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HomeMy WebLinkAbout0088 BAY ROAD - Health 88 Bay Road Cotuit, MA 026354 Ir �I JEFFREY"P. LOWERY January 4, 2011 Thomas McKean, Director Public Health Division. Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Mr.McKean: We received a letter indicating that we must remove our underground oil tank. As previously stated in a letter to Cynthia Martin,the tank is fiberglass and is located under our lawn, sprinkler system,�and rhododendron foundation plantings . It has safely been providing us heat for over 30 years with no problems. Therefore we would like request a hearing. My husband is a 69 year old quadriplegic and uses a wheelchair van with a lift. The unloading dock, which.provides access to the house, is also located in the area of the underground tank and would be disrupted during the tank removal. It would not be possible for my husband to enter our front door as the entire structure would have to be rebuilt if the tank were removed.Not only is there no other access for him but the expense of this project alone would be astronomical. In addition to the above problems, we would also have to revamp our heating system and plant.a new lawn which are additional expenses and provoke quite a financial hardship. In conclusion, we would like to propose,that we leave the tank in the ground but drain it and fill it with a substance of your choosing. I believe doing this is called "Abandonment in Place". We look forward to hearing from you so that we may resolve this matter. Thank you very much. Sincerely, Jeffrey and Nancy Lowery 88 Bay Rd. Cotuit, MA 02635 Phone 508-428-71 52 -.cell 1-508-361-6323 cc,Gy_nthia Martin,",, T . . o"wn of Barnstable o�'THE ri Regulatory Services Thomas F. Geiler,Director Public Health Division' BARN TABM Thomas McKean,Director y MASS. �* 200 Main Street, Hyannis,MA 02601 ATFD MA'S a Phone: 508-862-4644 Email: health@town.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 J' V✓ . I April 12,2011 Mr. and Mrs.Jeffrey Lowery RE: }Underground Storage Tank Removal, 88 Bay Road 88 Bay Road,Cotuit Cotuit, MA 02635 Map Parcel 007-024 Tank#1, Tag#00559 Dear Mr. and Mrs.Lowery: The Barnstable Public Health Division(BPHD) is in receipt of a copy of the"Application and Permit" for storage tank removal and transportation issued.by the Cotuit Fire District demonstrating that the underground storage tank was removed from the above referenced address on March 31,2011. The Public Health Division appreciates your attention to this matter and has updated its database to , reflect this fuel tank status change. Should you have any further questions please contact Cynthia Martin of. this office at 508-826-4645. Director of Public Health Town of Barnstable �FTHE 1p� Board of Health * 3ARNSfABLE, * 200 Main Street - Hyannis MA 02601 � MASS. g �pTfD MA't A Agreement to Extend Time Limit for Acting Upon a Variance Request Matter f variance r uest form received on In the a er o a request , the Petitioner(s), �/— A� JZA regarding the property at U a the petitioner(s)and the Board of Health agree that the Board o Health has untieU, r / (insert date)to act upon the Petitioners' completed application for a variance. In executing this Agreement, the Petitioner(s)hereto specifically waive any claim for a constructive grant of relief based upon time limits applicable prior to the execution of this Agreement. Petitioner(s): Board of Health: Signature: Signature: tetitioner(s)or Petitioner's Representative Chairman Print: !vim o � ��� ' T Print: Wayne Miller, M.D. Date: ate' Address of Petitioner(s)or Petitioner's Representative Town of Barnstable Board of Health Public Health Division 200 Main Street Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508) 790-6304 file q:extend.doc FEB-08-2011 12:26 From:BARNST HEALTH 150879063M To:me4286470 P.2/2 Town of Barnstable t t� � Board of Health _-- � X. 200 Main Strut - 14yann.is MA 02601 Agreement to Extend Time Limit for Acting Upon a Variance Request In the,Matter of a variance request form received on the Petitioner(s), i regarding the property at the petitioner(s)and the Board of Health agree that the Board o Health has until` AfC3 I (insert date)to act upon the Petitioners'completed application for a variance, In oxecuting this Agreement, the Petitioner(s)hereto specifically waive any claim for a constructive grant of relief based upon time limits applicable prior to the execution of this Agreement. Patttioner(s): Board of Health: SignatureXPeftoner(s) � Signature: or P 'tioneee.€toria;santative Chairman Print: 1 �,����� � � Print: Wayne Miller, M.D. Date; Address of Pe itioner(s)or Potitioner's Representative Town of Barnstable Board of Health Public Health Division 200 Main Street Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508) 790-6304 file wuxtanv.doc r Martin, Cynthia From: Martin, Cynthia Sent: Tuesday, January 25, 2011 1:56 PM To: McKean, Thomas Subject: UST Removal`Hearing Tom, Following is information regarding the Underground Storage Tank owned by Jeffrey and Nancy Lowery , 88 Bay Road, Cotuit. They requested a hearing to discuss the tanks"abandonment in place"and are on the schedule for February 8th. The original UST registration card indicates that the tank is not under the handicapped van access area, this appears to be substantiated by my site visit of January 11th. Therefore it seems that the.UST removal could be done without disruption of the van access area. (Perhaps this could be assessed by a UST removal company?)As discussed with you previously, the Lowerys do not have any receipts for the tanks construction or installation. I have left a folder in your"In" box with the following material * A copy of the PHD issued UST Removal Letter * The Lowerys written requests for information and a Hearing: * The original UST Registration Card indicating the tank location and Fire Dept permit for a fuel burner installation. * Four recent photos of the handicapped van access area,driveway and yard. Let me know if you have any other questions. 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Geiler,Director Public Health Division BARN sTasLE, Thomas McKean,Director v� ib S. 200 Main Street, Hyannis, MA 02601 Phone: 508-862-4644 Email: health@town.bamstable.ma.us " C : Fax: 508-790-6304 - Office Hours: M-F 8:00—4:30 January 6,2011 Mr.and Mrs. Jeffrey Lowery RE: Underground Storage Tank Removal, 88 Bay Road 88 Bay Road,Cotuit Cotuit,MA 02635 Map Parcel 007-024 Tank#1,Tag#00559 Dear Mr. and Mrs.Lowery: The Barnstable Public Health Division(BPHD)is in receipt your letter dated January 4,2011,requesting a Hearing with the Board of Health in regards to the above matter. Please note that your Hearing has been scheduled for Tuesday,February 8,2011,at 3:00 p.m. in the Town of Barnstable Town Hall Hearing Room, Second Floor,362 Main Street,Hyannis. The Public Health Division appreciates your attention to this matter. Should you have any further questions please contact Sharon Crocker of this office at 508-826-4644. Sharon Crocker, Administrative Assistant, Public Health Division JEFFREY P. LOWERY January 4, 2011 Thomas McKean,Director Public Health:Division Town of Barnstable. 200 Main,Street Hyannis, MA 02601 Dear Mr.McKean: We received a letter indicating that we must remove our underground oil tank. As previously stated in a letter to Cynthia Martin, the tank is fiberglass and is located under our lawn, sprinkler system, and rhododendron foundation plantings . It has safely been providing us heat for over 30 years with no problems. Therefore we would like request a hearing. My husband is a 69 year old quadriplegic and uses a wheelchair van with a lift. The unloading dock, which provides access to the house, is also located in the area of the underground tank and would be disrupted during the tank removal. It would not be possible for my husband to enter our front door as the entire structure would have to be rebuilt if the tank were removed. Not only is there no other access for him but,the expense of this project alone would be astronomical. In.addition.to the,above problems, we would also have to revamp our heating system and pfanf a new lawn'which are additional expenses and provoke quite a financial hardship. In conclusion,�we would like to propose that we leave the tank in the ground but drain it and fill it with a substance of your choosing. I believe doing this is called "Abandonment in Place". We look forward to hearing from you so that we may resolve this matter. Thank you very much. Sincerely, Jeffrey and Nancy Lowery J 88 Bay Rd,. Cotuit,,MA 02635 _ Phone 508-4N 152 cell 1-508-361-6323 cc:Cynthia Martin JEFFREY P. LOWERY /Cynthia Martin November 24, 2010 Public Health Division I own of Barnstable 200 Main Street Hyannis, MA 02601 Dear Ms. Martin: Today we received a letter indicating that we must remove our underground oil tank within 60 days. The tank is located under our lawn, sprinkler systems, and driveway, is made of fiberglass and has been providing heat to us for 30 years with no problems. We did not realize we were not in compliance with the law and have registered the tank faithfully eyery year,with the Town of Barnstable. The tag number of the tank is 00559. I am .handicapped and use a wheel"chair van with a lift. My unloading dock, which provides access to the house, is also located in the area of the underground tank and I�am not sure if I could enter my front door if the tank were to be disrupted. 1-1 w . The November 23,2010 letter mentions that we may request a hearing on this matter;agid after talking to Lindsay Parvin on the phone today, she suggested we write to you so we can discuss this matter as soon as possible. 7? Thanks you very much, Sfncerel , �1 � Jeffrey and Nancy Lowery 88 Bay Road 70c OX �711 Cotuit,l,MA 02635 Phone: 508-428-71.52 cell 1-508-361-6323 cc: Thomas MCKean _ JEFFREY P. LOWERY Cynthia Martin. November 24, 2010 Public Health.Division Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Ms. Martin: Today we received a letter indicating that we must remove our underground oil tank within 60 days. The tank is located under our lawn, sprinkler systems, and driveway, is made of.fiberglass and has been providing heat to us for 30 years with no problems. We did not realize we were not incompliance with the law and have registered the tank faithfully every;year with the Town of Barnstable. The tag number of the tank is 00559. I am handicapped and use a wheel chair van with a lift. My unloading dock, which provides access to the house, is also located in the area of the underground tank and I am not sure if I could,enter my front door if the tank were to be disrupted. The November 23,2010 letter mentions that we may request a hearing on this matter and after talking to Lindsay Parvin on the phone today, she suggested we write to you so we C) can discuss this matter as soon as possible. Ln L £'w i Co Thanks you very much, Sincerely, i= Jeffrey and Nancy Lowery 1 NO 88 Bay Road Cotuit MA;02635_ Phone: 5.08-428-7152- -cell, 1-508 361-6323, - " W �oFt"E, Town of Barnstable ti Regulatory Services Barnstable 9 MASS. Thomas F. Geiler,Director A&AmericaCilY 16,39. Public Health Division AlFD MA'S A Thomas McKean, Director 200, 200 Main Street Hyannis, MA 02601 O� Office: 508-862-4644 N-790-6304 November 23, 2010 Jeffrey P. &Nancy S. Lowrey PO Box 711 Cotuit, MA 02635 RE: Underground Storage Tank 88 BAY ROAD, COTUIT Map/Parcel: - 007-024 Tank Number: 1 Tag Number: 00559 j Our records indicate that your underground fuel or chemical) storage tank exceeds thirty (30)years in age, and has not been removed as required by the Town of Barnstable Code Chapter 326, Section 3, Fuel and Chemical Storage Tanks. You are directed to remove this tank within sixty(60)Aays from the date of this Notice. Upon completion of the tank removal and within ninety(90) days of receipt of this Notice, please submit to this office a copy of the permit for storage tank removal issued by your local Fire Department. This copy of the removal permit serves as documentation that the underground storage tank was properly removed and disposed of. You may request a hearing provided that a written petition requesting same is received by the Board of Health within ten (10) days after this order is served. Per Order of the Board of Health Thomas A. McKean, PS CHO j r Health Agent TIC QAHazmat\Under$rrou-ntd Tanks\]et Under md,tans 30 yr Nov .10.doc f (/ Health Master Detail t- Page 1 of 1 Health Master , Logged In As: TOWN\martinc Health Master Detail Tuesday, Novemb Application Center Parcel Lookup Selection Items Reports Parcel Septic Perc Well Fuel Tank Parcel: 007-024 Location: 88 BAY ROAD, COTUIT Owner: LOWREY, JEFFREY P & NANCY S Tank 1, 05/16/1979 New Fuel Tank... ` Tag number: 100559 - _ Install date : I05/16/1979 T rM Lo Capacity (gallons) : 1000; Construction: SS -1� M, Leak detection: r— Cathodic detection: Fuel stored: D Fuel storage reason: I H j Removal company: !Select company 4'- Licensed Site Professional: Select name =' Removal date : ( Removal notification date Abandon status.Abandon date : � � .. ,Select status 6=' Variance date : �- Variance granted: f7i Release tracking numb Comments: 9YRS OLD-DOESN'T NEED TEST8/88 Delete' Test 1 New Fuel Tank Test... Notification date : 11/23/1998 Date : Result Comments: - -- Del_. Save Fuel Tank Changes I Return to Lookup http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=007024 .-11/30/2010 NANCY S. LOWERY BOX 711 — COTUIT, MA 02635 ryuc-j aK (.A e Y'0 wok Oil e- cL Qj GI so, tic,-t 4- fa') Make application to local Fire Department. Fire Department retains ofiginal application and Tissues duplicate as Permit. £-, �Q(Y192//92CNZLGr4�+Gi�il2 Q���l f�GCUJ�2�+fi,� _ 1Jefiair�irr�m�a��rixe Cl iauu-ice� �- Ci�•cce a��ze�J/��rixe C��nl��ia� APPLICATION and PERMIT � - for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: Tank Owner Name(please print) tppMn to S,artature(ofappMnp Inr pema3j Address r Cay state ZIP Company Name y�- • 7G-o. 71nd1vldua1 -,�—&VrY-1�--+ �`/1 '� SG q � Pm,r Address O { ry 1 1.0-'JO rA`/f Address b - Pmx not Signature(if applying for pem7i) Signature(if applying for permit) ❑IFCI'Certified Other El IFCI'Certified El LSP If Other Tank Location (1j )Q ��}�y5reer City Tank Capacity(gatjons) t�/l.Y Substance Last Stored 0'i Tank Dimensions(diameter x length) Remarks:_ 1 l ArItr-aas.-ra75 4`►S7g 37K 01 5oA41a8 11S1 Firm transporting waste j'[' (j S 1�-- C�X� State Lic.# Hazardous waste manifest# 2_2 `"'E,��'�A # Approved tank disposal yard ©Gk• 0,4' * Tank yard# Type of inert gas Tank yard address City or Town G FDID# Permit# Date of issue_ `�\� l Date of expiration - Dig safe approval number: , Dig Safe Tall Free Tel.Number-800.322-4844 Signature/Title of Officer granting permit After removat(s)("Consumptive Ilse"fuel oil tanks exempted)send Form FP-29OR signed b Local Fire Dept.to LIST Regulatory 9 Y P 9 ry Compliance Unit, Department of Fire Services,P.O. Box 1026, State Road,Stow,MA 01775, 'Intemational'Fire Code I FP•292(revised 4/97) r6 � .. TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION 0 � ! ADDRESS: 6 �`! �� C04. 4 !' 4 MAP NO. � PARCEL NO. � � 1 5 - s+'•v Ti'_h OWNER NAME: H VILLAGE: INSTALLATION DATE: t°1'1� r_ !f 1 7`/' BY: `j ADDRESS: -rye�i< --)ICERT. NO. -plat 0 4c g ! a TANK INFORMATION LOCATION OF TANK: Ifs CAPACITY i 0 0 O `ri TYPE ak-", Sl&-rLAGE FUEL/CHEMICAL L L TESTING CERTIFICATION C ] PASS [ -] FAIL ,'DATE LEAK DETECTION C,x] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C J YES C ] NO - DATE'TO BE REMOVED,- FIRE DEPT. PERMIT ISSUED CVO] YES . C ] NO DATE ! f��i a 7 CUNSERVATION Cx] CHECK IF N/A DATEiQ BOARD OF HEALTH TAG/eNO. ]C ]C I[ ] DATE G/ t] PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD j a �i�r 1�e a�j�c.� U ct•i a C CA, d4 2a }— COTUIT FIRE DEPARTMU"T `64 High street Wit, 02635 429-2210 "- E ERVILLE-OSTERVILLE APPLICATION FOR PERMIT FIRE DEPARTMENT TO INSTALL-ALTER FUEL tL BURNING EQUIPMENT Date--__-..�'L�..t-Io____`_.19.4 To the Head of the Fire Department: Application is hereby made in accordance with the provisions of Chap. 148, G.L., and Regulations made under authority Viereof by the undersigned for permit to install- alter, for the person or persons and at the location name d ed herein certain eq uipment pment for the keepi— or use of f al or otiaer irularnmKiiie liquid products used for fuel as described-bel w. ME----�------------- NAME----• •----------------------•�----..—.. II Owner11or O up t) ( — Installer ADDR SS.- _0.-lam Description- Name --. •-- .... .�•�-..-"-- - Manufacture _ Burner: Type - C�C U.� .._ Model or Size.-_ Locatio _ _ .......... Mass.Mass. Approved No._ Storage Tank: Type ____.- �___._-. ,Oapacity..� v gals. (er) Size Location - — ..--------- ------ Amount of fuel required for testing urpose........ .._____.......gals. "'"s appli'cation is made with full ;mowiedge of the current requirements of the ` regulations governing such installation, which will be made in compliance therewith. Note: If this application involves alterations to existing equipment, describe fully on reverse side. 5040 7 Cat Co Py TOWN OF BARNSTABLE — UNDERGROUND FUEL AND .CHEMICAL STORAGE REGISTRATTDN OWNER AND I NSTAI L,ER INFORMATION ADDRESS: `` r a i �! r`__tl'i t.i } f'A r� MAP NO. r lam_ PARCEL NO. OWNER NAME: t C,t_�. �'�-� t VILLAGE: _ INSTALLATION DATE: BY: -1 , ADDRESS: .f I l 4 i.. ./ t r'c CERT. NO. I / TANK INFORMATION LOCATION OF TANK: CAPACITY r ` TYPE `� l.,AGE s a� FUEL/CHEMICAL `' L TESTING CERTIFICATION E I PASS C I FAIL DATE LEAK DETECTION E �7, CHECK IF N/A. TYPE/BRAND ZONE OF CONTRIBUTION C .] . YES C NO DATE -TO BE .REMOVED —A�- a FIRE DEPT. PERMIT ISSUED E✓I YES . E I NO DATE_ �^ CUNSERVAiION E 7 CHECK IF N/A DATE BOARD OF HEALTH TAG NO.0 7E ]E ]C 7 DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ' I j a �►'t Jcc�z� 9 v ... e I n C a 4,J �r 2.�c -L`"7 n -f IZ-dn V�; l�Af'1 Oct L 4-t . 1 '1 r�I I.. . l./• ' JEFFREY P. LOWERY January 4, 2011 Thomas McKean, Director Public Health Division Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Mr.McKean: We received a letter indicating that we must remove our underground oil tank:As previously stated in a letter to Cynthia Martin, the tank is fiberglass and is located under -our lawn, sprinkler system, and rhododendron foundation plantings : It has safely been providing us heat for over.30 years with no problems! Therefore we would like request a hearing. -r�s+eA? My husband is a 69 year old quadriplegic and uses a wheelchair van with a lift. The unloading dock, which provides access to the house, is also located in the area of the underground tank and would be disrupted during the tank removal. It would not bej y possible for my husband to enter our front door as;the entire structure would have to be rebuilt if the tank were removed(Not only is there no other access for him but the expense of this project alone would be astronomical. 7 Per- Wkopt In addition to the above problems, we would also have to -revamp our heating system and plant.a new lawn which are additional expenses and provoke quite a financial hardship. In conclusion, we would like to propose that we leave the tank in the ground but drain it and fill it with a substance of your choosing. I believe doing this is called"Abandonment in Place". , We look forward to.hearing from you so that we may resolve this matter. Thank you very much Sincerely, Jeffrey and Nancy Lowery 88 Bay Rd. Cotuit, MA 02635 : Phone 508-428-7152 :cell 1-508-361-6323 cc: Cynthia•Martin 1�oll SUBJECT TO APPROVAL OF No...... BARNSTABnn4�'�I LE��AAAC��ONSERVATION F�$ - -- THE COMMONWEALTH OF MASSA��TU"nnnON 007 ,,, BOARD 93F H TH - OF i ...................................-j`--- Applirathin for Elispnsal Marks Tons#rnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S4... ........_........... ---••-- .......................... ..._........_........._. Locatio Address or Lot No. --- .....��. rr� �!...... �.... ��_. y ....... -- ► �} AI. . ....................._..... �J ,p { Owner }Yddress ------.CO'AA A.lea.._V..0XICs!_QVAr.r.0_1✓___;,j... � -"--- .......14M 121).'s...-.�....M.Ae__..------•------•-•---•---- Installer Address pp Type of Building Size Lot___ _ ,y_ l?_.�_Sq..f t V Dwelling�No. of Bedrooms_________13___________________________________Expansion Attic ( ) Garbage Grinder (4/0• aOther—Type of Building IZW&47 29�4' To. of persons.....A.................. Showers ( ` ) — Cafeteria ( ) Otherfixtures --------•------,��----------------------------------------------------------------------- ---------------•••--------••••-•-• --- .................... W Design Flow____ ___ __ �___s:!_gallons per person Der day. Total daily flow------13_3_ _.cd—_Q .....gallons. WSeptic Tank—Liquid capacityiOLVgallons Length__ =_ __ Width__.H.-J.0 Diameter________________ Depth_.15___k x Disposal Trench—No. ____________________ Width.................... Total Length..............j____,Total leaching area....................sq. ft: Seepage Pit No........../--------Diameter........&....... Depth below inlet....... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) /6/.2,4•-J7 7 Percolation Test Results Performed by......................................................... Date______./....f _ .......... Test Pit No. 1,9R.SS___I.minutes per inch Depth of Test Pit.....l l.......a.. Depth to ground water...... f 0AIS (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ._-_i----------------------------------------------------------------------------------------------:..._......-----............_...-•----....._...---.....-- O Description of Soil --3-••• 1�'� `�k� C�l' ' v vtP- U Nature of ' epairs or Alterations—Answer when applicable______________________________________________________________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. SicL .. ................................................. ---•-•--•-•-Dat.e.............. Date Application Approved By.........-- `�� :.. 1+Lf1L'L ------....................... Date Application Disapproved for the following reasons:.............................................................................................................. .....................................•---•-•-------•-------------•---•--------------------•-•-------••-----••-•••--•-••-•-•---•••-•---•••=-•-•-••••------------•-•-•-••--••--•••-----------•••••--•-•--- Date PermitNo.......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS .. l� BOARD F' !-i ../ ........0F....... . .'m4W..k........ Appliratiun for Disposal Works Tonstrttrtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .........-•-....--.......................'/. ' .E'�.��........ Ga..! t.� .................--•••---•/--1.d•=��0l?... - ._....... ..._....... _ _ Location,Address r Lot �i ......\ r=-E .�:.!:./........... ! �•!/1,��� fir~�......... --.- C.�.�_/�.C���...�_.:� New.C?.. ............................. Owner W !�.,�.j:� C r 1 F fl'� �/!.��-, T_J-.�1±�_C!�-�:�C.. Addr��. c_. = "1 '.; a Installer ! ^ 'Address Type of Buildin g Size Lot_._ __ c._F f�_.:'._._S fe t -� Dwelling�To. of Bedrooms..........:h ............................Expansion Attic ( ) Garbage Grinder (�� Other—Type T e of Building �1 ���- F' Nl � yp g �>_ ._'...:...::.::.. .pl;To. of persons......!9.................. Showers ( ) — Cafeteria ( ) QOther fixtures ..------•------•-•--•-•-•--•--••---•- -----•---------.-------•------••...............•------•---•----•--........ Desi Flow ,� a ----�------------- ------- W gn �2,,gallons per person per day. Total daily flow....... � :..:�.......gallons. WSeptic Tank—Liquid capacity.i.06rgallons Length.._. .1_0.. Width__..'1.-J P Diameter................ Depth._57-1 O x Disposal Trench—No..................... Width.................... Total Length f Total leaching area....................sq. ft. Ir 3 Seepage Pit No.........../------- Diameter........ -- Depth below inlet..., ; Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank /Co }�} 7 f �'u ai! / Percolation Test Results Performed by........................................................... Date..... ..a ._._.._.. Test Pit No. 1 L-_1 = _. ..minutes per inch Depth of Test Pit....J1....i.:?. Depth to ground water........!?.,?W f� Test Pit No. 2................minutes per inch Depth of Test'Pit............._.._._. Depth to ground water........................ •....t..................................................................................................••••----•....•----••••-•-•-•--••••.................. O Description of Soil �--•�-"=-----'::��17. Y- • ._4���,r�/..z------•-•-----•------ ( ......................................................... - .;. _ _,e�.L _,._.e.. _!_...._i _ .. ....�-.—'�"..i ................................................................. .......... U Nature of .Repairsl_or Xlterat ns—Answer when applicable..................... ....---•------••-••--•-•-••-....••---...-•---••-------•--•••------------------•••-••-••-----••---•--•-•---•••--••----......-••------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig?'d,_;...__. -----------------------------•--•----•----•----.--------------------.._. ------------- .� Date Application Approved By........✓ ............. /._.!J•I.UJtl- ................... ... .........V...... / ...............................Date Application Disapproved for the following reasons:...................... ....._........ � •--•............................•----•-•-•-----.......------.......-----------••----------...----....-----•....._..----•------•--...._....--•-------•-••--- ............................................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS N BOARD OFj HEALTH .........d"'.. . ........OF.......... Fu°61u................................................... (9rdifiratr of Toutplittnrr , T S IS TO CER71�Y, That t 'Individual Sewage Disposal System constructed ( or Repaired ( ) byrii;rstal�lij� v��.{ '� ` ,�.................... / —� A at._...:...;. �. t-_ f --- ' .l y� �f !1-:4 1t•!t�Q= r = :��r ldr 4.a.1.!�i_has b4en in accordance with�l�Ye provisions of TITLE: 5 of The Stage Sanitary Code as described in the application for Disposal Works Construuction Permit No.................•...__................. dated---..%✓_ ___s 1.:__ .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............�• C4---O-Q•----------------•-----•---------------- Inspector..--- -------------------------------------------- f � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF? HEALTH `,t. ..:ln.�..........OF.. ! °> - Z�/...... t� ri b.... FEE....: .:.............. Bispo�l-� orks Tun Irt ion � �ernti# Permission ;s.hereby granted.------•... .+.......7S,,p ..........'......'1��.........--•-------- ..... to Construct (�) or. epair ( r) an Indiv"i` isp sal Sy` de D o stemat � �° ..�,_._rStreet as shown on the application r Disposal Works Construction Permit No.._____.. ___- Dated.._Z4_-�. ... ......... �. � Board of ealth ------------------ DATE............---------------------------------------------------•-........•••--- FORM 1255 HOBBS & WARREN. INC.. 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