HomeMy WebLinkAbout0020 CAPTAIN ELLIS LANE - Health Fr ,Capt.-Ellis Lane
250-030 Hyannis
s
r
08r 30 1999 09: 44 508-775-8804 STRA4JBERRY HILL RE PAGE 03
COMMONWEALTH OF AR ASSACHUSETTS
EXECUTIVE OFFICE OF ENVIROMENTAI..AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTEMN
ONE WINTER STREET. BOSTON MA 021pt1(817)292-55W
St103URFACE SEWAM i)MK)GAL SYBTEM IN "CTiON FORTH
PART A
CERTIFICATI(Al
PROPERTY ADDRESS: no Copt.Elms L". Hysaenlo me.02601 ADDRES OF OWNER:
DATE OF WGKCT*N: 0-2149 1143 Padins Ave.
NAME OF INSPECTOR: Wrn,E.Robirtoon J4m"Islow S.Cwrotlna
am a DEP approved systwm In8Pfoeor PufsuaM to Section 15-340 of TMe 8 6310 CMR 13.000)
00w&mY kam: Wan.E.ROVE 890 IM�Iwotlon.
M44"A1116OW": 43 Tomah.wAc DrM Cwatlwrrlww tUA OQd3Z �_
TIL04t01a 1776 7906 �-"
1 Fes_
I am*ow I tlwm*j x"—I m 0 ded to 1 iv egs dhp=d'WW1
%mdd bawl d ft i
SOW"vend oar epida we of the timw or I my tn+nlno am a a h tp*ppmW
Mnolk n and rrminl.nm�o.of w4ft*&MO di.pmW syarw. Th.fin: ►>',''
k 2N
X PAS863
CONDITIONALLY PASSES '?
NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
FAILS
milftcTgt}A 09MTURE: I
DA1'R: 8214iIG
r"
The MAW kwpsww NIA wuen*w oopy of tMw k w owm mw to em Appro ft A
ai S thl.Inepwopon, If tIw wy mn M 0 whmod*V4*n or haw• ftaw y(t,000 of HwIIN1 or DEP) thirty(30}"
�"ama NIB submit the report to thw 4waprts rwp"oft*of Ittw of E 0,�rw d�� a, he w W and tttw `
Iihotri0 a swam to ttlw wywbm mm wnd OOP"w.nt*ft buw,If*A*0adw� �4.tol FrtiOrGiurl. 1?k arm t r
wpproatno auttprNy.
NOVA AND COMMENTS. 8yst®m 000"of 2-§' A' book®sas
Sy06"is in wortdnp oondittarl LL
pt!!m®of insPiotlorl but Is not up ewnv Tltl�Cods t o NOW: I.
( w° tank ,
I
rftisd 912M 1
rJ`
08.•''.30/1999 09:44 508-775-8804 STRAWBERRY HILL RE PAGE 04
SvBSIURFACE UWAac DISPOSAL SYSTEM INSPECTION FORM
PART A
CENTIVICATION(MftnU@d)
PlaPs" Address: 0 20 C4l1t. ENIa Ln.HY&mW M*, 02601 Lot#j
Ownw: Lapara
Dolts of WGIP"U": 4414*
INSPECTION SUMMARY: Check A,B,C,orD.,
Al SYSTEM PASSES:
X I haw not lolxd any pttoratntlon NtMoh kraioalp Ijnt or eye viokitse ahy or Mar b�lftwe ae dahs�d In 3t 0 CMR
15.303. Any tatlure ormdg nt ev*m"d am k,*OWdbelay.
COMMIll ., SITE OVER ALL PASSES INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME
OF THE INSPECTION.rHEPtE IS NO GUARANTEE ON THE LIFE of THE 6YSTEM,
B SYSTEM CONDITIONALLY PASSES: WA
one of more eyabam 00"gxw Na as d.acrlbad In era•0miltiorail PW ssdipn nand to be replacm4 or mWfed, The
"Wem,upon of the t of rope',as AWMW by the Board of Ha"wNl Pepe, r
Indicate yus,no,or not d and(Y N,or ND). Describe N"of dowmlwtlon Ina h*wnoee, If'not datennwiew,001W,WV not)
T►w"I*I**Is mall,woft ft O*m or opwoor tree WmN v a oralan kwpww wah a at cartkag
(atoohaa)Ir"0 q V a'*the link"a how hin 11A1eled wk *(20) yms prior to#w ar of
blapectlon;or the sapit tank.OWOW or non, is cracked,' unsoun0,,�mrbayu"hwMaadon or
a dWroon,or tank is%&n i•krw*WM. The eya m WW Pon hwpectbn oonf it the arbrtk,p*soft tank is 1slrieo.d with a
amir�"Oletank as opprowd by the Boar!of Hawth.
�. -'*"P b'OkrP ar k*ekoo or hO ste#c water WKW obeawed 1,the dW,*Won bar I.Qua Io broken or obi PIMS)or**to a broken,satd.d or wwsn dlwAWkn box. The woe m w1w pm
Pon won If 04th q*twai of the board of Haeo).
Wohm P***)are replaoed
obrbmmdm k►nrraued
dyMrlarbon boot Is kwNad Or rapieced
Po**)'
The+Y P�ft mob than lar Umm s year due Ic breaker or C
P(WO WM W of ft Board of Haatth):
., bralsm POWs)era rapwwd
obalruallion Is rsn>o4*d
revi"d ar2M 2
J
09:44 508-775-8804 STRAWBERRY HILL RE R'GE 05
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INWEC noN FORM
PART A
CBRTIMATAOfii tocsat3in41wd)
RAY AA . 0=CW.Ellla La.Myaamio Me. 02M Lot#I
Or nw: Lepers
Deft of Irdweadm: &2140
C,FURTHLR EVALuATAON 18 REQUIRED BY THE BOARD OF HEALTH: NIA
Condttlorw"M vrt8da M%Af*U'"w wwl4mOm by ft Board of l twwal,in srder to 4a0sr"*"K tea o"bem M jWkV to
woomt Us@ Pubft h" w salsty mw ale wmvlrom anc
1) SYSTEM/WE.L PASS UNLM BARD OF MMTM DETERMINE$Sj ACCVj%W A VAT"9i•C#M 11I.M
(1)0)Tt1T THE SYSTEM 18 NOT FUMT IONN O IN A MANNER WWN WALL PROTECT THE PkWJC tVAL.TN AND SAFETY
AND Tole EWdWW#wgArT.
rasapocl or PAW is rM*M S0 lowt of a sundae vnlw
CanpW ar privy is v4d9n 50 deaf of a bwdodrq vagabded wwtttnd or a sat marsh.
:! SYSTEMS VALL FAIL U L 9"THE MAW OF"ALTM UM ptMLr_WATER BLWU ,E A)
OFTERM effe THAT TIME SYSTEM RI FUNCTIONM IN A MANNER THAT PROT'EC76 TNa puWX NEALTN AND
SAFETY AND TW EM1t1ot wofT:
The Wohn hm a aapik tank grad roil mmwPft n(GAS)eyed tbs SAS Is vdtM •
100%d of a auataom wMar supply or wry to a wxfwo wow super.
-- The system has a&A tk tank w4 sail atworpdwt system and the SAS Is vA*a Xom
1 of a public vow supply waY.
The system haw a■epic tank and OW Nbwgftn sya*m raid Ow SAS is**W So f®at
of a pr%Ws wow am*vow.
The system Page a asptic tank and soli s(wMw wAsm wrd ft SAS M lose own 100
Peat"50 feet armors from a prlva o wooer 04W wutl,xdm a wtil wwbwr w al m tnr ooidorm
bacW%and wdwo aparyu pompous lndWN that ow wsN M tree from p*Alm fl+ m Me faooy
04 the pnewnoe of arrw wA rftvW any!nbwo nRrW and is 04W bo or Maw tan 5 ppm. IAafhod
Used to detwrft w dledn s — ._off not va".
S) OTHER
rovis>pd 9/2/98
08/3,311999 09: 44 508-775-9804 S7RAWBERRY HILL RE PAGE 06
SUBSUOWACIE SMAf3E DOOPC SA.SYSTEM WSKCTION FORM
PART A
CfRlTWWAYMN(coil nuW)
PN P ft 1 0 So CaO. ESIa Ln.Hymnla m.. oMj t..4 S/
Dom at bupwtlon. f141w
03 SYSTEM FAILS: fwA
You moat'r A I a»OMNI*Yoe or`W to sect of If N jdw'iv:
I hoft deseew*wd*mom or mom of the+MlleaifnS o�eeelMloree aaSrt at Osaar�W M iU CI1N@
Ht.iq. Tfpr dais#w tfikr dsi9Wmbm umo is fdatttftW below. ThO Soard Of NO&Mh a 10M be CoWaofed to
Dstanryns wrint VA be n®co omy tw amr a!tfte Kura.
Yae No
0 MAW of aae1'aw kft%dft or atf►+Owtpanorti dw to an Oafteded or tdoppad
SAS or oaaapook
— D4oftV at pares of$Mum"b Vw wetioa of"Ww W Or surbm water-duo to w oweF
Loaded or ap4t10ad SAS or oeaspW. >
9aMic NgWd hnl in Vu dMIr1RN tw bast abow ottlkt W mn due tQ sn ovarbWod or dagpd
SAS of oseapool.
t4*W depth W toaanPool io hae I=T bobw h wrt or wvAm o rok"is W"Item%OW rbw
AWWbvdPa mot*nws 4 may►M tM het yee►llQ **fZ cld ar obwugad pito*@)
Nwvtw Any POMM of the Sol Aboorpft $Vft n,BaeoPool a pf*Is bakrw use high Wandaiatrr
Ekv dlon.
Any pab+Of a MOPOol Or prtvy Is Wr1tM 100 teat of wxfaw%gbw soppy or tt ,"ry b a
3wfto wow ew*.
Any p"w at a gaaapoal or pdVy is%NUM a Zan I of a pubk Wa.
Any Pw"m of a GOGO l or PdW is%41hh 6o Met of a prku*wow supply WQ.
Any pettlao a o osataooe a b leas than too Nast but praatar than eo ttrlt fh>no a priva4
Wad'a"**00 wtth n®aooWOW WSW quaaty anatyau. If Uw woll has bean wu*pW to be at OWWbis,
alPieoh Dopy or weq waMf arlet)wIs ttx t�llform becterta,vo6et11e orparc aornptxuoda,arnrr,orfrr rsibo�n and nitrat.
r>raropw�.
1_)LA tft SYSTEM FMCS: NIA
You mutt Mdlorls~*Yoe,or w as to amh of the fo WAV:
T�a cl ow.aPp►y to mw vp tla in ao mw to"*out t above:
The wAWWVft a bo tto tMlh a dsat5n flow of 10,000 mid or pruW(Lwp 8yastn)and toppM, is s
OOV*40#WW to p A*NOM and*stay ttnd Ow envWwwewtt WSM cm w mare of the tdkrWC Condklone OW;
Yaa No
NO lb- I.wW*v 400 Mot a a @W%os drW ft watK$UP*
_ the wow Is wom 200 tact of a tributary to a a m%"drtj*v wabor soppy
lM ayeMm I•bCatod in a nibopeh Ow"W a w"(Irttsnm WeBhaed ProtscW Aruw4wPA)or
mapped Zone II of a publlc waarr ewppy waft)
TAa aIWW or opsr br of any ouch atdm n shah UW&de the sy*%m In axon With 310 CHAR 15,304(2). Flow o %,A the k.W
ragbnal*Mm of the nqmtlwt for Arnlat Mfamadon.
►+ert�f><ed 5)J21� q
08 3J/1999 09:44 508-775-8804 STRAW3ERRY HILL RE PA(aE 07
SUMURFACE SMAOE DJSPOSAL SYSTEM~ECTlOW FORM
PART S
CHECKLIST
AAdrees: •W CSPL EUM Ln.liytmis Ma. O MIf Lot 89
Check M the tblorrkq have ban dw*:you must ktlPqgft wlhar'YW or'No"w to adt of the Nbvmv:
Yee No
n tvas PrCA*W by tht mm,ate,ar gQgM of H&IMt,
x None of"vo$gm oomP WWO hom ban pumW for ml We*two Halos axl M1t ayatant
ha not bean mo"normal flbw r*W dutinp VW PWW. lArVs rolumaa of WGW*4 not been NtlradwW
WA "As buo '!may or a pet Of this lnspaotlw
pins hays bw 1.1 a - and■rarrtktad. Note it V"a"not avai�am YAM WA.
X Thb +or wss kWO99 ee ror
X _ The eVOMI dos not No". s of aarugs tx ftw! .
x ^fir��weete flo4a:
x _-- - The ON vm ksapeoted 0&800 of bmaimA-
WA AM*Y*"COMPwwds,ftiu Mnp On 60 Abarpbm ay4iom,here ban Wagon on I*a".
The as *ttlnlr nwdmin Nan wWart W,woud,wW Mee Werlm of ow tap*lank wr
fhapaoted lbr Oonditn of boom or tea,rtaaterlat oB o0nab MUM,QlpNn WUo OWtt of*wW
Dtpth d WUdpe,dspfh of WAn. T►O alas and loon Of the Sop Absorption SyMsm an Mte Ilea
flee bean dommk Nd based on:
X EdIftbrto MMWn.Ex Prw st O.O.H.
X DnamdrtW In ft field(tf"of ttts lti*""AWW rotated to Pat C is t WWA,NWM"goM
X o1 d9 br*o is wwaoepwA)(t S.M2p)(b)l
The f ma j arrMr card Coouparea,K dWOMtl(rem aMWI w&v provided with Wft-go= an
ft Proper mwft wtw of 8ub-Ssxtaae O*Powl Sj46m,
ratWod 9Y2M g
9
081'30/1999 09: 44 508-775-8804 STRAWBERRY HILL RE PAGE 08
SUMURFACE SEWAGE DOWMiAL SYSTEM MWECTIONt FORIM
FART C
SYSTEM INPOWATION
P►nP@dy Addr"o: p Bfl Capt. EIHs Ln.*Amnis Ma. Oml Lot#I
fit: Lapsra
Offs of Hospsat4i m: 4.2i4P
FLOW COMOMOµ$
D'°itjn ttegr; — q,p,d.rbedroom for 8.A-s.
Tdd OEBM riomytWw of b (patwl): 3
NunoAer aaawnc rssidu+tbo; 0
Gwbw vftw(ysa or no): me
Lanky(sWonW sy" ) (}pt ar no): N. tr yat,oioparsoe itNptot47n r
Lanky ky wool kupodw(yrt or no): OuA
Sa.sralai+M to*or ro) Yat
YIOt11r nwhr nadinpo,0 avalhbi (2)Vier uttpt(Opd):
Oft or no): No
Lad daft of ooxupomy; N/A
Ty�s al ooAobio�Ostrsrf: �'
000 flow tspd�aa4d aoo .>fi) t
Bads of dnipn hear
arms tnp pnssnt:(ypp or no): ;
hoat/M Waft Wr,OV Tank pn o ow or no)
*"Wfty wmb dbo WVW to the Tom a systtm:(M a na) ....—
W?Ww mww raaclllgo.itaaolme:
tat dab at ooaipangr: p
O?"W.(Doom*)
i.aw dab of oo WWW
fR:MIERAL IN FORMATM €,
P4jMp**43 RECo"snd sauroe of in"o Wn: r
h pumped ss peA of MIA
insptoMon:(ysa a tw)
M m fl
TYPE Os t)Y'sTEM
—._ 84pot tartkmmmwan booNacd abaorphon
oompw
x— �O nw omapw
Shand%ftm(!as or no)(It pa,rfpoch prpNax fnopooytn mwr*,N
ter, 11A TaotkrokVy 00.ANSO OOPY of up to deb ap wvbm 4W m4hbrome contract.
-- TWO Tank----Copy of DEP Approvd
O»'
A✓pPROXiMATE AGE of all components,
WA dsta instsood(it 10O Wn)and source of lntormstion:
SWMP adore d*CWd w*w woAV st the Sft prey or no)
No
tee0so d 9t2M 8
.a
08/30/1999 09:44 508-775-8804 STRAWBERRY HILL RE PAGE 09
URFACE SEWACK 608POSA1.SY&TEM 4taftCTMN FORM
PART C
SYSTEM INFORMATION(ootwouw)
OaM o/Imp 4.21.0
sullama mR:WA
(Lawls on+Mt)+Mn)
�W sue!
+ orlon na _ 40 pvcolow" aellsr
Ctor ham Duds wow a**�at suotlon IMw
(oolldNo�A{pyiq.'wnM�,sNdw�a d MIS,aec.) ��..�
WPM TINS!(: �
(laaw an a"*n)
Dopim!,stow pads:
INIQuMI of ooRabt,omort
It tort M nw",IMt op w 0"w(om*kl)
1s M»M*mod by CMalbala ar compM,nC. {YssHb)
a n h oltt , a au p W
tfrsfsts� buftn of WU ea.ar bag:
�Mlt
owwm hm by of m m b by of 0AW tsa or haft:
OMlrles helm boom of wm b bottom of a"Ms or bwa..
Hm
dbnrna+orts
tetra agw„nt,w
Y,�dwioe d .OcOOrluwor►of brrt snd auMof bsN«b�,p�of y4Wd iauel!n raiaMan to o�,its(�>�hlrsl
ON""T'W:WA
(boo sn Oft pw)
bdow pub:
aartllrtrcttarl canorsts msm,l F�f�ss
Sawn fatal nno:
D""m ham tap of z;;telp tap of as t a.
O*VM Ram bolloel of ICKIM to b ottan Of OLI Mt In or bo%I6:
DIM d Mat pylr �;
comraris:
puffok'g.*-$'bon of WW and Ow"tsss or bOW,dew,or ttltllo Iwal h wleort to tube!bnult,stnx, NW
,.tc.)
I+ev�seq 81/a//88 7
08/30/1999 09: 44 508-775-8504 STRAirdBERRY HILL RE PAGE 110
sUBSURFACF-SEWAIX DOPOSAL SYSTEM INSPECTION FORM
` I+AitT C
SYSTEM INFOItMATK*(continu®9)
PsVF"tY 11 ea: s 20 C40. HIS Ln,NTannW Ma. 03M Lot;in
Odder: LOPWO
Do"of bmPectim. "14
TWW OR PK*M 0 TAfdK: WA (Tsnk must be vwrapw pricy to,or■t pme,of wapaotion)
(Laxis on ass 0m)
Dooh bow*wsdo;
WFaSs►Isl Of m0VN61dCfion Co+irrels ._ MAW Fd _ p yY coal(Ovwn)
Dhnensbns: �.
D640 kw.
C�eliOrle
Dwldty
Aba►n 1s+rd: Aismi in wofty ardor Yae; No
OIft of pip ---
ConosTa tY: ~'
(WWAan oI Iraq Us,amdtlon of als,wW tk d W^Cjas,skp.)
f
AISTRtWJTNM BOX: None:
(b0W on e1N pkn)
D4W of WW"obwa witM snarl:
00mmorb:
(rah N loft wid dwbAm is O*W,eVidenot of sollda owryovw,v dwxs of W60p Into or Out of bolt,W,)
PUMP CMMWR' N!A
(bows on alb pion)
Pun"In wow:(Yes or No)
AlW"k+vaor9rMtp Orderr(von or No)
ouvereorts:
(rw*oarrdirsm Of WJM Ownw,widlwn of p mw end finances,
reprised %2!'!38
08/301'1999 09: 44 508-775-8804 STRAWBERRY HILL RE RACE 11
' SU8>aUgFACE SEWA�OE
. D*OOSAL aY81'EAt iNiSpECTNDN FdMM
PART C
SYSTEM lf4FORMA"ON( mod)
Property Addrs"; M 20 COPL Me Ls.HMAls Mr. Ono, Lot Nt
Owner: Laws
Osse of wispecoon: "4
aft ANGORPTWN SYSTEM ("$):
('*"On d4 pbn,N ;um+W-eta e.qubw,b A bs OWIld Med by narv�ntrushw�eMtt+ods)
If not lo�,ern:
Typo:
Leocitktp pno,w>rbw, t.
9000
s
LfttlFv omwrw.mm w:
I dsoiiYtp loww'gs,rMmow,
�tMidt,rnolrtb�r,dw+�k+rM: `�`
Aftrnow
�Mrlbrr
Nem.of T.a�rtaoeY
cmwo , a�
(rtolo tom sod, oonfty dl of hosuik.. Jasl of portdpt0 (ipnp oexodliion ar w964110 n,sot.
No �. )
CEO:
j (boots on ab pion)
Dwim of wide imor
DwM of noun kW,
OW&vbns Of cumpool: gy8,
MOarbiO or co Csrn
Nww
Inaicotlon ate:
hftw(osopw mutt be j_w ers W yr ftpogjM)
COartrrwrtbo;: --
aa�Mon do01,v�-�+Mc fiuure,,Nnel aWaV,w-fton w Vsomwwn, )
mm mA s Nwv Pt/C tvilh f t OtlO ova fpw is!n eattlltiort but ro not nwv TrJws
PRIVY: NUA
(bow on Mb pbn)
M -m bis of oortsptmn:
Doo of mft: DMr _
camnaft
(nm Ooe4um a sots,siprto ar hydrauric fer♦kxe,bwl Of WWO,mullion of
wpoh�0on,stc.)
revised WV96 8
0-9/30%1999 09.44 508••775-8804 STRAWBERRY MILL RE PAGE.
SUBSURFACE SEWAGE DISPOG&8YSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinuad)
FIPIV A"*": P aD Cant.EXW La.Hym mi s Ma. O01 Lot&n
Ownw: LOPOM
Oslo 9f MwsePM210", "1.0
SKETCH Of IiE1MAOK SAL gygTEM:
k"am Uu to at W"kw W"Wwlt+ommoM bwmwow,bwwww$a
bole a4 w oft%W*100'{rode where p Aft warner&AVIV cm bdo halm)
VIRr DOM
�. REAR, 000tt
ke qs 14
D'
96,< �
ow oyi�i„f tadt
WTE. Hmot hA9 bcenv VAu+n
w�
Smct OCT- 15 All ;61S oty
14T Time OF• y11. etc 4foN
cessfft1, 00.c f,.fkcfa "44,14%tj
E. LP-sou Q 5�151'nm if �+c� WeAlff%Ls
• ® � 11N fR� CS7�4. ���• '
ruvW*d 10
08/3ar'1399 09: 44 508-775-8804 STRAWBERRY HILL RE PAGE 13
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Pia'eRy A 0 20 C80-EM a UL HymaW Ma. 0=1 Lot 64
00"W: Laylra
Ode of k"paft" "142
MRCS Raw name
300 TWO
Typiod d"plh to groundwater
us= Dale wabaft viNhed
Qbaaralkrn wink droktd
Oround water depth: shmomw Modarats Drip
SITE EXAM slops,
Suwl!aos avatar
Check COW
SheMow m"
Es*mftd Depth to ww*Aod r Fed
Plum irdoate ei the nmfhads um d b ddern* Miph{;swwrKAuells,r EywMbn:
Obished**m l omo Pyle*on r*oe�Q
Obaawl m of Sb(Aheft mpwty,owerm wl host,Mon"V^ s,tc.)
x Delnnlint a*am iaaal condlllans
Chu**0 Ioal Board Of htaNh
Check Fam h6 ps
Check pumpkV raoordo
Check I=*6004 tors,InehMas
X Uas,USM Deis
066a e N yew own words how you*eleNiahed tha H40 8mnndwmim F wallon. be canptebd)
Lot 01 It In*(So of no known high ground weter.USGS Into.
rovviaW 9/2M 1
FJL
_J THE COMMONWEALTH OF MASSACHUSETTS
J
S
rh DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
w
U!
William E. Robinson, . Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21 A of the
General Laws. Issued by The Department of Environmental Protection.
m
0
m .
April 20, MS
Aotan� Director of the w�n of water elution Control
m L
t
r
W
CL
4;cm=nbea U of ice
-
---------- - -- ------- ----
Department at. Fire Ser uices
1825 Stale Read, Stow, Ma
w
HYANNIS
w
CERTIFICATE OF COMPLIANCE
H
} CHAPTER 1489 SECTION 26F, M.G.L.
w
Date
'IfThis certifies that the property located at: �atatain LEri Lane
unit / apt. number has been equiped vAth approved smoke detectors and
was found to be in compliance with Chapter 148, Section 26F, Massachusetts General.
Lady.
Inspection / testing completed on: 7 by:
LT. DONALD CHAP,19,CFI
c PA 10 $10 Harold S. Brunelle. Chief
Head of Fire Department
m NOTI~' THIS PERMITFIRES fiD ®AYS FROM DATE OF-
_ISSUE
' tT
O�
O"
r
r�
' Ql