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Home My WebLink About0137 LAKESIDE DRIVE - Health 137 �Ay.�, �c'014?,,,Marstons Mills .15 i" J I I 3 t k t 4 +.jam,' 4054-06 D eill, li SEWAGE PERMIT NO. WA-TER,tABLE LOCATION NO. STREET A �A/Pf S'iZJ '1i/E 2 kV, INSTALLERS NAME & ADDRESS1J�/ � D ATE PERMIT ISSUED 61111 77 DATE OF INSTALLATION d DRAWING OF INSTALLATION ON BACK r =s 4' TOWN'OF BARNSTABLE V LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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 . , Z11 Commmveci th of Mooxhuseffs IN Execuff f Office of ENrommintal Affdrs John Grad D.E.P. Title V Septic Inspector Department of P.O. Box 2119 D E P Environmental Protection Teaticket,MA 02536 Dr (508 S64-6813 0VJ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PART A F�� CERTIFICATION RC(,�' 0 P" Mq y. ' Property Address�137 Barberry Lane Marstons Mills Address of Owner: r04 4 j� lib Date of Inspection: (If different) H '91 Name of Inspector:JohnGracl — WatterWalth:18Browning ngston;4%jW* Company Name,Address and Telephone Number: g �r CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes This Inspection is based on criteria defined In Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Fur er Evaluation 8y the Local Approving Authority performing at the time ofthe Inspection.My Inspection does Fail/bmit not Imptv any warranty or guarantee of the Iongevlty of the septic system and any of Its components useful life. Inspector's Signature: Abr Date: 5112197 The System Inspector shall copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A.B.C,or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as 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 completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. 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 septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street 9 Boston,Massachusetts 02108 9 FAX(617)556-1049 9 Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 137 Barberry Lane Marston Mills Owner: Walter Walth:19 Browning Dr.Llvingston N.J. Date of Inspectlon:412WO7 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box Is leveled or replaced _The system required pumping more then four 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 obstruction is removed 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 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 FUNCTIONING 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 surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 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 bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined 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 sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. (revised 11115195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 197 Barberry Lane Marston Mills Owner: Walter Walth:18 Browning or.Livingston N.J. Date of Inspection:4126197 D]SYSTEM FAILS(continued) 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped _. 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 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. 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 large systems in addition to the criteria: The system serves a facility with a design flow of 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: 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 with 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. (revised 11115195) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 137 Barberry Lane Marstons Mole Owner: Walter Walth:18 Browning Dr.Livingston N.J. Date of Inspection:4120197 Check if the following have been done: x Pumping Information was requested of the owner,occupant,and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. e►aAs built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was Inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 137 Barberry Lane Marstons Wills Owner: Walter Walth:18 Browning Dr.Livingston N.J. Date of Inspection:4126197 RESIDENTIAL: FLOW CONDITIONS Design flow: 220 gallons Number of bedrooms: 2 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): No Seasonal use(yes or no): Yes Water meter readings,if available: n1a Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or rio) No Non-sanitary waste discharged to the Title 5 system:(yes or no)No Water meter rea dings,if available: n1a Last date of occupancy: n1a OTHER:(Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped In the last year. System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons Reason for pumping: rft TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system X Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) X Other(explain) 1,000 gallon leach pit APPROXIMATE AGE of all components,date installed(if known)and source information: original47 years.Leach pit approximately 10-15 years Sewage odors detected when arriving at the site:(yes or no) No (revised 11115195) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . Property Address: 197 Barberry Lane Marstons Mills Owner: Walter Welth:18 Browning Dr.Livingston N.J. Date of Inspection:412W97 SEPTIC TANK:_ (locate on site plan) Depth below grade:rda Material of construction:X concreate_metal_FRP_other(explain) Dimensions: nfa Sludge depth:n1a Distance from top of sludge to bottom of outlet tee or baffle:n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance form bottom of scum to bottom of outlet tee or baffle:n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) n1a GREASE TRAP:_ (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions:n1a Scum thickness:Na Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle:n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) n1a (revised 11115195) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 197 Barberry Lane Marston Mills Owner: Walter Watth:18 Browning or.Livingston N.A Date of Inspection:4126/97 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade:rda Material of construction:_concrete—metal FRP_other(explain) Dimensions: n1a Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: n1a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Ma DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: We Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)_, Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) n1a (revised 11115195) 7 r. c. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 197 Barberry Lane Marston Mills Owner: Walter Walth:18 Browning Dr.Livingston N.J. Date of Inspection:b128197 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits,number: 1_000 gallon leach pH leaching chambers,number:Na leaching galleries,number: nfa leaching trenches,number,length: nla leaching fields,number,dimensions:Na overflow cesspool,number:Na Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) The overflow was empty at the time of the Inspection It is structurally sound It has not had more than 3 of water in It. CESSPOOLS:x (locate on site plan) Number and configuration: one Depth-top of liquid to inlet invert:_empty Depth of solids layer: nia Depth of scum layer: nla Dimensions of cesspool: VxV Materials of construction: block Indication of groundwater: none Na inflow(cesspool must be pumped as part of inspection) Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Main cesspool and all components are structurally sound Recommend pumping system every year for maintenance PRIVY:_ (locate on site plan) Materials of construction: n1a Dimensions: n/a Depth of solids: nla Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na (revised 11115195) 8 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 137 Barberry Lane Marstons Mills Owner: Walter Wam ill Browning Dr.Livingston N.J. Date of Inspection:4128197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' IR 6tA i C 31 Q N� DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 Vp MASS, Logged In As: Parcel Deta i I Wednesday, [December 3 2008 Parcel Lookup Parcellnfo ......... m. . .._........ ....._.. __.__ ........ . . . Parcel ID 102-155 Developer LOT 148 Lot ............_..... .. ..... �_... _.� _ _..,.._ Location 1137 LAKESIDE DRIVE Pri Frontage 127 Sec Road [BARBERRY LANE 1 Frontage Village MARSTONS MILLS Fire District.C-O MM Sewer Acct; Road Index 10858 Interactive R ' ,' Map 3, 45001 - Owner Info owner STATHOi'OULOS, GEORGE J Co-owner Streetl (2 MOUIN i AUBURN ST#208 Street2 City(CAM B>• 1 GE State 3MA Zip '02138 Country .USA - Land Info Acres 0 25 use'Sligle Fam MDL-01 zoning RF Nghbd 0106 Topography Level Road Paved ............. Utilities Public Viater,Gas,Septic Location Construction Info . _. ......... ................................................. ......... ......... ......... Building I al" Fµ Year _ _,....._ Roof .. Ext' .. 1960 { Gable/Hip Vertical Sidin Struct 3... ._ Wall � _ . Effect _... 748 As_..h/F GIs/Cmp AC None Area Cover Type� Roof` y f333 �y 3 ---- Style[Ranch I Int!Drywall Bed 2 Bedrooms �3!3! y Wall Rooms s, _. Int� Bath Model ResldPnt!n. Floor! Rooms 1 Full ........ l t Tot Heat i a Grade iAverage Minus Hot Air 4 Rooms 1 Type Rooms .. Heats. .. _._ Found- stories 1 Story Fuel Found-ation ITypical Permit History IIIssue Date I Purpose I Permit I Amount I Insp ®ate I Comments II Visit History _.._. . ..... _.._. ... Date Who Purpose 7/3/2006 12:00:00 AM Paul Talbot Meas/Est 5/17/1999 12:00:00 AM Donna Dacey_ Meas/Listed-Interior Access Sales Line Sale Date OwnerBook/Page Sale Price 1 9/23/1999 STATHOPOULOS, GEORGE J 12556/269 $1 2 7/13/1999 BROWN, PEGGY R 12402/159 $100 3 7/29/1997 STATHOPOLOUS, WAYNE 10872/169 $1 4 6/2/1997 BROWN, PEGGY R 10779/012 $60,000 5 1/15/1993 WALSH, WALTER M 8424/305 $1 6 WALSH, CARLOTTA M-792 9743/066 $0 7 WALSH, WALTER M & CAROLOT 1456/870 $0 Assessment History _.,. __...... _ _......._.. _. Sage# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2008 $70,200 $2,300 $0 $163,200 $235,700 3 2007 $70,200 1 $2,300 $0 $163,200 $235,700 4 2006 $71,300 $2,500 $0 $143,000 $216,800 5 2005 $68,900 $2,400 $0 $161,600 $232,900 6 2004 $55,700 $2,400 $0 $97,000 $155,100 7 2003 $48,100 $2,400 $0 $42,300 $92,800 8 2002 $48,100 $2,400 $0 $42,300 $92,800 9 2001 $48,100 $2,400 $0 $42,300 $92,800 10 2000 $37,500 $2,400 $0 $25,100 $65,000 11 1999 $30,700 1 $0 $0 $25,100 $55,800 12 1998 $30,700 $0 $0 $25,100 $55,800 13 1997 $31,700 $0 $0 $25,100 $56,800 14 1996 $31,700 $0 $0 $25,100 $56,800 15 1995 $31,700 $0 $0 $25,100 $56,800 16 1994 $35,100 $0 $0 $22,600 $57,700 17 1993 $35,100 $0 $0 $22,600 $57,700 18 1992 $39,900 $0 $0 $25,100 $65,000 19 1991 $46,000 $0 $0 $43,900 $89,900 20 1990 $46,000 $0 $0 $43,900 $89,900 21 1989 $46,000 $0 $0 $43,900 $89,900 22 1988 $40,600 $0 $0 $15,600 $56,200 23 1987 $40,600 $0 $0 $15,600 $56,200 24 1986 $40,600 $0 $0 $15,600 $56,200 Photos , � . , 2 \ All /»�» � » y - « 7 7.3 0 .._.....� .. ... Fps.....5.�0 ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town IV .............................---. ........0 F....Barns tab l e...------...-----------•------........................ Appfiration for Dis usai Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: // 49 ��... .......... - . ,W...L a..ct.i.�Q m-Address s .lr.sLot No.Carlottaa�s M1j ...... - .....::-...-- ..-------•---•--•-- - -------------- Owner Address ...... joae_ ' Centerville. ---------------------------------------------------------------•------•_.....Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder' ( ) a'_l Other—T e of Building ............... No. of persons............................ Showers YP g ---------------------------------•---•-----P--- ( ) — Cafeteria ( ) P4Other fixtures --------------•-•- -----••---•--••----•••-••••---------••--•-•-•••-----•--•-----------•-•••--•-------••----••.... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.....7..............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........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R'+ .............-............................................................................................................................................... 0 Description of Soil....... and...&...GrpKel............................................................................................................................ x UW --•------------ .......................................................................................................................................................................................... Nature of Repairs or Alterations—Answer when applicable..l-IODD___gal lon overflow___________________________ -------••--•----------------------------------------•--•-----•---------••••---••.•-----•--..........----.....---•-•-••--••...---•-•----•-------•-••••--•-----•------•----••-=-----•--•-•-.........------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n ssued by the hoar o4health. Signed //' . ate ApplicationApproved BY ............................................................... ..................................... Date Application Disapproved for the following reasons---------------•-----------------•----------------------------•-----------------...-•--------------._......---•-- ---.....--•------•-•----•-----•---------------•-....---------..........-------•-................--------- ------------------ Date PermitNo......................................................... Issued r........................................................ Date i A N 17.5 Ficz -7 0 tv.;7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH." Town .........................................OF....Barnst�a.h].......................................................... Applira.flaft for Disposal Works Toustrurtion pamit ApplicAion.is Hereby made for a Permit to Construct or Repair, (X_.).a.n Individual Sewage Disposal System at: ........... ..................................................................... .................................... ............................................... Location-Address or Lot No. Carlotta I-T, '�sh 14, . -T..1 ................................................................................................ ..... ................................ --------------------------------------------------- Owner Address JosephP. e.,. Pe q n.jo _:Lac........ ...... . . . ............................................................. ........................................................ ............ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( Other fixtures ................................... ------................................................................ -------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width________________ Diameter......_......... Depth................ 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 '_4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit................... Depth to ground water.___..___..._.......___. �T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.___._......._.......__. ............................................................................................................................................................. 0 Description of Soil.._..St10 d--- .............................................................................................................................. --------------- --------------------------------*---------------------------------- ----------*----------------------------------------*-------**--------------*--------- ......................:.............................................................................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable-1-- ...... -P 1 —, .............................. ........................................................................................................................................................................................................ Agreement: The',undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with "I, . the provisions of 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 issued by the board of,,health. Signed , P) , /"? /,- -I, ��, :�/, /7 ................... ................................................................ ............................... Date ApplicationApproved By................................................................................................... ........................................ Date Application Disapproved for the following reasons:................................................... ...... --------------------------------------------------- ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued------------- ...................... ............ Date THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH Town oF Barnstabip ............................................ .............................................................. Tntifiratr of Tomplinurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired -n h T' -v) — P k by....�L5, 3 -,,n ,r Ir P inr .............................................. .......................... ..............................................................................................................7 Installer 137 Lakeside Dr me. Marstons Mills WP I at...................--------L........................................................--------- ...---------------............................................. ..... sh has been installed in accordance with the provisions of TY&F, 5 of--The State Sanitary 'C' e s..described in the V- ---application for Disposal Works Construction Permit Noev- -----U .. ....... ..... da ...j......... ------_- ----- THE ISSUANCE OF THIS CERTIFICATE SHALLAkT BE CONSTRUED AS A;- ARANTEE THAT"THE SYSTEM ILr FUNCT)ON,,$�TIFACTORY. .......... ..................... ............. ...... ......... .,pecto ----- ..................... -DATE...... ....... ns r-. ye�........... ,THE COMMONWEALTH OF MASSA6HUSETTS BOARD OF. HEALTH 77 � 7,3, .......... .........T.�)11n........... ..................................................... No......................... Disposal Works inn ti'artion prrmft Permission is hereby granted. T^ ..................................................... ... .............. ............... ... ......... ..... to Cons I truct or Repair)( an Individual Sewage Disposal System 137 La_ Drive, Marsons Mills atNo:............... ..............t--------------------------------------------------------------------------- Street as shown on the application.for Disposal Works Construction Permit Dated............. ....... .............. &—/ 44-0-g - ..................... ...... Board of Health7.µ11�� DATE... ........................................ ..... ........... ... .......... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS