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HomeMy WebLinkAbout1617 MAIN ST./RTE 6A(W.BARN.) - Health 1617 Main StreW-Rte 6A (W.Sarn) W. Barnstable I A = 196 014 t. t� i ,I t w No. 4210 1/3 BLU s n Qo�CT 9 D Sm ESSELTE 10% A o o Q 4 ' f QE NA�. o Page: 1 CERTIFICATE OF ANALYSIS 4 Barnstable County Health Laboratory Report Prepared For: Report Dated: 11/24/2003 Order Number: G0323418 John Wass P O Box 553 West Barnstable, MA 02668 Laboratory ID#: 0323418-01 Description: Water-Drinking Water Sample#: 23418 Sampling Location: 1617 Main Street West Barnstable MA Collected: 11/03/2003 Collected by: Meehan Received: 11/04/2003 EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS MDL MCL Method# Tested LAB: GC/MS 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 11/11/2003 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 11/11/2003 1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 11/11/2003 1,1,2t Trichloroethane BRL ug/L 0.5 5.0 EPA 52.4:2 1-1/11/2003 } 1,1-Dichloroethane BRL ug/L 0.5 EPA.524:2 11/1:1/2003 1,1-Dichloroethene.; BRL ug/1, 0,5 7.0 EPA 524.2 .1-1/4-1/2003 l,l Dichloropropane BRL ug/1 0.5 EPA 524.2 11/11/2003 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 11/11/2003 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 11/11/2003 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 11/11/2003 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 11/11/2003 . 1,2-Dibromo-3-chloropropan BRL ug/L 0.5 EPA 524.2 11/11/2003 1,2-Dibromoethane(EDB) BRL ug/L 0.5 - EPA 524.2 11/11/2003 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 11/11/2003 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 11/11/2003 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 11/11/2003 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 11/11/2003 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 11/11/2003 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 11/11/2003 1,4-Dich1orobenzene BRL, ug/L_ 0.5 5.0 EPA.524..2, U/1.1/2003: 2 2 Dichloropropane BRL ug1L. 0.5 EPA 524,1 11/11/2003. 2-Ch1orotoluene,_ BRL, ug/L 0.5, EPA,5242- 11/.1;1%2003: 4-Chlorotoluene_:..t,.: BRL; ug/L 0.5, EPA;524.2: U/1,1/2003. 9 .i. i...s< .. ..... ! i Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 pF aAR'1',T. CERTIFICATE OF ANALYSIS Page. 2 Barnstable County Health Laboratory sgcrtus�.,� Report Prepared For: Report Dated: 11/24/2003 Order Number: G0323418 John Wass P O Box 553 West Bamstable, MA 02668 Laboratory ID#: 0323418-01 Description: Water-Drinking Water Sample#: 23418 Sampling Location: 1617 Main Street West Barnstable MA Collected: 11/03/2003 Collected bv: Meehan Received: 11/04/2003 Benzene BRL ug/L 0.5 5.0 EPA 524.2 11/11/2003 Bromobenzene BRL ug/L 0.5 EPA 524.2 11/11/2003 Bromochloromethane BRL ug/L 0.5 EPA 524.2 11/11/2003 Bromodichloromethane 0.7 ug/L 0.5 EPA 524.2 11/11/2003 Bromoform BRL ug/L 0.5 EPA 524.2 11/11/2003 Bromomethane BRL ug/L 0.5 EPA 524.2 11/11/2003 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 11/11/2003 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 11/11/2003 Chloroethane BRL ug/L 0.5 EPA 524.2 11/11/2003 Chloroform 20 ug/L 0.5 EPA 524.2 11/11/2003 Chloromethane 0.9 ug/L 0.5 EPA 524.2 11/11/2003 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 11/11/2003 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 11/11/2003 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 11/11/2003 Dibromomethane BRL ug/L 0.5 EPA 524.2 11/11/2003 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 11/11/2003 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 11/11/2003 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 11/11/2003 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 11/11/2003 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 11/11/2003 Methylene chloride BRL ug/L. 0.5 5.0 EPA 524.2 11/11/2003 n-Buhylbenzene BRL ug/L 0.5 EPA 524.2 11/11/2003 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 11/11/2003 Naphthalene BRL ug/L 0.5 EPA 524.2 11/11/2003 p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 11/11/2003 sec-Butyl benzene BRL ug/L 0.5 EPA 524.2 11/11/2003 Styrene BRL ug/L 0.5 100 EPA 524.2 11/11/2003 Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 w 1'�y OF pA�s� Page: 3 CERTIFICATE OF ANALYSIS ysacttus��`i' Barnstable County Health Laboratory Report Prepared For: Report Dated: 11/24/2003 Order Number: G0323418 John Wass P O Box 553 West Barnstable, MA 02668 Laboratory#: 0323418-01 Description: Water-Drinking Water Sample#: 23418 Sampling Location: 1617 Main Street West Barnstable MA Collected: 11/03/2003 Collected by: Meehan Received: 11/04/2003 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 11/11/2003 etrachloroethene BRL ug/L 0.5 5.o EPA 524.2 11/11/2003 Toluene BRL ug/L 0.5 1000 EPA 524.2 11/11/2003 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 11/11/2003 trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 11/11/2003 trans-1,3=Dichloropropene BRL ug/L 0.5 EPA 524.2 11/11/2003 Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 11/11/2003 Trichlorofluoromethane BRL ug/1. 0.5 EPA 524.2 11/11/2003 Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 11/11/2003 Approved By: VLb Director) it Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 ��eQ W_ Fee----- ------- BOARD OF HEALTH TOWN OF BARNSTABLE ApplieationArVe[r Congtruction Permit o6k;'01 '�fW_1v1 Application is hereby made for ermit to Construct ( ), Alter ( ), or Repair ( )an dividual Well at: Location — Address Assessors Map and Parcel Owner Address Installer — Driller Address �— — Type o Dwelling—' ---- -- ---- ----- Other - Type of Building-- ------ No. of Persons-- -------------- Type of Well �Df7/C——-- Capacity------------------ -- Purpose of Well-------------- ------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a CeLtificateof Compliance has been issued by the Board of Health. --- Sign --------- --- ce Application Approved By ——— —--—— — ao -`- _ date Application Disapproved for the following reasons: ----------------- ------ —--- date Permit No. — SO — Issued---�� — �� -- — -- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of COMPIiante THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by--------- G __ — iir/ ____ Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----------------Dated----- ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-—--- — --- — Inspector-- - —-- - -- - —---- Fee------��-�----------- '+ BOARD OF HEALTH TOWN OF BARNSTABLE ZipplicationArlVell Co0truct ion Permit Application is hhe�r�eJ y ma a for afrpeeJrmit to Construct ( 41, Alter ( ), orr Repair ( )an)' dividual Well at: —) Location— Address Assessors Map and Parcel Owner Address 1 Installer — Driller/ /Address Type/of,-Sa'ilTding j ! DwellinB�------ -- -- —-- — Other - Type of/Building-- -------- No. of Persons-- ---- ---- - Type of Well Capacity------------' r - -- —-- Purpose of Well Agreemenf' The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation untiZaertificate ,of Compliance has been issued by the Board of Health.`_ r --- Si n ---------- — - da te e Application Approved By --- --—-— / �-- date i r Application Disapproved for the following reasons: _ r ------------ SCE �-- Issued----/��a�_�a —date — !I r i j Permit No. � date I _i, BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of COMPhance THIS IS TO CERTIFFYY, �That tth'e'Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by------ Installer -- at- --/� /%/.9/rt/ s/ _�, �i� Gam/•_ ��i�.S' .�J/!--;,_, __'� 6 ----- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ----------------------Dated----- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- - -- Inspector------ - -- - — ---- BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con5tructionpermit No__ Fee— -�---- i Permission is hereby granted /�1�,�// /1114;17_ -- — ----— /1dEi��.IC'G I to Construct ( ), Alter or Repair ( ) an Individual Well at: !, No. —/��7/fli9�N S7� �f �o� Street � I as shown on the application for a Well Construction Permit No.-- '3 j U —--_ Dated Board of Health DATE � -7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (,1'7 Appliration for RspoiiFal Works Tnnitrurtinn Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Li .... ........ . a-41,(.......-•--•• -------------•------•-•--••-•-••---•--...._. .....---•----.........----......------... .Location-Address or Lot No. .- ._.. -- -------------- ..... W .:....... .tl.._ !.E�.eLa K=� ddre........— s Installer Address Uof Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms.---- 4�.................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e 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. 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..-----.--------.--.---- fi, Test Pit No. 2................minutes per inch Depth of Test Pit--............--.... Depth to ground water........................ a •••-••••-••••-•••-----------•••-•••••••-••-••-••--••-•-•-•-•••-••-•....•----.....-•-----•..........................••....-•••••-•-•-•-•---•--•-•-•--•--•.... 0 Description of Soil----------------------------------------------------------------------------------------------------------------------------------------------------------••-•----•-•--- x U W --------------------------------------------------------------------------------- ••• .....••••• ................ VNature of Repairs or Alterations—Answer when appli©ac�able -- J,............... ------•-••-•••--••-••••-•-•-•----•-•-•••••••--•-•••••••••••-•••••••-•.....----•G+' ---- el ------------------------------------------------- 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 Complianc a ee i sued by the board of health. Signed ----------- ..... ................... ------ ................................. ..............----------------------- Dare Application Approved BY �� ------- �[� ' Application Disapproved for the following reasons- -------------------------------------- ------------------------------- ------------------------------------------------------- -------------------------------------------------------------------------------- ------------------------------------------------------------ --------------------------------------------------- --------------------------------------- [e ppvv PermitNo. ------70---`-..� 5-------------------------- Issued -------- ..---------- .................................. Da[e i t No.... _115 - _ Fss.. ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE liratinn for Dispnstti Workii Tonstrurtion f unfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Lj � (�... ... ........................ .....•.._.._. ._.....------------------............---- _ Location-Address f or Lot No.-. Owner �esA /Installer Address Ti—I Building U Size Lot............................Sq. feet. welling—No. of Bedrooms-------I................................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..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No---------_---------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.--.--.............. Depth to ground water........................ r3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................--. a ---------------------------------------------------- -------------------- --------- ---------------------------------------------------------- 0 Description of Soil.........................................................................................................-............................................................... x x U Nature of Repairs or Alterations—Answer when applicable-- ems' �J �=-•------------ „'15 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 Complianc 8ha�' q�en is ued by the board of health. Signed---- ----- ------------------------------------ ------------------------------------------------- ---------------------_------------- � Date Application Approved By ............... ----------- -- e U Application Disapproved for the following reasons: ... -------- ..................................... -------------------------------- -------------------------------- ---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ........................................ Permit No. ....... .- �f 5 Issued e ....� ..................................... ...............--.-.--' ...-..-.-.-...-'----------'--.-...-.- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cex#iftrate of Qlantylian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by--------� :r J - at .-L - v. W ---....y. '--- s-- ---.---------------------- has been install led in accordance with the provisions of TITLE 5 of-��o.�The State Er}vi onmental Code as described in the application for Disposal Works Construction Permit No. ........-. . .. ........... dated- THE'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSED AS A GUARANTEE THAT THE SYSTEM W� FUNCTION SATISFACTORY. DATE.......:... / ------------------------------------................................ Inspector ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o - TOWN OF BARNSTABLE 3� No.......�.....1", .....J FEE........................ Disposal Works Tuna#rur#iatt "pamii Permission is hereby granted..........SN ...... a, .--•-•-•--•----•-•-------....-•------•--•-••.................................................... to Construct ( ) or Repair (X) an Individu Sewage Disposal S�yst n at No------------......-.I--•--..... --�-=-?7 r ecs s' ...... .. ---------**------...............................................•-------------- ... Street 9�— L/0 5 as shown on the application for Disposal Works Construction Permit No.. ......../. Dated.......................................... ............................. ut ................................................... DATE. % t � `7 _ QD Board of Health ........ FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS � lTOWN OF BARNSTABLE LOCATION'��� SEWAGE VILLAGE ASSESSOR'S MAY & LOT INSTALLER'S NAbfE & PHONE NO. _ f -3dd�� SEPTIC TANK CAPACITY_ 0® _ a LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED, ����' VARIANCE GRANTED: Yes — —No CoP � � s r �7\ �y`fv U - 1 �l 1 fTHE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Avvtiratiou for Disposal Works Tomitrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ystem at ..-- ---------------------------------------- ----••--.----------•-----.........-•----------•-------••-----•-----•-...---._.....---------------- cation-Address or Lot No. Address — -------- taller Address Pq Q Typ f Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.--... ._..: -------------------Expansion Attic ( ) Garbage Grinder ( ) 'k Other—T e of Building ..... No. of persons............................ Showers — Cafeteria A4 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. 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. I................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.----------------.------ ------------------------------- -•-- ............`...................................................................................................... O Description of Soil....................................... --_- .......... .4-------- ------ . x V .----------------------- . - ----------------------------------------------------------=------------------------•---------------------------------------------------------------------------•------------------------•---....... U Nature of Repairs or Alterations—Answer when applicable..............................:...................................................„ ......... ----•--------------------------------------•-------------------- .....----------------•-------------------------------------------------------------------------------------------•----------•--------- 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 Complia has bee vsseAhe board f he lth. y� Signed --- ---- - ----------------------- ------r -r-- --'-/-O Date ApplicationApproved By ----------------- -- ----- ...... ----- -- --. . .------ ................... ----------------- ---------- ---------................... Date Application Disapproved for the following reasons- --------- ----- -------- ------------------------------------------------------------------------------------------------------- ------------ ---------------------------------------------------------------------------------------------------------------- ------------------------ - ------ --------------------------------------- R ^ Date PermitNo. ----- 3--.-.... .. Issued -------------------------------------------------------------- -- '� Date i =.......... THE COMMONWEALTH'OF MASSACHUSETTS BOARD--OF HEALTH _.� TOWN OF BARNSTABLE �- Apptiratinn'for Disposal lWrks Ton-9trur#iun-rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ), an Indi"idual Sewage Disposal System at 4 • A�L6o„ cation-Address or- No ---------- O er •Address ...........................j ^J[/ I aller ' '.J Address � y d Type`df Building ��' Size Lot.......'......1._.._....,..�q feet aDwellingNo. of Bedrooms.......X.................. __.Expansion Attic Garba e'111_Grinder aOther ' Type of Building,!...........................�No. of persons_--------------------------- Showers (J ) w— Cafeteria ( ) Otherfixtures ---------------------------- = .............................................................................................................. W Design Flow........................t,..__:.......____gallonskper person per day. Total daily flow...................................--......gallons. WSeptic Tank—Liquid capacity.............ga110"ns Length................ Width................ Diameter---------------- Depth.......... x Disposal Trench—No.jA.1..........1`Width:................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........__._!�----- Diameter.................... Depth 'below inlet.................... Total leaching area..................sq.-ft. Z Other Distribution box( ) U Dosing tank (U��)J ti •� e -- a W Percolation Test Resultserformedl by......... .... Date---•---------------•------------------- 1 Test Pit No. I..............�'minutes per inchXDepth of Test Pit.................... Depth to ground water................I--____. 44 _.___Test Pit No. 2.......f .minutes per,in ch�u_Depth of Test Pit..................Depth to ground-water:..-...........L O Description of Soil........................................ w , , UNature of Repairs or Alterations—Answer when applicable.................................................. ._..._...._._._.._...__.._....___:. ----------------------------•---------------------------------------------------•--•------...........-----•-•--------------------•---------------------•--------------------------------•------••------- i 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 .s system in operation until a Certificate of Compliancyhas Wbeeissu�d y he board f health. /Signed ...-- .��, . . . -- - ---/-------------- -------- '.-�21--- 11 Date ApplicationApproved BY ----------------- -------------- . ... ..--. . .------ .... . ----------------. ---------- -----------.................. ---........ Dace Application Disapproved for the following reasons: --------------------------------------------------------------------- --------------------------- ------------------------------ .------..- ............................................ ..' ------....----------..............------ ......:-.. . .. --------'----- / Date Permit No. ���.' 3- ------------------------ Issued ...--------------.---------------------........ ------ Date; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH—-,- TOWN OF BARNSTABLE Ter#ifirate of Tomplianre THIS IS 0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�r by -.:-... � .... ....................................... . .. ..................... ....:... Installer at ............... ....... G�_aa tL .P l ... � I has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code s described in the application for Disposal Works Construction Permit No. ........ dated .-.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILLlFUNCTION SATISFACTORY. -/._._.__ DATE......;... A I--TO----------------------------------------------------------- Inspector ..... ..... �/.//�_�_---°%'-"-----------"`-_------------------- t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......................... FEE...= ..__............. Disposal Works Tonstrnrxion prrmi# Permission is hereby granted............. ....._ .� . to Construct ( ) or Repair ( "an Indlvidual Sewage DisposaY System atNo..........*_DL........ ....... ...............................•--•-••-----••-----•-•--......... Street qq� � as shown on the application for Disposal Works Construction Permit No.�Jri.�7� Dated.......................................... ...................•-..... t ------ ----------------------------•- Board of Health DATE............................•---•-•-•-----•--•--.....---••-•----•------........ ..fi FORM 36508 HOBBS&WARREN.INC..PUBLISHERS