HomeMy WebLinkAbout0361 OAKLAND ROAD - Health 361 Oakland Road, Hyannis
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11 r YOU.WISH TO OPEN A BUSINESS?
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For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate
esONLsiRnatlSTERS YOUR ures on this format at 200 Main StAME in c Hyannis.
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the y g
1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
Take the completed form to the Town Clerk's Office,
required by law.
DATE:H -y—� Fill in please:
APPLICANT'S YOUR NAME/S; ' I �
BUSINESS YOUR HOME ADDRESS
%Li'ti ` �'>•� -,, TELEPHONE # Home Telephone Numb r
it" �.1e�r.�:�;! •
NAME OF CORPORATION: -t — - PE OF BUSINESS
NAME OF NEW BUSINESS
IS THIS A HOME OCCUPATION. YES t ` 0 l�ll • MAP/PARCEL NUMBER 00 (Assessing)
ADDRESS OF BUSINESS
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
and licenses required to legally operate your business in this town.
Rd. &Main Street) to make sure you have the appropriate permits
1. BUILDING COM SION 'S OFFICE r' ST COMPLY WITH HOME OCCUPA T iON
This individual as b i f0 -ed p mit qeq iremerits that pertain to this type of busines ,U�ES AND REGULATIONS. FAILURE TO
11
t Auth ize i ature* COMPLY MAY RESULT IN FINES
COMMENTS: f Li
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2. BOARD OF ALTH TT AL4
This individual has been informed of the it r it ment hat perta' to this type of business. keC
�iAZARDOUS MA ERIALS REGULATIONS
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:
I oven of 15arnstable ;.
THE
Regulatory Services
�pp Jp�
o Richard V.Scali;Director C}
3.u,vSAR[,F Building Division
MASRSLv� s Tom Perry,Building Commissioner
prEn tnata 200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax:_508-790-6230
Approved: A),
Tee:
Permit#: /3
HOME OCCUPATION REGISTRATION
Date:
Name: D�/�/ G'� Phone#: �' ���aU�
Address:�,Cj I �q t1 Village:
Name of Business: e �� J� MAUI
Type of Business: l'e-1`S oyll ;11 Map/I of � l
1N'I=: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordnance,provided that the activity
shall not be discernible from outside the dwelling. there shall be no increase in noise or odor,no visual.alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the .
following conditions: ,
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located within
that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of
normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment
• There are no commercial vehicles related to the Customary Home Occupation,other than one van dr one
pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lofcontaining the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit
I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Applicant: Date:
Homeoc-doc Rev.103113
Y.
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Town of Barnstable REci§pr
"Bt 200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit
Application No: B-16-853 Date Recieved: 4/7/2016
Job Location: 361 OAKLAND ROAD,HYANNIS
Permit For: Home Occupation
Contractor's Name: State Lic. No:
Address: , , Applicant Phone:
(Home)Owner's Name: LEACH,ANDREW JOHN JR Phone:
(Home)Owner's Address: 361 OAKLAND RD, HYANNIS,MA 02601
Work Description: Spence Odd Jobs and Haul-a-way
Total Value Of Work To Be Performed: $0.00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
� t
Signed: Damion'Soence 4/7/2016
Applicant Date Telephone No.
Estimated Construction Costs/Permit Fees
Total Project Cost : $0.00 Date Paid Amount Paid Check#or CC# ( Pay Type
_ .MLA _
Total Permit Fee: $35.00 4n12016 $35.00 � � Cash q
_......._.._..._............................._...............__........__......_......_..........
.._............._...__x.._.._...__..__.._..-- ...._.....__...._...__._,..................._...__..__......................_......
._.
Total Permit Fee Paid: $35.00
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COmmonwealth of MassachusettsF, OIL
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offExecutive Office of Environmental Affairs�." ��°�' ant ofEnvironmental taCtiWWlam P.Wow
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A _
CERTIFICATION- -._.
Propmty Address: 361( 004 -4-)A
Date of Aodnm of Owner.
' 11 �� �V (if different)
Name of Imp tor. .
Company NA�dress Telephone Number. '
s", 67 dd-/ rrs�eef
CERTIFICATION STATMENT 60 8 Y-'7 7
I certify that I have personally inepetted the sewage disposal system at this address and that the information reported below is'ttue,ai:ewata sdrd cmnpkte ae of the time of inspection. The inspection was performed based on my m traieung and experience iu the proper function and
maintenance of on-site sew
. age disposal systems. The system: ,
Conditionally.Passes _ a
Needs Further Evaluation By.the Local Approving Authority
FeiLq
Inspectors Signature: Date: :.. ' •`-'
The System Inspector shall submit a copy of this inspection report.to the Approving Authority within thirty(30)'days of completing this
inspection. If the system is a shared,systeni or has a d4ign aflow of 10,000 gpd,or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.-.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSP$CTTON BUMMAR1h
Check A.B.C,.or D:
Al Ate: f
I have rot found spy information which indicates that the system violates any of the failure criteria an defined in 310 CMR MO.
Aoy failure criteria not evaluated are indicated below_
81 SYSTEM CONDITIONALLY PASSES:
ORB inspection.
M"system components need to be mplaaed or repaired- The sgetem,upon complstinn of the replacement or>nepair,paesm
Indicate yea,no,or act dstertained(Y.N.or ND). Describe baste of determination in all instances. If"not determined.explain why not)
The septic tank in metal,cracked,structurally unsow4 shows substantial infiltration or e:frltration,or tank fame is
huminent. The system will pass inspection if the existing septic tank is replaced with a gonforming septic tank ac appaaced .
by the Board of Health.
(revised 11/03/95)
1
One Wlmef S dal a easton,Massau:hueeue 0210E • FAX(617)536-1049 a Teiapeuarto(617)292-Mpp
�.J Printed an Recycled Paper
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM.01 L
PART A '
CERTIFICATION(eontinued)
Property Address: „`^tiQt - -
Owner.
Date of Inspeotion: -
Bi SYSTEM CONDTONAMY'PASSES(continued)
®. Sew V backup or breakout or high static water level observed is the distribution bom is due to bm' ken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health): _• s
broken pipe(s)-are replaced f
obstruction is removed..
distribution box is levelled or replaced
The system required pumping more than four tithes 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 \
C]i 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 the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES.THAT THE SYSTEM ISM NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy ie within 50 feet of a Bordering vegetated wetland or a salt marsh.
Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
,;. I)ETERMINF9 THAT THE SYSTEM IS FUNCTtONiNti'IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:7
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but W feet or more from a private water
supply well,unless a well water analysis for coliform bacteria and volatile organic compounds b diastes that the weU is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm.
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISP0:yAlt,tISfS`I'EM AAtfdJ['ECT1O
N FORM
PART A
CE TJM,CATION(continued)
Property Address:
Owner.
Date of Inspeodeq
D) SYSTEM FAIIA; k
I have determined that the system violates one or more of the following failure criteria as defined in 310 CBM 15.303. The basis for
this determinative is identified below. The Board of Health should be contacted to determine what will be neeeasary to correct the
failure.
Backup of sewage into facility or system component due to an overka4m 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
8tatie liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is lose than 6"below invert or avaibrble volume is less than 1/2 day flaw.
Required pumping.more than 4 times in the last year NOT due to clogged or obstructed pipelW.
Number of times pumped ,
— Any portion of the Soil Absorption System,cesspool ar privy is below the high groundwater elevation.
— Any portion of a cesspool or privy is 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 I of a public well.
. Any portion of a cesspool or privy is within 50 feet of a private water supply won.
Any portion of a ceseiooi or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analysed to be acceptable,attach copy of well water analysis for
mWorm bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility.with a design flow of 10.000 gpd or greater(Large fiywom)and the system is a significant threat to pubbc
health and safety and the environment because one or more of the fallowing conditions exist'
.� the system is within 400 feet of a sarfaoe drinking water supple,
the system is within 200 fact of a tributary to a surface drinking water supply
the system,is located in a nitrogen sensitive area(Interim Wellhead protection Area(TWFA)or a mapped Zane 11 of a pout
supply well)
The owner or aperator of any such system shall bring the system and facility into!fill compliance with the groundwater treatment yxgpv an
requirements of 314 Cbffl 5,00 and 6.00. Please consult the local regional Office of the Department for tlrrther information.
I
(revised 11103/95) s f-
SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM
PART B
CHECKLIST
ProPerty Adaress: �tjr
Owner.
Date of Inspection;
Check if the following have been done: ,
v Pumping information was requested of the owner,occupant, i
req , pant,and Board of Health,
one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water bave not been introduced into the system recently or as part of this inspection.
built plans have been obtained and examined. Note if they are not available with N/A.
_The Awility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste now
l�to was inspected for signs of breakout.
All/system components;excluding the Soil Absorption System,have been located on the site.
"The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or
tow,material of constriction,dimensions,depth of liquid,depth of sludge,depth of scum.
site and location of the Soil Absorption System on the site has been determined based on existing information or
s ted by non-intrusive methods.
_Uccfity owner and occupants,if different from owner)were provided with information on'theproper.e to p maintenance of Sub-
Surface Disposal System.
(revised 11/03/95) 4
4
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
T SYSTEM INFORMATION
.wroIeny Address: G / c7jV
Owner.
Date of Ins
FLOW CONDITIONS
BNWXNTIAU
Design flow: ona .
Number of bedroom.:
Number of current residents:
Garbage 8inder(Yes or no):—A jU
I sundry connected to system(yea or no):44i6" - .4
Seasonal use(ves or no):—hb
Water meter readings,if available: w`b
I®st date of occupancy: "
COMMERCIAL/INDUSTRLmL
Type of establishment:
'Design flowi_ seapona/day'
::Grease trap present:(yes or no)_ T
;Industrial Waste Holding Tank present: (_yes or no)!_
.:Non-sanitary waste discharged to the Title 5 system: (yes or no) -
Water meter readiuga,if available:
Last date of occupancy:
IAot date of occupancy:
GENERAL INFORMATION -
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no) p
"If yea,volume pumped: aailona i
Reason for pumping
TYPE OF'ftff=
Septic ion bmcMoil absorption system
Single cesspool
Overftw cesspool
Privy
Shared system()es or no) (if yes,attach previous inspection records,if any)
Other(explain)
�n ,
+APPROXIMATE AGE of all comgoaeats,date installed(if known)and source of information: YAO
$swage odors detected when arriving at the site:(yes or no)
(revised 11/03/95) g '
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONf FORM
PART C.
SY9T)✓M INFORMATION(continued)
Property A4.drew
Owner. ?-Q.- '
Date of Inspection: S_�
SEPTIC TANK:_
(locate on site plea)
Depth below grader ,
Material of construction:�ncrete—metal,,,,,,FRP a,v other(explain)
Dimensions: '`& lK 10,
Sludge depth: j -
Distance from top of sludge to bottom of outlet tee or baffle:2t1Li _ - -
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: 4
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping,condAon of inlet and outlet tees or baffles,depth of li level in relation"to outlet invert,structural integrity,
€evidence of leakage,etc.)
GREASE TRAP:
(locate on site plan) _
Depth below grade:
Material of construction:•_,,,concrete linetal_FRP—other(explain) -
Dimensions:
Scum thiclm�e:
Diehmce from top of scum to top of outlet tee or baffle:
.-Distance from bottom of scum to bottom of outlet tee or baffle:
Comments: -
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level'in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
t,tom' " SCU;m
r
trevised 11/03/95) 6 y t
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: 3(*1 j 0#-Uc,,�
Owner. •
Date of Inspection:
TIGHT OR HOLDING TANK
(locate on site plea) _
Depth below grade:
Material of construction•--.eonamte_metal_M_other(e:plain)
Dimensions:
capacity,. sallons
Design flow:-------.gaHonx1day .< "
Alarm level:
Comments:
(Condition of inlet tee,condition of alarm and float switches,*etc.)
DISTRIBUTION BOX-,,_ - ,
(locate on site plan)
Depth of liquid level above outlet invert:
Comments: R
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out,of box,etc.)
- "op- — -
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
s
Comments: "-
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
(revised 11/03/95) 7 r
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Ad 36
Owner.
Date of Inspection: 9 r7
SKBTCH OF SEWAGE DISPOSAL SYSTEM:
inchtde tins to at least two permanent references landmerka or benchmarks
locate all wells within loo,
G�
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DEPT11 TO GROUNDWATER
Depth to gtciundwater feet
method of determination or approximation: Gi-✓
(revised 11/03/95) 9
TOWN OF BARNSTABLE
LOCATION =� SEWAGE #
VILLAGE _ ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE
SEPTIC TANK CAPACITY
LEACHING FACILITY':(type) (size)
NO. OF BEDROOMS- PRIVATE WELL O PUBLI WATER
BUILDER OR OWNER C� h p►
DATE PERMIT ISSUED: /' / ) • !3
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS APPROVED
BOARD OF HEALTH 00,40able Conservation Department
TOWN OF BARNSTABLE —f7:
Appliration for Ui►ipwial Wor1w Tomstrurtion rmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................ ��••Q _ ._... -......
.._.L-- n t :\ddrrss __....or Lot No.
............... . ...... GGUL< Y..! ................... .................................. ------..__..._..------__.............-^---...--•---
Oa ncr Address
................ .. •. .... ..... -_<-- ---- ------------......-----------------......•._.......-•----•-----------.......•..--•-. ._...••--
IusL r Address
d Type of wilding Size Lot.................... Sq. feet
U Dwellin No. of Bedrooms._-_-_ -Expansion Attic Garbage Grinder
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a Other fixtures ------------------------------ - -
W
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................
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 ( )
Percolation Test Results Performed bY----------- ------------------•------------------------------------------- .Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit._..............._.. Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
a
0 Description of Soil........................................................................................................................................................................
W
U ••••--------------------•-•---•---•---•-••••---•-•-••••------•-••••-•-••---•-.------••••-•-•••------••---•-------------••-•--------•-------•-----•-•---•-•-•••••-•--••-•••...•-•.................-•••--.
W •-•--------------------------------------------------------------------------------------•---------•------- �---- ---- --
U Nature of Repairs or Alterations—Answer hen applicable •.. .-- .......
- -lam- --
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environment I Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliant as been issued th board of health.
Signed . ....... ........ . .C�-�...... ..........
Date
Application Approved BY ............C r................... .......... ..... 1 ......
Date
Application Disapproved for the following rearonr: .......................... .... .... . ....................... . .....................-- . .... ........
.......... ................... ..... ....................... ............................ ................. . ........... . ---.................. .. . ----------------------------------------
PermitNo. ........f�. ..................... ........ Issued ....................................................................
Date
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off. 7/ �07 {
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH -
TOWN OF BARNSTABLE
Applirattnn for Bt ip gal Wi ork.6 Tomitrnrttnn Crrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
--------------------- .�.. ` - .:......---------. u � n...........................................................
Lo lion•Address or Lot No.
...........
O�cner r
Address
W
111st. r Address
UType of uilding Size Lot............................S q. feet
Dwelling— No. of Bed rooms._____ ...................._-------._.-_Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons___--_-__---_--_-_---_.__ Showers ( ) — Cafeteria ( )
Otherfixtures .----•----------•---------------------------------------------------------------------- ----------•----•-------------•-------••.---------------..----
W Design Flow.....!1...................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity........_._gallons Length---------------- Width................ Diameter._---._._.___._- Depth................
x Disposal Trench--No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ....•-•......................•--•-......••---------•---••--••--•--•-•----•-••-•••-•-•-•-•--......•-•.........................................................
0 Description of Soil........................................................................................................................................................................
W ----...................................................applicable
.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions'of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance i4as been issued by the board of health.
Signed .. . - ....: .:.......... .. --.-------- . -- .............................
....
Dare
Application Approved By ..---------- i1... ........ /. -. 'J....
v .,^"........_...............----------`.................................. Dace
Application Disapproved for the following reasons: ..................................... ... . .............................................. ------....................
................. ................................................................... ......... . . . . .....,................. . .-- . . ............ .. .............................. -------
Dare
PermitNo. ........ ...------ ..a-.................... Issued ............................:.......................................
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
`LPrfifiratxE of 11((..��omplianve
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by .. ....... ........ .............................. ..........................................................................................
at ...... ....7�>...&../-- --0........���e .....l�fX-/---.._.�.. ��.� - .........................................................
h the
hhe application as been led for1DisposalaWorkstConstruc on Permitslons of TN�I,E 5 0�h�e St�ateE�rondated
ma edal.Code as described m
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................�o--..I I -9 >'..... - ---- Inspector -----... .....:. ............................................ ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Q TOWN OF BARNSTABLE
FEE..:.�2.............
Uiiipon Workv Tuniitr inn "rrntit
Permission is hereby granted............... ---..... � t......�.C'p_ t.� . --------------•---------.-- ..............................................
to Construct ( ) or Repair ( an Individual Sewage Disposal stem
at No ---------------------------------- ---- ------- --..............
----•----------•• -6-1----h.; .� - ------'ran --••----...._�rT, <_ .
V street
as shown on the application for Disposal Works Construction Permit No.-7:Xz.-_ Dated..........................................
Q .��
DATE. .
.................................. Board of Health
FORM 36508 HOBBS A WARREN.INC..PUBLISHERS