HomeMy WebLinkAbout0220 MEGAN ROAD - Health 220 Megan Rd
291-267 Hyannis
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-P t ,JOWN OF BARNSTABLE
LOCATION `, Q ( s) JCQ- A 0 SEWAGE# �d�T�Z Z 7
VILLAGE��-�'� 3� ASSESSOR'S MAP&PARCEL a
INSTALLER'S NAME&PHONE NO. 7L J rC y
SEPTIC TANK CAPACITY1000.
LEACHING FACILITY. (type) y ,-5'M k.(S'P G`o1AJ C (size
NO.OF BEDROOMS
OWNER '7- /FL ` f l
PERMIT DATE: COMPLIANCE DATE: 2 202—1
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility. Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) 'Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
`FURNISHED BY.
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ti TOWN OF BARNSTABLE
LOCATION It-0-4-0 SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT.,2-f/--.(c-)
INSTALLER'S NAME & PHONE NO. � �J4� GPr�-�zJ - 36
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER
BUILDER OR WNER
DATE PERMIT ISSUED:
DATE ..COMPLIANCE ISSUED: ��
VARIANCE GRANTED: Yes No
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TOWN OF BAPtNSTABLE
LOCA' ION 2-2VM 0 WULF SEWAGE #
VIIA.AGE '_ ASSESSOR'S MAP & LOT
31STALLER'S NAME&PHO ( h0.
SEPTIC TANK CAPACITY V V 0 Mad
LEACHING FACILITY: (type)ZLQ.9h (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation'Distance Between the: I
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any ands exist
within 300 feet of leaching facility) n „� Feet
Furnished by ��J
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No. la i — FEE /
COMMONWFAIJII OF MASSACHUSETTS
Board of Heait ,MA.
APPLICATION FOR DISPOSAL-SYSHM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon ❑Complete System dividual Components
Location Owner's Name
Map/Parcel# Address C
Lot# Telephone#
Installer's Name Designer's Name
Address e5lor" e— Address l
Telephone# Telephone# CY
Type of Building LJ[ �AAIIJII Lot Size sq.ft.
Dwelling-No.of Bedrooms Garbage grinder ( )
Other-Type of Building No.of persons Showers( ),Cafeteria
Other Fixtures
Design Flow (min.r quire ) gpd Calculated design flow Design flow provided gpd
Plan: Date 'Zo� Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator-d Date of Evaluation
DESCRIPTION OF RJZPAIRS OR ALTERATIONS
The unde i ed agrees to' tall the above described Individual Sewage isposal System in accordance with the provisions of TITLE 5 and
further to of p e th system in operation until a Certificate o Co pliance has been issued by the Board of Health.
Signed Date
Inspections
..�.��...... -- -- - --------------------
1
No. FEE 66 `
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t
_ COMMONWEALTH Of MASSACHUSETTS
{ a, Board of Hedlth) rw , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( Upgradek—AbandonO - ❑Complete System LU<dividual Components
Location = IVY Y & .� Owner's Name �.-�.•*
Map/Parcel# Address
Lot# Telephone# ��r A- ^) �•
Installers Name ! ��� ' Designer's Name
_ V'\" "� j
Addresst � `` r Address# _ Vj
Telephone# 5vt> 40 _ ,a Telephone# "' ►{
l�hu, /t.Ar�,�"i Lot Size s ft.
` Type of Building r q.
J
Dwelling-No.of Bedrooms Garbage grinder( )
�u•.'--.4_. _ .... w:.. ,R•i--.,:..., '-'—.r-...^., ...,, s:..:::;� ':.._;-... .. 34,;.�.y�— +?i•— .ram=, —r--'.. -
Other• Type of Bizildmg - -- No:of persons ~= r__-Show'* -(");-Cafeteria-()
r
Other Fixtures
Design Flow(min.required) � gpd Calculated design flow. �^^'�''' Design flow provided gpd
Plan: Date � t-�����:�' .,Number of sheets � �._ � ._\ t Revision 7/Date �P4 W,
Title
Tt ?'.rt'r'` .F�` k.r�- 1l�€r`" /�° C"�;7["" r )
Description of Soil s
Soil Evaluator Form No. ?1 A Ira Name of Sorl Evaluator 'jam..1 1 , r'1l`Date of;Evaluation
'R
DESCRIPTION OFREPAIRS'ORALTE TI,ONS
The undersiAed agrees to install the above described Individual Sewage Disposal System°m accordance with the'provisions of TITLE 5 and
�, l a1 _.'� fl e lt- � � a ,I;
further agrees to not to place thersystem in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed vi � .•/ Date 1 � �
{V '
Inspections
x •
No. �[� a y,,•f
v �`� (�- FEE ���c
iii COMMONWEALTH OF SSAC, USETTS
• Board of Health� MA.
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CERTIFICATE OF COMPLIANCE
Description of Work: :' Individual Component(s) ❑Complete System t r
The undersigned hereby certify that the Sewage.,Di�s�p,�sal Systerra; Constructed( ),Repaired O Upgraded( ,Abandoned ( )
by: ��-tom-' -0((' M �,,.:�i CT
at
has been installed in accordance with the provisions of 310 CMR 15.00.(Title 5) and the approved design plans/as-built plans relating to
application No. G�7 �'!A7 dated .. Approved Design Flow (gpd)
Installer .,� i
Designer "" Ins ector;• r..�-.,_.. Date• C.
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. '
. ., �.. .. � .. r ...-ri a,.; ^.-rT ^.•t%7 ( '1 i lr ;R ^( i t.' :'�" .y ..( 1. .. r - _ ``_ -_ - r .. � .. -
No. FEE 1 .✓'
COMMONWEALTH OF-MASSACHUSETTS
v
_• Board of Health, ,MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade( Abandon( ) an individual sewage disposal system
at Soo mf:0 F__J� 1�) ( as described in the application for
€ Disposal System Construction Permit No. Rai'a' dated
tl r
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
form 1255 Rev.5/96 A.M.Sulkin Co.Charlestown,MA Date -1 11�PA Board of Health
c• r l � -
Town of Barnstable
Inspectional Services
Public Health Division e;
Knss Thomas McKean,Director
16s9• .�
+° 200 Main Street,Hyannis,MA 02601 ;
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form *
Date: �Z� Sewage Permit# 0 - p�ssessor's MaplParcel Yl
Designer: Installers
Address: Address: G
On as issued a permit to install a
date) (installer)
septic system at 1 �� based on a design drawn by
(address)
dated
(designer)
V that the septic stem referenced above was installed substantially:according to
I certify p y
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected. and the soils
were found satisfactory.
I certify that the septic Systern referenced above was installed with major changes (i.e.
greater than 10',lateral relocation of the SAS or any vgrffcaf relocation of any component
of the septic:,system) but`in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system jeferenced above was constructed in compliance with the terms of
the approval lette (if applicable) OF
DAVID-`X �y
c
(I s le ' Signature) MAB ON
No.1066
(Des i r s Signature} (Affix. % Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS
BUILT CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
WoAdeptAHFAI TMSEWER cormecASRPTiCOesigner Certification Form Rev 514-13.000
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$30.00 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 to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
DATE QR- /4! 0/0 Fill in please:
APPLICANT'S YOUR,NAME/S:hARLQ LL Gy c c z
a �•+° , ' BUSINESS YOUR HOME ADDRESS:_�_Z ® �-(P e r A&) �� ��,�ct la �g y.
crmi M ra It
21<59-7�f4�6 L2 0
ti w k`h`, TELEPHONE # Home Telephone Number Z r 7L
� ,; ,,,
1416
NAME OF CORPORATION:
NAME OF NEW BUSINESSILower �o e- l.ardSc p Y TYPE F..BUSINESs LatnA,�,c.cx(2P ��<�s-Cc-Uc
IS THIS A HOME OCCUPATION? / YES NO ohsf
DDRESS OF BUSINESS 2 2
MAP PARCEL NUMBER [Assessinal
When starting anew business
siness there are several thins you u g y 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
g 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 e of business.
q P type
Authorized Signature*
COMMENTS:
2. BOARD OF HEALTH
This individual has been irAurmed gl th • requirements that pertain to this type of business. MUST COMPLY WITH ALL
lj( 4A7ARDOUS MATERIALS REGUI AT!nN!q
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
.Authorized Signature*
COMMENTS: s
4 Date:
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: No W( -V- o2 ALse �Ok-e�� U na5 La pe— o tU c0�1
BUSINESS LOCATION: 22o Re_ GvN �2-9 9x0_hy-.15 f`la 02(.01 INVENTORY
MAILING ADDRESS: 22-0 :akr 3- TOTAL AMOUNT:
TELEPHONE NUMBER: 77 "t — 2 — -]L/ 1-1(�
CONTACT PERSON:Marko L G U L cl-A U z(tc,/4-
EMERGENCY CONTACT TELEPHONE NUMBER: -71 &/-- 25 q — -7qk 6 MSDS ON SITE?
TYPE OF BUSINESS: La lnAsca ee- -z, csY\s��c-ucA L %h
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: 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 materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
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.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
()t\. NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. 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 (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes ma be toxic o hazardous (please list):
Laundry soil & stain removers
(including bleach)
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection,forms may not be altered in any
way.
,ii- �
Important: A. General Information
When filling out G
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC
Company Name
r� P.O.Box 763
Company Address
Centerville Ma. 02632
City/Town State Zip Code
(508)428-4028 S 14454
Telephone Number License Number
B. Certification
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 Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evalu i0on by the Local Approving Authority
9/24/2007 s
Inspect Vs Ign ure Date 'u
t
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 its is 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 syyea t owner
and copies sent to the buyer, if applicable, and the approving authority. t '
•.-d ram,
****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.
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts.
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 220 megan Rd.
Property Address
Adilson + Silvana Gibellato .
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007.
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I 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:
The septic system is in proper working order at the present time.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by .
the Board of Health, will pass.
Answer yes, no or:not determined (Y; N, ND) in the ❑for the following statements.If"not
determined," pllease explain.
❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial 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 will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that,the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health)`.
❑ broken pipe(s)are replaced
❑ obstruction is removed
220 megan rd.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
r
I
Commonwealth of Massachusetts
W Title 5 Official. Inspection Forma
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
220 megan Rd.
M
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
-
every page. City/Town State, Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if .
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
�❑ 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
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system 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 has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '
°M 220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
every page. City/Town State Zip Code Date of Inspection
Y
B. Certification (cont.)
/
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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 well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 must be
attached to this form.
3. Other:
x
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
El ® 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 1/2 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 100 feet of a surface water supply or
tributary to a surface water supply.
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�nM 220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes- No
❑ ® Any 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 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.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® 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) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes or"no"to each of the following, in addition to the
questions in Section D.
Yes . No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ E the system is located.in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have 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 failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
220 megan rd.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
f
i J
Commonwealth of Massachusetts ,
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is Hyannis Ma. 02601 9/24/2007
required for y
every page. City/Town State Zip Code Date of Inspection
C. Checklist
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
❑ ® 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?
® 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 size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ® 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)]
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 220 megan Rd..
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
every page. City/Town State Zip Code Date of Inspection
J
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 2
DESIGN flow based on'310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 3
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? N Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2006:116,00
g ( y g (gpd)): 2006:116,000
i
Sump pump? ❑ Yes ® No
Last date of occupancy: 9/24/2007,
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CM 15.203):
Gallons per day(gpd) ,
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
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):
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information. (cont.)
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?, ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspoo[
❑ 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 contract(to be obtained from system owner)
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe): Y
Approximate age of all components, date installed (if known)and source of information:
New leaching pit installed in 1995
Were sewage odors detected when arriving at the Site?. ❑ Yes ® No
220 megan rd.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
1' -
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 10+
feet
Comments (on condition of joints,venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank(locate on site plan):
8"
Depth below grade: , feet
Material of construction: _
` ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
------------------------=------------------------------------------------------------------------------------------------
8'6"x4'10"x57'
Dimensions:
61'
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
24"
Scum thickness 6„
4"
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
12"
How were dimensions determined? Measured
L220egan rd.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump septic tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank
appears to be structurally sound.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
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
Date of last pumping:
Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
/
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
� f
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/.24/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
No D-Box present.
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑, No
Alarms in working order: ❑ Yes ❑ No
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
every page.. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number: Two
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number,_dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
J
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
First leaching pit is full.Overflow leaching pit was 16"water to invert at time of inspection.No visible
stain lines above water level.
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
Commonwealth of Massachusetts .
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System'Form -.Not for Voluntary Assessments
^M 220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/24/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
J
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Commonwealth of Massachusetts
Iff
Title -5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .
220 megan Rd.
Property Address
Adilson + Silvana Gibellato
Owner Owner's Name
information is
required for Hyannis k Ma. 02601 9/24/2007
every page. Cityrrown State Zip Code _ Date of Inspection
D. System Information (cont.)
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.
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220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
220 megan Rd.
Property Address
Adilson + Silvana Gibellato'
Owner Owner's Name
information is H annis
required for y Ma. 02601 9/24/2007
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
Surface water
® Check cellar
❑ Shallow wells
Estimated depth to ground water: 35'
feet
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:
As-Built Card
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
USED:Gaherty& Miller Model.12/16/94 ground water elevations. USED:USGS Observation Well
Data June 1992. USED: Technical Bulletin 92-000-01 Plate#2.annual ranges of ground water
elevations.
220 megan rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
�] CERTIFICAT
G,r1 1l 0
Property Address: 220 MEGAN ROAD BARNSTABLE,MA 2668 N'y no k_% Dqk
Owner's Name: CHRISTENSEN
Owner's Address: 220 MEGAN ROAD BARNSTABLE,MA 02668
Date of Inspection: 6/22/04 Mai :�
Name of Inspector: (please print) JOHN GRACI,INC.
y
0
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET,MA. 02536
Telephone Number: 508-564-6813 FAX 508-564-7270
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 Section 15.340 of Titl 5(310 CMR 15.000). The system:
X Passes
_ Conditionally ses
_ Needs Furth valuation by the Local Approving Authority
Fails
i
.Inspector's Signature: Date: 6/22/04
The system inspector shall submit f
pyofthis inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspectiIfthe system is a shared system or has a design flow of 10,000 gpd or greater,the
inspector and the system owner shubmit 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
SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
****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.
Titlp. 5 TncnPrtinn Fnrm cin innnn
r Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 220 MEGAN ROAD BARNSTABLE,MA 02668
Owner: CHRISTENSEN
Date of Inspection: 6/22/04
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I 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:
SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
B. System Conditionally Passes:
_ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,
upon completion of the replacement or repair, as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain.
n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits
substantial 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 will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating
that the tank is less than 20 years old is available.
ND explain: n/a
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of
Health):
_ broken pipe(s)are replaced
_ obstruction is removed
_ distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
_broken pipe(s)are replaced
_obstruction is removed
ND explain: n/a
Page 3 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 220 MEGAN ROAD BARNSTABLE,MA 02668
Owner: CHRISTENSEN
Date of Inspection: 6/22/04
C. Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a manner which will protect public health,safety and the environment:
_ 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
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system 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 has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system 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 from a private water
supply well".Method used to determine distance n/a
"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 that 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 this form.
3. Other:
n/a %
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 220 MEGAN ROAD BARNSTABLE,MA 02668
Owner: CHRISTENSEN
Date of Inspection: 6/22/04 P
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for,all-inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
- X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
- X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow
- X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped SYSTEM WAS P11MPED 1 112 YEARS AGO PER OWNER.
- X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
_ X Any portion of a cesspool or privy is within a Zone 1 of a public well.
- X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ X 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 that 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 this form.]
NO (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. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the system is within 400 feet of a surface drinking water supply
- X the system is within 200 feet of a tributary to a surface drinking water supply
_ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have 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 failed. The owner or operator of any large system considered a significant threat
under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
a
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 220 MEGAN ROAD BARNSTABLE,MA 02668
Owner: CHRISTENSEN
Date of Inspection: 6/22/04
Check if the following have been done. You must indicate "yes" or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner, occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS, located on site
X _ 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?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
X _ Existing information.For example,a plan at the Board of Health.
X _ 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)]
1
S
I
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 220 MEGAN ROAD BARNSTABLE,MA 02668
Owner: CHRISTENSEN
Date of Inspection: 6/22/04
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):2 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):220
Number of current residents: 4
Does residence have a garbage grinder(yes or no): NO,
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump(yes or no): NO V
Last date of occupancy: n/a Q
COMMERCIAL/INDUSTRIAL J
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no):NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: SYSTEM WAS PUMPED 1 1/2 YEARS AGO PER OWNER
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X 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 contract(to be obtained from
system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
Approximate age of all components,*date installed(if known)and source of information:
1974 PER AGENT
Were sewage odors detected when arriving at the site(yes or no):NO
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 220 MEGAN ROAD BARNSTABLE,MA 02668
Owner: CHRISTENSEN
Date of Inspection: 6/22/04
BUILDING SEWER(locate on site plan)
Depth below grade: 12"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 6"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: L 8' 6" H 5' 7" W 4' 101''It
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle:32"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 17"
How were dimensions determined: MEASURED
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.
RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP: _(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert, evidence of leakage,etc.):
n/a
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 220 MEGAN ROAD BARNSTABLE,MA 02668
Owner: CHRISTENSEN
Date of Inspection: 6/22/04
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: n/a
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
NONE LOCATED
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no):NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.):
n/a
R
Page 9 of i l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 220 MEGAN ROAD BARNSTABLE,MA 02668
Owner: CHRISTENSEN
Date of Inspection: 6/22/04
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 2
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS
OF FAILURE.PIT D HAD 4' OF LIQUID IN IT AT TIME OF INSPECTION.BOTTOM IS AT 8 FT. PIT D HAS 2'
OF EFFECTIVE LEACHING LEFT IN IT.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) ,
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no):NO
Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):.
n/a
No..... --- - Fss... ® ._...
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for 'Diij-paii al Vi mrk,i Towitrnr#iun Vantit
Application is hereby made for a Permit to Construct ( ) or Repair (*< an Individual Sewage Disposal
System at:
....��......................................... a o----- ! `^1 ,Jt.s-------------------------------------------------------------------
Loca6 , -Address
W Owner n ss dCrc ...
Installer Address
UType of Building Size Lot............................Sq. feet
►� Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder (--�-,*.f Q
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d Other fixtu s ----- :.
w Design Flow.................______-_____gallons per person per day. Total daily flow-------------_��__.�Q-----------,......gallons.
WSeptic Tank—Liquid capacity e ___gallons Length---------------- Width________________ Diameter._.--__...__.__ Depth____-_________--
x Disposal Trench— No_ ______________ _____ Width.................... Total Length--------------_--- Total leaching area....................sq. ft.
Seepage Pit No.�-:.-J IDiameter__--..-�.6---_..__ Depth below inlet______.__........ Total leaching area..................sq. ft.
Z Other Distribution box �� Dosing tank ( )
Percolation 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' ---------------------- ......................................................................................................................................
0 Description of Soil.......................................................................................................................................................................
x
w
i
U Nature of Repairs or Alterations—Answe, when applicable_ -v�- ............/UQ�-.......
n P PP
.............. tF— - ---------------------------------------- .........................................
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 been i e by the board of health.
Sign --- -- -------- ..
--- ------- ----- --------------------------------- 7NI.
ie
Application Approved BY _..... . - --- --- -------- ---- ---- ...
�,
Application.Disapproved for the following reasons: -:.. ...................._...__. ... ------------ ------------------------------------------------------I---------
..............?(.,- - ---
Permit No. .... ./ Issued .-��C� --- .....
f Q� ' , -7
No.._ ---....--• Fes$... ......
�t` THE COMMONWEALTH OF MASSACHUSETITS
R BOAR® `OF HEALTH `
TOWN OF BARNSTABLE 't
Appliratioit for DioVooa1'4Vvr t, C�o�tr riirtion erntit
' ., Q_
ti Applicaon is hereby made for a Permit•Co-Construct ( ) or "Repair (b<) an Individual Sewage Disposal
System at: '
Locat'oi -Address
f3 .mac i r_ %�t rYl d 2/�
owner p Address
... •C.0 evJ i--•--• '�..� ..... ►. M ` �t!D i/..................................
i` 'Installer
Address
UType of Building Size Lot............................Sq. feet
►, Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder (---�n1 U
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Other fixtur s - -
W Design Flow........
......................... per person per day. Total daily flow.------------ ....._-...__._.___gallons.
F
WSeptic Tank Liquid,capacityl�...gallons Length---------------- Width_-------------- Diameter---............. Depth................
x Disposal Trench—No. -.__-.. -..._ ._. Width-------------------- Total Length-------- I-._-.-_ Total leaching area--------------------sq. ft.
Seepage Pit No. .-- -N Diameter.----../...4_....... Depth below inlet....... ........... Total leaching,area..................sq. ft.
z Other Distribution box'O_ Dosing tank ( ) '
'" Percolation Test Results Performed by--------------------------------------------------------------------------- Date-------:.--'.............................
W
Test Pit No. l-------1--------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
fro Test Pit No. 2...............minutes per inch Depth of Test Pit-------------------- Depth to ground:water..--.------..--.....-.-.
0 ..............................................
-------- ...................................----------------------------------------•------••--------------•------•-•----------•------------•-•-----------
... p Description of Soil........... ••.-•-----•---•................•-••-•---.=-------------------..-....._.------------------
U .......••••-------------------•••--....•.-......•.. ........--•-• i
W t
-
U Nature of Repairs or Alterations—Answe' when applicable- 144 A------�---AIL-J E,- Ai.- S -------------Zko..__...
Agreement: t ,
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 Ee has been i by the board of health.
------
Sign
-_-.......... - - - ............. 6/.a / ---
Application.Approved BY � - ................ ?`" ..
Application.Disapproved for the following reasons- ----- -- -------------------_---------------------------- ._........... - ....
.... `
Permit No. t.... ...... -- .............. Issued ._..: - ;� - I
...
y Da
1:�...o:�- �i�e.a�etm-�Jacses-+a•..�.e._>.w...�. �-....-w�+-..-..s>v.,+>.x xx>�-.
` a .� --,- ..re�...-h .y+n. .�.;. .�,.�r. �-rMr-�.�..�r.wr.r�>r�,�s.�_�L. _ ..'+za-•-._�,a�Mf�� e.r-�
THE COMMONWEALTH OF MASSACHUSETTS
` BOARD OF HEALTH
TOWN OF BARNSTABLE
t .
THIS IS TO CcE Y; That the Individual Sewage Disposal System constructed ( ) or Repairedby ( p�)
.C7�--� ZaJ ....... !04 -- --------
Iacrdlrr -
at ---------------------------------------_..--- ---�-- - .--------- .-----�---- ----------.. ...�..-.-...- L�/�f�tL�,l.. -
has been installed in accordance with the provisions of TITLE of The St te, vironmental Code.as described in
the application for Disposal Works Construction Permit No. _..._,C?`' - _..-.- dated .--.--...._._.___ _.---__....._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUE,AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SAT SFACTORY.
It- � i
DATE ....................... ....... -------------------------------------------- Inspector ( - . :: -------------------------------------- ---------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH f
r
TOWN OF BARNSTABLE
No...../_ . _ .� FEE..-:�6.._�_.
Dispnoat VvrA Tnnntriu-tinn rantit
Permission is hereby granted................. ._-----.a� U .!a�.
to Construct ( ) or Repair ,(<) an Individual Sewage Dis. sal System -
at No-----------= ==------------••---• =». Q------• `mac ¢� -/ �-..
Street
as shown on the application or Disposal Works ConstructioVPmit No-- ------------� ate- .�
Board Hca h
DATE..............-....�-�.l / - - ------------------------------------
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS ,
E
Ale
ASSESSORS MAP NO- '21 1
N. .......
PARCEL NO-
THE . ��� Fz�$.... ... ...
COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
, pVtiratiun for Dityuittl War1w Tuntrnr#tun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System
at: A d
Location-:\ddress or Lot No.
/ 9.W
o"•'-?---- Nisi<. __ d rlC� ! ti_ . ,v11/iS
ner t- --•-----drescf ^
Installer Address
UType of Building Size Lot............................Sq. feet
., Dwelling—No. of Bedrooms----_------------6-----------------------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.........................................
Test Pit No. I________________minutes per inch Depth of Test Pit--------------------- Depth to ground water........................
�14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
9 ----------------------------------•------•--------------••----•-----•-•---------------......_------ --------
0 Description of Soil-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
V .....-----••------•--•-----•----••--•----------------•--•--•----•--•--•----•-•-•---------.._...-------------•----•--------------------••------•-•-----•--•----------•---- -------••-•-------•-,�
W -------------- ------------------------
Nature .----•--••-• ..
--- -- - - ---------------- -- -----------------
U Nate of epairs or Alter i ns—Answer wh a pcable._______.. _.
----- ...
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—T e undersigne rther agrees not to place the
system in operation until a Certificate of Compl- e be i t . boa of health.
Signed - . ..... ---------- ------------ ....
re
Application.Approved G - ' -----------._.:7T ----------
Dace
Application Disapproved for the following reasons: -----------------------------.....---------------------------------.....................--------------------------------._-----
----------------------------------------------------------------------------------------------------.........---------......------------------.....----.......................---...---------------- ----------------------------------------
Dare
Permit No. 's/" �'
...4,Z' ......:. ,1r' /./........................ Issued - J�. ..- . ......
Date
------------------------------------------------- ----------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
CIler#ifira e of Complinure
_i�IS TI ,' That�e,Individual Sewage Disposal System constructed ( ) or Repaired'( )
by.... �''`-'^v _ ..r..0. . ...........------------------------------------------------------------------------------------------------------------------------------------------
'�Insr.Jlcr
� QN.- - - - ----------
at ....� D----..-1�.L - - -
has been installed in aYcordance with the rov ions of TITLE of The State Environmental ode as described in
p ���
the application for Disposal Works Construction Permit No. .. .. ... dated
pp p 1 ,._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.....-- ..... --- -------------------------------- Inspector
------------------------------------- ------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE 1tj 00
No... � FEE----.....�_.....---• _
�tnuL r n Chun #rnr#iun "rrnti#
Permission is hereby granted �o�✓ . .rt1C r --------------------------------------------------
to Construct or Repair ( a Indivi; al Sewage Disposal System
atNo...15OAA 49--Ad ------ --------------------------------------- ----------------------------------
Street C �i,�p
as shown on the application for Disposal Works Construction Permit I i` _ 7 Dated________-_ _- -0
----•--
S Board of Health
DATEs j----.... -- --------- -------------------------
FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS
No..9;`_- f, to FRS .... .......................
THE COMMONWEALTH OF MASSACHUSETTS F
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Di-nVinittl Wor1w Towitrnrtion rrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at-
..1_4, 1. 0 /per An/ il.,_ . ,
................•---•------..._..-----•-•--•-----. .._..
Location-Address or Lot No.
(� -�/ f (/ J .............
.....
C(.:_s11� (4 !�t1�_sprJnv - 26 �� ra tJ' tJ lYt�Ae�/U�S
.(�'J�,'`J ownei
Al/l 11. f/�........ `f 6-/-- __ /_ C �✓....................................................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms------------------ ---_-__----_-_---__.-_-Expansion Attic ( ) Garbage Grinder ( )
p.I Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
al 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.
3 Seepage Pit No........... .......... Diameter..--.---------.----. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water..---.-.-----.--_._.-.-.
fT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1:4 ---------------------------------------------------------------------•----...................._.............................................................
0 Description of Soil........................................................................................................................................................................
V .----------------•---------......•-----•-----..............-------------••.................-•-•-..........•-----------------------------•....----••.--------------•---.......---------•--.... =
x ----------
------- ------------------------------------- ...........................................
U Nature of Repairs or Alterations—Answer when applicable.--._- �' --- jb '......................... [
Agreement: a +�
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 as been is� .......... health. -- -=Z.
Application,Approved By
Dare '
Application Disapproved for the following reasons: ......................... ......... . . ............. ..... ..... . ...........................
.......... . ....................... ............. . . . .................................................. . . ......................_........ .......... ----------------------------------------
Due
Permit No. _,.�-r-/-:,>............_,--------...------------------------- Issued ........ �..�. --
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ge>rtiftrate of Tomplianre
,T_HIS S T6 C,ERTI That tbe,Individual Sewage Disposal System constructed ( ) or Repaired ( )
by �.... .(6V 5----- `�C.—�— ° v----------------------'-N-n-s-t-a-l-l-e-r-------------------------------------------------------------------...............................................
at .... ..... �e(- �
.. . .. .. .... � d
.{ -- - _..... _...- -- .........
has been installed in aclordance with the provi-s'�ions 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 NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............. ..' 5.��.'-.�i --------_.....--------- ---------- ----------- Inspector ..------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No... TOWN OF BARNSTABLE FEE..... .:..D�-
��Tonotrudion f rrntit
Permission is hereby granted............. cC��.!_o_KJ.-•_----_•-•_
to Construct ( -or Repair ( �) an IndivZll�
al Sewage Disposal System
at No e1-�'�A......�--Zerf--=`�.&i• • _7 ..... �'a ��l q c-------- ......--•........
,. t a-
57
as shown on the application for Disposal-Works Construction Permit ,o � Dated.--.-_----�- --� ..-
=•-•--•••..........••-•.............•----------------•-----•--•---------..............---.........._--
Z
DATE------- C .......................................... Board of Health
5------j`----------f--•---
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
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0
Ins t ji
_ t , {. �'� h ,ii r,t t rl�:= town
`j � �. � ;� + {-- _ t� --2 � ta: '1 5.}i ciEi :il'ntl�i�(lfr?{ .. _ +:
p :i p �,a i ;�t'ii tn1A11I^SEd��it
_ _ _..�•-' � �' { .,� F _. _. 5L`iil: G' :}_' . ' `i . tail �" li Ot Je i(t. �'t t - .
S�/ Pfii € i =d Fi 5
! `,�� ! fT'� •1. � �1 f� �J� - 't/Y . f/ �.t/' ,� � .c A '"j,j,`r <?� .. 11ii tri) f j"}'.?<;�:1 ,., .
E, � __ r � �.__��.� -t' iG ,{li?rr11'irlQ:l," -:r1!. �S'i{w ;i'•� it;C,3�rC.^t� =vr;-'r SC':ti+?r
- T•1 ►{
�1
�t-' C .:::I _, 1` - tXISFfI�g S? tt:i Cblil�TtiJiit`lii5
_ 67 __ \ '} gra vit Sewer #pif�� ;i b 4 inc • s•, e ,ut t0 PVC at s 2 Fee r,;
" „ #a , o r ' n i h k r 1: first t J'.!•`.
TH! --. di"T ibu-ion box 5h:;b ba ki; -ping cornectiO►zs
i ` u _ is Se�Jti(_dp5ion sJiar is t1:. t ,ifs ..i r! for Ali >f�sr .in' .s, r,;`tire.... . , fcr-any other
Z11D �V ------`. pose olhr-!.: Eii -1I�";?fiii:1Rf.52C� $"T:c _,Ys;, r1, i11Stailatioi,
. —� c. 1 /,. - t:: Z:T;a . '/71}1�`,:atlY di4 t; 11t?PS jiiif> t`$:)t_'r:#f}C$rio 5 {
w.+a.wc esrs f� �lt IC�' (. '�� ,(7V d'k3T1PSra}l ?l {�'Clhq.ria�ta }' ii .?Z;t,V .Q�r1porlf:rfs�3Z��..e •„•ri fi'! :,; i9�f o.aded.
-= ,/k { � xiSti,lk iea.F;in• .',j=::i:i-. ae puillr-'eci and filled with a� r;. t~ ,lie�[
1"'_2flliii '.Cl CSS>�3t'it^is5i c3f1C�t�'itt7't111:d3fcra ti{ :vifilltl i�i�
�1
/0 posk is r ! r=e Sa Title pecifir t; m
r•ro 5�>:-' . ar }wrrl�lL ed an re;.-iaCed with . .ar. rrt'1 pPf i i V s _ a �� ,.
SF:*ltic--omrio-lents are l,� '%- �.' _ water service Une. 'iPv+ei f;li ,, _ ng a wa}af lihii
il2P.i!EC.t ;�Jljf r�1t 3D:?" ''r1E'CUlE`r1Q �r`L W.Si; �iIL7; (C7liE2f: Tt+p ?{cr S"e'V .:_ t'
ov±•`it. yet•= _ - `.I) the$IEeue I),��ng
7 _ !f" P•;;rbage' i?t i'lder PX.OS 1:1 i,3} S!f :{tv,r2, it iS TO be. r,�.'mok :`'1" 5�Ci' `:Stern is not
? tg Ff t=:+ 8i.: rl;tlF l4�''%t a `tip
3 - rt . � h.7Z7F er•+leer. ... . . .. .. rope
t} rl•L:..'"�i r ��� t y y.,l•>k �/ �� I'lklr3li.. },r. �'?i3 'n �' �I r? 'r,• r. = r 1� Cf" :lta
tecli^-- the st?':}C3t: f= i. ` e f 't"'^,g tt t' i t :rdSs O� tlt Sepik.
�+�.�•, .,t. -•Tr., t r r_.S 1.It ,
� # ,'� � _ �.i�� •� i.!:-. .. _ <��: :fir { t }+.- � -,+. „♦ .�♦n �•M Tir+t, l
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,+ranients. i
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1 - - - / - Wt�sk'�br,J/ l✓` ;gn flokv. Instaliatic";, of tho sr?i)tu:.`,):,tern ca5 ,^a opcsed and reCe*'Pj nertt for She tietii�i
C C, G-- 1 d.i be deenipd 'l�i,,o;ii!':f i ,i =d,,':iPi! .ritefia ov tilt.? prf?,,e r J ?•t•'rl$r_7. _r?t of-
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` tiF✓ T� V.. I t i` or the vatidi;•. piar" sh" 11} _xclrP{)i�Dian o. t -
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