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HomeMy WebLinkAbout0359 SEAPUIT ROAD - Health 359 Seapuit b sterville 1 I� ,.. t ENNET T nO 'REILLY, Inc. Engineering, Environmental & Surveying Services 1573 Main Street Sanitary 21E/Site Remediation Property Line PO Box 1667 Site Development Hydrogeologic Survey Subdivision A Brewster, MA 02631 Waste Water Treatment Water Quality Monitoring Land Court U 508-896-6630 Water Supply Licensed Site Professional Trial Court Witness 508-896-4687 Fax BO01-3242 December 11, 2001 Centerville, Osterville, Marstons Mills (COMM) Fire Department 1875 Route 28 Centerville, MA 02632 Ann. Lt. Wilcox FC l RE: UST CLOSURE ASSESSMENT: In-Place Abandonment Tows 71? 0 359 Sea uit ResidenceFallon Road ti�o yo�'s, �1 j P FoT .: Osterville, MA Dear Lt. Wilcox, Please be advised that BENNETT & O'REILLY, INC., in conjunction with EnviroSafe, Corportion, has completed the environmental closure assessment and in place abandonment of a 1,500 - 2,000 gallon underground storage tank(UST) at the above referenced property. This work was conducted in accordance with the"UST Closure Assessment Manual"requirements of MA DEP Policy #WSC-402-96, as consistent with the provisions of 527 9.07(J) and 9.07(K). It is reported that the subject vessel was historically used as a cistern to store water within the basement of the dwelling. When the need for this type of storage became obsolete, the vessel was used for the underground storage of#2 fuel oil for on-site heating needs. Inspection of the tank and its location within an exterior wall of the dwelling has indicated that the structural integrity of the building would be jeopardized by its removal without extensive shoring. As such, with the concurrence of your Department,it was determined that this tank would be filled and abandonment in-place,subject to the inspection of underlying soils. On November 8, 2001, EnviroSafe Corporation, cut open and cleaned the subject UST in preparation for abandonment. Upon inspection,the tank appeared in good condition with minimal corrosion and no evidence of leakage. As such,two holes were cut through the bottom at each end of the tank and a soil sample was collected from 0-V below the tank, as witnessed by the COMM Fire Department,in order to investigate potential contaminant impact to soils associated with historic underground fuel storage. Each soil sample was subsequently placed in a sealed 300 milliliter jars with an aluminum septum and the jars were agitated to develop organic vapors. The soil samples were then screened in the field with a photoionization detector (PID), 10.2 ev lamp by "jar. headspace"method for total organic volatile(TOV),as consistent with thL-�MA DEP"Interim Soils Policy..."WSC 94-400. No significant impact was indicated at either location,with low-level TOV . 1 DECEMBER 11,2001 FALLONBOOI-3242 PAGE 2 OF 2 UST CLOSURE&ABANDONMENT concentrations <_4.4ppm. In order to further qualify these results, a PetroFLAG analysis was conducted on the "worst case" sample, as a field measure of total petroleum hydrocarbon (TPH) concentrations. The analysis reported no petroleum impact in this sample, which was later forwarded to Groundwater Analytical of Buzzards Bay, MA for confirmatory diesel range organic (DRO)analysis. This work is consistent with the"UST Closure Assessment Manual"requirements of MA DEP Policy#WSC-402-96. Laboratory analytical results received November 16, 2001 reported the "worst case" soil sample[tank bottom-rear] as below the reportable limit(BRL)of the DRO analysis. This reporting limit (61mg/Kg) is well below the applicable RCS-1 Reportable Concentration (200mg/Kg). Additionally,it is well below the strictest S-1/GW-1 Method 1 -Risk Characterization soil standard (200mg/Kg). Therefore, based upon laboratory analytical reporting no significant impact to underlying soils, it is the opinion of BENNETT & O'REILLY, INC., that in consideration of the structural integrity of the subject dwelling,the in-place abandonment of the subject vessel represents the most desirable and cost effective solution�'without further threat to the environment. As such, the environmental contractor was authorized to fill the vessel with a concrete slurry to protect against settling and complete the abandonment, in accordance with governing regulations. Copies of the COMM Fire Department permit for the in-place abandonment of the vessel and the Hazardous Waste Manifest for the sludge removed in the cleaning of the vessel, as well as the laboratory analytical are enclosed for your reference. If you have any questions, or require any additional information, please contact our office at your earliest convenience. Very truly yours, BE ETT& O'REILLY, INC. John O'Reilly, PE Kara Risk, S II Principal Project Manager encl: Photographic Documentation COMM Abandonment Permit Hazardous Waste Manifest Laboratory Analytical cc: John Fallon- Owner Tom McKeon- Barnstable Health Department David C. Bennett, LSP -BENNETT& O'REILLY, INC. Gro ater GROUNDWATER P.O.Bo 1200Analytical,Inc. P.O.Box 1200 ANALYTICAL 228 Main Street Buzzards Bay,MA 02532 Telephone(508)759-4441 FAX(508)759-4475 November 16, 2001 Ms. Kara Risk Bennett & O'Reilly, Inc. P.O. Box 1667 Brewster, MA 02631 Project: Fallon/13001-3242 Lab I D: 45993 Sampled: 11-08-01 Dear Kara: Enclosed is the Diesel Range Organics Analysis performed for the above referenced project. This project was processed for Priority One Week turnaround. This letter authorizes the release of the analytical results, and should be considered a part of this report. This report contains a project narrative indicating project changes and non-conformances, a brief description of the Quality Assurance/Quality Control procedures employed by our laboratory, and a statement of our state certifications. I attest under the pains and penalties of perjury that, based upon my inquiry of those individuals immediately responsible for obtaining the information, the material contained in this report is, for the best of my knowledge and belief, accurate and complete. Should you have any questions concerning this report, please do not hesitate to contact me. Sincerely, Jonathan R. Sanford President J RS/amb Enclosures GROUNDWATER ANALYTICAL EPA Method 8100 (Modified) Diesel Range Organics by GC/FID Field ID: Tank Bottom-Rear Laboratory ID: 45993-01 Project: Fallon/13001-3242 QC Batch ID: HF-1600-M, Client: Bennett&O Reilly Inc. Sampled: 11-08-01 Container: 250 mL Glass Received: 11-09-01 Preservation: Cool Extracted: 11-12-01 Matrix: Soil Analyzed: 11-13-01 % Moisture: 3 Dilution Factor: 1 Analyte; Concentration Units Reporting:Limit Diesel Range Organics BRL mg/Kg 61 QCSurrogate.Compound. -<; Recovery QC Limits ortho-Terphenyl 93 % 60-140 % Method Reference: Test Methods for Evaluating Solid Waste, US EPA,SW-846,Third Edition, Update III(1996). Analytical protocol modified to quantify total petroleum hydrocarbons. Results are quantified on the basis of 5a—androstane. Results are reported on a dry weight basis. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution and sample size. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Project Narrative Project: Fallon/13001-3242 Lab ID: 45993 Client: Bennett &O'Reilly Inc. Received: 11-09-01 A. Physical Condition of Sample(s) This project was received by the laboratory in satisfactory condition. The sample(s) were received undamaged in appropriate containers with the correct preservation. B. Project Documentation This project was accompanied by satisfactory Chain of Custody documentation. The sample container label(s) agreed with'the Chain of Custody. C: Analysis of Sample(s) No analytical anomalies or non-conformances were noted by the laboratory during the processing of these sample(s). All data contained within this report are released without qualification. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 /� �Ip/ e�,q 228 Main Street,P.O.Box 1200 1{'9�®LdI Y®GlY/°7��� Buzzards Bay,MA 02532 CHAIN-OF-CUSTODY RECORD ANALYTICAL ,��\?� Telephone(508)759-4441 AND WORK ORDER N2 053892 FAX(508)759-4475 Pr jectName: Frm:\�'V/!I}1�Ip r ' TURNAROUND ANALYSIS REQUEST ` Volatiles Bemivolatiles Pes erD CBs metals Petroleum Hydrocarbon Haa. ❑ STANDARD(10 Business Days) m acla I al. d P al.PH waste GeneralChemlatry other Project Number: Addres 6 PRIORITY(5 Business Days) - L e / at RM I 3z (RAN- (Rush o C e L�� t�V ;�rG' � ❑ RUSH Sampler Name: City/State/Zip- Please requires Rush Authorization Number) D ❑ ❑ ❑ > p ❑ r Please FAX YES 0( / Np g 6 r FAX Number: N 9 ❑ 7 Project Manager: elephone: BILLING a g' G o c ❑ ❑ ❑ ❑ ❑ a Purchase Order No.: GWA Reference No.: e ❑ j INSTRUCTIONS:Use separate line for each container(except replicates). �J�v�-��tZ m o � a ❑ o o ° 0 6 Sampling. Matrix Type $ m -Container(s) -Preservation Her c ❑ o ❑ ❑ ❑ 0 ❑. o ❑ o 06 s 0 SAMPLE _ - ' LABORATORY W < 'a g 8 2' o f IDENTIFICATION ."- '� " o it - NUMBER �" e'1 1J a _ m T m - ❑ i< 0 ❑ TO , o: o W > a S o > j os. m (Lab Use Only) m a m a e Q �` 5 > r pS@ 0 = ❑ _ €_ o E E E a E a E a E Tv, f n $ $ o e o - N - t m `g ,•' S 3 ", gO c .B `E < ° O ' ❑ cg i 1 ^i o 0 ❑ ❑ 0 0 0 0 ❑ ❑ 0 ❑ a 0 ❑ 0 ❑ ❑ ❑ ❑ ❑ ❑ a ❑ ❑ 0 ❑ 0 ❑ 0 ❑ bl �Z> Hill I hfifl41­­ j___L_i__L.f REMARKS/SPECIAL INSTRUCTIONS DATA QUALITY OBJECTIVES CHAIN-OF-CUSTODY REC ORD Regulatory Program Project Specific QC NOTE:All samples submitted subject to Standard Terms and Conditions on reverse liweP 7i� - ❑Safe Drinking Water Act Many regulatory programs and EPA methods require project Reli auished b Sampler. Date Tame R ceiJed by: Receipt Tempemlu�e: ❑MA DEP Form specific CC.Project specific OC includes Sample Duplicates, /)g A i - �NPDES/Clean Water Act Matrix Spikes,and/or Matrix Spike Duplicates.Laboratory OC is _ Specify State: not project specific unless prearranged.Project specific OC �RCRA/Haz.Waste Char. samples are charged on a per sample basis.For water samples, Relmquished y: ate Time Re ��6o—rto7 Shi m Airbill -_I _ each MS,MSD and Sample Duplicate requires an additional nIJ.q.MA MCP(310 CMR 40) P P� Q Numbef��`♦=llleportable Concentrations sample aliquot.❑RCGW-1 6IRCS-1 project Specific OC Required Selection of OC Sample Relinquish y: Dale Tlms ReceivedCustody Seah p RC GW-2 RCS-2 y �/� j� Cooler Serial ❑Sample Duplicate ❑Selected b laboratory ��C CCC� f' t '. ❑MA Dredge Disposal Number: U Matrix Spike ❑Please use sample: ❑NH❑RI O CT❑ME Method of S'hiom WA Coc.rier n Express Mail O Federal Express Specify Category: 0Matrix Spike Duplicate -- - , 0UPS 'l Hand 0 f GROUNDWATER ANALYTICAL Quality Assurance/Quality Control A., Program Overview',: Groundwater Analytical conducts an active Quality Assurance program to ensure .the production of high quality, valid data. This program closely follows the guidance provided by Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans, US EPA QAMS-005/80 (1980), and Test Methods for Evaluating Solid Waste, US EPA,'SW-846, Update 111 (1996). Quality Control protocols include written Standard Operating Procedures (SOPS) developed for each analytical method. SOPS are derived from US EPA methodologies and other established references. Standards are prepared from commercially obtained reference materials of certified purity, and documented for traceability. Quality Assessment protocols for most organic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. All samples, standards, blanks, laboratory control samples, matrix spikes and sample duplicates are spiked with internal standards and surrogate compounds. All instrument sequences begin with an initial calibration verification standard and a blank; and excepting GUMS sequences, all sequences close with a continuing calibration standard. GUMS systems are tuned to appropriate ion abundance criteria daily, or for each 12 hour operating period, whichever is more frequent.. Quality Assessment protocols for most inorganic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. Standard curves are derived from one reagent blank and four,concentration levels. Curve validity is verified by standard recoveries within plus or,minus ten percent of the curve. B. Definitions Batches are used as the basic unit for Quality Assessment. A Batch is defined as twenty or fewer samples of the same matrix which are prepared together for the same analysis, using the same lots of reagents and the same techniques or manipulations, all within the same continuum of time, up to but not exceeding 24 hours. Laboratory Control Samples are used to assess the accuracy of the analyticalmethod. A Laboratory Control Sample consists of reagent water or sodium sulfate spiked with a group of target analytes representative of the method analytes. Accuracy is defined as the degree of agreement of the measured value with the true or expected value. Percent Recoveries for the Laboratory Control Samples are calculated to assess accuracy. Method Blanks are used to assess the level of contamination present in the analytical system: Method Blanks consist of reagent water or an aliquot of sodium sulfate. Method Blanks are taken through all the appropriate steps of an analytical method. Sample data reported is not corrected for blank contamination. Surrogate Compounds are used to assess the effectiveness of an'analytical method in dealing with each sample matrix. Surrogate Compounds are organic compounds which are similar to the target analytes of interest in chemical behavior, but which are not normally found in environmental samples. Percent Recoveries are calculated for each Surrogate Compound. -,r Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Sample Category: EPA Method 8100 (Modified) QC Batch ID: H F-1600-M Matrix: Soil Units: mg/Kg Analyte Spiked Measured Recovery QC Limits Fuel Oil No.2 130 100 75 % 60- 140 % QC'Surrogate Compound Recovery , QC,Limits ortho-Terphenyl 86 % 60- 140 % Method Reference: Test Methods for Evaluating Solid Waste, US EPA,SW-846,Third Edition, Update III(1996). Analytical protocol modified to quantify total petroleum hydrocarbons. Results are quantified on the basis of 5a—androstane. Results are reported on a dry weight basis. Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. y � Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Method Blank Category: EPA Method 8100 (Modified) QC Batch ID: H F-1600-M Matrix: Soil Analyte Concentration' Units Reporting Limit Total Petroleum Hydrocarbons BRL mg/Kg 60 QC Surrogate Compound Recery QC.Limits.- �ortho-Terphenyl 89 % 60- 140 % Method Reference: Test Methods for Evaluating Solid Waste, US EPA,SW-846,Third Edition, Update III(1996). Analytical protocol modified to quantify total petroleum hydrocarbons. Results are quantified on the basis of 5a—androstane. Results are reported on a dry weight basis. Report Notations: BRL Indicates concentration, if any, is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution and sample size. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Certifications and Approvals CONNECTICUT, Department of Health Services, PH-0586' Potable Water,Wastewater/Trade Waste,Sewage/Effluent,and Soil pH,Conductivity,Acidity,Alkalinity,Hardness,Chloride,Fluoride,Ammonia,Kjeldahl Nitrogen,Nitrate,Nitrite,Orthophosphate,Total Dissolved Solids,Cyanide,Aluminum,Antimony,Arsenic,Barium,Beryllium,Cadmium,Total Chromium,Hexavalent Chromium,Cobalt,Copper,Iron,Lead, Magnesium,Manganese,Mercury,Molybdenum,Nickel,Potassium,Selenium,Silver,Sodium,Thallium,Tin,Titanium,Vanadium,Zinc,Purgeable Halocarbons,Purgeable Aromatics,Pesticides,PCBs,PCBs in Oil,Ethylene Dibromide,Phenols,Oil and Grease. C. MAINE, Department of.Human Services, MA103 Drinking Water Reciprocal certification in accordance with Massachusetts certification for drinking water analytes. Waste Water Reciprocal certification in accordance with Massachusetts certification for waste water analytes. D. :-MASSACHUSETTS, Department of Environmental Protection,'M-MA-103 Potable Water Antimony,Arsenic,Barium,Beryllium,Cadmium,Chromium,Copper,Lead,Mercury,Nickel,Selenium,Thallium,Nitrate-N,Nitrite-N,Fluoride, Sodium,Sulfate,Cyanide,Turbidity,Residual Free Chlorine,Calcium,Total Alkalinity,Total Dissolved Solids,pH,Trihalomethanes,Volatile Organic Compounds,1,2-Dibromoethane,1,2-Dibromo-3-chloropropane,Total Coliform,Fecal Coliform,Heterotrophic Plate Count,E-Coli Non-Potable Water Aluminum,Antimony,Arsenic,Beryllium,Cadmium,Chromium,Cobalt,Copper,Iron,Lead,Manganese,Mercury,Molybdenum,Nickel,Selenium, Silver,Strontium,Thallium,Titanium,Vanadium,Zinc,pH,Specific Conductance,Total Dissolved Solids,Total Hardness,Calcium,Magnesium, Sodium,Potassium,Total Alkalinity,Chloride,Fluoride,Sulfate,Ammonia-N,Nitrate-N,Kjeldahl-N,Orthophosphate,Total Phosphorus,Chemical Oxygen Demand,Biochemical Oxygen Demand,Total Cyanide,Non-Filterable Residue,Total Residual Chlorine,Oil and Grease,Total Phenolics, Volatile Halocarbons,Volatile Aromatics,Chlordane,Aldrin,Dieldrin,DDD,DDE,DDT,Heptachlor,Heptachlor Epoxide,Polychlorinated Biphenyls(water),Polychlorinated Biphenyls(oil). E. MICHIGAN, Department of Environmental Quality. "- Drinking Water Trihalomethanes,Regulated and Unregulated Volatile Organic Compounds by EPA Method 524.2;1,2-Dibromoethane,1,2-Dibromo-3- chloropropane by EPA Method 504.1 F. NEW HAMPSHIRE, Department of Environmental-Services, 202798 Drinking Water Metals by Graphite Furnace,Metals by ICP,Mercury,Nitrite-N,Orthophosphate,Residual Free Chlorine,Turbidity,Total Filterable Residue,Calcium Hardness,pH,Alkalinity,Sodium,Sulfate,Total Cyanide,Insecticides,Herbicides,Base/Neutrals,Trihalomethanes,Volatile Organics,Vinyl Chloride,DBCP,EDB,Nitrate-N. Wastewater Metals by Graphite Furnace,Metals by ICP,Mercury,pH,Specific Conductivity,TDS,Total Hardness,Calcium,Magnesium,Sodium,Potassium, Total Alkalinity,Chloride,Fluoride,Sulfate,Ammonia-N,Nitrate-N,Orthophosphate,TKN,Total Phosphorus,COD,BOD,Non-Filterable Residue, Oil&Grease,Total Phenolics,Total Residual Chlorine,PCBs in Water,PCBs in Oil,Pesticides,Volatile Organics,Total Cyanide. RHODFISLAND; Departmenf of Health, 54 a Surface Water,Air,Wastewater, Potable Water,Sewage Chemistry: Organic and Inorganic 1 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 7/29/2021 ShowAsbuilt(1653x2338) X � S TOWN OF SARNSTABLE LOCATION. •35-9 Seng"? r- SEWAGE:#: VILLAGE (SS'. r ASSESSOR'S MAP&LOT McrS Pof INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1�.'5bc� LEACHING FACILITY:(type)' - C v<(�("sizej NO.OFBEDROOMS BUII DER 01t OWN�Ri � _ PERMITDATE: —l_-dI COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leach ing:Facility Feet Private Water Supply,Well and Leaching Facility (If any wells-exist- on site or within.200 feet of leaching facility) Fdet Edge of Wetland and,Leaching Facility(If any wetlands exist within 300 feet of leaching f5cili Feei,. Furnished by 'o t C D0 _ rt https://itsgldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=095009&sq=2 1/1 7/29/2021 ShowAsbuilt(1700X2800) LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLE R1. ,NAME A ADDRESS - oil OWNER DATE ►ERMIT ISSUED y S'- . DATE COMPLIANCE ISSUED . https:HitsgIdb.town.barnstable.ma.us:8431/Home/ShowAsbuiIt?mp=095009&sq=1 1/1 r LOT 13 408t' 30.33, o W rd 4Z'33'44" ' 5.8 368.88, i / IST, v COT 9 L I I SHEDin V - - -a c 1 II Z "'f i l l i 1 1 Quo J3 . ' I37' 11 1 IZ, jj1 100% y�PP to y O lRsSERVE O L rsrORDG VEGETATHD H�E�L4ND i I r ,98 BY N ESR I NNINOUS 2 m I ro I in 11 ?� ' ah��.``O DRIVE u 3 IN37'43'03" W r. 8753 /! D-Bex L/_ P X�P CONC 4.3 I ' r SEPTIC 120• / /r ! ,° TANK .S` A•`` 10, GARAGE /�• n / I i ���LLLMInI. � 5�;��•. � 1 40 I ' / o I / I 1 � ZONE:. In 1 'STY fn I ORELLIND 1 2 STY RF-1 I I DWELLING ENGINEER TO VERIFY 4T TIME or- 01I Area (min. 43,560 SF I I I qF}� \ 359 SEAFu IT a0 HE 9oLAT10N THE SLIITAI3%LT4 OF FfOntOgge (min) 20' � I 1 r .'I I I9a'Qp/,?>. 08TE0.V1LLE,MA / Zdth tmin) 125' — I I 1 /T.9\ Setbacks: 11 i i r 'oaF Front 30' II I j M �o4o4oc Assessoas REF. Side 15' 1 I 1 °�t� / MAP 9 5,PARCG L. 9 Rear 15' I 1 1 1 41.2' ` —— . I 1 t N 37.43'03" W 325.78' LOT 48 PLAN VIEW Scale: I"=60' SITE PLAN PROPOSED SEPTIC SYSTEM OF UPGRADE AT SM R 359 SEAPUIT ROAD 00.29M � OSTERVILLE , MA CML FOR JOHN & ANTOINETTE FALLON SCALE: I"=60' DATE:J U N E 30,1998 Qp SULLIVAN ENGINEERINGINC. OSTERVILLE, MA G SHEET Iof2 t • NOTES DESIGN DATA 1.Water Supply ForThis Lot is Municipal Water. Single Family-3 Bedroom With no Garbage Grinder 2 Location of Utilities Shown on This Pion Are Approx. Daily Flow=110 x 3= 330 GPD At Least 72 Hours Prior to Any Excavation ForThis Septic Tank:330 GPD x 200%=660 GPD Project The ContractorSholl Make The Required Use 1500 Gallon Septic Tank Notification to Dig Safe(1-800-322-4844) LEACHING AREA 33 The Contractor is Required to Secure Appropriate Permits From Town Agencies For Construction 330 GPD/0.74=446 SF Required Defined by This Plan. Sidewall = 2(12'4-25)2=148 S.F, Bottom Area= 12'x25' = 300 S.F 4 Install Risers as Requiredto•.Within 12!'of 448 S.F.Total Provided Finished Grade. LEACHING CHAMBER DESIGN 5.All Structures Buried Four Feet or More or Subject' All Pipes to be Schedule 40.Use to Vehicular Traffic tobe H-20 Loading. 2—500 Gal.Leaching Chambers in a 6 Septic System to be Installedin Accordance With if x 25' Washed Stone Field as 310 CMR 15.00 Latest Revision And The Townof Shown. Barnstable Board of Health Regulations. - T All Piping to be Sch.40 PVC FG.34.0 F.G.32.5 Qz 31.0 30.0 30.8 30.6 Top EI.31.0 30.4 Bot.E 1.28.0 30.2 Bedding as 23� Per Title 5 10" 10.5, 10 10' 12 Ground Waterf&E 1.Less Than 5.0 From T.O.B.Ground Water Map DEVELOPE D PROM L E OF PROPOSE D S EPTIC SYSTEM Not to Scale ' Finish Grade OF Filter _ � ro Fabric ~� Compacted Fill SULg 33 CIVIL Pea Stone • Leaching 3/4°-1 1/2'�Double aLL "2e_1 Chamber Washed I �s 4!—Id I 12,-0�� CROSS SECTION OF CHAMBER NOT TO SCALE FALLON 359 SEAPUIT RD. OSTERVI LLE,MA SHEET 2 of 2 TOWN OF BARNSTABLE LOCATION 3 S 9 &M RV/ r- Ali SEWAGE# 9 YO 0 ti✓ILLAGE ASSESSOR'S MAP&LOT M45- F'o INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY \ ti 75pe, s r 1, 000 la1 r•►D ��.,w LEACHING.FACILrfY: (type) bo size) fg.` le 6 V NO.OF BEDROOMS �O BUILDER OWNEBL �-- PERMITDATE:� 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 C� (� ✓fie rJ r At o 7 �r yri No. r _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2ppli(ation for Mi,4poga1 *p5tem Cottgtruction Permit Application for a Permit to Construct( )Repair(K)Upgrade()()Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 Sq S EA<i,s l\ Owner's Name,Address and Tel.No. C)r.M%mot LLB:- Assessor'sMap/Parcel M9s 4?C) Installer's Name,Address,and Tel.No. D ner's Name Address and Tel.No. !�_ l_L\V Ala S L Type of Building: U FOO.r.a, Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �,6w gallons per day. )culated daily flow �J�J� gallons. Plan Date ObO — W, 1990 Number of sheets Revision Date "C. hA Title S t z'E LAvQ. 2 P"OS-eQ OM C-S-ST;vt l L)K-X QND Size of Septic Tank 1 Type of S.A.S. 5c0GKA .L©r_A Leacou yoC CLAOMi3q Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Board of a�----� Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued r . ry No Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. ,v/ f k PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS Yes - 01ppYication for jDitpozal *pgtem Construction Permit Application for a Permit to Construct( Repair(X)Upgrade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 59 ErN,<0 l fl Owner's Name,Address and Tel.No. ... �TL Lam/t t_[.,t=. �e•l-1 ti..t �-f-.��.o i�.a Assessor's Map/Parcel 'Mc)s ?G- 59 5 E;4�lT '2 Installer's Name,Address,and Tel.No. D ner's Name,Address and Tel.No. _f I rl��L.r�? Type of Building: U PL�a,� �7 Dwelling No.of Bedrooms 2^ Lot'S"ize RD137U sq.ft. Garbage Grinder( �O Other c Type of Building No. of Persons Showers( ) Cafeteria( ) / Other Fixtures Design Flow�J gallons per day. culated daily flow �JrJ� gallons. Plan Date U Q E W, ^ �umber of�she s /17, Revision Date l Ace ,4 l=, Title c.AVQ d" � ' C /ST£vtA U?ae NO Size of Septic Tank 1`jam Type of S.A.S. ��ti1 �.Et� yVG CIB Description of Soil LA,5S Nature'of Repairs or Alterations(Answer when applicable) >'n 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- cateof Compliance has been issued 4is Board of th. Signed 0.4 `\ Date k `ti Application Approved by Date ~Y . t"'N' Application Disapproved for the following reasons �s 10, Perinit No. Date Issued ^ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired( ) Upgraded( J() Abandoned( )by at 0559 t T-FjF— (1 L. , has been constructed in accordance with the provisions of Title 5 and for Dis osal System Construction Permit No. AV dated 0 R'-. Installer *s�Ar A" / Designer The issuance of this permit shall not be con trued as a guarantee that the system will;,(unctioon as designed. Date 1 u :7 — 4�_ Inspector � v No. ---------=----Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS li,qpoga[ *pgtem Construction Vermit Permission is hereby granted to Cstrtct( )Repai,r., )Upgrade(&)Abandon( ) System located at 3� C—,al PO cT K6A LL(:j ' and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5l and the following local provisions or special conditions. Provided:Construe on mu t be pleted within three years of the date ot .Date: Approved bymv TU W N UV BAKN S rAti LE LOCATION 3 S SOg ge i a" 108 SEWAGE # 9 & Yd U 'VILLAGE ASSESSOR'S MAP & LOT M4Y INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY \ . TOO S r 1, CeO C":I,e_.,� � LEACHING FACILITY: (type) 'SbC ckv-v _5Xsize) ! r Y 6 V NO.OF BEDROOMS �O BUILDER OWNER►. �` l`� PERMIT DATE: aI _ COMPLIANCE DATE: — .7 A 8 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 facilit Feet Furnished by ' v l 00 o 16 �c _1J \ �L3 `6� _ T � o t . o 11/17/2001 04:00 FAX 508 888 9093 ENVIRO SAFE [a 02 PRESS HARD-YOU ARE WRITING THROUGH EIGHT COPIES. SEE REVERSE SIDE FOR DIRECTIONS COMMONWEALTH OF MASSACHUSE:TTS DEPARTMENT OF ENVIRONMENTAL PROTECTION DIVISION OF HAZARDOUS MATERIALS One Winter Street Boston, Massachusetts 02108 Please print or type.(Form designed for use on elite(1 2-pitch)typewriter.l UNIFORM HAZARDOUS IPGe�+er t U S EPA ID No. Manifest 2.Pape 1 Information In the shaded areas WASTE MANIFEST pLLL °oco1 1 nt."' of 1 is not required by Federal law. 3.Generator's Name and Maili%Addtess A:State MailHdat DoeYmtint Ntartber 359 Seapuit Road #'tA: :;.'M; 508-4 Osterville,MA 02655 ;e.s;� t.• 28-0573 r ,.:„�� is•.;.i;''-ri , 4.TGenerator's Phone f lTV 1'7'6'= rafe C��itlYNomo A D 9 N m r Me T fD = N 7.1 ransporte, 2 Company Name B. US EPA ID Number 'D.Trdr+apdreei"e phone — r . rests:• - �; l�Iefl:ieli Ft, Yi4�1r►��1�s� Pi e s (NE) Inc.10_ US EPA ID Number 63 Howard Street F:TcanaporWiPhpna'I' '==•),i'.: i, " °DLowell , MA 01852 i A D 0 4 7 7 5 7 3 "s` i0 ` ' ii:e ` N —- Li:Faattty — . -. 12.Con hers 13. 14. E d 11.US DOT Description!including Proper Shipping Ndmt'.!fa]ard Class,and/D Number/ Total Unit Wi+BooNa p No. Type Quantity WtlVol ca tote Regulated Waste Oily Material c D M P �.- m f m G b. o N ; .T O A: d. I .ram Z J.Additi0 alDescriptioms for MetervkListedADove/ineludephy-'rd State aridlimerr%troJaij' ;; I ';.r: K•Nandr+r9CeeasfeeWeateteLLoedAbovs'` w ' T. t— b. tl. d. E35r 6 ripr��Frw�nal/uc`IorytpRpi►ddtupnal,InfP , 388 5478 19.GENERA Oft•S CERTIFICATION:I hereby dealers that the aonrent,s of this Coneionment are tufty and accurately dowibad aaove ay ` proper of ipping name and are eia"Ifled,packed,marked,and labeled,and are to all respeota in proper Condhlan rat transport by highway accardin I to applicable tntcmational and natianel government MgUaians. UIf 1 am a I ugettuffribly generator,I eerufy that I have a program In place to reduce the volume and tonicity of waste generated to The degree I have determined w be ecanamiT:ally practicable and that,Nave selernad The practicable method of Raumank storage Or diapaeai Currently avallaale To me whLGn mintmires the present end rytwe threat w human health and the aennron- mans;OR,if I am a small quantity generater.I have made a tread lath effort to minimise My wa6te generarion and select the best wasw management,method dtat is aaailable to me and that I m aanaffa4 DtKe PrrirftvdlTypOd N9rne SiggafWC AtttlrtmJ Day Year 2 0 m T 17.Transporter 1 Acknowleduumsnt of Raca;pt of Mataflals Dtrte A PnGIrT er►t� M1to»M AsY Peer "� s . p Date R i 8.Tren otter 2 Acknowled ement of Racer of Materials T PrrrrtadlTYped N e Monde Day Year F R � 9.Discrepancy lndics6on.9pace F A C I L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this mentfest except as noted in Item 19. I I Date T Y Printed/TypedName S,gnatlwe MAIM Gay year .11/17/2001 04:00 FAX 508 888 9093 ENVIRO SAFE 1RI03 0 PRESS HARD — YOU ARE WRITING THROUGH FOUR COPIES- SEE REVERSE SIDE FOR DIRECTIONS COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION FOR INNATE WASTE DIVISION OF HAZARDOUS MATERIALS OIL ONLY One Winter Street OR INSTATE V$QQI HW/WO Boston, Massachusetts 02108 Please print or type.(Form designed for use on elite(12-0itch)typewriter.) UNIFORM HAZARDOUS 1.Ganera wUS EPA ID No. Manifest 2.Page 1 Information in the shaded areas WASTE MANIFEST M P 51018 41218101517131 ""r'etrt 0 N° of 1 is not regtAredbyFederel law . 3.Generator's Nanlo and Mailiag Address rallon KeSlaence tj•Sbsw'Msrifr�rpoeiari,or�='N,,,,,�r, 359 Seapuit Road 508 428-0573 Ostery i i 1 e, MA 02655 4.Geewator's Phone ( ;: . 5 Transporter 1 Cony Name 6- US EPA ID Number Env.lro-Safe71orp. MAD985269323 - 7.Transporter 2 Company Name B. US EPA ID Number ?p.c"h. Atli. a-:; "r'.•,•,r;:�:"•._: is j: iti�, 0 9•ILlisign.Tj Facwty Name and Site Address 10. US EPA ID Number I, •a: 1' t t ' cc 441R Canton Street r iiT; �• '�::v.:`'�: u= a Stoughton, Mil 02072 MAD 0 6 2 1 7 91819104 " _ 12.Contalnent 13, 14. O 11.US DOT Description(InchnsogPruper Shipping Name,Hazard Chm,arldIDMrmherl Total Urul< 'Wpjdsf)j•': 0Q0 No- I Type Quarnlry Wt/trol T Ida s t :''• a Petroleum Oil NOS m Non DOT Regulated. 010,1 T T G ,'a` o N al R c. �" 0 r R d. �+ t I Z ',��„ �.i1• Dt (pfio,;:#o.lNaierle(syeted' , a „r�. ��• ' HaiiditgCadesfar'1h!aN9a4ribov. =`�;,•,'�a•`'' ti',� ,d„t& �"�(-'v ",�a _4L�.,ti�,:.:,. „�' ,c�•� � 5;'c:7�i?�w,: ,i'�i';,' " I � - 'i • � •• ''�� (k J ��,:,�M K.� �:%+K a�• r� ':1 �i i�ter;;°- •,'i:• '-�P, v, .:_.,� 7r. .a: :�•.' �,, ...,; y4., .z�.l„ �. �„rr-'Tiyy� Mir-'n`'L,rS �yQ�B_�G?t!,,.d`�.'�f ;i...it'' .,� 'C ,,• y7,tt� '1 QI •'r-.•` 1: .':'••�U•., '•,w`r:,;i'i.%we?t ,�!.'.Rd'Y ..,yi.i. "Y' 'S'dc�i is •In;,i 1 .~1 �7�• •`'�i-j' , y.,: •.ljj:_ �: ,'+,:;_ ,sMT;•..:t'1 .��Y J�'�+' 1: _Ci•: r4•„ St 7ti•�-'r•' � �:� . L ti fTn, i:� t � !-.,7 ,•�?tM , N .� I-AL,.ry.a;�,;:r, m 1 S•S e 1 Non lin Instructions and Addltieno Information r, r 2� M�RGENCY CONTACT # (508) 888 5478 ;a Mate�ial tested as MA97 'l Ia.G�]JERpTOA S CFATIFICATION:I hereby declare drat the contenw of this consignment are fully and accurately described above by vi V prone,' 'DP^9 name and e,a desar,ed.padtea merkea.and labeled and ate m ell roapects In proper contlRlon for transport by highway a according to anplicabletntemational and national poovnmentreptdations. Cl It Ism a Large quantity generator,I eerhly chat I have a program at place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable C a,d that)have solected the p,ael-Cable method of aeslment.e00009.or diagonal cwwriV avaailabls ro me whlbh minwnitae the pra om antl future area=To numan health and ee w+viron- menr,OR,it a am a small quantity generator,l have mada a good faith offort to minimize my waste ge n and select the best waste management method that is available tome and that I b.44) ten efface. t� Dana eAl- C ypedit ` I n` ne' Month Day Year IleI KL� 14 N 1 ,Trans orter 1 Acknowledgement of Receipt of Materiels IfDew v f4rnted/TypedName r Month Day Year n 19.Transporter 2 Acknowied most of Receipt of Materials Data E W+ffred/TypodNeme S+grlatune Mond► By Year R 19,Discrepancy Indication Space F A C L 20.Facility Owner or Operator.Certification of receipt of hazardous materials covered by this manifest except as noted In item 19, I � T ' Date Y irnred/TypodNeme Signature Manth pay Year 1 1 t 11/17/2001 04:00 FAX 508 888 9093` ENVIRO SAFE 04 4 rvlako applicatiuir to lucal l=ile Udr;rrtrncrrl. FII'( (JC17artI1lCllt retains original at)t]11Ci111011 arlll issuC3 L11I111tCLltl? Js Pcrlt,il_ �G��fdci�-Glia�icCn� .�r�WJN�I�G+GCt�l —✓rJocr�lG�'�' � -� '_•,�•..`. • s A P P L 1 CA ! I O 1�l Ca n d PERMIT , Fee_ $25:III~- 5 for storage (aril;removal and transporlation to approved lank disposal yard ill accordance will 111e provisions 01 M.G.I.- Chal)[or 140, Section 3VA, 527 CMA 9.00, application is hereby made by; . fr Tank OwnerNattta(plea,o prim) _ Fa1�gQsi dpn� .` X ' Address 359 S�aP, uit Road Osterville, MA 02655 zo 1 C'r Srars CampanyNanro Enviro—Safe Corporation7Address rladividual_ Bennett & O'Reilly Address PO Box 810 E. Sandwich MA 253 PO Box 1667 Brewster MA !'IfL f7Ytl Si9natirre fir y' for nii) ture(if appl ' n r Q�IFCI Cerltliu�! Other CI Certified ❑ LSP fi. Other _ , GAY i Tank Location 359 .Sed up it goad Osterville, 1+SA, Tank Capacity(Uallun,) — =0 Subslonce Last Stored oil Tank 0k onions (diameter x lenytlr) Hemaiks: Tank j &_s?b€_abandnnAd in P1 Ar-P Firm transporting w ale Elly1 ro—Sa Pe Slate Lic.rr 329 MA t Hazardous waste rnaniiec,ly MAM77 2 8 4 0 L.P.A.a MAD90.5269323 Approved lank clispost!1 yarrJ n/a �Tank yard 11 Type of inert gas Tank yard address City Or Town FD(Drl 01920 permit Date Of Issue Oale of expiration November 13, 2001 Dig safe approval number. 20014204004 '�DlgjSafe Toll�Tel. tber-80022A844 Signature/Title of Officer granting permit After removal(s)send Form FP-29OR signed by Local Fire Dept.to UST Regulatory Compliance Unit,One Ashburton place, Room 1310,Boston,MA 02108-1618, -4;(revisor!9M61 s � � w � �� �, ,, .: .. -,. �,...,�. -; a,�*. � �„- � �,� •�� x ,�.� x �. ,�. , ��; �,� �:, a' y.„�„ �'3 , x .ti v. i� 4 w � .,r', n ^ f ' j{f� - �� `� - ' �� __ �� .I 'd ��9 R�:.� � _. is __ t ��, �W �. - — '�- r � i.. -- � :.. .. _. _ � � � �_ ..II f - �. s �+ . a x$ �. � �'v` .i k �.. ��� .A� S r^�yq�T rtr •r „k � � �'� :y^F� k� r�:. {- J � 4 a w { S.r.� �` �" kr€'a r' '� is �� � �+� � � 'ti � � � �is � m .', �" > r. � � r LOCATION SEWAGE PERMIT N0. VILLAGE M T L L E ;'S NAME i ADDRESS TI - (.�`�c'.Csl t 0f OR � OWM ER DATE PERMIT ISSUED DATE COMPLIANCE .ISSUED `--- � e V No................ ....... F> .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TC/Y1..... OF........... ]�.. ..... ........................... Applira#ion for Disposal Works Tnntrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal KD4 System at: --•---------------------------------------- ---•-------------------. ......---..... .Ltd (,� . �.....t. .. { ����--�-��� Loca ion- �,e�ss or Lot No. n o c Address i l✓ .................................. Installer Address gg Q Type o Buildin Size Lot__l �,� _____.____._Sq. feet U Dwelling To. of Bedrooms--------------------------------------------Expansion Attic ( ) Gartfage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers Cafeteria Other fixtures --- --- ) ( ) ------------- Flow____________________________________________gallons per person per day. Total daily flow.___._.____ _: `.......------------------------------- Design all s. g P P P Y Y gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter................. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---- --------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) , Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...........__.____...... (% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a O Description of Soil..... t'__ x W ---------------------------------------------------- ----------------- ..............................................A -- '.............................' UNatur of Rep.,rs o- X terations ,f nswe �pplicable =, f � .......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TT T;. • p S of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue the board�health. ate Application Approved B Date Application Disapproved for the following reasons-----------------------•---------------------._...-----------------------....................................... ..-------•---------------------•-•----......--•-------•-----------•------•••----••--•••-------------•--•-••----•••••---•-----•••-•---••-•------•------••-••--•-------•--------•----•------ ---------- Date PermitNo......................................................... Issued-...... __^_ .... Date n No. - ....... Fmc............... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OE HEALTH �;.� � 41(c4l Applira#ion for Ui4pniial Workii CnoWitrnrtiun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systat- .- � . .......... ..... -------------••••"•--'••--•--•• •---- �. .. ad c bn-A4d ess or Lot No. ...- ......... _•-- -_.. . ....... ............................. .................................. _ --- --•-••-- O n �f f/� t ddress dType o Buildi Size Lot_�_Taerr. ____________Sq. feet UInstaller Address Dwelling ,No. of Bedrooms........................................ Expansion Attic ( ) e Grinder ( ) a p 1 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q+ Other fixtures --------------=-------------•--- . W Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. 9 ; Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth_............. W Disposal Trench No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. _ x Seepage Pit No.,,j---------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) . Dosing tank ( - -) Percolation Test Results Performed bY........................................................................... Date........................................ Pit,No. l------------------minutes per inch ..Depth of Test Pit.................... Depth to ground water........................ (z, Test Pit Nro. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.-________-____----__-. Phi -- -- O Description of Soil.._... ___-_, x � U Natur of Re Airs 4 lteration ns pplicable.._; ' , .x ~ . ------------------- .' Agreement: The undersigned agrees'to install the aforedescribed Individual Sewage Disposal System in accordance with T�'1=�'• the provisions of ,l'1 TITLE' 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been s ed b the board f ealth. -' Signe .� . 77 ._ °�- ate Application Approved B '- ----- - _ .............."-•••--•-- -6............................. PP PP Y--------- ,-=--- - Date Application Disapproved for the following reasons___________________________________________________________________________________-•--'-... ......'- ._.._ -•-------------------------------------------•--•-----------------------------------••- Date PermitNo......................................................... Issued....................................................... Date R.. Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT V. ......OF.........�1!�..!�,�?, ..... .. ..��.................. (9rdifiratr of Tomplianrr TH S-TO ERT�Th4t e Individual Sewage Disposal System constructed ( ) or Repaired by- .._....:-f .. I.............................. - .... ............................................. Installer at..... . ..... .... ....... ---------------------------------------------- has been installed in accordance with'the provision of Q ` of The State Sanitary Code a descr•becL in the application for Disposal Works Construction Permit N __." v�1______________ da.ted_.-..__ '_. _'_........................ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM .-WILL FUNCTION SATISFACTORY. DATE....................................................-•........................... Inspector_....................--=------ .................................................... THE COMMONWEALTH OF MASSACHUSETTS '� BOARD HFAL-VH .�i'� a . :? !t ` .............OF..:... .. ...G ! % is%! --% No...... 5 FEE... ................ M1411 ion rrmit Permission is hereby grant d '`� �� - j� to Const ct ) or aI• �" an Indi id Sewage Dis, S y stem ......................................... Street w.do-_cCd±......_. as shown on the application for Disposal Works Construction Per it No.___ ___..mot_._ Dated.._._. f � '� � /- Board of Health DATE.---. ` .''._xf- .:_._.._.. /f� FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS