HomeMy WebLinkAbout0226 WASHINGTON AVENUE - Health 226 Washington Avenue, Osterville
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r. Town of Barnstable P to 1 ,100
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N ti� Department of Regulatory.Services
+ BARNSTABM
" Public Health Division Date °�
y MASS.
1639, 200 Main Street,Hyannis MA 02601
Prf0 MAC
Date Scheduled �'� Time Fee Pd.. CMG
Soil Suitability Assessment for Sewage Dis sczl
Performed By Witnessed By. /
LOCATION & GENERAL.INFORMATION
n Location Address zuo ��� Sf OS�C+f%I(t Owner's Nan1e '3,Vvic Cp ej
Y / 1&01 N. Ocagn alud•
Address
Golf S ihre...% � PL
Assessor's.Map/Parcel: 064, 1 34 j Po.l q/ Engineer'sNaine 5kp.lhw A W 1ST ,R.8'
NEW CONSTRUCTION ✓ REPAIR Telephone# /
v Land Use �,es kc6"hr.4 Slopes(%) Surface Stones n C4 G
Distances from: Open Water Body ft Possible Wet Area 11 Drinking Water Well ft
Drainage Way ft Property Line 14 Other ft
SKETCH: (Street name,dimensions of lot,exact locations of test holes&,perc tests,locate wetlands in proximity to holes)
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..
WASHIN0,T0N AVf N
40.00 FEEt',VVIDE 1956 TOWN LAYOUT
L
Parent material(geologic) C0/4 er 21 00pnic')k Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Pace
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing A�in obs,hole: ill. Depth to soil mottles:
Depth to weeping front side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
PERCOLATION TESL' Date !o 23PSTimc
Observation P
". 1 ".
Dcpth of Perc �8 y 5Z i Time at 6"
Start Pre-soak Tine cr . l/ 17 //. CFO Time(9"-6")
End Pre-soak ll:32 !/>'S0 v4ab6i dd 'oak ,
Rate Min./Inch > 2 W1M tack
Site Suitability Assessment: Site Passed_(� Site Failed: Additional Testing Needed(Y/N)
Original' Public Health Divisiioil { ` ' ""Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100, of wetland,you must first notify the .
Barnstable Conservation Division at least one (1)week prior to beginning.
Q:HEALTH/WP/PERCFORM
DEEP OBSERVATION HOLE LOG Hole#,
Depth from Soil Horizon Soil Texture Soil Color Soil Other.
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,
Consistency.%Gravel)
d-6 ii Scrd L•c a>rh I m Y s
it
Z lO San .oa r� 6
M ed,tuw+ S0,4
►o lerz
ti hyleeQturl SanCQ t0 `t+1Q !o
� I Zlo C
DEEP OBSERVATION HOLE LOG Hole# 2
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Milli sell) Mottling (Structure,Stones,Boulders.
ons' to is °o Gravel
G - S Sa+c( La aw% 10 Yte (0/Z r
Sae'oQ La a,► '% to Y{Z y
�2+'-72.`` C� 1'11cc1tuv►1 $�"� 16 `(��O (O
C2. YYleclw�+ Sand I A `� (o
DEEP OBSERVATION HOLE LOG Hole#
Depth.from Soil.Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA). . (Munsell) Mottling (Structure,Stones,Boulders,
Cons'istencv.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon. Soil Texture Soil Color Soil Other.
Surface(in.) (USDA) (Munsell) Mottling (Structure,-Stones,Boulders.
i istency °Ao Qrnvell
Flood Insurance Rate Man:
Above 500 year flood boundary No_. Yes ✓
Within 500 year boundary No I/ Yes
Within 100 year flood boundary. No /� Yes
Depth of Naturally Occitri inPervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the.
area proposed for the soil absorption system? �s
If riot, what is the depth of naturally occurring pervious material?
I
Certification
I certify that on y (date)I have passed the soil evaluator examination approved by the
Department of Envi nmentaI Protection and that the above analysis.was performed by me consistent with
the required training, expertise and.experience described in 310 CIv1:R 15,017.. .
Date
Signature
(o L S
Q:1•I EALTl-1/W P/.PERCFO.RM
— .
` psi �3�c �,�_ ��-• i � � •
BORTOLOTTI CONSTRUCTION,INC. �
'� 10w°Feq `� 199
765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 �a�TyoPTjgeCF t~'
508-771-9399 508-428-8926 FAX: 508-428-9399 A
SUBSURFACE SEWAGE DISPOSAL SYSTEM IN
SPECTION FORM - �' Z
PART A ~�.
CERTIFICATION
Property Address:
Date of Inspection: Inspector shame: —
Owner's Name d Address:
iA
CERTIFICATION STATEMENT*
I certify that I have personally inspected the sewage disposal system at this address and.that the informs- °"
tion reported below is true,accurate and complete as of the time of inspection. The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site.sewage .yx,
,nfy i
disposal items. The System:
Passes
Conditionally Passes
4.
'Needs Further Evalgation Byth o fAproving Authority i
Fails / _
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving authority within thir-
ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 .. :
gpd or-greater,theinspector and the system owner shall submit the report to the appropriate regional
office of the Department of Environmental Protection. The original should be sent to the system owner1
and copies sent to the buyer, if applicable and the approving authority. ty d
INSPECTION SLIMMARY�
A)SYST M PASSES: ;.
I have not found any information..which irdic^tes that:he system violates az-cy of the a;lare
criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated
below.
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or repaired. The system,upon comple-
tion of the replacement or repair,passes inspection:
Indicate yes,nor,or not determined(Y,Ni OR ND). Describe basis of determination in all instances. If
"not determined",explain why not.
The septic tank is metal,cracked, structurally-unsound, shows substantial infiltration or
exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep-
tic tank is replaced with a conforming septic tank as approved by The Board of Health. -4
Sewage backkup or breakout or high static water level observed in the distribution box is due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The
system will pass inspection if(with approval of The Board of Health):
. r.
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\X
ell SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
,► CERTIFICATION(continued)
Broken pipe(s)replaced
Obstruction is removed-
Distribution Box is levelled or replaced
The System required pumping more than four times a year due to broken or obstructed.pipe(s).
Thtsystem will pass inspection if(with approval of The Board of Health):
Broken pipe(s)are replaced
Obstruction Wremoved'
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 ifs r{
the system is failing to protect the public health,safety and the environment.:
1),SYSTEM`.WILL PASS UNLESS BOARD.OF HEALTH DETERMINES THAT THE
,SYSTEM'-IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE
PUBLIC HEALTH AND 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.
2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM-IS FUNCTION-
ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE;
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 Feet to a surfacei
water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is with a Zone I of a public
water supply well.
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100 Feet but 50
Feet or more from a private water supply well,unless a well water analysis for coliform
11 'ori from
h well is free from uti
con 'unds indicates that the po
bacteria and volatile organic po •
the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm.
D)SYSTEM FAILS:
the violates one or more of the following failure criteria as defined '
I have determined that system < ;
in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health„ .
should be contacted to determine what will be necessary to correct the failure. `
Backup of sewageinto facilityor syst
em component due to an overloaded or clogged
d SAS
or cesspool.
Discharge or ponding of efluent 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 clog-
ged SAS or cesspool:
Liquid depth'in cesspool is less than 6"below invert or available volume is less than 1/2 t
day flow. .S
Relui
tru
red Pum in mora than 4 times in the last ear NOT due to clogged or obscted
,�s..
pipe(s). Number of times pumped
-2-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a 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-I 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. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant
threat to public health and safety and the environment because one or more of the following
conditions exist: k .
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 Area
(IWPA)or a mapped Zone II of a public water supply well.
The owner or operator of any such system shall bring the system and facility into full compliance wtth the'`
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check If the following have been done: '
_Pumping information was requested of the owner,occupant,and Board of Health.
.---None of the system components have been pumped for atleast two weeks and the system has : ' f
+ pY +
been receiving normal flow rates during that period. Large volumes of water have not been ;r ^
introduced into the system recently or as part of this inspection.
r�p �
__k,'As-built plans have been obtained and examined. Note if they are not available with N/A.
r/The facilityor dwelling was insp
ected for signs of sewage back-up.
✓The system does not receive non-sanitary or industrial waste flow. y
✓ The site,was inspected for signs of breakout.
v All system components,excluding the Soil Absorption System,have been located on site.
_!C The septic tank manholes were uncovered opened,
and the interior of the septic tank was,,,,-,depth of
for condition of bales,or.tees,material.of construction,dimensions,depth of liquid, a
v The th of sludge,depth of scum
size and location of the Soil Absorption System on the sitc rhas`been determined based on
t,
existing information or approximated by non-intrusive methods.~'
3-
SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
f The facility owner(and occupants,if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
1.- PART C
f ' SYSTEM INFORMATION
FLOW CONDITIONS
RVISIURNTI&L.
Design Flow: " allons Number of Bedrooms: Number of Current Residents:
Garbage Grinder:4 w Laundry Connected'1'o System(�� Seasonal Use:
WaterMeter Readings,if ailable: G
Last Date of Occupancy: AA t
COMMLRCLALIINDUSTR_IAI.A,')
y Type of Establishment: f a
Design Flow °' gallons/day 'Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:,a
4
System Pumped as part of inspection:_ If yes,voWne pumped: gallons,
Reason for,pumping:
TYPE OF'SYSTEM:
-Septic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach previous inspection records,if any)
Other(explain):
AP 'RO TK AGE of all components,date installed(if known)and source of information:
V . :
S&age 6dorf detected when arriving at the site:
-4
rs
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C �I
GENERAL INFORMATION (continued)
sr
SEPTIC TANK; !�
Depth'below grade: /p,11 Material of Construction: ✓concrete metal FRP Other ,
(explain) -
DiMisions:?,S;t to `X S r Sludge Depth: / Scum Thickness:
Distance from top of sludge to bottom of outlet tee or baffle: 3
Distance from bottom of scum to bottom of'outlet tee or baffle: 9" '
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level;in ation to utlet invert,structural integrity,evidence of leakag ,etc.)QA
i/ 4
Al
GREASE TRAP: Ny
Depth-Below Grade:. Material of Construction: concrete metal FRP Other
Dimensions: Scum Thickness:
-
Distance from top of scum to top of outlet tee or baffle: t ,
Comments: (recommendation for pumping,condition of inlet and outlet tees or.baffles,depth of liquid t�f
level in relation to outlet inveit;.itructural integrity,evidence of.leakage,:etc.)'
S }t
I•,x1;1rr i;i.. . � lr ,
y
TIGHT OR HOLDING TANK:/)D ,
_art
Depth Below Grade: Material of Construction: concrete metal_FRP_Other(explain),,
Dimensions: Capacity: gallon Design Flow: t;allons/day
Alarm Level;
Comments: (condition(condition of inlet tee,condition of alarm and float switches, etc.). ?'
DISTRIBUTION BOX•
Depth`�of liquid level above outlet invert:��
Comments: (note if 1 I and distribution is equal,evid8dce of solids carryover,evidence of leakage into
or out of box,etc--
2V4 .
PUMP.CHAMBER:;
Pump is in working order: _
Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) '
-5-
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77Ai�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMw
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS):
f,
(Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive
methods) If not determined to be present,explain: :,
Type: .
`Leaching pits,number: Leaching chambers, number:Leaching galleries,number:
Leaching trenches,number,length:
Leaching 5elds,number;dimensions:
.,Overflow cesspool, number:
Comments: (note condition of soil,signs of hydraulic failure level of ponding,condition of vegetation,.
etc.) k&4 Ae aJ A— --
z
CESSPOOLS:,
Number and'coitfiguration: Depth-top of liquid to inlet invert: l
Depth of solids layer: Depth of scum layer: Dimensions"of Cesspool: b.
IFYk
Materials of construction: Indication of groundwater: f.
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, E
etc.) '
Materials of construction: Dimensions:
Depth,of Solids:
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc:)
fi.
-G -
I
'SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, landmarks or benchmarks.
Locate all wells within 100 Feet.
-,�p _
tag,.
"d .
5
kt '
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DEPTH TO GROUNDWATER:
Depth to groundwater: y Feet
Method of Deternn lion r Appr mation:
-7=
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/ TOWN OF BARNS.TABLE
LL LOCATIONrVoZ(o kAJ SEWAGE #
VILLAGE ASSESSOR' MAP 3L�oir
&LOT_`3Y 0
(
-WgPpr tie NAME&PHONE NO.
SEPTIC TANK CAPACITY 1600
LEACHING FACILITY: (type) tip ]' /L4 43,) (size)
NO.OF BEDROOMS
BUILDER OWNER
`PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well 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 A e `L
0
TOWN OF BARNSTABLE
LOCATION ia�Jl'� SEWAGE #
VILLAGE 0= 727Z'L1'"-E ASSESSOR'S MAP & LOT/� —07�-/
INSTALLER'S NAME & PHONE NO. 46F�M v
1 SEPTIC TANK CAPACITY /0 00
LEACHING FACILITY:(type)
NO. OF BEDROOMS PRIVATE WELL OR BLIC TER
BUILDER OR OWNER /CC-1 k.;
DATE PERMIT ISSUED:
DATE; COMPLIANCE ISSUED_ /.�
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS APPROVED
BOARD OF HEALTH Barnstable Conservation Department
13
TOWN OF BARNSTABL � �
Appliration for Di�ipimal lVurkii C�onmrurtiun amit Date
1P — —
Application is hereby made for a Permit to Construct ( ) or Repair (D4�' an Individual Sewage Disposal
System at:
_........ � 4� '_ -\,Ae-
.....
................. .. ........•-
Loritioi -:\ddress
y or t No.
O+rncr ddress
l�f�.'� ��si 6
w ------------------------------7�°-...- -----�'�'���`�•---�-G--•-•--•-----•-
Installer Address
Type of Building Size Lot............................Sq. feet
►.� Dwelling— No. of Bedrooms..............--_3_-_________-_____.-___Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons.__---__-__--__-__.___--.___ Showers ( ) Cafeteria ( )
adOther fixtures -----••-•-----------------------------•--------------------------------- •................_..._._.....--•••-•-•---•••........._......•--.............
w Design Flow....................... ........gallons per person per day. Total daily flow...-.___-__ ----2---��-..................gallons.
W Septic Tank—Liquid capacity.. gallons Length....K� Width_.............. Diameter....------------ Depth_......-.......
.
x Disposal Trench--No. ---------Z .__.. Width.......... ..... Total Length 7 Tota1 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........................................
Test Pit No. 1................minutes per inch Depth of Test Pit._.._____..__....... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----------------------- ------••------•---•. --------••-••--•--....-----•-•••-••--•-......................-•-••-•---•--•••---•--••......------------.--•--
0 Description of Soil...................... -------- l1 �X1 .S U6S0/ c ... 1J..
x
w
UNature of Repairs or Alterations—Answer when applicable.__,l!J ? ? _----- S........�......!............aax..... f. ..._r_.�1 %L ' !d�?a / �'`�-._ - ^� ......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance h be n issu d the oard of health.
._. _._ V4Dac
Signed --- `..........Application Approved By .. -- --- .1........................ ... ...... ...
Application Disapproved for the following reafonf. ...................................... . .......... .............................................................................
............................................ : ...... ........... .. ... ........... .
Permit No. .J. _..... Issued - ...- ......
e...Or ...... e
666
+. 2 A
b'* THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
:"k t Appliration for Dirivaiial li urk,i Tonstrurtion 1hrmi#
Application is hereby made for a Permit to Construct ( ) or Repair (><I an .Individual Sewage 'Disposal
System at:
.......................I . ..=...,•—S.i�'z.....L c..
Location-Address or 1,ot No.
(C
--................•-- /��f�o.l � l� GJ1Sliw - a1 s................... .:....
Owner .. Address
W ,CS�C1l�-Ger��/ rtL41� e9 2� i._es!I
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms._..._...__.� -----------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons._____-_-_------_----._-. Showers ( ) — Cafeteria ( )
dOther fixtures ----------------------------------------------------------------------- -------------------------------------------•--------------•------------------
WDesign Flow........:...............`a .'.........gallons per person per day. Total daily flow...........-. �70..................gallons.
WSeptic Tank—Liquid capacity_. gallons Length___. _s'_�___ Width---------------- Diameter-----........... Depth................
x Disposal Trench--No. .......... _._._. Width......... --_-_ Total Length f7�25_Total leaching area....................sq. ft.
Seepage Pit No--------.---_--.-.- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-------------------------------- --------•---------•----------....•----•.. Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit...._......_.._.__.. Depth to ground water........................
0-4
Lz, Test Pit No. 2................minutes per inch Depth of Test Pit--------_........... Depth to ground water........................
----�---------------------- ......
..--------...... .................---•-------•----•------.........................--
0 Description of Soil---------------------- —� `-'�''}� `_r.`S UISSo c '� �� �.....................1J
x
W
Z ...............�J� �
_....._.__.-___.............. .. `. ._.___._____._....._.......___._....-______....__._.._.....___._....._____-__._.....�........�._.........�...................
U Nature of Repairs or Alterations—Answer when applicable._--1!q4-;r— .45..____ �/�/U.. �� 5 6'-e�'
--------------------
Agreement--
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has be n issu d by the board of health.
Signed 1�................................ . ----- .......... ^
Application Approved B7w�.l�f:,.. yfl U L .............................. 1.--
Dare/
Application Disapproved for the following reasons: . ............ ................................... -- .................................. ...........................
:..------ -- ------------------------------------------------------------------------------/.... .........................
/.....
/care
Permit No. .. ......... ..................:.... Issued — ....------ ._ ......
J Date '
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(ILler#tfira e of C�umpliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
b �S'Ua.Lt_' c7..........Ga ?. 'Lvc�7-tu r.1
Y ---------------------------- ------ ----------- ..............._._ ..........
1nsr.J lcr _
at ............................ ------............ --------._l!L 9S.f l��.LF_/(a�.......�1a/.............................................................
has been installed in accordance with the provisions of TITLFIS of.-The State Eny-ironmental Code as described in
the application for Disposal Works Construction Permit No. .. �.'"-_ . . .`3..... dated --:.._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
ICj -- ............... --------------------------
DATE .....................-.... .t... 1..`../ ��......------... --.........:.. Inspector ... -- -
ly
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
9 TOWN OF BARNSTABLE
Ropnoal Workii OpUlmitr il<tlt
Permission is hereby granted =.. r,.G4i7 l
..................................................................
to Construct ( ) or Repair (^X-) an Individual Sewage Disposal System
Jam/' C,cY9.r�`..t.t l��T... .a a'J- - ......-�--.-----•................
at No-------------------------------------
/ ... . _.......
�-`Street
as shown on the applicati n for Disposal Works Construction Permit No._l.__m....__�._,),ated..........................................
l oard o eal,
.................................... t�I)r
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS