HomeMy WebLinkAbout0011 OLD KINGS ROAD - Health � 1 OLOVn
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TOWN=BS:TAIBLE
LOCATION %� ���min S SEWAGE #9 4�"
VILLAGE C64u / ASSESSOR'S MAP &f/LOTe��-v-� ,�0
INSTALLER'S NAME&PHONE NO. a7/ �APe �l/L G),'!S f
SEPTIC TANK CAPACITY /.5-r94 G / 2-3D,<
LEACHING FACELIT`Y: (type) -J7 X y>1 c; TRTW40nOe- -e5 (size) �' tZ x CJ
NO.OF BEDROOMS ' L
BUILDER OR OWNER
PERMPTDATE: —COMP LIANCE DATE: "
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Separation Distance Between the: . .
Maximum Adjusted Groundwater Table and Bottom of Lething 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
III kn within 300 feet of leacIlt faci 'ty) Feet
Furnished by 10 r
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TOWN OF BARNSTABLE �� ��
LOCATION AA01,1 SEWAGE # '9-A;5,h
VILLA GE rat 7- ,kid S . ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)Ai"3cF'1 9 (size)
NO.OF BEDROOMS f'
BUILDER OR OWNER � Yf'" �
PERMTTDATE: 7 1 �—% COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 41kJ l
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No. V C� _ O L-I® Fee if
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSMtY
0(pplicatton for Mtgo$al *p5tem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair(ZanOn-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � r'
1 Wes`U`r� (�11 ��✓�S �
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow J y gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 46
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 Certifi-
cate of Compliance has been issu oard e 3 C _.FA Signed Date J
Application Approved by
Application Disapproved for the following reasons '
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# Permit No. Date Issued - as y
No. 0 4 C,,� — (f Fee
THE.COM#ONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSET '§`--�
01pprication for Migaar *potem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair(Zan On-site Sewage Disposal System at:
Location Address or Lot No. nn Owner's Name,Address and Tel.No.
oo �w�5 l`Ol4 r_� 60-T L,,1 rA wrr
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )`
Other Fixtures
Design Flow gallons per day. Calculated daily flow '5 _L gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil {
Nature of Repairs or Alterations(Answer when applicable) / S I'M ST, K Q 67'_.
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Date last inspedted:,."-
Agreement:
The undersigned agrees to ens7e 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 Certifi-
cate of Compliance has been iss oard
Signed Date
Application Approved by
Application Disapproved for the following reasons
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Permit No. I a I Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of Compliance - -
_ THIS IS TO CER IF that the On- S wage Disposal System installed( )or repaired/replaced(�on
0 by I for q TT r✓i th vv
as vt ( 14 6a, ` has been constructed in accordance
with the provisions of Title 5 and the or Disposal System Construction Permit No. 9a dated
Use of this system is conditioned on compliance with the provisions set forth below:
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No. 9 r d/ 2 Fee 7 U
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
wi5po5ar *p!gtem Construction Permit
Permission is hereby granted to 1�-- Q� rF--d ✓`�
to construct( )repair(---J'aii On-site Sewage System located at
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.
PY g P P
All construction must be completed within two years of the date below.
� ` ..
� Date: 9 k► Approved by °
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CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION-PERMIT(WITHOUT DESIGNED PLANS)
I hereby certify that the application for disposal works '
construction permit signed by me dated � ,r0 , concerning the
property located at_ /� 010
meets all of the
following criteria: C
There are no wetlands within 300 feet of the proposed septic system
•. There arc no private wells within 150 feet of the proposed septic system
v The observed groundwater table is 14 feet or greater below the bottom of the leaching facility .
There is no increase in flow and/or change in use proposed
There are no variances requested or needed.
SIGNED : DATE: �—�f0
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system Also if the licensed ins
taller posesses a certified plot plan,
this plan should be submitted].
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DATE: _ 4/19/96
PROPERTY ADDRESS: .11 0ld--Kin5,sRoad.
Cotuit,Mass . RECEIVED
96
026350 . i. i_E
On the above date, I Inspected the septic system at the above address.
This system consists of the following:
1 . 1-21x51, block cesspool.
.2. 1-81x8l block cesspool.
eased bn my Init action, I certify the following conditions:
1 . This is not A title five- 'septic system.
2. This is a sewage system.
3 : The sewage system is in failure.
•4. The. _present system must be upgraded to a title five 'septic system.
81GNATUR!7-:
Name: J_P_M_acomber Jr...'',—_ ___ i
Company: J. P_MacoMber. &—
Son-_Inc ,
Address: --- ------
--Centerville LMa_ss__02.632
Phone:---5C18-,Z7.5.-3338------- -, 1
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
(JOSEPHT. MACOMBER & SON, INC.
Tanks-Ceupools-Leachflelds
Pumped Installed 4
Tuwn Sewer Connection:
P.O, Box '66" Centerville, MA 02632-0066
775-3338 775-6412
I'Q.
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
Wllllam F.Weld Trudy Cox•
aoVrnw a—Ary
LL Govemor Paul Glluccl David Bar
ee �I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
PropertyAddr"&- 11 Old Kings Road Cotuit,Mass . Addreas of Owner..C/O General Delivery
Date of Inapootl,on: 4/19/96 (If different) North Mansfield,Mass .
Name of Iaspeoton Joseph P.Macomber Jr. 02059
Company Na:ne,Addreas and Telephone Numbcn
J.P.Macomber & Son Inc. Box 66 Centervine,Mass . 508-775-3338
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on•sita sewage disposal systems. The system:
t ;
_ Passes
Conditionally Passes
uNeeds Further Evaluation By the local Approving Authority
Inspoctor's Signature: 'GQ�' " "—`�r Date: �-0*
The System Inspector 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 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 oMea 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.
INSPECTION SUMMARY:
Check A, B, C,or D:
A) SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CUR 15.303.
Any failure criteria not evaluat.od are indicstod below.
B) SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repairod. The system, upon completion of the replacement or repair,passes
inspection.
Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. It'not determined",explain why not)
V Q e, The septic tank is metal, cracked,'itructurally unsound, shows substantial infiltration or exfiltration,-or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a yonforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
One Winter Street • Boston, Massachusetts 02108 • FAX(617) $56 1049 • Telephone (617) 292.5500
`� Printed on R"W P+,-xr
CERTIFICATION(ooatluuod)
ProportyAddre' 11 Old Kings Road Cotuit,Mass . 02635
Owner. Matthew Byrne
Date of Lup"tions 4 19/96
B)SYSTEM CONDITIONALLY PASSES(continued)
'JIbt Sewage backup or breakout or hob static water level observed in the distribution box I fib'° obstructed yo,
or due to a broken,settled or uneven distribution box. The system will pass pwtlo approval of the
BoarHsalth)s
broken pipes)are replaced '
obstruction is nmoved
dlstsibutiou boi is levelled or replaced
a.ysar due to broken or obstructed pipet ss
). The system will pa
The system required pumplag awre than four times
inspection if(with approval of the Board of Health):
brokea pipes)are replaced
obstruction is removed
• i
Cl 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.
I) SYSTEM WILL PASS UNLESS BOARD
BLIC HEALD SAFETY AND THE ENVIRONMENTS TH DINES THAT THE SYSTEM IS-NOT CTIONIN(I IN A
MANNER WHICH WILL PROTECT T E PU
Cesspool or privy is wlth!n 60 feet of a surface water
AV. Cesspool or privy is.within 60 feet of a bordering vegetated wetland or a salt mash.
Z) SYSTEM WILL UNLESSIS HELIC ALTH
SUPPLIEF,IF APPROPRIATE)
sT—r2i FUNCTIONING MANNER THAT PROTECT THE PUBIJO HEALTH AND
D� TTH
SAFETY AND THE ENVIRONMENT
The system has a septic tank and soil absorption system and is within I00 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.42P .
The system has a septic tank and soil absorption rystem and is within 60 feet of a private water supply well.
The system has a septic tuLk and soil absorption system and is Is"than 100 feet but 60 feet or more from a private water
+upply well,unless a well Rater analysis for ooliform bacteria and volatile organic compounds indicates that the wall is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than b ppm.
S) O/THHEER
(revised 11/03/95;
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 11 Old Kings Road Cotuit,Mass . 02635
Owner. Matthew Byrne
Data of Inspections 4/19/96
D) SY9 MISS •
•
ZI Navy d•tarmined that the system violate+ens or mory of the following failure criteria as daflnad in 310 CUR 16.509. The bail for
this detasminatiou is identified below. The Board of Health should be oonucted to datarmins what will be necessary to correct the
failttrw.':
Backup of sewage into facility or system component dug to an overloadod or clogged 3A4 or oeupooL
Discharge or pondiag of effluent to the surface of the tround or surface waters duo to an overloaded or clogged SAS or
cesspool.
.t/ 4r - Static liquid level in the distribution box above outlet invert due to an averloadod or clogged SAS or cesspool.
Ij Liquid depth in cesspool it Iasi than 6"below invert or available volume is less than 1/2 day flow.
#3D Rsquirod pumping more than 4 tunes in the last year NOT duo to clogged or obstructed pipo(s).
Number of times pumped _
�J ► Any portion of the Soil Abaorption System, cesspool or privy is below the high groundwater elevation.
dify Any portion of a coaspool or privy is within 100 foot of a surface water supply or tributary to a surface water supply.
&0 Any portion of a cesspool or privy is within a Zone I of a public well.
.l O Any portion of a coaspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is lass than 100 feet but greater than 60 foot from a private water supply well with no
acceptabla water quality analysis..if the well has boon analyzed to be acceptable, attach copy of well water analysis for
coliform bactsria,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:
_ -
0 or ter( System) and the system is a significant throat to public
a facility with a der' Slow of 10,00 gpd grey Large
The system serve tgn
health and safety and ths•environment bocause one or more of the following conditions exist:
• � the system water su is within<00 foal of a surface drinking PPIY
dL4 the rystam is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogea sensitive area (Interim Wellhead Protection Am MA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shal bring the system and facility into Rill compllMN w(ih the Vvuawattr troatmaut proV=
requirements of$1{ CMR 5.00 and 6.00. Please consult the local regional office of the Department for Auther information..
E'
(revised 11/OS/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART 11
CHECKLIST
Property Add resa: 11 Old Kings Road Cotuit,Mass . 02635
owner. Matthew Byrne
Date of InspectIon:4/19/9 6
Check if the following have been done:
1%lumping information was requested of the owner, occupant, and Board of Health.
None 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 have not been introduced into the system recently or as part of this inspection.
PAW
,U As built plans have been obtained and examined. Note if they are not available with N/A.
le hl facility or dwelling was inspected for signs of sewage back-up.
,/The system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
2All system components,excluding the Soil Absorption System, have been located on the site.
4.)J.Vc, The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of banes or
tees, material of construction, dimensions,depth of liquid,depth of sludge, depth of scum.
ZTh,size and location of the Soil Absorption System on the site has been determined based on existing information or
:eapp ,1�ated bynon-intrusive methods.
cility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub.
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 11 Old Kings Road Cotuit,Mass . 02635
Owner. Matthew Byrne
Date of Inspection: 4/19/96
FLOW CONDITIONS
RESIDENTIAL:
Design flow: lions peg-��y •
Number of bedrooms:,
Number of current residents:
Garbage grinder(yes or no),E� -
Laundry connected to rj�m(yes or no):-
Seasonal use(yes or no
Water meter readings,if available
2 qqg- r .(�
Last date of occupancy:
COMMERCIAL NDUSTRIAL•
Type of establishment:
Design tlow:_4jjg__gallons/day
Grease trap present: (yes or no)&
Industrial Waste Holding Tank present: (yes or no)A1 •
Non-sanitary waste discharged to the Title 5 system: (yes or notio-
Water meter readings, if available: AA,
Last date of occupancy:
OTHER(Describe)
Last date of occupancy: tV
GENERAL INFORMATION
PUMPIN 3 so info t'on• '
System pumped as part of' pection: (yes or no)� env�U
It yes,volume pumped: of
Reason for pumping-
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspools
Overflow cesspool
Privy
Shared system(yes or no) (if yes, attach previous inspection records, if any)
Other(explain)
AP RMMATE AGE of all components,date installed(if known)and source of information: -'o)
Sewage odors detected when arriving at the site: (yes or no)
(revised 11/03/95) 6
b
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (oontinued)
PropertyAddresa: 11 Old Kings Road Cotuit,Mass . 02635
Owner. Matthew Byrne
Date of Inspection: 4/19/96
SEPTIC TANX-AbWi, e
(locate on site plan)
Depth below grade:,U,#
Material of constnution:d/ concrete_metal_FRP—other(explain)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: A-)A-
Scum thickness:_
Distance from top of scum to top of outlet tee or baffle: A)14-_
Distance from bottom of scum to bottom of outlet tee or baffle: Q)
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.)
L
GREASE TRAP:AGayC-
(locate on site plan)
Depth below grade: 0
Material of conatruction:119concrete_metal_FRP_other(esplain)
Dimensions: A
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:-A2Q
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,structured integrity,
evidence opeakage,etc.)
lV6
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (oontlnued)
proPertyAddress: 11 Old Kings Road Cotuit,Mass . 02635
owner. Matthew Byrne
Date of Iaspeotioa:4/19/9 6
TIGHT OR HOLDING TANK:AI-04✓ '
(locate on site plan) e
Depth below gmde:iv"
Material of construction: ncrete_.metal_FRP_other(e:plain)
Dimensions:. ll�)
Capacity: ns
Design flow: ons/day
Alarm level:
Comments:
(oon&tioa f inlet tee,condition of alarm and float switches,etc-)
• Ad1�
DISTRIBUTION BOX:I&IlM-
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if le,91 and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box,etc.)
A;v C •ter yt .r��S
PUMP CHAMBER:'N��(%
(locate on site plan)
Pumps in working order:(yes or no) N�
Comments:
(n coadi'' a of pump chamber,condition of pumps and appurtenances,etc.)
.VD CAS'API
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(revised WOWS) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 11 Old Kings Road Cotuit,Mass . 02635
Owner. Matthew Byrne
Date of Impaction: 4/1 9/96
SOIL ABSORPTION SYSTEM (SAS): -
(locata on site plan,if possible;excavation not required,but may be approximated by non intrusive methods)
•
If not drtermined to be present,explain:
Type: leaching Pita,number.
leaching chambers,number.CDlea:hang p1leriee,number:
leaching trenches, number,leNA:
leaching fields,number,d* ions:
overflow cesspool, number it
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
CESSPOOLS:Z
(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: A'7C6 l-
Materials of construction: �'ele
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection)_ G
Co nts: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,.ptc•)
$011••San •No signs of h dr fai1ura • Nn 10 -a'—porldin Vegetation
1 x c ssns�ol is -11 �' g t.xg..i block cesspool
i Y`auaTnexsystem is an• a1 re . an not handle 6 bedroom
design, Old pumping records shows this. Little use past few years .
PRIVY:A&:Itl
(locate on site plan)
Materials of co n• �!� Dimensions:
Depth of solids:A
Co ' (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,otc.)
I n'i�-�to eA2 rS
(revised 11/03/95)- $
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
propertyAddreaa; 11 Old Kings Road Cotuit,Mass . 02635
Owner. Matthew Byrne
Date of Inspection:4/19/9 6
SKETCH OF SEWAGE DISP08AL SYSTEM: •
iaciude tied to at least two permanent references landmarks or benchmarks
locate all wells within 100'
Cotuit Water Company
428-2687
Y
( ` N� �p
// h P?d-
DEPTH To GROUNDWATER
Depth to groundwater. 1 L +feet
method of determination or approximation
pproxima ' n:
�Illig hole �ixfeet Belo bottom o e cesspoo
� 4 dry. No suns o wa1;e
(revised 11/03/95) 9
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TOWN OF Barnstable. BOARD OF HEALTH
St113S till FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
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-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 11 Old Kings Road Cotuit.Mass . 02635
ASSESSORS MAP , BLOCK AND PARCEL #
•
OWNER' s NAME Matthew Byrne
PAIt7' D - CERTIFICATION 1
NAME OF INSPECTOR Joseph P. Macomber Jr. .
COMPANY NAME J.P.Macomber & Son Inc.
COMPANY ADDRESS Box 66• Centerville ,Mass . 02632
Street Town or City State LIP
COMPANY TELEPHONE ( 50 ) �75 3338- FAX ( 50
, _, 8 790 1578
iS�HR iSi ICCC.C■ L^J i�
CERTIFICATION STATEMENT
I certify. that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate , and •
complete as of the tilne . of :inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one: ;
Systeui PASSED
Tile inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
XXXXXXXXXXSystem FAILED*
The inspection Which I have conducted has found that the system fails to
Protect the public health and the environment in accordance with Title
5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signatur Date 4/29/96
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable) and the BOARD OF ItEALZ`II.
* If the inspection FAILED the owner or""� erator shall u
P � p pgrAde ' the system
within one year of the date of the inspection, unless allowed or required
otherwise as provided in 310 CmR 15 . 305 .
z
Ln
THE COMMONWEALTH OF MASSACIHUSETTS .
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
P. Macomber Jr,
Joseph ..
Has satisfied the Department .s qualifications as- required -and- is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
` June 8. 1995
Acting Director of the ' ' ion of Water Pollution Control