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Home My WebLink About0032 PAINE AVENUE - Health 32 PAINE HYANNISPORT A=288.142 E i { a Town of Barnstable Inspectional Services Department sa1No& Public Health Division 639 Al 200 Main Street, Hyannis MA 02601 Office: 508-8624644 FAX: 508-790-6304 Thomas A.McKean,CHO March 2021 Elaine Busias 297 Stoney Cliff Rd. Centerville, MA.02632 RE: SEWER CONNECTION,DEAD LINE EXPIRED.:', - } 32 Pa ne.Avenue,)Hyannis A= 288=142 Dear Property Owner; Your sewer connection extension deadline has passed: Please contact the Public Health Division Office to provide an update relative to the . status of property's connection to public sewer (i.e. contractor. name, DPW sewer connection permit number, anticipated connection date.) If you would like to request an extension, such request must be in writing addressed to . the Board of Health (200 Main Street Hyannis, Massachusetts) or e-mail Sharon Crocker at: sharon.erocker@town.Barnstable.ma.us within fourteen(14) days. I Sincerely yours, Karen Malkus-Benjamin Town of Barnstable Health Division Coastal Health Resource Coordinator karen.malkus(cDtown.barnstable.ma.us 73/1 g—j- Z 1_ THE Town of Barnstable i a + BARNSPABM + "9. ,�� Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 John T.Norman Donald A.Guadagnoli,M.D. January 11, 2020 Ms. Elaine Busias ' 297 Stoney Cliff Road Centerville, MA 02632 o RE: BOARD OF HEALTH�DECISION w SEWER CONNECTION EXTENSION.GRANTED 32 Paine Avenue, Hyannis Map & Pakel288-142 Dear Ms. Busias, You are granted a one- year extension to connect your dwelling located at 32 Paine Avenue, Hyannis to public sewer. You and your daughter were both present during the Board of Health hearing held on December 17, 2019: You testified you have limited funds and that you were billed for the sewer line. construction work completed in the street. After hearing your testimony, the Board voted to grant you an extension. Your..dwelling shall be connected to public sewer on or before January . 1, 2021. It is suggested you begin planning ahead by obtaining at least three bids for the sewer dine connection work before making a decision as to who will do the work. If additional time is needed, please be aware that all requests for extensions shall be in writing to the Board of Health at: 200 Main Street,Hyannis, MA 02601. Si re yours, 4 ohn . Norman Chairman Q:\WPFILES\SewerExtension 32PaineAve Basias 2019.docx F1%; �1 � .� Town of Barnstable UMqWABM Board of Health 39 s6 . �� o 19 200 Main Street, Hyannis MA 02601 OFFICE: 508'862-4644 Paull.canniff,D.Mb. FAX: 508-790-6304 Junichi Sawayanagi Donald A:Guadagnoli;M.D. Elaine Busias, 32 Paine Avenue,Hyannis, MA 02601 ACKNOWLEDGEMENT OF RECEIPT: November 22; 2019 We nave received your submission to the �Boardof ifeafth Re: 32 (Paine Avenue, fyannis; 914A. requesting a deadfine extension to connect to.town:sewer Thankyou.' Your item is scheduled to be heard at the Board of Health Meeting on the: Date of: Tuesday, December 17, 2019 or, if preferred, Tuesday,November 26, 2019, Meeting Location: Town.Hall, 367 Main St, Hyannis James H. Crocker, Jr. Hearing Room, Second Floor Time: 3:00—6:00 P.M. Approximately three days prior to meeting,an agenda will be sent out to you.— once it is available. It will also be available on line at the town website: www.town.barnstable.ma.us Go to ..."Boards&Committees > Board of Health - or- Go to . Official Agendas Please call Sharon Crocker at 508-862-4739 and leave a contact phone number, and email address, if you have one. Thank you. Q:\AGENDAS BOHUet Receipt of BOH Submission 32 Paine Ave Hyannis"Nov2019.doc t � Town of Barnstable CAB Board of Health 200 Main Street,Hyannis MA 02601 OFFICE: 508-862-4644 John Norman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Paul J.Canniff,D.M.D. November 22, 2019 Elaine Busias 32 Paine Avenue, Hyannis, MA 02601 RE: Request to extend the sewer connection deadline Dear Elaine, To clarify the enclosed `ACKNOWLEDGENT OF RECEIPT Your request to extend your sewer connection was received. The Board of Health makes the determination of whether to extend the deadline or not, and they,meet once a month. We would like someone to attend the Board meeting to state why you would like the deadline extended. If you are unable to attend,please write the reason in a letter which I can submit to the Board for their December 17, 2019 meeting. You were placed on the agenda,in error, for the November 26, 2019 meeting. If you do prefer to attend the November 261h meeting-which happens-to be a very long agenda, you may do so. Otherwise, you will be on the December 17, 2019 agenda. I will send you a copy of that agenda once it is available. I would greatly appreciate having additional contact information for you. Please let me know your phone number and, if you have an email address, I would like that as well. Regards, Sharon Crocker I Administrative Assistant 508-862-4739 Q:\AGENDAS BOI\Iet Receipt of BOH Submission 32 Paine Ave Hyannis 2 Nov2019.doc aFt►+E r�� Town of Barnstable Inspectional Services BARNST"M MASS. Public Health Division i0leo r39. 60 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 -October 11, 2019 . Elaine Busias 297 Stoney Cliff Road Centerville, MA 02632 IMPORTANT NOTICE Map & Parcel 288-142 RE SEWER CONNECTION 4)EADI;INCEXPIRED _ rV -.c '� v� s6.� J',tiC50-� e" f ,r= `��».+a �a'.r• .. t 32 yPane Avenue; Hyannis «, r# _ . . -¢ . _ ll Dear Ms. Busias, Your October 30, 2018 sewer connection deadline has passed. -Please contact the Public Health Division Office to provide an update relative to the status of property's connection to public sewer (i.e. contractor name, DPW sewer connection permit number, anticipated connection date). If you would like to request an extension, such request must be in writing addressed to the Board of Health (200 Main Street Hyannis Massachusetts) within fourteen(14) days. Sincerely yours, Thomas A. McKean, R.S., C. . Director of Public Health Town of Barnstable q:\WP\SewerConnectionEXPIRED 32 PaineAve 2019.docx Town of Barnstable Inspectional Services 'U'''S'"BM ` Public Health Division 039. ' Thomas.McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 December 10, 2018 Elaine Busias 297 Stoney Cliff Road Centerville, MA 02632 IMPORTANT NOTICE Map &_Parcel 288-142 This is a reminder that your property at 32 Paine Avenue, Hyannis,.MA, was due for connection to public sewer on 10/30/2018. The property owner was previously notified of the obligation to connect sewer and to establish a sewer account with the town. Information about Licensed Sewer Installers is available on our web site at http://www.townofbamstable.us/PublicWorksTech/sewerinstallers pdf Please note the following two permits are also.needed to be in compliance: 1) Septic Abandonment Permits ($ 25) are issued'at.the.Public Health Division, 200 Main Street, Hyannis. The old septic system must be either removed, or filled in, due to future safety concerns. This may be done by the same contractor who connects you to the sewer. 2) Sewer Connection Permit'issued by DPW-Water Pollution Control Division,617 Bearse's Way, Hyannis. Once you choose a contractor/installer have them call Dave Anderson at(508) 790-6244. If you are unable to proceed with a sewer connection you may request a show-cause hearing before the Board of Health. If you would like a hearing, please send,or e-mail, a written petition requesting a hearing to Sharon Crocker at 200 Main Street Hyannis, MA 02601, or sharon.crocker@town.bamstable.ma.us If you have any questions,please call the Health Division of 508-862-4644. Thank you for your prompt attention to.this matter. Karen Malkus Town of Barnstable Health Division � .. • IIaOFFICIAL - USE c Postage $ nJ Certified Fee C3 Postmark E3 Return Receipt Fee Here M •(Endorsement Required) O Restricted Delivery Fee O (Endorsement Required) rl M Total Postage&Fees rq C Eliane-M Busias _ i 297=Stoney Cliff Road Centerville MA 02632 Certified Mail Provides: o A mailing receipt n A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. n Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery o If a postmark on the Certif led Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT-Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 I o Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X it ❑Agent o Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C Date of Delve o Attach this card to the back of the mailpiece, or on the front.if space permits. r- 5q.6/�S iI (✓j D Is delivery address different from item 1? ❑Yes 1 Article Addressed to- If YES.enter delivery address below: ❑No st Eliane M Busias 297 Stoney.Cliff Road 3. Service Type Centervil.leWA 02632 ❑Certified Mail ❑ Express Mail Q Registered ❑Return Receipt,for Merchandise El Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. ,Article Number (Transfer from service labeq 7 b 12 ' 1010 0 2 o 0 2851 1685 kLS Form 3811 February 2004 i Domestic Return Receipt _ 102595=02-M-1540 UNITED STATES POSTAL SERVICE, First-Class Mail Postage&Fees Paid USPS Permit No.G-10 •Sender;• Please print your name, address, and ZIP+4 in this box • Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 f�;�,�i�i,arl�f�iit};�j��lnzlii,ili�i�ill#Ptil�}(teast�ii�l►7I1� At •CJ3�,L:L37La • � $ • • • • P.R o Complete items 1,2,and 3.Also complete ;. 9 ture item 4 if Restricted Delivery.is desired. X ❑Agent o Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Receiv by(Printed Na e) C D elivery 0 Attach this card to the back of the mailpiece. - or on the front,if space permits. D Is delivery address differe Teo item f ❑Ye 1. Article Addressed to: If YES,enter delivery ad r��si below: ❑ No p O Maria Norris-Doylei--wl i 5 15 Lantern Lane 3. Service Type Milford, MA 01757 ❑Certified Mail ❑Express Mail 11 Registered ❑Return Receipt,for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes' 2. Article Ndmber 11i - w-;-��-�—— (rranster from service(abeq 7 0 12 1010 0000 2851 1289 I PS Form 3811,_February 2004 Domestic Return Receipt -102595-02-M-1540 I I UNITED STATES POSTAL SERVICE, First-Class Mail I Postage&Fees Paid USPS I Permit No.G-10 •Sender;,Please print your name, address, and ZIP+4 in this box • Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 !}IIjI� Ii3iI�3iffl- IEFtil jlilWN3i Hill i1F12£Iit�iiiiil Town of Barnstable Barnstable iwe F rp� '" Regulatory Services Department ;micaM BAMSTABU- ' 16 Public Health Division m s639. Alf°""RYA 200 Main Street, Hyannis NIA 02601 2007 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1685 January 13, 2014 Elaine M. Busias 297 Stoney Cliff Road Centerville, MA 02632 IMPORTANT NOTIC Map & Parcel 288-142 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at 32 Paine Avenue, Hyannis, MA, to public sewer on or before 10/30/2018. a The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see enclosure. PER ORDER OF T BOARD OF HEALTH S Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health • Eric I I Q:\SEWER connect\Sample order letters for sewer connection\32 Paine Ave Hy Jan 2014.doc I Parcel Detail http://issgl2/intranet/propdata/ParceiDetail.aspx?ID=21892 MASS b 77 00 Logged In As: Parcel Detail Monday, January 13 2014 Parcel Lookup Parcel Info Parcel f __._ _._.�... ._,��_..�;_..� Developers�;--- ID i288-142 Lot I`OT 13& 14 Location 132 PAINE AVENUE Pri I I Frontage1180 Sec f— — — ___ Sec —.. Road Frontage Village JHYANNIS ' ire District District Town sewer exists at this Road � 1202 - J address jNo Index Asbuilt Septic Scan: Interactive , 288142_1 Mapl r ) Owner Info Owner IBUSIAS, ELAINE M ICo Owner F Streetl,2 STONEY CLIFF RD _ Street2 City CENTERVILLE ) State EA Zip(02632muT Country j Land Info__ _ Acres 0.35 �__j. Use Single Fam MDL-01 ZoningFRB j Nghbd 0 Topography ----- Road Utilities� —_^ Location F Construction Info Building 1 of 1 Year - Roof Ext 1945 Gable/Hip Vinyl Siding Built Struct Wall Living Roof r AC --- 864 fAsph/F GIs/Cmp None Area CoverInt Type Be Style;Ran � Wall ,Drywall Rooms I' Bedrooms , Int _ _ Bath `a � er q� d2 Model Residential J Floor Carpet Rooms FFull �� e ,� Grade Average Minus Heat Hot Water Total15 Rooms ) �.n ,a r .4. Type Rooms 'Heat--"' :—.._. _ _._.._._ Found- __ __.__.___ .._ Stories F1 Story Fuel(O�I-�--------- ationConc Block Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=21892 1/13/2014 No,,061,-�) r—d,�Y J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS RppliLation for Misposal *pstrm Construction permit Application for a Permit to Construct( ) Repair e-) Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No. 7j 2 Pi4iTl C 4r/G l-�r�m►.if Owner's Name,Address,and Tel.No. Assessor's Map/Parcel `2 S t,4'L. —90$';95 �f T71^ &1(.(( Installer's Name,Address,and Tel.No. Y2 7 Fr 7^7 Designer's Na e,Address,and Tel.No. 15-3 C-q ." -,-I c-C;AY/ S n 44 4,3; Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title //pp Size of Septic Tank t 5k,:� C,44 Type of S.A.S. 1(zW6' Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt , Signed Date Application Approved by Date 3 f Application Disapproved by Date for the following reasons Permit No. do L Date Issued 3 No / � R Fee CJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Disposal *pstrm Construction Permit - Application for a Permit to Construct( ) Repair OCL7) -Upgrade( ) Abandon( ) ❑Complete System A-Individual Components Location Address or Lot No. 'j 2 Poo.,-,I C' 4-vd- l jya,,,,,f Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 'L� (`-� L "'� �U��✓a S Cfi ► 7 7/^ 491(4/ Installer's Name,Address,and Tel.No. ti L f a-;" g 7-7 Designer's N e,Address,and Tel.No. e,4PCw,;d&- e7d1 ?��n> e 5 LCc /-T-3 4-O'Y,s.-,C/G;;41 G1-, s21 5 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No:of Persons Showers( ) Cafeteria( ) Other Fixtures t> F Desigd Flow(min.required) gpd Design flow provided gpd Plan + Date Number of sheets Revision Date Title Size of Septic Tank 15-6O C,Aj Type of S.A.S. Zi i rno.� �ye•,�(/'l Description of Soil Nature of Repairs or Alterations(Answer when applicable) s a c-h '.•, or gel'" Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt . ,Sign Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. cJ f a Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS V (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )b (7-n., t> r at 3 Z FO iH A-{ Iku e 44,K; s has been constructed in accordance with the provisions of Title 5 and the or Disposal System Construction Permit No,u/J c .l dated I 1 3 Installer �,i(�(�,,,y '� c�e ��, �! .��, et . Designer #bedrooms f Approved design ow {,� gpd m The issuance of thispermit shall not b const,'ed� a guarantee that the system will fiinctio.as designed. Date Inspector/'/ s � � t �`� --------------------------------------------- - -- --- -------------------- ----------------- -_-- -- - --- --------=----_---- No. =)0/3 Fee / �Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS MlBtlDsaY 6pstPm Construction 3pErmit Permission is hereby granted to Construct( ) Repair!" Upgrade(; ) Abandon( ) System located at 3 1 D4Cr k,4_ 4 V%f (`— A--h; and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. rt Provided:Construction must be completo within three years of the date of this permit. Date Approved-by TOWN OF BARNSTABLEQJ ' LOCATION k SEWAGE # VILLAGE 11, ASSESSOR'S MAP & LOT o I INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size)i1'� .AtiA. 47 NO.OF BEDROOMS BUILDER OR-OWNER PERMTTDATE: Ff -1 ` , -Cl 5 COMPLIANCE DATE: MSeparation 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 --� 4 �r �?'�� , !"" � t�' o W � a �� b No. Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �. es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES Yv MASSACHUSETTS Application for Miopoear ,*proem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel q9- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. & Type of Building: Dwelling No.of Bedrooms _ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Ot Size of Septic Tank I b Opt/ Type of S.A.S. Description of Soil d S Nature of Repairs or Alterations(Answer when applicable) W Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 o - ental Code d to place the system in operation until a Certifi- cate of Compliance has be`n issued by t is of Health. 1 Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. �r A Date Issued TOWN OF BARNSTABLE ' 1 LOCATION PO..t•H:r. kk SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. QVt%-,.,e 9 U SEPTIC TANK CAPACITY ,-r LEACHING FACILITY: (type) `7` ,� ,J.r(size) Li-fir � NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: Sf—_1 COMPLIANCE DATE: I- E 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 ck i I � A3� Ci3� No. J v �. ✓ �r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OFBARNSTABLE, MASSACHUSETTS Zipprication for Miq gal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(`Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner s Name,Address and Tel.No. ti r S Assessor's Map/Parcel 4��- 42� (^ti'"sS ( Installer's Name,Address,and Tel".No. Y . Designers Name,Address and Tel.No. .�pu L> �ci Type of Building: Dwelling No.of Bedrooms _ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures ��^^ Design Flow -> gallons,per day:,Calculated daily flow ,'? gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /,S�'L �gP &&i-/ rTvne of S A S.'f i',. `C_f O�,Cr t�L Description of Soil.x "' d Ste/ �4 . -a • i� + i Nature of Repairs or Alterations(Answer^when applicable) T'w Date last inspected: Agreement: The undersigned agrees to ensure the:construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 o ental Code d no to place the system in operation until a Certifi- cate of Compliance has bri issue"d y tii of Health._ 1 Signed Date s-�� Application Approved by Date Application Disapproved for the following reasons 1 Permit No. —.rS Date Issued Z --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sew a a Disposal System Constructed( )Repaired( )Upgraded) Abandoned( )by 01 O-C 44 01C\e— at ` . ciw a ` Chas been construc_te in accordance with the provisions of Title 5 and the for Disposal System Construction Pe 't No. — •fir 7 dated _ - Installer Designer The issuance of this pe t sh 11 nQ�b construed as a guarantee that the systeiA will function as designed. Date 7 Inspector r No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogar *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )UpgradeC Abandon( ) System located at � J S !�- .m on 1TT and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following,local provisions or special conditions. Provided:Construction m st be completed within three years of the date of this rInit.# Date: Approved by _ /,C 160 NOTICE: This Fo rm Is To Be Used For the Repair.Of Failed Septic Systems Only t - - CERTIFICATION OF SKETCH AND APPLICATION FOR A ISPOSAL WORKS CONSTRUCTION PERMIT'(WITHOUT D ENGINEERED PLANS) • ' 6e*7 .hereby certify that the appiicatton for dispo sal works it si me dated ' cocerning the , construction perm by Q� rs meets all of the ; pY located ate followingrt criteria: 1 �4 There an no welI'nds loested within 100 reet of the propose leachMs fbeilitq Lam' 'fhete are no prlvate wells wlthM 1So het of the proposed die system There b no htt rem in new and/or change to ose proposed ere no verlanas or needed. There Irma proposed leeehM`(benitp will be located within 250 feet or any.vm1ands,the bottom of the ; pbpeitd Inch itls k1lity will no be located less thanroutteen(14)feed Above the maximum adjusted etoandwater table elevation. t I r ! please eempleh the fetlowier. • A etOrei�nd Elevation(according to the Engineering Dl riston Oa,S.map) )Top droundweter Table Elevetlon(seeordln6 to Heakh Division well map) B)observed �� DATE: slam• LICENSED 3 C SYSTEM' ALM M THB TOWN OF 9ARNSTABLE NUMBER i Ake Ito*ties WASIlir Penn"a o tined plot plan, d1b pla dould wbteitted). • i ^� !y � �i