present Lime . SIGNATUR.r /1� /I Name: E'-Ma_C-Q-ffub-Q L-1r j . .I-1 . Mac6mber, Address: B6x 66 Cent'qrviile , Mlnss . '026j,Z; ,, � 508-775-3338 Phone:----:i THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY II �# JOSEPH P. MACOMBER & SON, INC. Ttn ka-Ce"poollsLeachf le Ids Pump*d L InsUlled Town- Sewer Connections SEPH TS P. M ER & SON, INC. d,nk CO e h :1 SD E & jLp*d7 n' " f I C I!L P u M & I SUI I T 0 W n Sew r C 0 nnoc t10 n 6 x r 3 6 P.O. Box 66 Centerville, MA 026332-0066 775-3338 775-6412 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM Address of property 448 Strawberry Hill Road Centerville Owner' s name Ruth Muldowney Date of Inspection 7/1-4/95 PART A CHECKLIST Check if the following have been done: Y-es pumping information was requested of the owner, occupant, and Board of Health. YPS None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. Yes As built plans have been obtained and examined. Note if they are not available with N/A. Yes The facility or dwelling was inspected for signs of sewage back-up. Yes The site was inspected for signs of breakout. Yes All system components , excluding the SAS , have been located on the site . Yes The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions , depth of liquid, depth of sludge, depth of scum. Yes The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. Yes The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance '.of SSDS. 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ` SYSTEM INFORMATION /) FLOW CONDITIONS If residential 0 number of bedrooms One room house with bath . 1 number of current residents NO garbage grinder, yes or no Yes laundry connected to system, yes or no NO seasonal use, 'yes or no If nonresidential , calculated flow: Water meter readings, if available: Not metered . Presently Last date of occupancy GENERAL INFORMATION Pumping records and source of information: Tank pumped annually By - T P A1acombPr N, Son Tnc tlo System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system No D-Box YPR Septic tankZ3i,-gtr)pjgtip)Dg)ppXz/soil absorption system Single cesspool Overflow cesspool Privy NO Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: 3 years NO Sewage odors detected when arriving at the site, yes or no • y 9 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATI0I,7 -- tinned SEPTIC TANK:1-1000 gallon septic tank . (locate on site plan) depth below grade: 1o" material of construct ion:Xxxxxconcrete metal FRP other(explain) dimensions: 8 ' 6" Long .4 ' 10" Wide 5 ' 7" High _ 0 sludge depth Tank pumped 15 days prior to inspection . _ 6 distance from top of sludge to bottom of outlet tee or baffle _0 scum thickness _0 distance from top of scum to top of outlet tee or baffle .�0 distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of ir-!Iet and outlet tees or baffles, depth of liquid level in relation to outjl -t invert, structural integrity, evidence of leakage, recommendations for r.. . -:irs, etc. ) Recommend pumping tank once every three years.. inlet outlet tees fine . Sch . 40 4" pipe 4 ' 3" liquid level to outlet . Tank structurall sound with no signs of leakage No repairs needed . DISTRIBUTION BOX:NONE (locate on site plan) 4011E depth of liquid level above c• 7 t invert Comments: .(note if level and distribution is equal , ."ence of solids carryover, evidence of leakage into or out of box, rc:! nendation for repairs, etc. ) NQPIE PUMP CHAMBER: NoNg (locate on site plan) %lIL1E pumps in working order, yes or no Comments : (note condition of pump chamber, condition pumps and appurtenances, . recommendations for maintenance or repair::- ; . NONF ... . .... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : 1-1000 precast leach pit . ( locate on site plan , if possible ; excavation not required , but may be approximated by non-intrusive methods) If not determined to be present, explain : Type. leaching pits and number 1-1000 Pallon leaching leaching chambers and number Pit packed in stone . leaching galleries and number leaching trenches , number, length leaching fields, number, dimensions overflow cesspool , number Comments : (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) Sand & gravel no signs of hydraulic failure ; no ponding vegetation no rmal ; No repairs needed . CESSPOOLS ( locate on site plan) : number and configuration NONE 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 (cesspool must be pumped as part of inspection) Comments : (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) NONE PRIVY : (locate on site plan) materials of construction dimensions NnNF depth of solids Comments : (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation , recommendations for maintenance or repairs, etc. ) NONE . 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L'SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Town water 4) DEPTH TO GROUNDWATER 251+ depth to groundwater method of determination or approximation: n lled system next door 452 . Dup test hole 13 ' nowa'ter . M- ,di ,m to fine sand . fi 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes , no, or not determined (Y, N, or ND) . Describe basis of determination in all instances . If "not determined" , explain why not) NO Backup of sewage into facility? ,,\12 Discharge or ponding of effluent to the surface. of the ground or surface waters? NO BOX Static liquid level in the distribution box above outlet invert? Yes Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? NO Required pumping 4 times or more in the last year? number of times pumped NO Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? 1 Is any portion of the SAS , cesspool or privy: NO below the high groundwater elevation? NO within 50 feet of a surface water? NO within 100 feet of a surface water supply or tributary to a surface water supply? NO within a Zone I of a public well? No within 50 .feet of a bordering vegetated wetland or salt marsh- (cesspools and .privies only, not the SAS) ? NO within 50 feet of a private water supply well? No less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water anal' for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. Nate .. .�.�� r . Conservation SAVE Tips . . . ME! CHECK FOR LEAKS Water Loss in Gallons Due to Leaks Leak this Loss Per Day Loss Per Month Size • 120 3,600 • 360 10,800 • 693 20,790 • 1,200 36,000 1,920 57,600 3,096 92,880 0 4,296 128,980 ® - 6,640 199,200. 6,984 '. 200,520 8,424 252,720 9,888 296,640 11,324 339,720 12,720 381,600 14,952 448,560 TOWN OFBarnstable BOARD OF HEALTH ' S1J13S1JRFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D CERTIFICATION -TYPE OR PRINT CI,EARLY- PROPERTY INSPECTED STREET ADDRESS 448 Strawberry Hill R,,,,-d Centerville ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAMERuth Muldowney PART D CERTIFICATION NAME OF INSPECTOR Tnqpph P. M@(;QmLer_ jr- . - COMPANY NAME J. P . Macomber & Son Inc . COMPANY ADDRESS Box 66 Centeryille Mass . 02632 ZIP Street Town or City State COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( 790 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa-1 system at this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : XXXXXSystem PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED The inspection which I have conducted has found that the system fails to protect tile public health and the environment in accordance with Title. 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature /" iv J/� Date 7/17/95 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. If the inspection FAILED, the owner or operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doe Cc, ,mcnwecrn cr mcss=7,, serS ExecuTive Office cr EnvronmenTC, Department of Environmental Protection Water Pollution Control Tecnniccl Assmcnce end Training Sections wlutam F.weld ao.WnW Trudy Cox• s•a~y.ECCA Thomas & Powers A4"c4MM-.Qr- 06/12/95 ATTN: Joseph P. Macomber, Jr. Joseph Macomber and Son PO Box 66 Centerville, MA 02632- Dear Joseph P. Macomber, Jr. , I am pleased to inform you that you have attended training, met the experience qualifications, and have passed the Title 5 System Inspector exam, pursuant to 310 CMR 15 . 340 . The passing grade for the exam was 39/52 or 75% . This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15 . 340 . You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at the following address : Kimball Simpson D. E. P. Training Center 50 Route 20 Millbury, MA 01527 Thank you very much for your time and consideration in this matter. Sincerely, Kimball T. Simpson, DEP Training Center Director (2 4 0 5) Routs 20 • Millbury, MA 01527 0 FAX 508-755-9233 • Telephone 50&756-7281 t/ No.... .,,.06 FI�$........�...3 0..00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratioii for Mopwial Worth Tomitriirtiou rami# Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: 452 Strawberry. Hill Road Centerville ..._•------------------------------- ---•------------------------....•• ------•----•-------•----•-----•-•-•-......_.....--------•-----•---•..........••••...--••......---- Ruth Muldo;,rney Location-Address or Lot No. ----••---------••----------------------------------------- Owner Address --•. -------------- ---------------....--------------------------•--•-----------------•------•--------•••......------. Installer Address UType of Building Size Lot............................Sq. feet Dwelling XXv o. of Bedrooms---------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------•••--------------....-----•-•--.-._...-•----•-•--------•---------------------------•--------- WDesign 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. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water..----.-_---_._-_--.-. f.4 Test Pit No. 2................minutes per inch Depth of Test Pit-_.-----.-.._-_--_ Depth to ground water...-.----------_-. ---. ------------------------------•--•----•---•------•----•----•-•--••-----------------........._------......................................................... O Description of Soil...................................Sand & Gravel x c., W x Add---orie...I----I"OOII---di—d' 5n...I_(�5acYi...pit U Nature of Repairs or Alterations=Answer when applicable.-------------------------..............---------------------------------------------------- to existing tank & pit . ....-................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has be n Viue,/by the boa of ealth. 9 Signe ....... -- t . ........ /27/94 .... ......... . ................ .................. Date Application Approved B a `� pp PP Y -- ----------------------------------------------------------------- ........ �.- ../ Date Application Disapproved for the following reasons- -------------------------------- -------------------------------.........-........------------------------------------ --------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- -------------------------------------- Permit No. ---------y--6 Da--------------------------- Issued ----------------------------- ...........................Date...... Dare �...30.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripugal Workii Tonotrnrtion rrrntit Application is hereby made for a Permit to Construct ( ) or Repair (2(X) an Individual Sewage Disposal System at: 452 Strawberry Hill Road Centerville j ......................•----........................."""-----•-•---"-.....................--------- -----...---•-••-----......----•---•--•••--....--------........................................... Location.Address or Lot No. Ruth Muldowney """---"-"-------""---------------------"----"-"------------•------•---••-•----............-- Owner Address J.P.Macomber Jr. t Installer { Address UType of Building 1 Size Lot............................Sq. feet Dwelling yXNo. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons...........-................ Showers ( ) — Cafeteria ( ) 04 d 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-..__._._-______--_-__-- 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' - -- -------- Description of Soil Sand---&- Gravel-"""""-"....-------•----------------------•----------------------------------._........--------- x ---------------------------------•----------------...............-----••........................•--- V ...............................•.......--------...........----••-•------••------......_._._...•----------•-••--••-------------...-----------------------•• ............................................. Hdd orie t"-r�0G ..0. "llciii I" "a�11iL U Nature of.Repairs or Alterations—Answer when applicable._.__._......................................................................................... to existing tank & pit . ............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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. Signed ....---.!Q. !!'I--1r:.!�'l Cad ............. 9/27/9 Dace Application Approved By ............. .....S. �. ..�.r.w. rJ. r.%,.- b� f ' Date Application Disapproved for the following reasons: ..... -- . .. . ........................................................... --- _ _ - - - - ....................... .......................---.............. ........-.......--- ------...-------------- ------------------------------------- ---------------------- ------ -------- PermitNo. .......q. ...Y.,.( -------------------------- Issued ...................—'. ..............—.............te...... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CITexttftrate of .Cnoraptia re THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired'(XX ) by .P.Macomber Jr. - -------------------- .tall........... Installer at --45.2....S.tr.awberry.....Hil l_...RQ.a.d----Ce.n.t.e.rmi- l"-----------------------------------------------------------------------_......_--------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental 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 SA ISFACTORIY. �g DATE �f!.. 7 Inspector � � . ........... ...... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Cq TOWN OF BARNSTABLE $ 30100 No...... FEE........................ �io�rosttl orko �on,�tr�rtion �lermit Permission is hereby granted...J.P.Macomber Jr. to Const uct ( ) or Repair (XX) an Individual Sewage Disposal System �2 Strawberry Hil Nad Centerville atNo. -"-."-""-""---•-••----...--•-"•--••--- -- -----------------•-•---•--.._.....------.....------. Street as shown on the application for Disposal Works Construction Permit No._ -Y.l4?041. Dated..../4.-?.- i .---...--- - ----------------------------------------------------- Board of Health C DATE - V---"---------------------- FORM 36500 HOBBS R WARREN.INC.,PUBLISHERS LO CAT I N S EW A GCE PERMIT -21 gyR VILLAGE INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUEDlyl DAT E COMPLIANCE ISSUED \�j9. Tpne d� - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --........... ' ---------------------OF.....515# JT !� Appliration for BiopooFal Works &nuitrnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal System at: ...••-- ••--•- Location-Address or Lot N ......... I1 �1P��11Mae. •. �8 S`112aw 1�±u �Q�.. �0 . ..• ---•-....•---..._.••••- ner ddress a .�Qlral :fh! .......( ? y......' ''!�*�?.� }... 5 __0. .4 .. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............. .........._._.____......_.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures _._._.... W Design Flow..................%F...................gallons per person per Pay. Total daily flow....... 0................gallons. W Septic Tank—Liquld capacity.)o e _gallons Length__:......... Width....... '.... Diameter...-. _.... Depth........#r ....... 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 ( i) Dosing tank ( ) Percolation Test Results Performed by........... ............................................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P •-----------------------------------------.................................................................................................................. 0 Description of Soil........................................................................................................................................W V ........-•-••----------------•----------...--------.....•-••••....----------•---..............-•--------......------------------•---•------••--------•-------....----...-----•-•--...._...--•-••......-- W x ----------------------------------------•-----------------••-•-•------ --------------.....------. .......---------- -- ............ U Nature of Repairs Pr Alterations—An,syver when applicable_.k......................................................... ..�3r7X.............. -4� 0-----�,P!.`•Fh�ej� .... W� � � �l�Lfl�_1.�1.1{+�2_��rlZ�S`(1!.�G--PeT io_As 4f'(...810....f��t,D$b, Agreement: The undersigned agrees to install the afor scribed Individual Sewage Disposal System in accordance with the provisions of iITLU 5 of the State SanitW d The unders' ned further agrees not to place the system in operation until a Certificate of Compliance hathe b of health. �� ----- Application Approved By.......... . _ a L- Date Application Disapproved for the following re -------------------------•----------•-----------------------•-------•-----•---••••----••-•... -------------------------------.._..-•---------------------------------------------------------------------• -- Date PermitNo......................................................... Issued....................................................... Date i U..V...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH "(`.,tPJ.�.......................OF......r jle lt_t i:�.l irk------------------............_....----------- ApplirFa#ion for 11iopos al Works Tono#rnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair (;() an Individual Sewage Disposal Systenj at-• ; ......t-C 111Z i J �l �J l(o ti n-Address L C4 I;;,VA fJLyj or Lot No, ............ ................ ................................ ..........--......----••......•.----Y..........-......... . t ............... 7?�I�r .. �.l t -� 1 I Address 1 Arta IGt1 .:.t�4a...�.��' Installer Address d Type of Building Size Lot............................Sq. feet aDwelling-No. of Bedrooms.............?_•...........................Expansion Attic ( ) Garbage Grinder ( ) p4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----•--•--------------------------------•------.........---•--------------------------. --•-•-•-•........_...................-•-------•-.....-------- W Design Flow.................��...................gallons per person per flay. Total daily flow__....._._........ d............-__gallons. loco r3 W Septic 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 ( 1) Dosing tank ( ) IH Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... rXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••••--••----•••••••--•----••---•--•••••••-•---•-•---•-•...............•---------•---•••....•..•-•--•......................................................... 0 Description of Soil.......................................--....•...--------•-••.-•--•-----•--•---------------------------•-------•------•-----------------------..._......-•------------•- x tJ -•----•---•--•••--•-•----•-•••--•-•--•---•---•-----------•-------•-••••-•--•-----•-------------•-•-•--•----•--------•--•-----•------•••-•-......----•-••--------•--=------------•-••.....-----•--•--•-- UW -•••-•-•--• . . -----------•---•------•------•-----.•-----.---i-�-F---'-� ...... ----�rd------;..---•------ -------------------- Nature of Repairs pr Alterations—Ans@!yvler when a hcable_..... .ate ................'______.____ �!_�__ �� :' �_`.,.._........... ,A-P I to Y, £kA 0 T l � -��'t`Up--!J C �"l K,k: ",.e''�"Ls --.4�'-'-.. "0� A),14� 1._ t=11 17, Agreement: The undersigned agrees to install the aforglescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitar ode— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issued by the bo4hf health. 41 r f Slgne�..._ r ....................................................- ....._.._._.. Date Application Approved BY -' •--------------------- ----- /?tel Application Disapproved for the following reasons:-----------.........--•-•------••-•-•---•----•-••---•--•-------••--••---•-••--•---••-•-•-•---•-•••.....-•---•-- Date PermitNo.............................................-------•--• Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 Ut.t/A\ {` A.4%!41 c f�'r't .................................... .............. ....................OF........... -...:........r......... Trrtifiratr of TompliFana T X S LS TO CERTIFY, Thayhe Individual Sewage Disposal System constructed ( ) or Repaired ( ) Install 6 7 4 - � << K] `�d t�..�L e 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.,P2.__.,> -t�._.•_______-._. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUARANTEE THAT THE SYSTEM WILL FUKTION SATISFACTORY. DATE....,1 Z .-�/ `.................................................. Inspector.. = THE COMMONWEALTH OF MASSACHUSETTS BOARD 'OF HEALTH ................................................................. FEE.,...1,'P£ .0 0 No._ .,,�`�-.��•'.,t-' .........-•--- Disposal Works Tono#r ilan rrntit Permission is hereby granted.... !'' �'=_r_....�.:.0VV ..&� l N'f• to Construct ( or Repair ( ) an Individual Sew ge Disposal System at No.! 4 ?!_,f ti\:t► "1'L �s' f:1 ?�1-0 ...Gn .1- --- --••- ... --•-----------•---------------- ...................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ....- •ryrV�---••.;.,f�GJ3� � ealth----•-•-•----------------••----•---•--.- DATE /l ------.....-•-• r� FORM 1255 A. M. SULKIN, INC.. BOSTON - — li t A yyff TOWN OF BARNSTABLE 1 LOCATION 4/S-f- ;rX,4uw,9eAAk #ILG I?oes SEWAGE # VILLAGE C' eA9re/w, Vjj-L ASSESSOR'S MAP Q LOT,? INSTALLER'S NAME & PHONE NO. w SEPTIC TANK CAPACITY a p p LEACHING FACILITY:(type) / (size) /.O o® NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER *tMMER OR OWNER // Av� ��/,o ! DATE PERMIT ISSUED: /4 � — DATE COMPLIANCE ISSUED:�� VARIANCE GRANTED: Yes No �� \ � i ,� � � / �J(o �� %�,. � � � �� A ,_ ,