Loading...
HomeMy WebLinkAbout0030 IRVING AVENUE - Health 30 Irving Avenue Hyannis P •A = 287 001001 i I i I i COMMONWEALTH OF AC �`Z MASS HUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 0 , DEC O TITLES TOWN OF B, ALE HEALTH OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 30 Irving Avenue OVarini Sport iAAP Owner's Name: R1 i7a G11eparrl Owner's Address: b Acacle ,- liana PARCEL Date of Inspection: , GT 06371 LOB a Name of Inspector:(please print) Wi 1 1 i am E_ •Robi_nson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 _Centerville, MA Telephone Number: (508) 775-8776_ CERTIFICATION STATEMENT i certify that I have personally inspected the sewage disposal system at this address and that the information reported . below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Se Wn 15340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 4 f, L- Date: 7 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth*or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 Irving Avenue Hyannisport Owner: Eliza Shepard , Date of Inspection: Inspection Summary: Check A,B,C,D or E I ALWAYS complete all of Section D A. yst S Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: _ B. System Conditionally Passes: One or m re system components as described in the"Conditional Pass"section need to be replaced or repaired.The sys em,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or of determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits su4stantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the - existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank twill pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the is less than 20 years old is available. ND explain: Observation o Isewage backup or break out or high static water level in the distribution box due to-broken or _ obstructed pipe(s)or i ue to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of I lealth): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system r quired pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if( ith approval of(be Board of Health): broken pipe(s)are replaced obstruction is Mmond ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_ 30 Irving Avenue s. Hyannisport Owner: Eliza Shepard Date of Inspection:_ .J/.-� `j C> �--J C. Further Evaluation is Required by the Board of Health: Conditio sexist which require further evaluation by the Board of Health in order to determine if the system is failing to prot ct public health,safety or the environment. 1. System ill pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system ' not functioning in a manner which will protect public health,safety and the environment: _ C sspool or privy is within 50 feet of a surface water esspool or privy is within 50 feet of a bordering vegetated.wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier;if any)determines that the system is functio ing in a manner that protects the public health,safety and environment: _ The syste has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a surface water supply or tributary to a surface water supply. — The system i has a septic tank and SAS and the SAS is within a Zone l of a public water supply. — The syste i has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more fronl a. private water supply well** Method used to determine distance "This systerrt passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and�Iblatile organic compounds indicates that the well is free from pollution from that facility and - the presence f ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criter a ar�^tliggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 Irving Avenue Hyannisport Owner: Eliza Shepard Date of Inspection: /> ^15-- 6f' D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within I00.feet of a surface water supply or tributary to a surface water supply. jAny portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory.,for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from MA facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to(his forma (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. La a Systems:To be cAsidcrcd a large system the system must sen•e a facility with a design now of 10,000 gpd to 15,000 gpd• You must dicate either"yes"or"no"to each of the following: (The follo� ' g criteria apply to large systems in addition to the criteria above) yes no th system is within 400 feet of a surface drinking water supply the Astern is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone ll of a public water supply well If you h/ve answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has fi ikd.The oAmer or operator of arty large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR_ 15.3 4:T ystem owner should contact the appropriate regional office of the Department. 4 r Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 30 Irving Avenue Hyannisport Owner: Eliza Shepard Date of Inspectlon: !-- Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health l� Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection?.. V Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? _4 —, Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper main of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes nog. / - �/Existing information.For example,a plan at the Board otHealth. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 30 Irvine Avg-nu Hvannisport Owner: Eliza Shepard Date of Inspection: 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):.s Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): .�0 b Number of current residents: _ Does residence have a garbage grinder(yes or no):Zj� Is laundry on a separate sewage system(yes or no)r/G66 [if yes separate inspection required] Laundry system inspected(yes or no): .�i$ Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): 0 3./0 4 — 4 4, 2 5 0 Sump pump(yes or no): 02103 — 36, 000 . Last date of occupancy: COMMERCIAL/INDU TRIAL Type of establishment: Design flow(based on 10 CMR 15.203): gpd Basis of design flow(eats/persons/sgft,etc.): Grease trap present( es or no):_ Industrial waste hol tng tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter read' gs,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: a pi / 4,15 Was system pumped as part of the inspection(yes or no):., /v If yes,volume pumped:__gallons—How was quantity pumped determined? Reason for pumping: _ TYE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contact(to be obtained from system owner) Tight tank Attach a copy of the DEP approval Other(describe): .. ...... . .. . .. .... .. . ..... . . ... .. .. . Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):_6 6 I'agc 7 of I I OFFICIAL INSPECTION FORA'I—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Irving Avenue Hyannisport Owner: Eliza Shepard Date of Inspection: BUILDING SENVER(locate on site plan) Depth below lade: Materials of construction:_cast iron 40 PVC_other(explain): Distance froln private realer supply well or suction lute: Comments on condition ofjuints,venting,evidence of leakage,etc.): SEPTIC ANK: (locale on site plan) Depth below grade: f Material of eonstruuion:Z1111cc1c metal fiberglass_polyclhylene _othcr(explain) _ — . If tank is metal list age:_ Is age confinned•by a Certificate of Compliance(),es or no): of—(attach a cop}' certificate) Dimensions: e__4e_L -'r, I-a. Sludge dcplh: V'7 Distance Gore lop of sludge to bottom of outlet tee or baffle: 13-0 Scum thickness:_ a Distance from top of scum to top of outlet Ice or baffle: _ Distance from bottom of scum to bottom _ of outlet ice or I low were dimensions dctcnnincd: battler � Comments(on pumping recommendations, inlet and outlet Ice or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of Icaka e,etc.): 1 GREASE TRAP:_(locate n site plan) — Depth below grade:_ Material of construction: concrete rectal fiberglass Polyethylene`other (explain): — Dimensio710)0 Scum thic Distance fs mn to top of outlet tee or baffle: Distance fof scum to bottom ofoutlet tee or baffle: Date of laConunenting reconunendations, inlet and outlet Ice or battle conditio:t,structural integrity, liquid levels as related erl,evidence of leakage,etc.): 7 'age 8 of I I OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORIIIATION(continued) Property Address: 30 Irving Avenue yannispor Owner: Eliza Shepard Drtte of Inspection: TIGHT or HOLDING TAN (tank must be pumped at time of inspection)(loca►a on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explaul): Dimensions: / Capacity: / gallons Design Flow: / gallons/day Alarm present(yes or,no): Alarm level: Alann in working order(yes or no): Date of last pumping: Con-unents(con di ton of alann and float switches,etc.): DISTIUBUTION BOX: Z(ifprcscni must be o pened locate on site Ian I )( plan) Depth of liquid level above outlet invert: Conuncnts(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,ctc.): PUMP CHAMBER: ocatc on site plan) Pumps in working -order(,des or no):— Alamo in working orde (yes or no): — Conunents(note condi ton of pump chamber,condition of pumps and appurtenances, etc.): J f ° Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_30 Irving Avenue Hyanni sport Owner: d Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavatiodnot required) If SAS not located explain why: Type aching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,Angth- leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool ust be pumped as part of inspection)(locate on site plan) Number and configuration: _ Depth—top of liquid to inlet ' vert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwate inflow(yes or no): Comments(note conditi,n of soil,signs of hydraulic.failure,level of ponding,condition of vegetation,etc.): I I PRIVY: (locate on'ite plan) Materials of construc ion: Dimensions: Depth of solids: Comments(not condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): i 9 r Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Irving .Avenue Hvannisport Owner: Eliza Shepard Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. /(2-0 U o T v a- U 004, JA �� . 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Irving Avenue Hyannispor Owner. Eliza Shepard Date.of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: �. .0)-d 2: 11 �- � ._ 0a (-,, '' :.� No........... .. .... Fss............._.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Divjipoial Mirkii Tomitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --o- ti ;,-i\ddress(J or Lot No . . ........ ------ ---- .......................................... ................................................ 71 .. r ess Q W a ...................................... )------------------ Installer Address Type of Building Size Lot............................Sq. feet Dwelling4No. of Bedrooms-------- - --------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures -------------------------------------------------------------------------- W Design Flow--------------------------------------------gallons per person �rf day. Total daily flow.........---.....................-----.--...gallons. WSeptic Tank—Liquid capacity/'O�.gallons Length --------- Width.------------ Diameter................ Depth.. ............ xDisposal 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. l----------------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..............--....---. 9 ......--•--------------------------•-----•--------••-----..........•---••---•------•----....._------......................................................... ODescription of Soil........................................................................................................................................................................ x U ••-••••••••••••-•••--•--••••---••----••--•-•-•--•-•...-•-•--•--••-..........•--••-•--•••--•••••---••••••••----••-------•--•----------••--••-•-----•----••-••-•--••••---•--••--•-•-....-•••---••-------- W ------------------------------------------------------------------------------------------------------------- -- ----- U 1? aturgiof Repairs or A attons—Answer wl}en a linable.---_%2?4ir v..-_ .:, --tE -...... ._..... 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 beeissued by board of health. Signed ............ .... ..... . -------------------------------------- -------------------. -- ............... —....c�t.... ® I D­ Application Approved By .. ----.../_..., ............. - '? Application Disapproved for the following reasons: ------------------- ----------------------------------------------------------------------- .----- ------------------------- ............. ------------ Permit No. ................... ._---- -------.---- Issued .......:' -... _ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (famplianre THIS IS TO CE—RTIF , That the In ual Sewage Disposal System constructed ( � or Repaired �l1. .......- l✓ G..• -_---------- ---------------------- ----------------------------- ------------------------_--- by ......................... :� _....... . �. ..... yrV.4. -.--` -------------------------------------------------------- has been installed in accordance(with the provisions-of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. . . _ -� �. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOrBErCONSTRUED AS A GUARANTEE THAT THE7 SYSTEM WILL FUNCTION SATISFACTORY. ✓i DATE..... X0 "' - ....... __---------- - Inspecro - v 06 No................-....... ' Fes$..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ­ , pVftrtttion for MoVoottl Workii Tomitrnrtion Famit Application is hereby made.for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... . ' ... :.n.. ....:..... _ r �:1 ...----------------------------------------o..Lot No--------------------------...------------. Qo atiou-Address •--•--------•-------•_-----•-•-•................................................................. -w el +— Address ! " a Wa--• {_ P1-----------------------------•--•----- �J __�__ _ e ; Installer Address Type of Building Size Lot............................Sq. feet .a Dwellingf=moo. of Bedrooms--------- 5 -_F� -.-Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures ------------------- -•-------------------------------- W Design Flow_____________ _----_---------____gallons per person per day. Total daily flow............................................gallons. WSeptic_Tank—Liquid capacity,/__7©�_galIons Length ____-__-- Width_51--____-_-_. 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 ( ) Q Percolation Test Results Per --- Per-formed by.......................................................................... Date/..0.. Test Pit No. 1.-_______--___minutes per inch Depth of Test Pit____________________ Depth to ground water........................ LZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ,/ --------------------------------------------------------------------------------•-•---------.----------•----------•-----•-•------------•-••------------------ Descriptionof Soil xti--------------------------------------------•----••..........----------------------------------------------------------------------------------------------- U ................................................-:..................................................................................--------------...................................................... W U Xaturp,of Repairs or Alterations—Answer when ap licable._.__ ""�'___._:_; 5 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 beej/ issued byrth board of health. Signed ......... #� ..� _a�_ � <r ---- --------------- - - - ........................................ � .. Application A ...... . ......... 1..................._...._....... ` : _"'1� PP � Approved BY ...... Dace Application Disapproved for the following reasons: `�- - ...................... ..._...._.................. .... ...._.. . .......... --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- Da Permit No. ----------- Issued �. �............... .. Dare __---—____..__._'__. —.-- _, — —__—_.--_ —_—____.— —.____-- r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CITErtifir to of Compliance THIS IS TO CERTIF , That the Ind.vidual Sewage Disposal System constructed ( l') or Repaired ( ) by -------------------------------- 2 ... .�-------�G_ ------�-a..... .............. - -- - ...- - �.. II'«ue at .... ..` v. �. !-' -y .ly./! - tea=' '.. ------ -------------------------------------_ x� �� ` has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. . ..... ... .. .....�f6. dated THE ISSUANCE OF THIS CERTIFICATE SHALT. NO BErCONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE /� .."''--.... - .....: - Inspecto� .e� ..��.,_;C {....s-' r`- < pl THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.. .�_.. .Q FEE........................ l . Eksp ial orko �unotrnrtion rrntit -� ----- ���...---�-.------. --- Permission is hereby granted-___-_ c _.?` _ _ to Construct (A ) or Repair ( ) an In•ividual�Se-wage Disposal System at No.......... WAS.... '�'1� � `�/'� i/v� s r:� " ��----------- Street n�— ,.p..+ as shown on the application for Disposal Works Construction Permit No._._s..________-'__ �^.�/ Board of Health '�� DATED ` j�................................... / FORM 36508 HOBBS&WARREN.INC..PUBLISHERS I I I . 1 i� I I I I I I I 1 I I I I - I I I I I I I i I 1 I I I I 1 I I I I I I I I i 1 1 I I 1 I I I I 1 1 I I I I I }, I I I I I I I I I I � I I _-- I I I ' I f i I Y T' ', I � I I I f' I I I f I I 1 i I I I I i I I I I I i 1 f 1 I: I I 1 f I I I I �00 L 0 C A T IQPI : 4 E. A E P1! RIR1°i NO. - ( -� ;V1'l! AiGE_ A4,""' .! :SST !;�� �.EtR'S HAVE. �� -��io l E 3 S �_ t Q UlLUE R ®R", OWNER ` •'OATS PE MIT' ISSUED l DA#TE : C0ArPLIANCE ISSUED { r.{ --� ' •� r'.,,� .. ter, .� �i / s �. �. ! / I i � �. J 1� � W '\ i �. � �, ��0 �� �. � � . � . . � � � `�� -'}� , .. , y y f, � ,+''I. �,, ' NJ Cl Nd� Notslnlagns 1 U --------------- 10 �1 G 8Z ddW NM 1 �o N /MOy �i�fl�P� 3 nN �� b' OZ p 1 o via .8 �1 � .aQ 77Prrry ' Garos IDr 11,411 na i1-7'f1.fiu7a 3o lolaflo:) I."INAlomi 3141 L e 1 r 1 a3L'If17321 J.::i! 17ACL''J:i'J t ,P e •nr -1 HZ71no7 vt�oQ e,no7 cu �� ��• • 3•I�lJS ri � � t��•,nd I .�..••� .�. C../It pw.hllll I .. I 1 _Y•__ a Od • E i i ' I / . .... - ...... � �'�•. I ANY a} // Oo 'Mo�';ggoSf?5-►- �' t a /IG,49 II- 0 00 ,., . 6G'6Z � MOB-,90 OQS•-- / I � � / ,, �� � Sal 1.72 a C- I A 'J. • '�' t T