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HomeMy WebLinkAbout1024 ROUTE 149 - Health 1024 ROUTE 149 MARSTONS MILLS A = 103 103 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is MARSTONS MILLS required for MA 6/5/09 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. 'p°'l"`When filling out A. General Information W forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A. BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A. BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S 14297 Telephone Number License Number B. Certification 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 the inspection. The inspection_ was performed based on my training and experience in the proper function and mair'ttenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to S ction t%340 of Title 5(310 CMR 15..000). The system: ® Passes ❑ Conditionally Passes ❑ F ko ❑ Needs Further Evaluation by the Local Approving Authority co +�3 co Y 6/5/09 >~- I spec ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title V Inspection Forrn.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is MARSTONS MILLS MA required for 6/5/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: TANK WAS PUMPED BY SCOTT FRANK AS PART OF INSPECTION, FOR MAINTENANCE B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed Title V Inspection Form.doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information for is re MARSTONS MILLS MA every page. Cit State y/Town Date of Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title V Inspection Form.doc-08/06 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information for is re MARSTONS MILLS MA every page. Cityrrown 6/5/09 State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well`*. Method used to determine distance: *�This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppmm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title V Inspection Form.doc•08106 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is required for MARSTONS MILLS MA 6/5/09 every page. City/Town State Zip Code Date of Inspection B. Certification D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 d- 10,000gpd. gp ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered,a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 i— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is required MILLS MA re wired for 6/5/09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Tide V Inspection Form.doc-08106 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is required MILLS MA re wired for 6/5/09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 07-120 08-123 Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title V Inspection Fortn.doc•08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r< 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is required MARSTONS MILLS MA re uired for 6/5/09 every page. City mown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: PUMPED BY SCOTT FRANK IN MAY 09 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 1500 gallons How was quantity pumped determined? TANK TRUCK Reason for pumping: MAINTENANCE Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ 1 Other(describe): Approximate age of all components, date installed (if known)and source of information: UNKNOWN Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is MARSTONS MILLS MA re wired for 6/5/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No - - - - - - - - - ----------------------------------------------------------------------------------------------------------------------1500 GALLONS S Sludge depth: 0 RECENT PUMPING Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title V Inspection Form.doc-06106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments < 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is required MARSTONS MILLS MA re wired for 6/5/09 every page. Clty/Town State Zip Code Date of inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS RECENTLY PUMPED FOR MAINTENANCE Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Title V Inspection Form.doc•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page t0.of 15 s � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 't 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is required for MARSTONS MILLS MA every page. & State Town Date of Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cunt.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): UNABLE TO FIND.D-BOX TANK AND PIT WERE LOCATED Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title V Inspection Form.doc•08fG6 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is required for MARSTONS MILLS MA every page. &rtyrrown State Date of Zip Code Date of Inspection D. System Information (cont.) Comments (ncte condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology.- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): PIT HAS ABOUT 4 FT OF USABLE SPACE AT THIS TIME STAIN LINE AT LIQUID LEVEL Title V Inspection Form.doc•08/08 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts UIPTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is required for MARSTONS MILLS MA every page. City/Town 6/5/09 State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I x , Title V Inspection Form.doc•08/08 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 13 of 15 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is MARSTONS MILLS required for MA every page. City/Town 6/5/09 State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal.system.including tie's���+ to at least two permanent reference landmarks or benchmarks. Locate all wells-w'ithin 100 feet. Locate where public water supply enters the building. f. � I � I f Ll G 2 � Ll� IA l Title V Inspection Form.doc•0&06 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 14 of 15 1 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug 1024 RT 149 Property Address PEACOCK Owner Owner's Name information is required for MARSTONS MILLS MA 6/5/09 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Title V inspection Form.doc•08= Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•page 15 of 15 a ,TOWT�I60ME F BARNSTABLE / f t/ LOCATION SEWAGE # ZOO VILLAGE AGE M fl 0-S dV1 l«S ASSESSOR'S MAP & LOT /03- INSTALLER'S NAME&.PHONE NO.' J\n da M 1 t Q— "` '7 57-� 3 SEPTIC TANK CAPACft Y 4EF66 a.S -00 i' LEACHING FACILITY: (type) (size) I( NO. OF BEDROOMS oZ ..BUILDER OR OWNER FT � I r T / PERMITDATE: G I ©/ COMPLIANCE DATE: /�S O� Separation Distance Between the: j 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 j Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by LIA sl t Yl t�i 15 1�►1 CC�r�a i i I- - 1 _ YOU Wj.SJH TO OPEN A BUSINESS? as For Your Information: Business certificates (cost$�O.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. a DATE: / Fill in please: a APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: �' [ntv e fie. 1f2 TELEPHONE # Home Telephone Number S"UR 47-o � NAME OF CORPORATION: NAME OF NEW BUSINESS C - TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES N ADDRESS OF BUSINESS toZY R-b� f`t'Y C Z)f —rz 1t'I,�1S �2 G51iQ MAP/PARCEL NUMBER O D,�j (Assessing) �{ _e_ �� � v Z Whe rting a new businessYSere are sev�tgsyou must do in 6rdAr to be i�om liance wit truTes and regulations of thb Town of / Barnstable. This form is intended to assist you in obtaining the information you may need. You MU T GO TO 200 Main St. - (corner of Yarmouth-- Rd. & Main Street) to make sure you have the appropriate permits and licenses required to lega4 operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has been MrMgM the permit requirements that pertain to this type of business.(� MUST COMPLY WITH ALL Authorized Signature** NAZARDOUS MATERIALS REGUI-4710M.(� COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY] This individual haneandoformed of tPe licensing requirements that pertain to this type of business. Authorized ignature** COMMENTS: •,:; Date:, /��/ ��iTj�l TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: rt_r_ aF� BUSINESS LOCATION: �a2`j C 6- ,-1 ' CR&A INVENTORY MAILING ADDRESS: / bKLI.,< A14 /t4 (,)2_64eR TOTAL AMOUNT: TELEPHONE NUMBER: < oA z�17 77-91 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE UMBER: L4 2,0 -77S/ MSDS ON SITE? TYPE OF BUSINESS: ��� zn� �c•h .►cc.,2, INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum ,/,le_ Antifreeze (for gasoline or coolant systems) ra�.o Miscellaneous Corrosive NEW ❑ USED A I ,o Cesspool cleaners Automatic transmission fluid / , Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) J Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED � (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) vv,,L Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink 6 Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout 14j Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda A/ Rustproofers Miscellaneous Combustible A), Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners /� (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers o hydrochloric acid, other acids) OV,-e- Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Appl' nt's Signature Staff's Initials TOWN OF BARNSTABLE / t� LllaATION Wq Q1 1(VI SEWAGE # zoo/-S0� VII:'LAGE M A ASSESSOR'S MAP & LOT /03-/a3 INSCTALLER'S NAME&PHONE NO. �A Ca OX 16 L(Z, " '7 5-. 3�3 Q' r SEPTIC TANK CAPACITY r l4S.-C 0 LEACHING FACILITY: (type) (size) I( NO. OF BEDROOMS oZ BUILDER OR OWNER / u VLO� PERMITDATE: COMPLIANCE DATE:l/S-1O/ 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 G, Y� No. Fee $ 5 0.0 THE COMMONWEALTH OF MASSACAUSE*S Entered in computer: Yes / PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZippYication for Migpo!ml *pgtem Conaruction Permit Application for a Permit to Construct( )Repair OM Upgrade( )Abandon( ) D Complete System ❑Individual Components Location Address or Lot No. 10 2 4 Rte. 149 Owner's Name,Address and Tel.No. 5 0 8—4 2 8— Marstons Mills,Mass. Ester M. Murray Assessor'sMap/Parcel / d 3 /O3 1024 Rte 149 Marstons Mills,Mass. Installer's Name,Address,and Tel.No. 5 0 8-7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8-7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632 Type of Building: s q7 ti c.se I Dwelling XX No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil;Loamy sand t o medium fine -,and- Nature of Repairs or Alterations(Answer when applicable) Omitting main cesspool. Installing 1 -1500 gallon septic tank & 1 -Distribution box to the existing 1000 gallon leaching pit. c.oti, d 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 issue by thi o of alth. Signe Date 6/2 9/01 Application Approved b Date -F Application Disapproved for the following reasons Permit No. 24-0 d .S'b 4 Date Issued 0I / No. ..� RWU/ Fee�j'� $ 50.00 t ��bl y THE COMMONWEALTH OF MASSACaAUSEgtrS Entered in computer: V - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ✓ i rication for - i� ogaY *pgtem,_, Construction Pit ? it- Application for a Permit to Construct( )Repair(XX)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1024 Rte. 149 Owner's Name,Address and Tel.No. 5 U 8—4 2 8—5 7 Marstons Mills,Mass. Ester M. Myrray Assessor's Map/Parcel / d 3 r0 3 1024 Rte 149 Marstons Mills,Mass.-- Installer's Name,Address,and Tel.No. 5 0 8—7 7 5-3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 .P.Macomber &• Son Inc. J.P.Macomber & Son Inc. Box 66 Centervil'ie,Mass.02632 Box 66 Centerville,Mass.02632 - Type of Building: 01 F c re I Dwelling XX No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Z L Size of Septic Tank Type of S.A.S. x Description of Soil Loamy sand to medium f i ne sand r Nature of Repairs or Alterations(Answer when applicable) Omitting main cesspool. Installing 1-1500 gallon septic tank & 1-Distribution box to the exist ng 1000 gallon leaching pit. �; (� %, -S�cr t, /,'a 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 Environmen4 Code and not to place the system in operation until a Certifi- cate of Compliance has been issu bX o d of alth. ° Signed .r.1 t-, -r Date 6/2 9 1 Application Approved b _ rY Date �i Z Application;Disapproved for the following reasons 9 4 J/14 r 1 t Permit No. �/Q"o Date Issued —i =-------- ----------------- ---- THE COMMONWEALTH OF MASSACHUSETTS ,BARNSTABLE, MASSACHUSETTS Q'ertificate of (Compliance 7, THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired -XX)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. <. at 1024 Route 149 Marstons Mills,Mass. ` has been construc ed injaccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer J.P.Macomber & Son Inc. DesignerJ.P.Macomber & Son nc. , The issuance of this permit ssh° l'hot a construed as a guarantee that the syste func '_rr design Date 1tr f� Z0`0 f Inspector —Zen Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwiigo$al *p$tem COn$truction Permit Permission is hereby granted to Construct( )Repair J{X)Upgrade( )Abandon( ) Systemlocatedat 1024 Route 149 Marstons Mills,Mass. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructi n mus be completed within three years of the date of this pe t. _ Date: 6 Zf �'/ Approved b iA__1 l/6/99 i NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) L Joseph P.Macomber Jr, hereby certify that the application for disposal works construction permit signed by me dated 6/2 8/01 concerning the property located at 1 024 Route:. 149 Marstons- Mills,Mass. meets all of the following criteria: /The failed system is connected to a residential dwelling only. There are no commercial or bu siness es associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. •There are no wetlands within 100 feet of the proposed septic system •• There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or Po change in use pr oposed sed P ere are no variances requested or needed. The bottom of the proposed leaching facility will Abe located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor J method when applicable) •/ If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fotutecn(14) feet above the maximum adjusted groundwater table elevation, r Please complete the following: A) Top of Ground Surface Elevation(cuing GIS information) �/ Q B) G.W. Elevation + the MAX, High G.W, Adjustment .7, A _ // 7 'g �-DIFFERENCE BETWEEN A and B 7 , la SIGNED : DATE: 6/29/01 (Sketch p o sed plan of system on back). Q:hcaJth folder cen .. ;* :'fit." b .� � � � � -� I ����� S . V.: r —� �� t� FA .� e �,,' v '� + tiI .�: i 03nssl 33MV I ldWO 3 3 IVO 4 OVISSI, IlWV3d 31VO 17771,,%.. ........... V3kfAO NO V I a 11 n 8 SS3VOOV I 31N'V N SA 3 11 V I S N I 35VII-IA *ON 11MV3d 35VM3S Nol IV 3 0-1 G�-�.,: ,-,cam. - �� _.r, '� �� � � �l � o�� I ^.�i � � � �� �� t - '�\„/` ,)• ��� ��� i :,,, � /�I C d.V 2— �i-8/ l Fes$. �`= No. ' .. .. ..... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD E L ............. O F........... . ... . . . . .... -- . Appliration for Ui"vii al iYorkg Tontitratrthitt Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..1........,.----•-•-...•-'-.--, t d—........................................................... . ..................... Location-Address or Lot No. .... ••v... ....... . ........................................ .........^........t............•-•-•---.• -.....................-.....--- .. ............... ' Jf� er �ess G -1...................................... �_.........__._. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other 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.........._____.....sq. ft. 3 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........................ ri Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil......__ �sZ ._..2 .. c4 L � ----•---------------------------------------------------------------------------•-•-------•----- x W •--•••--------- ---------- ---------------------------------------------------- --------------- -- ---------------------------------------------- --------------------- U Nature of Repairs or Alt rations Answer when app ' ble_ _. .. _ .._: _.�k ����® /° ------ ...................• --.............................................................................-----•-•••••••---------•-•-............---- Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT iL, y g g p y 5 of the State Sanitary Code— The undersi ned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the boar&ol lth.Sig d. ..... --•-- . ... ....... ............ Y-v Date Application Approved BY `�664- . . 2 . <•----------------------•-- -•--•--=/ Date Application Disapproved for the following reasons-----------------------------•--------------------------------------------------•---............................ -••--•--•----------------•--•--------------------------------------------•--------------------------......---•-•---------------------...---------------------�---.-....... ....--------------------.-•---- Date PermitNo......................................................... Issued_--4� �-=- ---_-----f......................... Date N .r....l...... FEs... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD H ........... ....................OF................................................................................................ Apphrati'n.'fnr Uhip aal Workii Cnnnitrurtion .erntit s, Application is-hereby made,,for a 'Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal v System at: .... ----------------- ..------------. ...................... Location Address or Lot No. --- ---- . �--- --------------- ---------------------- -----------° --,--- --. er a Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )�, 4 . 04 Other—Type of Building ............................ No. of persons.........:.................. Showers ( ) — Cafeteria ( ) P4 Other fixtures -------------------------------------------------- W Design Flow..........................................galf6ns per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Wi r Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter--_-___-.-__.__-___- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (, ) Dosing tank ( ) Percolation Test Results` ;Performed by.......................................................................... Date........................................ a- 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........................ O Description of Soil =N x J 1---.5 s.'4!14 --------------------------------------------------------------------------------------------------- W ------------------------------------------------------•---•----••---•--•-•----------------•--------------------•-------- -... _r.......... ___------- ---- U Nature of Repairs o Alt rarions -�,�nswer when app liable __-_._ _ ................ ------------------------- --- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 5T T'1, 5 of the State Code—The undersigned further agrees not to lace the system in the provisions of t y g g p y operation until a Certificate of Compliance has been iss ed by the board o 1 lth. 64ts/n Date Application Approved By.................................. ............................................................ ----------------- ----------------------- Date Application Disapproved for the following reasons:................................................................................................. ..-------•-------------------•---•-•--------•-----------------------------......••. ....---------------------•-----------......------------------...-•--•------•------•---------------•-------------. ,r' Date PermitNo.....................................:................... ''. Issued_....................................................... Date ^ THE COMMONWEALTH OF MASSACHUSETTS-, BOARD T �t ..................................OF.. ':.". ..................................:>......................---............ rrirtt�le laf f�unt�r�i�nrr .. � THIS IS T CE. Y, at the Incividual,Sewage Disposal System constructed ( ) r-Repair ( ) t .... y� - ----�• . r--ta at `-...As---o..... -. . ..•l�..... �...-- . .. ...-•----------. -•--------------•------------------.....--• ------------ has been installed in accordance with kfie provisions of TIV � �he State Sanitary Cod ,,k J! rij�e�} .the application for"Disposal Works Construction Fermit �'o____ _________________________•- dated_....___-_._._-_______-_-____-__-.._.__......... THE -ISSUANCE OF THIS CERTIFICATE,SHALT. NOT BE CONSj1rRUE® AS A UAARANTEE THAT THE SYSTEM Wb LL FUNCTION SATISFACTORY.-- DATE... .......... :.1._ �........................................... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH OF.. . ... °� No.- .. FEE........................ Disposal. n ' T n n it Permission is hereby granted_.... ,._ ------------ to Construct ( ) or epair n Individ al Sewage Disposal System U 7 Stree :r w as shown on the application for Disposal `,"oiks Construction Perr, 'No....__ ,/ __________ �jr � -- Board of Health �,i V DATE----------- -=~------...------�---------------------•--- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS j1 7y No............ ._....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® J HE LTH ApplirFafion for Dispvii al Works Tonstrurtion i1trutit Application,I< Ord for a,Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Y-r U- e j f f q , ... ......:. .... ...................... _.... --- Location i or Lot o. ...•..... --- .. ......... .........� - , . _ .. :: _.. ..- .. t � W .� .. ne .................................... .t:_`.. dK a Installer Address Type of Building Size Lot._ .....Sq. feet Dwelling4-;-Ro. of Bedrooms._.Z...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............... No. of persons_....__..................... Showers — Cafeteria Q' Other 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. .................... Widlh_.._i.._._.._._.... Total Length........... Total leaching area....................sq. ft. 1 � d� Seepage Pit No._-•-.1............ Diameter ____ _______ Depth below inlet... Total leaching area. ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test 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........................ P.' •-•• -----------------•----- O Description of Soil....:.. . .. .. ...... - '` _ x V W •--•---•------------------------•---------------•---•--••-•-----•----•---------•----•--•-•--------------------••••----- jA U Nature of epairs olte ions—A er when a plicabl ........................................ -- ' ' . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI:'LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by Oe boa d Aofth, Sigd ..... ................ . --•--•----.---------•---•--- f-a� .... Date Application Approved B _ % _.......................... , Date Application Disapproved for the following reasons---------------------------------•-••--------•-----------------•--............................................ --....•-------------------------••.•-•----•---•----------•-.--•--••----•-••-••--••------•......--.-----_•-••--------•---•---------------------•-•-------••-•-----------•-•--------------•--•-----___---- Date `�.. Permit No......................................................... Issued.--4r,�'•--•--.._.. ,......................... Date t No......................... F>cs.. �................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH it'f%tM. ..OF..........Ft.......44X .: f Appliratiun for Disposal Works Tonstrudiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... ....t.:.. ... '. .................................... ..................... --... . Location ddress / or Lot ............................. ................r...........__�._..._......._......._.._..._..._ ......... ... o .- ...- .................................. ...... �. % 5.Vic" ! Xr...... y ' :: . "".........:.....J �. 1�... Installer Address Type of Building Size Lot../ . .....Sq. feet U Dwellingo. of Bedrooms-•-oe...........--------..._._._._.......Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria P4 Other 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..................... Wid h ................ Total Length...........f....... Total leaching area....................sq. ft. Seepage Pit No......I------------ Diameter ......... Depth below inlet.../,&............ Total leaching area. 4.4!...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY-----••-•-•....*........................--------------------------------- Date........................................ 4 Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -a -----------i------------------------ -------- Description of Soil...... t " x W -•-------------•-" ------ " ... --------- ----•---------- --------------•--- --•-•-----------•---•-----•--- -•-•-• ---•••.. --•-• --- ---/r .- U Nature of epairs or to sons—A er when a phcabl . .._.__..d......_ ................. " .I::.. ------ `" ....... . ......... ...•---•. ................................................... .............................. Agreement: The undersigned agrees to install the aforedescrified Individual Sewage Disposal System in accordance with the provisions of TITS..•" 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been I s d by tZe boa Ed of th. g . ._ Si d . . -er Date .. A lication Approved B ' ........................ /Date Application Disapproved for the following reasons:.............................................................................................................. •----------•................................................."""-"......---------"..."-"•--"-------""""---••--••-----••=---••••--•-••••••-•••••••••--•••••-•-•-•••-•••------••----•......••------------ Date Permit No.......................................-• « -------------- `i ;� Issued ..................................................... f Date THE COMMONWEALTH OF MASSACHUSETTS,— t BOARD OF HEALTH j. �?�F?. .............OF........ .'.......................... ler#ifirtt#r of-ToutpliFanrr THI I 0 C RT 't the Ino vidual 'Sewage Disposal System constructed ( ) or Repaired f bY ......... � r / .. ."------""" :... ""----------"---"------""" J. has been installed in accordz(ce with the provisions of TIT! � 5 of. The State Sanitary Code as described in the application for Disposal Works Construction�',Rer>:rlit No ���r ..._.. ............. dated.... _ THE ISSUANCE OF THIS CERfIF16 Af9 SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................... Inspector........ THE COMMONWEALTH OF MASS,ACHUSETTS �, BOARD O� HEALTH 7 .rya /? f- _�...�!.......................OF......... ... ............................................. �" No.............:........... FEE..... EE..... ..".............. Disposal IV Ms un n rrmtit �-. - Permisslon Is hereby granted_.._,.''( - ................ to Construct ) or ep&ir ( ) an Individl al e'w •a Dis os Syst • ' Street ., as shown on the application for Disposal Works Construction Per"`ryt No.1-111-z. . XiDated.." r.fy". "....f ... ...... ............. DATE..... oard of Health • - • -...----FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LO CAT ION ' SEWAGE PERMIT NO. VILLA E INS . , Ll It ME i ADDRESS 8UILDEIt OR OWNER mod.. DATE PERMIT ISSUED E COMPLIANCE ISSUED ` OAT _----�-� - �` �/� �J � �� �� L/ � �'�/ z THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA e .. i• - ,: l 'A * . ?..CA kF' Z- - A. , .1 I a - ,• , I. .. P.. ._-. _..., ..- ... �.. .- ... .- '-...' - „�. •dry S` ,t p j ` T• mil_ yy_ .. _,. a ... � ... .e- .- F.. '-+.s...n:.. _'�••::_. .. :. - widl�''� .,r:..� " � Qa. Y�- '�:� a.•lr-rye. - tl 4 a e qr— I 4 ! ' • L � �I ' f j 1�-! t.I � •- I t f I1 I ! ' I i i ••� I f I i G7lC-' VIP 'O'''J?T DONALD I.MEYER Professional Building Designer P,O.BOX s32 So-Yanrouth,MA 02664 Z R vfmo� .� � -• a • _ .. .. .. ._.... . (5W)394-52% . --- j F1FTIF I d96; i o43 v _ 4 Low �' vo IL e lw r;33w T�k 4to�w i>0�b 4 DONALD I. MEYER D�G.D I,.-1! rj -OCR 2 ��Lp I� bu*-AL "=l'o" Professional Building Designer ' So. 532 Ya muth,'MA 02664 onawnhc gwmEn • (508)394-5296 —..L-�. _ — _� Y a ' v. • I ,-T_, o: : E �— I i� --F Fr 11 T,.I - -- - a - O E DETECTORS O.Ka SMOKE �. _ - NEW SMOKE DETECTOR REOUIREMEWS B L nn UILDNG D-k f /; '. _. - HE ADDITION OF A •�. I� E � .\ LAW-Y� EVEN E N T . . -. ARE NOW WILL. TRIGGER AN NEW BEDROOM i _----:-=_- — UPGRADE OF THE SMOKE DETECTOR YOU MUSTFOR THE WHOLE HOUSE. PLAN. ACCORDINGLY AND HAVE ELECTRICIAN TAKE OUT THE APPROPRIATE :-( ! -- — PERMIT AT THE FIRE DEPARTMENT.- Lw '07J! l`>St '. _ro't i��1 {+Ab`+Ye►f++ `�s ;`E ;' - - - - ---- ---- DONALD I. MEYER — Professional BuildingDestw' P.O.Bmc 532 L\I /'�''� l +✓6! .'.i�:i'_'.. _o�wHcr�u_D , .. n • So.Yaramotfi,MA 02664 _ v - � it _ F IL •< ter;. _ ^�a 1 1 A _ .4 ^'r 10 2.5- - _ •r__ _ - .x r: 777) NIj T8 - I 'lI Q� 7 oa _ s` _ •yam.` - •h% .its--,.. - - . b< �.�' -' - .:. •. ,. . .- .--•- --- . ..• :• -� tom'- --- .. - .. _ . . .. •_ -...,'. N I i�F— r - • r r • r , rl TIA W7'�L1 I s ? GO6ry•-F�f 7�D L� �-r � '' "'L �n-�sj i r � a i -_ —��,� - '1! •� vc-o• ! '` ' jl Ll �-----�• - ----, �/ !I ky 6' ti eA e- - '--- - -- - --- e•-�tl :�- - P I` I rI_E i -I••�•--r_� _ t 3 as �_ I l �, - -- GJ� S�-1�—� n I N � �• M ..e•� 1 � ' ' Ilk TW ilk- _ _ J t - p� to— •- DONALD I.MEYER ftfessiosai Balding Designer no.Bw So.Yarmouth,MA 02664 a • (5081394-5296 Tin !'t om ---- --...... . - o Lev' QL�.. I41 I I - P� IL ti fly, a t ...m - — L X. I - � I r - - Tw la'llo'TIN 410�W-fv3b F'tzo�ob> ✓I boti� to..u_.:. _..ALjc �Tto+a.�: Q � M� M - m DONALD I. MEYER pE tp G Q Ij h OO e_ rLp,k hcaA4>� Professional BuiIdingDesigner - — ' .. P.O.Box 532 a+�wnnc rxwmEn—_ So.Yarmouth,MA 02664 — (506)394-5296 �. A .. 1 ;._ fit rL� _meaty cv 1 { �Zr rDKr, V 5 N ir ! — rb 1 ry -off d!4%�2? LeirEX2 ►awl Cp vI Dh -4`_ -1'-d' -� c(J QJI O� I ccilx¢ r� - 1 — — — — -- -- — — — - — - —• — 4tLo .05.=11. . .�1�G21. ���.-.fit = a bN'� O G -Pt�F h'�OIz, M�Lt g -�4 1'2- �6 •'VI'C — R - Ito-Q1601h DONALD I. MEYER `J 0 Professi n O.BOX53ngDesigner �. .eo><53z or so.Yarmouth•MA 02664 - e • (508)394-5296