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Home My WebLink About0131 COUNTRY CLUB DRIVE - Health F 131 COUNTRY CLUB DR. BARNSTABLE v e a , v r , W • s � a , 1 y >E` « as" r , r - e u . ,..• ,, .• iJ:w �,, a ff N.' .. � .. ". ., I V . e a- fk - '" :i � x i� D �j No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0ppItration for Migpooar bpgtem Congtructfon i3ermit Application for a Permit to Construct( )Repair( ./jUpgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. /3( �'pvn�Py c�h 1. Owner's Name,Address and Tel.No. Assessor's Map/Parcel 2�O r D 37 2,37 - 73 73 Installer's Name,AddreA W N:MN`►0 Designer's Name,Address and Tel.No. 350 Main Street . YarmoOih. MA 02673 Type of Building: Dwelling No.of Bedrooms 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 Nature of Repairs or Alterations(Answer when applicable) IZ t.0 6t c, q`t PVC 4-0 C<SS P a 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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed j' Date 0 , a �'d Application Approved by Date 6 r� , Application Disapproved forte foll tng reasons Permit No. Y 91R Date Issued No. : Zenon — .... . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for 30iopooal 6potem Congtruction Permit Application for a Permit to Construct( )Repair(./ Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. 1 ( CvU,� f y u(a Owner's Name,Address and Tel.No. Assessor's Map/Parcel O 37 -, 7 7-� ? Installer's Name,Address,an&WS CAIVCD Designer's Name,Address and Tel.No. 350 Main Street SIN. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms 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 "L Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ��c��a cc "� t�L/C +O CZ SSP v ti Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. I Signed 1� Date a a a ? Application Approved by Date g;-�Q, - Application Disapproved for a following reasons - _ T Permit No. �i Y � Date Issued ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(•/Upgraded( ) Abandoned( )by �'��/IC o at o un F r C/a / d' e,s 1,n-1 , has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nowlao_ _ t/95f dated Installer Designer?m2_ Sr 9 rf The issuance of this pernAt shall ngiL a construed as a guarantee that the system v i £urTsion as designed. Date Inspector r ^ ———————————————————————————————————— — � ^ No. �— 1/ O q,9 Fee .S THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Awtopozaf 6potem Con0tructton Permit Permission is hereby granted to Constra ( )Repair( gr�de( )Abando ( ) System located at 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:Construction must be completed within three years of the date of this permit. '._ Date: g - 7- Approved by YA s, = (COMMON WEALTH OF MASSACHUSE 1 TS EXECUTIVE OFFICE OF ENVIRONMENTAL,A.FFAIRS` - DEPARTMIENT OF ENVIRONMENTAL PROTECTION +ONE WINTER STREET, BOSTON MA 021081 (617) 202-5500 TRUDY COXF, 350 MAIN STREET = , Secretary ARGEO PAUL CELLUCCI WEST YARMOUTH, MA DAVID.B. STRUIiS r Governor Rq�iJ V.�.� = 508-775-2800 4 Comnussioner �.e�Ga6 � 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A x. CERTIFICATION E� MAP 350 PAR 037 PROPERTY ADDRESS: 131 COUNTRY CLUB DRIVE;CUMMAQUID , "':ADDRESS OF OWNER:,:' DATE OF INSPECTION: AUGUST 6, 2000 NORM LEAN. .„ NAME OF INSPECTOR : "•JAMES D. SEARS f ' I am a DEP approved system inspector"pursuant to Section 15.340 of Title 5 9310 CMR 15.000)` ,e f COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 CERTIFICATION STATEMENT v personally inspected the sewage disposal system at this address and that the information reported below is true I certify that I have e Bona ms h d Y P Y P 9 „P Y P 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 sy,stems. The system PASSES- CONDITIONALLY PASSES X NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS T INSPECTORS SIGNATURE: DATE`. AUGUST,11,2000 The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty'(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 wgional 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: NOTES AND COMMENTS: iA SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS•BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE CAN THE LIFE OF THE SYSTEM. - NOTE: SYSTEM IS BLOCK CESSPOOLS .,O i T f z q4. r ; 101 revised 9/2/98 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION (continued) Property Address: 131 COUNTRY CLUB DRIVE, CUMMAQUID Owner: LEAN, NORM Date of Inspection: AUGUST 6, 2000 INSPECTION SUMMARY: Check A, B, C, orD: r A] SYSTEM PASSES: N/A _ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A 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. 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,unless the owner or operator has provided the system inspector with a copy of a Certificate Of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is 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. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pa 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 mope than 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 y revised 9/2/98 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 131 COUNTRY CLUB DRIVE, CUMMAQUID Owner: LEAN, NORM Date of Inspection: AUGUST 6,2000 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: X 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 IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)THT 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 ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER SEE ATTACHED LETTER 71 revised:9/2/98 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 131 COUNTRY CLUB DRIVE, CUMMAQUID T Owner: LEAN, NORM Date of Inspection: AUGUST 6,2000 D] SYSTEM FAILS: N/A You must indicate either"Yes"or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described 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. Yes No Backup of sewage into 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 over- loaded 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: 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: 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 mapped Zone I I of a public water supply well) The owner or operator of any such system,shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST a Property Address: 131 COUNTRY CLUB DRIVE, CUMMAQUID Owner: LEAN, NORM Date of Inspection: AUGUST 6,2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: - z Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for,at least two weeks 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. N/A As 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,including the Soil Absorption System,have been located on the site.• X The manholes were uncovered,opened,and the interior was inspected for condition of material of construction dimensions,depth of liquid,depth of sludge,depth of scum. the size and location of the Soil Absorption System on the site was based on: X Existing information.Ex.Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)) X The facility owner(and occupants,if different from owner)were provided with information on = the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 ti 5 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 131 COUNTRY CLUB DRIVE, CUMMAQUID Owner: LEAN, NORM Date of Inspection: AUGUST 6,2000 FLOW CONDITIONS RESIDENTIAL: - Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 3 Number of bedrooms(actual): 3 Total DESIGN flow Number of current residents: 1 Garbage grinder(yes or no): NO Laundry(separate system) (yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): YES Seasonal use(yes or no) NO Water meter readings,if available(last two(2)year usage(gpd): 1099 14,000/1998 63,000 Sump Pump(yes or no): NO Last date of occupancy: N/A COM M ERCIAL/INDUSTRIAL: Type of establishment: Design flow: Gpd(Based on 16.203) Basis of design flow Grease trap present:(yes or no): Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: z GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) YES If yes,volume pumped: 1,000 gallons Reason for pumping PART OF INSPECTION TYPE OF SYSTEM Septic tank/distribution box/soil absorption system X Cesspool X Overflow cesspools Privy Shared system(yes or no)(if yes;attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known) and source of information: UNKNOWN Sewage odors detected when arriving at the site:(yes;or no) NO revised 9/2/98 . 6 w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 COUNTRY CLUB DRIVE, CUMMAQUID Owner: LEAN, NORM Date of Inspection: AUGUST 6,2000 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction cast iron 40 PVC other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) ' SEPTIC TANK: N/A " (Locate on site plan) w Depth below grade: Material of construction concrete metal Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions:' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How dimensions were determined `a 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.) GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction " concrete metal Fiberglass Polyethylene other(explain) Dimensions: 4%- 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: 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.) revised 9/2/98 7 R - - - .- s •ems. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 COUNTRY CLUB DRIVE, CUMMAQUID Owner: LEAN, NORM Date of Inspection: AUGUST 6,2000' TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction concrete metal Fiberglass Polyethylene other(explain) Dimensions: Capacity: Gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order Yes; -:No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: N/A (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 8 SUBSURFACE SEWAGE DISPOSAL SYSTEWINSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 131 COUNTRY CLUB DRIVE, CUMMAQUID Owner: LEAN, NORM Date of Inspection: AUGUST 6, 2000 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type Leaching pits,number: Leaching chambers,number. Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number, 1 Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil;condition of vegetation,etc.) OVERFLOW OOL 6'DEEP.TWO IN NO TEES,COVER 2'BELOW GRADE. CESSPOOLS: (locate on site plan) MAIN LEFT MAIN POOL RIGHT Number and configuration: 1 1 Depth-top of liquid to inlet invert: 4" 2' Depth of solids layer: 4' 2" Depth of scum layer: Dimensions of cesspool: T DEEP 4'DEEP Materials of construction: BLOCK BLOCK Indication of groundwater:. NO NO 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.) LEFT MAIN POOL AT WORKING LEVEL,ONE IN,ONE OUT. NO TEES, RIGHT MAIN POOL ONE IN,NO TEE,ONE OUT WITH TEE. PRIVY: N/A (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.) .g revised 9/2/98 _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) M e •,u Property Address: 131 COUNTRY CLUB DRIVE,'CUMMAQUID Owner: LEAN, NORM Date of Inspection: AUGUST 6, 2000 SKETCH OF SEWAGE DISPOS AL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house) ,23 Ste' t � tj 'S �t� • . O j � 7 revised 9/2/98 10b " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 131 COUNTRY CLUB DRIVE, CUMMAQUID Owner: LEAN, NORM Date of Inspection: AUGUST 6, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers 46. Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) 5 LOT AND AREA HIGH NO GROUND WATER PROBLEM. t revised 9/2/98 11 350 MAIN STREET TEL: (508)775-2800 WEST YARMOUTH MA 02673 (800)698-3993 ®t FAX:(508)778-9628 Septic Service Mechanical Services Pumping & Heating & Plumbing Installation Fire Sprinklers Since 1930 August 11, 2000 Norm Lean 131 Country Club Drive Cummaquid, MA 02637 ' RE: Title V Septic Evaluation 131 Country Club Drive The system is three (3) cesspools.' The pool to the left of the house is close to wetlands.'The system will pass with the approval of the Health-!'Department. The pool to the far left is filled,•and the pipeline, is re-piped to the middle cesspool and the tee is installed. Note: The system is working' at the time of the inspection.' The system is of cesspool block construction. •• . 1. � t. ii:"' t v li TOW14 OF BARNSTABLE :LOCATION 13 ( (,c,�y j/l (c.� 7 C �lil�-� SEWAGE # VILLAGE ---' `� �037 G 3 C ASSESSORS MAP LOT F INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1 SrULl F LEACHING FACILITY:(type) i A 1a / A (size) I f NO. OF BEDROOMS 3 PRIVATE WELL O �UBLICWATE i BUILDER OR OWNER a I�t ll v yk�+0A DATE PERMIT ISSUED: f i DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t i � o t TOWN OF BARNSTABLE LOCATION / / C'o Y C 32 SEWAGE # VILLAGE 0 1i 410 b ASSESSOR'S MAP LOT 3 So 67 /Als/0fc7T,es IN9`f��4L 'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No /cif o m 7- 0 a {t' TOWN OF BARNSTABLE • LOCATION C l ud ,?/f SEWAGE # . VILLAGE 0 ASSESSOR'S MAP & LOT 3 Sa . 07 9 /A�S FC?a,e.S 'S NAME PHONE NO. A & B CPO= 775-6264 .SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 0/P/� ,g A.- DATA PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No O TOWN OF BARNSTABLE ,LOCATION 13 t C,c,,qiAti Cf A SEWAGE # ASSESSOR'S MAP LOT G 39 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) j A to i/L / r% (size) NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER �'`�a k�„„�.�� t� f DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r 0