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Home My WebLink About0056 IRVING AVENUE - Health 56 IRVING AVENUE HYANNIS A= 287 - 147 I �I 4 I i I, 0 Commonwealth of Massachusetts Adz8 �� Tithe 5 :Official Inspection Form � p ' Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments Property Address — `? Owner Owner's Name Information is =' required for every `7 �7� Pale, City/Town State Zip Co Date of Inspe6ti0h ;F �P Inspection results must be submitted on this form.inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Lnspector Information 57 j v Ming out forms m the computer, use only the tab key to move your Name of Inspector cursor-do not �i c use the return Company Name key. Company Address Cityfrown State Zip Code Ste$ -�S"2� -36 6� . r _ Telephone.Number License Number $,. Certification 1 certify that: I am a DEP approved system inspector in full compliance with Section 15..340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection.I have determined that the system: 1. Passes 2. ❑��` Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails � z� 19 Inspector's Signature ba e The,system inspector shall submit a copy of this.inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Please note:This report only.describes conditions at the time of inspection and under the conditions of use at thattime.This inspection does not address how the.system will perform in the future under the same or diffenmA conditions of use. i6�sp doc-rev.7/26/2018 rrde 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Alk Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage //Disposal System Form-Not for Voluntary Assessments Property Address �.r�� t/ owner Owner's Name h0ormation is f° �o— �r� wired for every —� fie. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes- 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: d �c7 u r�l l� 2) Sy m Conditionally Passes: ❑ One more system components as described in the"Conditional Pass"section need to be replac repaired.The system, upon completion of the replacement or repair, as approved by the Board o alth,will pass. Check the box for"ye "no"or"not determined"(Y,N,ND)for the following statements. If"not determined,"please expl The septic tank is metal and ove years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltrati or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced 'th a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if structu it is sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years o is available. El [—IN El ND(Explain below): 1 dk p doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name �r Worrnation is //4/fV&IyAdR T required for every Me. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) S stem Conditionally Passes (cont.): ❑ mp Chamber pumps/alarms not operational. System will pass with Board of Health approval if pu ps/alarms are repaired. ❑ Observatio of sewage backup or break out or high static water level in the distribution box due to broken or structed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection ' (with approval of Board of Health): ❑ broken pipe( are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is remo ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is levele replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year du o broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of H Ith): Elbroken pipe(s)are replaced El El ND(Explain below): ❑ obstruction is removed El El ❑ (Explain below): N f� 3) Further valuation is Required by the Board of Health: ❑ Conditions exis ' h require further evaluation by the Board of Health in order to determine if the system is failing to pr eet bl�Htenn![Les y or the environment. a. System will pass unless Boar in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner w 1ch-wfll-p otect public health, safety and the environment: ftmpAoc•rev.712WO18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Properly Address Owner Owner's Name information is � required for every Me- Cityfrown State Zip Code Date of Inspection //C. Inspection Summary (cunt.) �`A ❑ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or.a salt marsh ❑ P P vY 9 9 b. System ill fail unless the Board of Health(and Public Water Supplier, if any) determines t the system is functioning In a manner that protects the public health, safety and envi nment: ❑ The system has septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface w er supply or tributary to a surface water supply. ❑ The system has a sep`c tank and SAS and the SAS is within a Zone 1 of a public water su PPIy ❑ The system has a septic k 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 from a private water supply we Method used to determine distance: This system passes if the well water analysis, pe ed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of mmonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criten are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El dogged 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 dogged SAS or cesspool ap.doc•rev.7/26/2018 rNe 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address �it/loEG�Qy owner Owner's Name 'urtoanation is fj�Y,y n/n/is P v All& pZ(-¢7 ¢-2 —19 required for every Me. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ rn 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 Y2 day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ �G] Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ � �jn Any portion of cesspool within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a.public water supply ❑ rlla well. ❑ [� n(�q Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Q d/4 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.) ❑ M The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ H The system iis. 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. 5) Larqe Systems: To be considered a large system the system must serve a facility with a des' ow of 10,000 gpd to 15,000 gpd. For large s ms,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system�within110-feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributa =(Inten nking water supply 11 El the system is located in a nitrogen sensitive -lll-e(head Protection Area-IWPA)or a mapped Zone II of a public water supply wel Sftp.doc•rev.7/2fi/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments S�o•��'✓liJf�� Property Address / �6 CGC7�V�N Owner Owner's Name information isj��/f oZ�4y required for every p"e, City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6, You must indicate"yes" or"no"for each of the following for all Inspections: Yes No ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® 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? ❑ n Have large volumes of water been introduced to the system recently or as part of `e this inspection? El available 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? ❑ 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 maintenance of subsurface sewage disposal systems? The site and location of the Soil Absorption System(SAS)on the site has been determined based on: Ns$utlf ❑ Existing information. For example,a plan at the Board of Health. ❑ 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(5)) ftap.doc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address / ��LZyoGCo�/ Oar Owner's Name information is 17�,QaY4115Pa� { 02� �'Z¢-19' qui rered for every Paw- City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): `� Number of bedrooms(actual): —� DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): �`3v Description: - Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes ] No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes No Seasonal use? 14 Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail- 2G17 177oov Sump pump? �je,y v�v� ® Yes ❑ No Last date of occupancy:��26!$ /�2 �r�lbvyvf� , /1-j��raq Date .docftap -rev.7/2612018 Title 5 Official inspection Forth:Subsurface Sewage Disposal System•Page 7 of IS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name Information is /R//S 2�- - �ZG�7 ¢�z�l- 1 9 required for every City/Town State Zip Code Date of Inspection D. System Information (cont.) NIA, 2. Commercial/industrial Flow Conditions: Type of Es ' hment: Design flow(based o 10 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats rsons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes [A No If yes,volume pumped: gallons How was quantity pumped determined? 4I/A- �YUT/�z�-SS �r md►� c�d�/d�� Reason for pumping: a'V'I c7 P/ e e b,",)fee eleem a/o ftalpAoc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address IlaRAI Owner Owner's Name information is *4/a✓/S/aa/lr OZ 6, required for every Rom. City/Town State. Zip Code Date of Inspection D. System information (cont.) 4. Type of System: ❑ Septic tank, distribu=re Single cesspoolII Overflow cesspool ` f ❑ 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 contract(to be obtained from system owner)and a copy of latest inspection of the 1/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 11 Were sewage odors detected when arriving at the site? ❑ Yes df No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: �qcast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: -r, ,4L e m O ll feet �I/1^/fQ �I/+� �� Comments( n cond' 'on of joints(venting violence of leaks , etc.): 6 WbWda•rev.7/26/2018 Title 5 OfSaal Inspection Form.Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address / Owner Owner's Name Information is required for every City/Town fie /Tv State Zip Code Date of Inspection D. System Information (cont.) 6. Se tic Tank(locate on site plan): Depth low grade: feet Material of c struction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Comp nce?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or ba Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations,inlet and outlet tee or baffle conditio structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): MkV.doc•rev.7/26/2018 Tltie 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name Information is ,¢41A1YSP12T Q2ro47 required for every City/Town State Zip Code Date of Inspection D. System Information (cunt.) 7. Grea Trap (locate on site plan): Depth be%conrs e: feet Material oyfction: ❑ concrete metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top o\outlet Distance from bottom of scum to br baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or ffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): N14 8. Ti t or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below gra e. Material of construction: ❑concrete ❑ metal El fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day WnWdoc•rev,7128/2Q18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 1S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address / �dl/6�2�2N Owner Owner's Name irdormaredtfon is for every /}q/�S�o�1 - 47mqui Pam, City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. t or Holding Tank(cont.) Alarm prese : ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float swi s,etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. ' tribution Box(if present must be opened)(locate on site plan): Depth of id level above outlet invert Comments(not ' box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage' to or out of box,etc.): t05ko p.doc•rev.7/28/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address ) Owner Owner's Name _ y q information is required for every page_ City/Town State Zip Code Date of Inspection D. System Information (cunt.) Plld0. Pump Chamber(locate on site plan): Pumps i orking order. [] Yes ❑ No Alarms in working der: ElYes ❑ No` Comments note conditio f pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: G?C�%✓/�7�rJ `O �W /li/!R// &-XC ✓0}/?�!L / ri a� Yo v��( {�2L�Irc� Lj 0!�3 c^t 4 'Ll 'e S �� n.nr,,-Ve3—M69, Type: leaching pits number: Da✓5- ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: 15knp.doc.rev.7n612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name a4orrnation is oi/�L/1 S P a/tT 41,4- OZG 4 7 required for every page City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) cont.) Comments(n a ndiyy n of soil signff hyydraulic failur , lCvehof poQding �g pp ssQoil, �ition of vegetation,etc. �1 oVjvrn�a // 9 lyi�S�a�Lev �lgl6 !/Q c a S 7L-GEn?L /r2�c`! r Z S �v�� r e 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool J'j ''!r'd'q�ite�� G 7 �a✓end Materials of construction alvG 6Gk- indication of grou dwater inflow ❑ Yes ' ( No Comments (n a condit)on of soil) igns of hydraulic failur level of pondin1 dition of vegetation) etc.): ;l 011�1 / �� f'�S�I' v`� Va�,P�%k„� rt/ S�or/�✓ � �✓ee� 0 6v� k�� tfi wnp doc-rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name hformarequired for is �/ 62GQ7 �-Z1e-/9 required for every page- Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 413. P 4=cons plan): Materition: Dimensions Depth of solids Comments (note condition of soil, signs of hydrau I ilure, level of ponding, condition of vegetation, etc.): Gwesp doc•rev.7/26/2018 Title 5 OMdal Inspection Fornrc Subsurface Sewage Disposal System•Page 15 of 18 AN Mr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name Information is �/��,�/�f�pa�-� �1 required for every f City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: (� hand-sketch in the area below 0 drawing attached separately j Z R,L Mi doc•rev.7126/2018 Title 5 Official Inspection Foam Subsurface Sewage Disposal System•Page 16 of 18 \- Commonwealth of Massachusetts Alm Witte 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is 1-1,Y*a✓q//S?v eT required for every -- page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: [�Check Slope z Surface water n11A- Check cellar dv y� Shallow wells �p✓ ✓��c5 74- (zI Sc L"r �I V 35 o� Estimated depth to high ground water: �� ' � .� Z Or Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ 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: di/�dd /q/Ws&- You must describe how you established the high ground water.elevation: _ 4 _ 0 4 s 2 /7f 1 r7 ole'l L 5 9AY ��✓y Before filing this InZction Report,please see Report Completeness Checklist on next page. VIaWdoc•rev.7/2612018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name Information is W,c //j//S�O�ZT CMG¢7 required for every Page City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of. A. Inspector Information: Complete all fields in this section. B. Certification: Signed&Dated and 1, 2, 3, or 4 checked [� C. Inspection Summary: / 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed j D. System Information: / For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included SkWdoc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 18 of 18 LOCATION SEWAGE PERMIT NO. VILLAGE �-V I CP 2:77 A'& B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER /1/11?,r, L BUi ss L®y L.. I .. DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ® - C c - 1 I�'i