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Home My WebLink About0223 BARNSTABLE ROAD - Health �,:223;Barnstable Road , Sewer Acct # 4304 . ;...�.....�:. �;Hyannis , - 310i-J 58 ° o 0 I v u a v o N ° o n a ° v °e Town of Barnstable Hazardous Materials On-Site Inventory and Inspection FACILITY INFORMATION: Business Name: A11A)I/1 C I Business Location: zz J [3A"S1-&�i� N AJt10LS Mailing Address: A5 A&VE Telephone Number: .fd r- - :Z r/ - Contact Person: 4Z H RCA) 9'V&— J Emergency Contact Telephone Number: Type of Business: /�A,//J77/CI(9_ HAZARDOUS MATERIALS (CHAPTER 108) Virgin Product Total Quantity Container Size(s) Storage Location Major Materials Gallons or Pounds Quarts,gallons, Shed,retail store, drums,tank,etc... cabinet,closet,etc � ti ✓�"j�Uv,u� �,tvS f3 E7r12 �2i,JT 4'4 4-dRJ �U H kS ld �� DOH - 1 - i Misc. Combustibles Misc. Corrosives Misc. Reactive Misc.Toxics Inventory Total Amount: Hazardous Materials License Posted?Yes No Av/A Contingency Plan Posted? Yes No Fire District: �A- kJ/S Fire Extinguisher Service Date: Metal Covered Rag Bin: Yes No Absorbent Material Available? es No Type of Absorbent: Speedy Dry/(!ad Pigs Other: MSDS on site? es No d Cop Computer Access Hazardous Waste Handling Hazardous Waste Generator Identification Number: Type(s) of hazardous waste product(s): Date of last hazardous waste shipment,type of waste and quantity: Hazardous Waste Transporter(s): Designated Hazardous Waste Facility: Hazardous Waste Storage Area Description: Is hazardous waste storage area labeled: Yes No Are tanks/drums/containers labeled with the words "Hazardous Waste",the type of waste and the associated hazard (i.e. ignitable,corrosive,reactive or toxic) Yes No If hazardous waste is stored out of doors is it covered from the elements? Yes No Is it in 110% containment? Yes No If hazardous waste is stored indoors is it on an impervious floor? Yes No - 2 - t FLOOR DRAINS (Chapter 381) Town Sewer Account Number: Indoor floor drains: Yes 0 If yes,circle one,does it discharge to a: holding tank dry well on site septic. Outdoor surface drains: Yes V If yes,circle one,does it discharge to a: holding tank dry well on site septic. v FUEL AND CHEMICAL STORAGE TANKS (Chapter 326) Underground Storage Tank(s) on site? Yes No Age: Is removal required? Yes No If yes,when? Is testing required? Yes No If yes,when? Out of doors above ground storage tank on site? Yes No If yes,is it protected from the elements? Yes No If yes,how? Is it on a foundation larger in size than the tank? Yes No COMMENTS/RECOMMENDATIONS/CORRECTIVE ACTIONS 34SCb oX) rM5' XUfe nTy ®F AwX rFler.-. "/� /3as/AJ03 /s AUa7— Su g✓-72�F 7-6 7 y k)A.1 OF "*-7 rz/A-tS 141114�S/AJ 0 RIB/AJ -NrE ) - Sftowr-� B� /9 056 o A-t DG 'tfC 3tt®P( c� S-4-+ -A /i2E EX77IJ6ul ,0SnEZ-77o,J SNowzD 6C Gip TD )DA•7E. C:'0"Qo 5 rI Q GE /Pk06MC-s 86 Cova2t� WhF Vo-r 667AI6, use,-D. Date: Public Health Inspector: &Ajf*4 41f ;r7A Facility Representative: ' - 3 - YOU WISH TO OPEN A BUSINESS? A For Your Information; Business certificates (cost R .00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.- it does not give you permission M"operate.) You must first obta.in the necessary signatures.on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 6 /30 11 Fill in please: { , '! APPLICANT'S YOUR NAME/S: �vo�N ItI�r r�1v Ka r�eAl F Ve- r.S ti�a4 a Si 4 i 3?;n!L(�la ?:{jt�,;.r: ,.; �,, .•` ;ar . a BUSINESS YOUR HOME ADDRESS: �y9 13,, N ;4ree f p r1 x i �OF' 7 7/- 8`SOO New /� 61,2 7 q.S TELEPHONE # Home Telephone Number S o$- gy NAME OF CORPORATION: He rr1iya 1�tic NAME OF NEW BUSINESS /`1 i,ycl4- ,^^o„v Pre SS TYPE OF BUSINESS Pn:v j,iV4 .IS THIS A HOME OCCUPATION? YES NO X 2 ADDRESS OF BUSINESS „?a 3 MAP/PARCEL NUMBER "�� C' '� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2: BOARD OF HEALTH This individual has b7 fo edrof t e permit requirements that pertain to this type of business. Authorized Sig ure* COMMENTS: Z y. 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been infnrmed of the licensing requirements that pertain to this type of business. �I1�R,�(�t-cR---� �� C( ►,lJ 3— —((ii' lip;; Authorized Signature** r COMMENTS: NU (Lk'ZI� yV�() �'GIN� r �lP, �I�S 1�1�ti LLM_ WbC0 30Pgdj 01 • y: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: gerv-�/g Lyr_ An ILA)VlP/`1qA/ Prels BUSINESS LOCATION: Pat /INVENTORY MAILING ADDRESS: Za2 94rNslAble- Rol, Nam^'—' s ,r��t a�r„o t TOTAL AMOUNT: TELEPHONE NUMBER: ,SCR'- 27/ - I?Foo CONTACT PERSON: EMERGENCY CONTACT TEtERHONE NUMBER: �lDl- g.3��3/l l MSDS ON SITE? TYPE OF BUSINESS: P ,' Y-.-- S INFORMATION/RECOMMENDAT ONS: Fire District: - vI j x Waste Transportation:p Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. i LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. i Observed / Maximum Observed,/'Maximum , Antifreeze (for gasoline or coolant systems) - Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners i Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake-fluid) : ,. _ 1. Refrigerants -- - - Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED gw Photochemicals (Developer) Miscellaneous petroleum products: grease, lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal ,�jpA 0 inting ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda r Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison",labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers ;,(including bleach) Spot removers&cleaning fluids i (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS A plicaot�Signature Staff's Initials TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 3.2.A to Body Shops O unsatisfactory- 4.Manufacturers COMPANY `%pC— I'Pt��-5 (see"Orders") 5.Retail Stores c� 6. Fuel Suppliers ADDRESS Z� �/1/JT.9 i'�� Class: �/ 7. Miscellaneous Y�►�N� QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) I " new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAL'RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublic O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORI)ERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5Naste Transporter Name of Hauler Destination Waste Product Licensed? YES NO 2. Person(s) fnterviewed Inspector Date Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: / BUSINESS LOCATION: MAILINGADDRESS: 32-�� .4s. ,nib�e ��, f..� .� �s Mail To: T Board of Health TELEPHONE NUMBER: �• Town of Barnstable CONTACTPERSON: /�A vn�., � i2 y12oi]�i fir. P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: s o Q—y��— 4oGy Hyannis, MA 02601 TYPE OF BUSINESS: ,p iA N C. Does your firm store any a toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: 2 TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants $ Engine and radiator flushes (Halite)Road Salt Halite Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) ! Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing inkDegreasers for for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Fee THE COMMONWFALTH OF MASSACHUSETTS Entered in computer: .' �t s PUBLIC HEALTH DIVISION`S TON OF BARNSTABLE., MASSACHUSETTS 01pplication for Miopaal 6p.5tetn COngtruction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon) ❑Complete System ❑Individual Components Location Address or Lot No. a33 a tlu � Owner's Name,Address and Tel.No. Assessor's Map/Parce i— ^p' I l I G �/OItJ Q 1I I �Tt-ec� t v rtwt� drf' Installer's Name,Addr* I& d1ANCo Designer's Name,Address and Tel.No. 350 Main Street W.Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms y Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) C-e S S C/v ` r✓l, Date last inspected. Agreement: The undersigned agrees to ensure the construction and main a of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro ntal ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of al Signed Date Application Approved b Date r-�, Application Disapproved for the following reasons. Permit No. Date Issued V-• a THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THI TO CERTIFY that th On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by O at P has�een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit fztX -: _,_,dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector F �.. ��-,,.,�. .E�_'+, ...;ysv.,' �r •.,, -z•.'c'-+.,.- rs5a4,•L�.."a'b•. 'ems' '+i�' +.m• '"�i.-..+..z. ;:+::: LLA.j 100— -M._---_—: _ Fee i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -f6v!N OF BARNSTABLE., MASSACHUSETTS 01pprication for Migonl *pgtem Construction i3ermit Application for a Permit to Construct( )Repair( )Upgrade O Abandon ) ❑Complete System ❑Individual Components Location Address or Lot No. I i13 4 Owner's Name,Address and Tel.No. Assessor's Map/Parc Installer's Name,Address,A Tel.No. Designer's Name,Address and Tel.No. A CANCO t 350 M6in $trod pe of Building. Yarmouth, MA 02&3 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other \ Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures t J r Design Flow �. r gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title r Size of.Septic Tank Type of S.A.S. ~Description of Soil , Nature of Repairs or Alterations(Answer when applicable) cfe S S2 C/ 0 �(, ✓(. Date last inspected. Agreement: The undersigned agrees to ensure the construction and maintepame of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enqeal ntal ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board ofSigned V ' Date Application Approved b Date 6�/4 Application Disapproved for the following reasons r Permit No. - Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THI TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by Q at ( 2692 has eeenn constructed in acc rdance I _ with the provisions of Title 5 and the for Disposal System Construction Permit ated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *proem Construction ermtt Permission is hereby granted to-CConstruct( 1 Repair )Upgrade( )Abapdon( ) System located at 3 lY tt S 1A 6l ��• 5��o J vt j and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this it. Date: Approved ��/� seco�/ TOWN O ::S LOCATION y2' t VILLAGE__26�yf a4 N 1 - ASSESSOR'S MAP & LOT .3/0 - 3 J. CRAIG MEDEIRDS INSTALLER'S NAME & PHONE NO. 78 r lumN CrT SEPTIC TANK CAPACITY /d u a�� HYANNIS 001 LEACHING FACI.LITY:(type)/oou �vl I I NO. OF BEDROOMS PRIVATE WEL O PUBLIC WATE BUILDER OR OWNER _�� /�/i/� f�"' (Q� '13 aell'rr DATE PERMIT ISSUED: ZZ2Z DATE COMPLIANCE ISSUED_ /—' VARIANCE GRANTED: Yes No ✓ ., d::. � �" ., ,+ 1�. /� . � b C ".v.. 1 � � '' / '� �y`� 7 ?�� .-� _. .. �v� � 'LZ `�� . �" � THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH Barnstable Conmerado11 fib TOWN OF BARNSTABLE 1� 4 signed applIM M 115"r- Disposal Works Tonatrnrtiun JIrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 7C !0L- s � j� as ....... ... ... . ... .... .. .. rFo Loca' n-Ad rrfss Ow dres ..., .. �w 5 �.��- .�► . y i ............... �� ^ Installer Address Type of Building Size Lot............................Sq. feet U a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.................... fr4 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ O Description of Soil................. `t1.�'k. ........9'�`a � x ---------------------------------------------- c.� -------------------•------------.----------------------------- .-..--------- ....-------••----------------- W ---•---------------------------------------•---------------- ---------------•-•------------------------- U Nature of Repairs or Alterations—Answer when applicable.. _-..ft..S1 .. L:0-..o _ . ------------------ - - ?� �--b� Gov .... / �' %(/"v d--------------- ` ..... 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 Complia ce ha een issued by the board of health. - Signed -- ---------- .....~. ............:......- ..:...�. :....... 9....::........ v ApplicationApproved By .......................................................................... Dace Application Disapproved for the following reasons: ........................................................................................................................................ .......................................... ....................................... q Date Permit No. ........./. ,;t..: �............................... .............. .... Issued ........................------...........................-.......... Date T . I No..... N Fxs ... d THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applutttivit for Dispusttl Works Tonstrurtiun 11rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ............... Z3.. .......... ......°'..... .......... ................... -....._ ._....._.....___.................... Loca••n-Ad•rps o� •°t—No� ......... .��..�✓....1._: ...,t' J_.e�.. .'�-'..-- `' .tom efi....�.`.J ...k...t..,2.?---^..C� .n.�.�?c.�•--•'•- ;ne �— -Addres3�- Installer Address Type of Building - Size Lot............................Sq. feet �..� Dwelling—No., of Bedrooms............................................Expansion Attic ( `) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers W YP g -•-------------------------- P ( ) — Cafeteria ( ) 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.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ......... K)....................f-----..............-•-------.............................................................. 0 Description of Soil.................. `� "�.......:.?.'� ?.�� ..� ..................•----•----•---------...._._....._... x W •-•••----•••--.....-•••••••••----•••••••----•------•--------------------------•-------.......-•-....--------------•-----•------•-----------•••••••••-•-••--••---•-•-'-,--••••..._.._..._...__-...._1 I p UNature of Repairs or Alterations—Answer when applicable._--_-2,A.1-1.. '?�_��-__�..0_.-_-"_.._:? a �/....... I 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 Complia ce has been issued by the/board of health. Signed .:. .......... �:.... E:! 'a:.-*."-.....---...---.....-----f��./.!...1 ......... re Application Approved By ...................................................:.......................... . ....................................---........................... .................D--ue.................. - Application Disapproved for the following reasons: ........................................................................................................................................ ................................................................................................................................................................................................................ ........................................ Date PermitNo. .........72...-...�............................... Issued ...-----............................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (Eomylittn.ce THIS 1 TO,C-E�ZTIFY, h the In 'vidual Sewage Disposal System constructed ( ) or Repaired ( ) by ..............:>.:... ..... �. ................. .. :'.... ..: fir. ........ ............................. _5.................... at . �� ..... ns,to f� �{�.F..Y.,/- P..,: '...........� ................................ 4 I r has been installed in accordance with the provisions of TITLE 5 o�heSt to Envirorrimental Code as described in the application for Disposal Works Construction Permit IS .............................................. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT�THE SYSTEM WILL FUN TI N SATJSFACTORY. DATE... ............. ............................................ ........ Inspector ................... ........................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qqy�� TOWN OF BARNSTABLE No...�l............... F$E.....3 O..___-... Disposal nrks � rcutrtts#tun Prrmit = - ::R-::1.�M...__.:_5.::.....::.: :....•••...............___......-•••._................................ __..Permission is hereby granted.�� . to Construct or Repair (,_,),a Individual�S�ewa a Disposal System - ! -- at No......1_ A �� rf�.................... ... ---•'•=•..................... -•-'---...... Street q� e as shown on the application for Disposal Works Construction Permit No.... Dated.......................................... �l ................................. °'-:---•--•.......................................................... DATE.. ____________________________________ Board of Health FORM 36508 HOODS 8e WARREN.INC..PUBLISHERS '