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HomeMy WebLinkAbout396, 394 BEARSE'S WAY - Health �396/394",Bearses's�-, q x. Hyannis �, e9a . i Y tint�tw ---- -- - --- - A = 29?. 159�'055 . I; i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: v l key to move your cursor-do not Kevin Cochran U J use the return Name of Inspector key. Aardvark Environmental Inspections VQ Company Name PO Box 896 Company Address , „ East Dennis MA 41 City/Town State Zips ode 81 508-385-7608 SI 13356 c_ Telephone Number License Number vCD —n I � M. 01 B. Certification co 54 I certify that I have personally inspected the sewage disposal system at this address aid that the information reported below is true,accurate and complete as of the time of the inspection.The insPectio^ii was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12/10/13 Inspector gnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official InspectioVSurfcesuj;;eo1ispo1sl1_stem•Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bea rses Way Property Address Jason Bovamick Owner Owner's Name information is Hyannis MA 02601 12/09/13 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: i B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined" (Y,N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health- *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ~ ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11110 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 3 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Cfty/Town State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All-Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow t5ins-11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is Hyannis MA 02601 12/09/13 required for every page. City/town state Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection El El Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered `yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15,304.The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bea rses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information.For example, a plan at the Board of Health. ® ❑ Determined in the field (f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) P10 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 6 Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is Hyannis MA 02601 12/09/13 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (f yes,attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5Offcial Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 07/02/79 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.9 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 1.9 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,500 gal Sludge depth: 4" t5ins•11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Cityrrown state Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Dace t5ins-11/10 TrUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovarnick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan,excavation not required): If SAS not located,explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/aftemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): This system has a 6'x6'precast pit surrounded by a foot of stone.There was 19"between th inlet invert and the liquid. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Titre 5 Official Inspection form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): I Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•11/10 Title 5 Offxial Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately rear 39 38 28 49 t5ins•11/10 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of ovet20.0 feet. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 394-396 Bearses Way Property Address Jason Bovamick Owner Owner's Name information is required for every Hyannis MA 02601 12/09/13 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A,B, C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Otrxial inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 � - SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A• 77 , item 4 if Restricted Delivery is desired. k ❑Agent ■ Print your name and address on the reverse 5� ❑Addressee so that we can return the card to you. B. Re v d ` P.n ame) �C'. Date of Delivery ■ Attach this card to the back of the mailpiece, 0 or on the front if space permits. D livery address different from item 1? ❑Yes 1. Article Addressed to: ES,enter delivery address below: ❑No 4 .rI.Y Jason Bovarnick °? PO Box 336 Westwood,-MA 020-90.. ' 3. Service Type VkArtiffed Mail ❑Express Mail "{ ❑Registered �'Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number, a i i 7 0 0 8. 3 2 3 0 .q q.0 2 51718;�MJ 02 8 I (Transfer frvrri service labeo I I ! K, . i ,i I PS"FoRn 38131;Fetiruery 2004 j i j j I :`•Domestic Return Receipt 1 o2sss-o2-M-i.s4o UNITED STATEyyCC��. 1BirL18sr`as ✓S ' aid p • Sender: Please print your name, address, and ZIP+4�in this box • OWIl Ot'(3'art1S[u0)e ` 6r Healtli 1 1vl i01 y i Hyannis,.CIA 02601 . 4 Certified Mail#7008 3230 0002 5178 0028 Town of Barnstable Barnstable Regulatory Services ANnMcaQlv + lARNSPABM ' MAW Thomas F. Geiler,Director I i639• O39`A Public Health Division 2007 0 Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 8, 2011 Jason Bovarnick PO Box 336 Westwood, MA 02090 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.- The property owned by you located at 394 Bearses Way, Hyannis, MA, was inspected on March 8, 2011 by Timothy B. O'Connell,R.S., Health Inspector for the Town'of Barnstable. This inspection was conducted in accordance with the 2006 Barnstable rental registration ordinance requiring yearly inspections of all re�toperti The following violations of the State Sanitary Code were observed: 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities Missing face plate to light switch in living room. 105 CMR 410.300 and 310 CMR 15.00: Sanitary Drainage System There were a total of three (3) rooms being used as bedrooms in this side of the dwelling; however, the existing septic system (permit#2005-267) is for four(4) bedrooms and only provides adequate flow for two bedrooms in each side of the duplex. 105 CMR 410.401—Ceiling Height Observed room on second floor, which* lacks proper ceiling height, being used as habitable space. V4, ? n — - The following violations of the Town of Barnstable Code were observed: V45V�l Chapter § 59-Comprehensive Occupancy �59=3 Prohibition. Current occupant told inspector that six(6) occupants live in dwelling and he observed a total of six (6) occupants are residing at said residence. This exceeds the maximum occupancy at said residence which is three (3) adults. 74 y You are directed to correct the other State Sanitary Code violations listed above within thirty (30) days of your receipt of this notice by replacing face plate on light switch and to cease and desist using second floor as habitable space. You must also ensure that ONLY a total of three (3) occupants reside at said dwelling. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100:00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF T BOARD OF HEALTH Thomas A. McKean, R.S., C Director of Public Health Town of Barnstable f Cc: Ronald Bougeois; Property Manager Cc: Blanco Torres; Tenant I _ TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 3 - Time: In Out Owner ~ ' / -0'y r Tenant Uc,� ty7� Address �b 33 6 Address 3� ( � ynre�� Compliance Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities r 3. Bathroom Facilities i 4. Water Supply 5. Hot Water Facilities —t S,-C/ 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities i�r}rruv�u. 10. Curtailment of Service - - 1;0ca; 11. Space and Use - 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width l S 19. Number of Tenants ObservedPb' 1 5 �� PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) f Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here � TOWN OF BARNSTABLE BOARD OF HEALTH ii ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date � 4 I Time: In Out Owner J-'ZIJ T)OVq RO l C K Tenant Address o (� L� 3 Z)b Address<—) 10 � S 1j" I�e6-f D0 D 1M0 Compliance Remarks or Regulation# Yes/ - NO Recommendations i 2. Kitchen Facilities ell.I 3. Bathroom Facilities V 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 4XPo�=� 00 �GT �W t)P57i�iRS 8. Ventilation ��V1Y1�R6v�> O<P-DS&D Wl�l;S 9. Installation and Maintenance of Facilities . 4 Rom MIS iro & ri-l: 10. Curtailment of Service C-j L41;MS ax mygolvis 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 01 14. Insects and Rodents �O1gC1} PnCi - 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal vp, i�JPC�X� 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition ZD '5(i Number of Bedrooms 2, Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed( iv Inspector , f- VV If.Public Building such as Store or Hotel/Motel specify here Certified Mail#7008 3230 0002 5177 9817 TKE r Town of Barnstable Regulatory Services * ERA RN5TAELF- MASS. g Thomas F. Geiler, Director ArF°MAAA Public Health Division Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 6, 2011 Jay Bovarnick 121 Granite Avenue Medfield, MA 02052 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 396/394 Bearse's Way Hyannis, was inspected on January 6, 2011 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Town of Barnstable Health Department. The following violations of the State Sanitary Code were observed: 105 CMR 410.200—Heating Facilities Required/Temperature Requirements. Heat not provided at property due to the electricity being shut off. 105 CMR 410.354—Metering of Electricity and Gas. Electricity shut off at time of inspection. Based on the results of that investigation, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E) the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (C) (B) Failure to provide electricity. Heating system not functioning due to lack of electricity. QAOrder letterMousing violations\3941396 Beares's Way.doc The following violations of the Town of Barnstable Code were observed: 1& 70-4—Certificate of Registration. Rental units are not registered with the Town of Barnstable Health Department. You are directed to correct the violations listed above within twenty-four (24.) hours of your receipt of this notice by providing electricity to all units; by registering all rental units at this location by filling out applications for each unit and paying the appropriate 2011 fees. i You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. i PER ORD;McwKean, E BOARD OF HEALTH .S., CHO' Director of Public Health Town of Barnstable Cc: Ronald Bougeois; Property Manager I i QAOrder letters\Housing violations\394/396 Beares's Way.doc TOWN OF BARNSTABLE BOARD OF HEALTH / ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION j Date 6_ l Time: In Out ` Owner �, Tenant Address �Z� `�''� Address 3 Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities Alp 1j, 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities / 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed 16 7 '5 PART 11 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date _ — I Time: In Out Sd — 360 Owner 5�- �' Tenant ZIAACrA -6dras 6U0,,-ad4 Address a' I Address 10(5�L 1�*� h� Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities T b.3 5, I J 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use - 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed L41 ,O PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolitiori Number of Bedrooms Number of Vehicles Allowed (max) Number,of Persons Allowed (max) Person(s) Interviewed Inspector If Public.Building such as Store or Hotel/Motel specify here TOWN OF BARNSTABLE LOCATION DSEWAGE-# 1 ,VIl.LAGE �d� ASSESSOR'S MAP & LOToF`?,�—,CS FNSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS . B.M;D� OWNER U O'YQ/I PERMUDATE: COMPLIANCE DATE: 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 No. 20Y !b 7 Fee U THE COMMONWEALTH OF MASSACHUS&TS -� Entered in computer: +� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS OppliLAtio for Rio ooi 6pgte �or�gtru tiott snit Psi � �- 39x39� Application for a Perh it to Construct( . )Repair Upgtade( )Ab don( ) Complete Syste dividual Components Location Address or 39 l j•: Owner's Name,Address and Tel.No. Assessor's Map/Paz �� CY1t��S LV AY - 158 Installer's Name,Address,and Tel.No. Designer's Name,Address'and Tel.No. O'2lr Q-a15ao 53� Type of Building: Dwelling No.of Bedrooms 4 Lot Size �tTsq.ft. Garbage Grimier No.of Persons a A Other Type of Building � Sho wers(�/) Cafeteria Other Fixtures LAvffay_,Y . k.-rcmy l Csrn1c, ugwv,)�A. Design Flow gallons per day. Calculated daily flow 4� ®4 --gallons. Plan Date Number of sheets 4Revision Date Title i C V Lj Size of Septic TaWr*j 0C�) Qa� `- Type of S.A.S. Description of Soill Nature of Repairs or Alterations(Answer when applicable) , mac" c °aT 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 Environmen ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this BoOZ of Hea . Signed Date tIZ113 Application Approved by 4A i em Date U Application Disapproved for Re following reasons Permit No. 7 Date Issued 1 oo No: DO 3 � t` Kam."�^ t 1— A— Fee 1. THE COM�M- EALTH OF MASSACHUS&4 Yes Entered in computer:✓ PUBLIC HEALTH..DIVISION=TOWN OF BARNSTABLE, MASSACHUSETTS Zp lication for­30i9;po5a1 bpgtem CCon5truction ermit R - -= Application for a Pert to Construct �J pp j ( . )Repair%DUp fg ade( )Ab don( ) ❑Complete Systerr�individual Components Location Address or l( 3S to „ Owner's Name,Address and Tel.No. Assessor'sMap/Parc l .- NJ�Cl1c>\� GJAY �0 ?t+` �}�p$A ESM q Ct— 1 -Installer's Name,Address,-an Tel.No. Designer's Name,Address and Tel.No. q S*-%Vkd E�u, Sq CS. := Type of Building:, �.. `.' Dwelling No.of Bedrooms Lot Size i_ 4on sq. ft. Garbage Grinder( F1),� Other] Type of Building 1A o cat No.of Persons i�d r Showers(✓) Cafeteiia( �� —OtherF*Xtures 1 _A.WrMK> k%arx� ,l , l ct')c-,e,\ Design Flow 44n gallons per day. Calculated daily flow A44 n�{ ' gallons. Plan Date Y„ /ii e' Number of sheets 1 Revision ion Date —Title Si a of Septic TaTW5T r Type of S.A.S. � - '�TSn Description,of.Soil -\m �:p\Ctp, J Nature'of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ,o, 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 Environment ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo of Heal Signed' n o Date !7 i . ,1 Application-Approved by Date U ` Application Disapproved for Tee following reasons r t A� Permit No. "DL rw z )( "7 Date Issued i .»':��'-�a,- .���:��� �-� -,- _ .:.��e vim.��<�������_-..�.�.-... _.�.� .•�-- .-•-...�'�i"�v-`4-�•.-'."�`�, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance V_Reclfio y,j THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired OO Upgraded( ) Abandoned( )by &JA o,u at 'k. has been constructed in accordance with the provisions of Title 5 and a for Disposal System Construction Permit No. U0 2 dated Ali ilo Installer Designer The issuance of this permit shall not be construed as a guarantee that the system-�'411(fuo as designed. Date (o ( 1 S / 5 Inspector \, . --------- _ __ — ._..__ . . No.��Y)S�'�7-----� --�-------------Fee �dlf . - . . . . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS ` ]DigpogaY *pgtem Congtruction 3permit Permission is hereby granted to Construct( )Repair(�')Upgrade( )Abandon( ) System located at q/1.� Rp"O or w A L, /" _ 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 must be completed within three years of the date of t ys a rrnit. Date: -i Approved by V r 9/16103 L Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, Z5."W ,hereby certify that the engineered plan signed by me �cP dated concerning the property located at �4 g^%eets all of the following criteria: • This failed system is connected to a residential dwelling only. There.are no.commercial or business.uses.associated with the:dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests.at the site without a health agent present. •. There is no increase.in flow and/or change in use proposed 0 There are no variances requested or needed. • The.bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) �a B) G.W.Elevation +-adjustment for high G.W.o?, _ -IIJD DIFFERENCE BETWEEN A and B oC ,9O SIGNED : DATE: b S NOTICE Based upon the above information-, a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc -----------s� -----'--l�---_._ TOWN OF AARNSTABI;E -- --:- - -- /. - Li`CATION SEWAGE `YT-1.,AGE, ASSESSOR'S MAP && LQT INSTALLER'S NAME&PHONE NO. ' G SEPTIC TANK CAPACITY %y"J. LEACHING FACILITY: (type) (size) 1 NO. OF BEDROOMS - BUILDER OR OWNE PERMTTDATE: COMPL CE DATE: 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 fac w Feet Furnished by T" . 1 cc0 CAT ION SEWAGE PERMIT NO. 4y ��- w�I L rWr INSTALL R'S NAME S ADDRESS B. UItDE R OR 0, ER DA T E PERMIT ISSUED DAT E COMPLIANCE ISSUED ?- 2 - 7 �_ _ T �. • �� �'ch `� � 4 �. `� 4 4 Q �� o. /$' �� � , �=- �qq��- �o \@� ,. C .� ,; , ti J _71— No.................�` y Fms..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD " HEALTH ... .'...............OF........... a!�' U.--.............:............. Applir ation for Disposal Works Tonstrnr#ann rrrmit Application is hereby made for a Permit to Construct ( ) or Repair VZ an Individual Sewage Disposal i System at: • ..............Lam: Ard(�• l .. ---.___V.......................... ......... •-----------. ....----------- •---•------------ •........... ....... it-ion or�ot N - .. - ........................... �f. .....-�..�.. `tc1Ar -----...----- -• O wn r A ress ... __ .:� ................................ .�o.--- c,� __...... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.:..........................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .............. No. of persons.........---............--.. Showers — Cafeteria a' Other fixtures ................................. . Design Flow............................................gallons per person per day. Total !�4y flow............................................g�llpns. WSeptic Tank—Liquid'capacity i�....gallons Length.......... Width..jf,r.......... Diameter................ Depth..�(o........... x Disposal Trench—No. .................... Width......r............. Total Length.._._.._ :_l____... Total leaching area....................sq. ft. Seepage Pit No....._rk........ Diameter........(P....... Depth below inlet..... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water................... .. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------- -•-•..........................•---..........----•----------••---......... IX Description of Soil = ......................... .............................. 4���'�-----•-•----. x W -----•-•••-•...................•••-•••-••--•--•---•••-•••--•---------------------•---------•--•-----•-••--------••-••••--••--••--------•---•---•••••••--.-. ._.... --•.. x aJi C----•--••--••--- . U Nature of Repairs or l�lt"tions—Answer hen a plicable.--.�. :��--_.._ ............ ................................. . ........OR?.-----• ....................... d.�......•-----••••-••-••••-••--•---•-........_••--- Agreement: The undersigned agrees to install the aforedes ed_In ' ' ual Se age Disposal System in accordance with the provisions of LITLZ 5 of the State Sanitary Co e he undersign er agrees not to place the system in operation until a Certificate of Compliance has been is ed by the oar - ealth. ned ate Application Approved By.......... ................. .....Y77!:A - 7........... Date Application Disapproved for t e f ollowi ons:-•-•---•••------- -----------•--•-••••-•••••--•-•-••-----•••••--------------------••......•••---......._......_ ...:-•---•------------•..................•---------------------...•--------••---..................................--.................................................. ................................. Date PermitNo......................................................... Issued......4 1 - / L No.....:...... FiEZ...............a......_ THE COMMONWEALTH OF MASSACHUSETTS _ BOARD HEALTH 4r ......................OF....... . .. J.... yfiratiun for Disposal Works Cnunitrudiun trrmi# Application is hereby made for a Permit to Construct ( ) or Repair �an Individual Sewage Disposal System at ...............1-Y 4,_" .c ................................................... ..................... .............. •--•---•-....--------.................... taro :A r s ........Q .... .t -- .................•-----..... .._ � °..._..NL.tt3:...:.- r 4 Own r �+ 1A dress ................ Installer � Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ........0................... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------••-•-•-•----------------------------------------------•-•--------------------.....----•--•----•-------•-•---------....------..._......---- W Design Flow.................. .......................gallons per person per day. Total 'y flow............................................ Lons. WSeptic Tank—Liquid'capacity!.O.gallons Length..... ...... Width.. d�.......... Diameter................ Depth...t .......... x Disposal Trench—No. .................... Width___.F............. Total Length.......Cy_ Total leaching area...................sq. ft. ' � � Seepage Pit No.......?............. Diameter.......d..._.._. Depth below inlet...... ............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per.inch Depth of Test Pit....--.............. Depth to ground water......--................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GG -------- ......................... .---•• ..... ---.......... ---- ODescription of Soil - ................ ........... ..�: -•-----------•--------••----------------.........--------.....-----•----- x14, U .-------------------------------•------••--...........••---------------•---.......-•-•-----.....----......•-----------.......--------•---•---•---•--•---------------.._.........•--..._....---------•---- w x -----------------•--------------------- ------------------------------------------------•--------------------------------------...--------------------- U Nature of Repairs or t tions—Answer hen a plicable_..1-V�L.Ismlklul..... : .... ... .................................. Agreement: The undersigned agrees to install the aforedes ed I74A u Disposal System in accordance with the provisions of TITLE. 5 of the State Sanitary Co e— Thher agrees not to place the system in operation until a Certificate of Compliance has bee Is ued byh. ned....... ------f -•.....-•---.....-- f ApplicationApproved By-------------------- • -----•--•-•---•••----•--......-••--••-----.................•---_----- Date Application Disapproved for the follow ons---------------------•--•-------•-------.............------------------------------.....................---.._._ --------•----------------------------------------•-------•----.--•--------------•----••------•--------------------------•----------------------------------------------------------=•--••------- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF............... . G ,tJ��.... ...................................... Tpr#if irtt#r of Tumptianrr THIQIVS TA CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� w ,,� ---------- �- has been installed in accordance,wlftljtlze.provisions of T �of The State San' ry C/ode as described'"in the' application for Disposal Works Construction Permit No. .----. .............. dated_.. /.-."-. !'L-"-'7- ....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH '7g y .... z.....OF.......... ...... ...................--------...---................. . .. No................. FEE--.. . ............. dun #r r#uan Jon Permission 's reby granted----• --- ----= <.sr!�i...(&­;-P­0-;�--� to Constr oroRepal ( ) an ndividual S 'w y at No. It• .t�,14, t ` � �' . -- .... ..-•- ---- .................. `� Street , as shown on the application for Disposal Works Construction Permit N1. ................... at9d-- ---------------- ._-- ------ .t Board of ea th DATE...... v 2 7 ........... ` FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS