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HomeMy WebLinkAbout0180 BISHOPS TERRACE - Health 180 Bishops Terrace Hyannis F/R Y A = 251 174 i i� r e ii TOWN OF BARNSTABLE LOCATION ►S r I e SEWAGE.# l �a. VILLAGE n ' ASSESSOR'S MAP & LOT�'�i—I y INSTALLER'S &PHONE NO. /V F G K SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 2—Exz cam i. r^GM6Csfie) 2, x 13 - NO. OF BEDROOMS BUILDER 0 R ✓t✓l PERMITDATE: COMPLIANCE DATE: /U /UZ Separation'Dist.ance 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 MAP NO. C_2 A T e o=.1.�&Z�- LOT NO. DDRESS 601:f ll®dj l;a-x,Cj 014NERS NAME:SEWAGE PERMIT NO. :,too.A-4/9j'NEW: REPAIR: DATE ISSUED:/D)J ell DATE INSTALLED: INSTALLERS NAME INSTALLATION OF:)t-4,po4,ot x1, : WATER TABLE: FINAL INSPECTION BY: t DRAWING OF INSTALLATION ON REVERSE SIDE : W N � No. CL CC'Egp Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compute Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for 321i$po 6petem Construction 3permit Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. rzL c _,p._ Owner's Name,Address and Tel.No/��. 'fsc-�r/'T �'j✓7 Assessor's Map/Parcel e J / ^� C( , `� / S � / f -,t C v� Installer's Name,Address,and Tel.No. � Designer's Name,Address and Tel.No.DAI& ���,`,, �S � �jryJ N►r�,o S ors s � Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building '6421c 02 7No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `� gallons per day. Calculated daily flow 3el v 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) cJJ� a!V /t/P �i holycc� � ������ ✓—f 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 tronme aLCbde_and_not_to_p1apg the system in operation until a Certifi- cate of Compliance has been is y th' Signed Date Application Approved by Date Application Disapproved for owing reasons Permit No- Z ��� Date Issued his - N. v Fee� �• y M THE COMMONWEALTH OF MASSACHUSETTS Entered in:compute�� i Yes PUBLIC HEALTH bIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Application for i5 o 'a" *v5tem Construction Permit Application for a Permit to Construct{ )Repair(( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. j e p- ',�r✓+z Owner's Name,Address and Tel.No/�J Assessor'sMap/Parcel / , �- �( �ya�ti15 l -slx� �-��`� Installer's Name,Address,and Tel.No. j��(,,Q Designer's Name,Address and Tel.No.Dki d/ �- �� ►Jle,Z,v �- Type of Building: Dwelling No.of Bedrooms " " Lot Size sq.ft. Garbage Grinder( ) Other Type of Building le AOr No.of Persons Showers( ) Cafeteria( ) Other Fixtures a r s Design Flow gallons per day. Calculated daily flow `3y gallons. Plan Date Number of sheets i Revision Date m Title s Size of Septic Tank Type of S.A.S. Description of Soil! Nature of Repairs or Alterations(Answer when applicable) .l c46 3 Date last�inspected- Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system iri"accordance with the provisions of Title 5 of the Enviro n a Code.and,.not to-place the system in operation until a Certifi-. :-r `` cate of Compliance has been issued by t'"�hts oard_0 ._ea _ r Sign Date Date Application Approved by `� Date: Application Disapproved forrthj-fdl owing reasons a-� Permit No. _ Date Issued —_-_—_ ------ —————————— -------— — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE ,tha the On-site Sewage DisposalSystem Constructed( )Repaired (�)Upgraded( ) Aband ed( `):by / _' / "T7� N e, at ! ! r , ,PO 1-r," - _ , has been,constructed in accordance with the provisions of Title 5 and the for Disposal System Cons d ction Permit No.r WA 40l ated Installer Designer The issuance of this ermYshall no be construed as a guarantee that the s Metwll function as dsigned- 'b.DateInspectorl I. ��2 ----'---------'----------- No. Fee_" ` � c✓ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Migo!5ar *pg-t Construction Permit t Permission is hereby granted to Construct( Repair Upgrade( )Abandon( ) 9 System located at r6� 1.SZt < t 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 in st be completed within three years of the date o s errn / Date: �6/?%° Approved by� . f t , t r, .. F.. { TOWN OF BARNSTABLE LOCATION © 1�� I le-rr'aCe SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S &PHONE NO. IVFCk Ja�M ,. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) rC^r'" ) 2,V - 3 � } NO. OF BEDROOMS Ir BUILDER Q R c en rin or PERMIT DATE: COMPLIANCE DATE: 231 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by i o - � . 3 3 19 . 3 �z a sex s A 9 � I { Commonwealth of Massachusetts Executive Office of Environmental.Affairs John Grad D.E.P. Title V Septic Inspector Department of . P.O. Box 2.11.9 ' .Environmental Protection Teaticket, MA 02536 WUI m F.Weld (508) 564-6813 . Trudy t.oxe Bee t.,Y.EOEA David B. Struh4 i Comminioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO PART A c/G All .. .. CERTIFICATION 41 Property Address: ' 6C �t�1"1OP,S �e. � Cttl'(1lS Address of Owner: r*� I l 9� Date of Inspection: ����q� (If different) �� 6- Name of Inspector: Company Name, Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: `Y 1 Lasses _ Conditionally Passes _ Needs Further Eval ation By the Local Approving Authority Fails Inspector's Signature: Date: u. The System Inspector shall submit a copy of this inspection .report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a.shared system or has a design floe. of 10,000 gpd or greater, the insPector"and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. " The original should be sent to the system owner and copies sent tv tier buffer, if applicable and the approving authority. INSPECTION SUMMARY: _SUMMARY: Checl(A,16, C, or P A) SYSTEM PASSES: L-T'ha,e 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. 61 SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement.or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND)I Describe.basis of determination in all instances. If"not determined", explain why not) The septic tank is-metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Whiter Street • Boston,Massschusetts 02108 • FAX(617)SWID49 • Telephone(617)292-OW 40 Primed an Rwycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION (continued) Property Address: t Owner: Date of Inspection: BJ SYSTEM CONDITIONALLY PASSES (continued) 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 pass,inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass a inspection'if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ" FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC.WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT.THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT _ I UhP >\G(pl nd? d lerllC IdnA dll !U auaorprionsysten, and liKinUn feel .i o Su1io_cc v.-Sic.- ujjI., t ir.,Lu. u:arr tau surface water supply. _ The s\sle- ha, a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The sy�iem has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to'or less than 5, ppm. D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in`310 CMR 15.303. The basis for this determination is identified below. The.Board,of Health should be.contacted to determine what will be neces sary to correct the failure. Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. Discharge or pondin of effluent to the surface of the ground or surface water;'due to an overloaded or clogged"SAS or let cesspool. (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D) SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). 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 a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no . acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist, the system is within 400 feet of a surface drinking water supply the system is within 100 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 welh The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 6/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: zV Owner: Date of Inspection: Check if the following have been done: _L.,­u'mping information was requested of the owner, occupant, and Board of Health. one 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. (�s built plans have been obtained and examined. Note if they are not available with N/A. ►�e facility or dwelling was inspected for signs of sewage back-up. ufre system does not receive non-sanitary or industrial waste flow L—WO site was inspected for signs of breakout. system components, excluding the.Soil Absorption System, have been located on the site. - _.-_�fte septic tank manholes were uncovered, opened, and the interior of the septic tank was.inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum, The size and location of the Soil Absorption System on the site has been determined based on_existing information or appyoaimated by non-intrusive methods The fadLt, c,% ­ if difiprpnl frnm owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION Property Address: Owner:Date of ln� C.g(bP spe ion. lit` .FLOW CONDITIONS RESIDENTIAL Design flow: �, �-j al�ns Number of bedrooms: Number of current residents: Garbage grinder (yes or no)�LD Laundry connected to system (yes or no):-114e$ Seasonal use (yes or no):�� Water"meter readings, if available: f occupancy:, I Last date o COMMERCIAL/INDUSTRIAL:No - Type of establishment: Design flow: gallons/day. 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: GENERAL INFORMATION PUMPING REC Sand source of informs ion: System pumped as pan of inspection: (yes or no) If yes, volume pornpred gallons „ Reason for pumping: TYPE OF SYSTEM L—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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: ' E Sewage odors detected when arriving at the site: (yes or no)�O (revised 6/25/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART L SYSTEM INFORMATION (continued) Property Address: Owner: NA ^� Date of Inspection: SEPTIC TANK: (locate on site plan) Depth below grade: t Material of construction-, ✓concrete ,_metal _FRP­other(explain) Dimensions: IL 410k. tt Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: �7►i Scum thickness: y t Distance from top of.scum to top of outlet tee or baffle: tl Distance from bottom of scum to bottom of outlet tee or baffle: (y tt Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, dep h of liqt�icl level in relation t outlet invert,structural. integrity, evident a leakage, etc.) A O(YY\ (�,4Q_" Adoc- OV Crc4nft odC GREASE TRAP:C)"i (locate on site plan) Depth below grade: Material of construction: concrete _metal FRP other(explain) Dimensions: Scum tnic{,ne». Distance from top of scum to top of outlet tee or baffle: Distance from boom ni cr, n rn bottom of outlet tee or baffle 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 8/.5/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION,(continued), Property Address: (�\ Owner. Date of Inspection; TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: concrete—metal —FRP_other(explain) Dimensions: Capacity: Rallons Design flow: Qallons/day Alarm level: Comments: (condition of inlet tee; condition of alarm and float switches, etc.) DISTRIBUTION.BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: note if levei and dietnuuuur. o equal, e�jdviice of solid: ca:,)o,er, evidence of leakage into or out of box, etc.? PUMP CHAMBER:_ (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:,VRrN Owner: Date of Inspection: (.D( q SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may approximated by non-intrusive methods) If not determined to be present, explain: Type. \ leaching pits, number._,,ow �Qx\%L V1Qf.h �t leaching chambers, number._ leaching galleries, number. leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number. Comm ts: (note condition of soil, signs of hydraulic failure, level of pondin condition of vegetation,etc.) �. S CESSPOOLS: ���( (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 ground•,:a:c-. 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.) PRIVY: (locate on site plan) Materials.of construction: pimensions: Depth of.solids: Comments: (note condition of.soil, signs of hydraulic failure, level of.pond in& condition of yegetation, etc.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of , SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' ' � g C� e o rR b � 0� 346 DEPTH TO GROUNDWATER Depth to groundwater:__21feet method of determination or approximation: ('T cl. ����.� ��M a (revised 8/15/95) 9 47 No...... 1� Fes$. ...................._ THE COMMONWEALTH OF MASSACHUSETTS `�� BOARD ®F HEALTH H aw ..... ........0F......�'�/ /ke...... -............................. A Iiration for Big osai Morkii Tonii1rudion runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �............. .................................. .... ......L,.O �.-.�.�.... -•---....._.. ..�,��®,ems .7! ....,. , ............ Location-Address ..........ft1.1 L. /.. �. ..,.....L.:...A1.. .............. ........s„F...7A..........f%U...:. ' �1�..... ��y� �•--•---- ;.. Owner Address W Instalier Address UType of Building Size Lot............................Sq. feet b .....Expansion Attic ( ) Garbage Grinder ( ) Dwelling—No. of Bedrooms.......... ...'....._..._..._..... aOther—Type of Building .... ....................... No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. W Design Flow.....:ZE!1-------------------``--_--.-gallons per person per day. Total daily flow..........�.?l.d!__......._....__.._...__gallons. WSeptic Tank—Liquid capacity/AdAgallons Length................ Width------_-------- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No/d-A.O---7*1DDfameter-__--___-___•___---_ Depth below inlet.................... Total leaching area... f'. Jsq. ft. Z Other Distribution box6 ) Dosing tank ( ) aPercolation Test Results Performed by..................... ..................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ rXI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 ••-----•---------------••------•••-•---•••--•-••••-••-.......---••--•••-----•---•-•---•----------•-•........................................................ O Description of Soil....................................................... ............ -- •--•---•------••--•--------------------------------•------------------ �� � .... - W -- ----------------------------------------------------•......._...................-----------------------------------------------------------•--------------------------------------------------------•-- 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 Article XI of the State Sanitary —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be i yued��� / d of h th. / Signed------. ..... i��'�� F. --- ---•. ............................ F �j -------------------- Date Application Approved BY G' +r'`�%�' Date Application Disapproved for the following reasons------------------------•----------------•-----•-------•---..--.-......_....-----------------------•------...-•-- •---------------- --------------------............---•------.._....-----...---------------------•--•....------------••--•-...-•• ---------•-•---------...-•-•••------•-•-••-•-••-•--•-•••---•----• Date Permit No...._Y3a.j....................................... Issued...--- Date No........a ... Fps..... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n ........._-.....--..OF..... N�.......... ..... pliratio t far Buivatial Ton.5trudivit Vrrmft Application is hereby made for a Permit to Construct ( ) 'or .Repair ( ) an Individual Sewage Disposal System at: ............:.... ...^ ..::.................................._.._...,_.,,..........,.,....... ............ .......�........ ....:............. .•Location-Ad ess N W .........., Owner ....... J ........Z................................................dress r a .......................................................... ...... ---.............. -................. ....:.... Installer Address U Type of Building r Size Lot...................._......Sq. feet .; Dwelling—No. of Bedrooms...........................................:Expansion Attic ( ) Garbage Grinder ( ) a`-4 Other—Type of Building No. of persons............................ Showers — g ---------••--••............. P ( ) Cafeteria ( ) d Otherxtures ............................... ----------------- .+ _' ----------- W Design Flow...... -- ............... _,.gallons per person per day. Total daily flow.-------. ga llons. WSeptic Tank—Liquid capacity.........---gallons Length................ Width.....----------- Diameter................ Depth................ r Disposal Trench—No...................... Width.................... Total Length.................... Total leaching area....... ___�,,,sq. ft. 6 �f .0 z" Seepage Pit No.-.--'--:-w-- !..._. 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.-------.----.-.-..---.. w Test Pit No. 2................minutes per inch Depth of Test Pit,.--.-.----.--_---- Depth to ground water--------.---.------. --- .....-----•• -•--•-------•_. ...........•.• ............................................................................................. 0 Description of Soil............................... ---------------------- ------------- -----------_:_: ------------------------------------ , . ;.+ /fir :; U =---•••-•-=-=--•--•--•••--••-----•--•------•----------•----•-.....Vy--- W ------------------------•----•-•_.....----•------------•-----......---------------------------••--------------------------------------------------•-•-•----••--•-----------•---••---•••-------•...----- 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 Article XI of the State Sanitary Co e The undersigned further agrees not to place the system in operation,until a Certificate of Compliance has been iss ed by of heal S>gned _...... . .. .R.. ------------------_-- Application Approved BY----.--- .`__:" "``.. +; Date . ---....-- ......................... .......... . ........................................ •--•---------- -------- --------• Application Disapproved for the follouvin�j reasons:-------------- -- ------------•- Date ----------------------------------------------------------------•-----------------•---•----...----•----............................ ---•-----••--••---•---•--•-....----••......-•--•-•................ Date Permit No........ '/' ...... Issued........... 6.;,7 ........:......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c f �d*' f. ............................OF........,...<:. r.:........ ......................................................... re THIS I O CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) �nstalle has been installed in accordance with the provisions of Article Xa of The State Sanitary Code as described in the application for Disposal Works Construction Permit tiro...--, _ ------------------------- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE DATE WIB�LI'ICTIOfd-SATISFACTORY..----• Inspector.---...----'•'�---.�-���...���t� �`��. ................................................. „ h1leo., ., r' THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH .............. FEE.. ................... Permissiongishereby granted,---:..........................-................................. •-•-••••-•---•--•-•---..................................................... to Construct,(` ) or Repaiyr ( ) aiL I;ndi�idual r t° Sewage l.sposal System hh r .......................................................•-- Street „ as shown on the application for Disposal Works Construction Peen it,Nc�: � ))ated � ..." :.' ...................... 4i .... .. .._•___.. i..,y:".............. . .a ---------- ......... .w e . a y t Board of Health DATE ..` .f .._ ....-; '` r . FORM 1255 H06BS &WARREN,. INC., PUBLISHERS ASSESSORS MAP : S\ _-_-- - ----___ TEST HOLE L 0 G S PARCEL : L -- ------- -- FLOOD ZONE: SOIL EVALUATO : ! �f7 vv���� _ REFERENCE: J �. Z WITNESS : b t _� Co` _ DATE:' Z - �--�1 .'G PERCOLATION RATE: Z UUl( 1 I� ---_- -�_1vY� W o - 1 TH- 1 TH-2 --Z � ICJ l _ 5nLotkm il LOCATION MAP �� �- µ� ,- �jIt1T t,o 1' r h ems-- PAW,, 6+4 0 ' �`��-• i ^mf r _-_.-.-_ _ _� _____-__._-__.._._ a _ —_ . -gyp �� _ _ - ,��d�� � �- r$� ----- ' 'sliim;s:/YC- -y, ,.aFr-.Y',ki,_Y ^ i`A.' '*Sef 's' ..9 ,f EVrI ) �.Y-Y /1 V •\1 t, V _--.._ �� + — 1� • I y_—(Y / V .yam/ .E Fly- SEPTIC SYSTEM DESIGN lht, IL _ tr k I 1 FLOW ESTIMATE ----- IR P . 3 BEDROOMS AT C�� GAL/DAY/BEDROOM - 3�OGAL/DAY ---- - ---"------- - - ----_ __T___ SEPTIC TANK 3F. 3?Q GAL/DAY x 2 DAYS d GAL i ` ) USE IOU,) GALLON SEPT 1 C TANK I p� w rit�(��.{ - 5(�-rL--ABHOR N �Sr�fiEM `� _ C 'r t wr . 1�5� � 5 � g '�►2 ���2 w�c, TE _. S I DE AREA: BOTTOM AREA: 1 = -0:23 r D ipej Ou -_• S C SYSTEM SECT I ON L4o.-5l M1 4: \3 4 W 74rr I i 7 r D_BOX [00 D GAL (alo to —__ SEPTIC TANK _ .._.W� -% - 3 -I I -D0_ UP/ W +� 39OF x !3 7 SITE AND SEWAGE PLAN /TA 'f LOCATION : - �� 15NOP�J .� PREPARED FOR : IR05ee W� oC.0 IOC. P A o , SCALE: 1. W z DAV I D B . MASON R5 DATE: O dZ DBC ENVIRONMEN AL DESIGNS W EAST SANDWICH . MA W DATE HEALTH AGENT - 2177 ( SO8 ) 833 Z