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Home My WebLink About0281 MEGAN ROAD - Health 281 MEGAN_ ROAD, HYANNIS A= 291250 f e i i TOWN OF ARNSTABLE 5,OCATION SEWAGE #. VILLAGE ASSESSOR'S MAP & LOT p 'NAM &PHONE NO. L 'Q Tot SEPTIC TANK CAPACITY �� ) % LEACHING FACILITY: (type) .l /J (size) NO.OF BEDROOMS BUILDER R OWNER PERMIT DATE: COMPLIAN DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � - .. �� I O - I �,. QJ .. 7c-� �� _.. �_ -� __ ;t P a9/ ! i . BORTOLOTTI CONSTRUCTION,INC. ' 19�8 765 WAKEBY ROAD,MARSTONS.MILLS,MA 02648 508-771-9399 508428-8926 FAX: 508428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 6 PART A - - t r, , CERTIFICATION Property Address: , Date of Inspection: nspectors Name: ' Owner's Name and Addres LET' 62V 2e- t CERTIFICATION TA ENT: , I certify thatI-bave personally mspectedrthe sewage disposal system at this addressYand that the i if rma- tion reported.below iittr' e,accurate compiete as of the time of inspection`The inspoctionr yas per- formed on mytraining a on s nd experience in the proper function and,maiptenance of f%rwago disposal , stems. The System:' Passes, Conditionally P Needs Further nation By ie Local Aproviug Authority - :Fails I—�-f Inspector's Signature:` Date`. ' The System,Inspector shall+submit a copy of this inspection report to the�Approving authority'within thin- gtyp(d30)r stet completing and ttiFe nstem owner si ail submit report st m or has o destgtt flow of 10,000 nspec system to thkappropriate regional offce_of We,Department ofEnviroruoental Protection. The original should be'tent to the system owner ` and oopies'sent to the buyer,if applicable and the approving authority. PASSES: L I have riot found any i'gi€orniation which indicates that the system violates."y of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are mdicarted} , 11. below HF.L B)SMEM CONDITIONALLY PASSES, , }, One or more system components need to be replaced or repaired, The system;`upon comp e;. lion of the replacement or repair,passes`inspection. , i t Ar:._. . i e:Ir, r r.!�i•y s�g;r .,',. '; .;r - i! sr< t. !fi mi :i Indicate yes,nor,or not determined'(Y,N,OR NIJ).Describe basis of deternation in all instances. If not determined exp�tatn why not,r ir.,, s The septic'tank is metal,cracked,structurally unsound,,shows substantial infiltration or r } exfiltration,or tankLfailure is imminent The system will passiinspection-if the existingsep-. tic tank is replaced with a conforming septic tank as approved byr:he Board of Health. x it Sewage backkup or.breakout or high static water level observed in the.distribution box is due to bro1.ken or obstructed pipe(s)or due t.6 a broken,settled or ti ievete'dlstribution box. :The system will pass inspection,if(with approval of The Board of Health):§ - 1 €5. .r 1;tM b z >� a t e `•E lww'g 4• yr'�� xS.�Y. 'a-�dri `','n'r'+Fafi r f4�r l• ,i' �r'dk$,:jrl 'fir.¢,.: .+k 5t : �i,°rv, -� rprF.��§c 61r, , �1� i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �t► � 1i �, PART A CERTIFICATION(continued) • � 1�T� Broken.pipe(s)replaced �.•-''' Obstruction is removed Distribution Box.is,levelled or.replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass.inspection if(with approval of The Board of Health): Bro$eri;pipe(s)are replaced o r 1 Obstruction:.is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board.of Health,in order.to deterr%=if failing�to rotect the ubhc health,safety and thcenvironment. �.4. vit I+ � i the ,.fit p ,,, p ��F� y j s51)SyST. +,WILL]PASS,UNLESS BOARD OF HEALTH DETERMINES THAT THE, R o ;.y SY$TEM'.LS NOT,iFCO WH H 'O PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:,, Cesspool or privy,is within 50 Feet of a surface water t '+ w Cesspool or,privy 4s within 50 Feet of a bordering vegetated wetland of a"salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD.OF;HEALTH"(AND PUidLIC.WATER F SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM L5_FUNCTION- ING IN A MANIJERTHAT PROTECT THE PUBLIC HEALTH AND SAFETY ANDwTHE" ENVIRONMENT: �•, „�. The..system has,a aeptice tank and soil.absorpuon system and is within 100 Feet to a surface° r a: water!supply or;tributary to a surface water supply. % , The.system:has,4 septic tank and soil absorption system and is with a Zone I of a pubLc° n�� ;. :water supply well. The system has a septic tank and soil absorption system and is within SOw Feet of a%prrvale ' water supply well. The system.has a septic tank and soil absorption system and is less than,l001eet but.50 1 Feet or more from a private water supply well,unless a well water analysis for'colifoim bacteria and volatile organic compounds indicates that the well is free:from,pollation ft= �I;• t ' w#, the facili ran p g g t d the,presence of,ammonia nitrogen and nitrate nitro en is ual,to or less . „• than 5,pP Es . 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 Hoard of Health should be contacted correct the failure. to,determine what will be necessary to ;Y Backup of sewage into facility,or system compon to an due an overloaded or clogged SAS. ' or cesspool Dischargeor,ponding of efluent to the surface of the,ground or surface waters due to�ane+! t.w overloaded or clo ed SAS 4.cesspool. Static ligtud level,in the distribution box-above outlet invert due to an overloaded or1clog- E., p ged SAS or cesspool Ligwd depth to cesspool is less than,ti below invert or available volwne is less than 112 aay Regmred pumping more than 4 times in the last yearOT N due to clogged or obstructed pipe(s).':Number of times pumped ll -2- < � t SUBSURFACE'SEWAGE DISPOSAUSYSTEM INSPECTION FORM PART A ; CERTIFICATION(continued) 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 asurface,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 copiof well water analysis for conform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: , ° xq The following criteria apply to a large system in addition to the criteria above i The desrgn flow,of a system is 10,000 gpd or greater(Large System)and the system is aslgniflc-4nCz threat two4.6bl►c health and safety and the environment because one,or.more of the followingltt,,r:w conditionsextst' ; f The system!is within 400 Feet of a surface drinking water;supply: � 777 'T�m.its within 200 Feet of tributary,to a surface drinking watersupp y The system is located in a nitrogen sensitive area InterimVellhead Protection (I1 IPA)or;;a mapped Zone 11 of a public water supply well The owner or operator of any+such system shall bring the'' stem and facility into:full oomphanoe�wrth groundwater treatment'progmmi requirements of 314 CMR 5.00 and 6.00. Please consultthe:local Y 0y1- regional office of the Department for further information. " } - - ..,J , ,•� b(atyi4-6 z SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 6,he*c'k11if,,t4e following have been done: Vj Pumping information was requested of the owner,occupant,and Board oftHealth -tt _ one of:the system components have been pumped for atleast two weeks an&th_e sy,4tem100", ti been receiving normal flow rates during that period: i✓arge volumes,oftwaWihave-not been introduced into the system recently or as part of this inspection. As4milt plans have been obtained and exanuned. Note if they are not available,with N/k I'he facility or dwelling was,inspected for signs of sewage back-up. e system as receive'non-sanitary or industrial waste flow. q y i Thesite,was inspected for signs breakout' JGAII system'eonponents,,excluding the Soil.Absorption System,have been located on site. y . septic tank manholes were uncovfered;'opene�i,`and the intenorof the septicttanlwas�in ,t J • TV r" •", �dep*� for fbafflesor•tees,material•"of constrution dlmensionss ef sludge,depth of scum.and;location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. :.. -3- f - ` r� ��*r�'� � "n �s1ti` �`k { ^r Fg ,.Jl � � R,; r r;Pi• is tlrr '� .,,, - 't-k � 'j��?�' " ��zf M�49L(eY r t 1.1 i i '.`SUBSURFACE SEWAGE DISPOSAL`SYSTEM INSPECTION FORM PART B CHECKLIST(continued) Tht3 facility owner.(and occupants,if different from owner)were provided with inf • • '" ormation on tlie.proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION. I / FLOW CONDITIONS nt Design Flow: Ilons Number of Bedrooms: Num r of Cu it,Reside,nt Sattiase Grinder Laundry Connected To System: Seasoital Use. �Water`Mete ,'Readings,if av ' ble: Last Date, Ooccupincy j . (iAMMERCIATmNDLISTRiAi -Ab Design Flow `4, '""4 aall'ons/day°',l Grease Trap Present: (yes or no) _ Industnal:Waste Holding Tank"Present T i%.... •. Non-Sanityry'Waste Discharged To The Title V System: Water Meter Readings;IfAvailable: Last Date of Occup cy.,,, A 4 OTHER Describe) Lust Date of Occupancy r "GENERAL INFORMATION 1 PUMPING,RECORDS and source of informLion. fn I Ijo System Pumped as part of inspection if yes,Afoltime purilped: salons: 11�easgn for pumping:=1 TYP$'OF`SYSTEM: } ,1 ,p`s6p4c Tank/Distributioni.Box/Soil'Absorption System 1 Single Cesspool Ove IIow�,Cesspool 9 Privy , Slimed System(If y ,attach previous inspection recortiss,if y) / i, f4 ,, 1 Other(e�iplain) <� + O TE'AMP all cqlqpo ne ts,;date install (if lutown).Vo,source,qf uif� lion' ,r Sewage odors detected when arriving at the site: i i i i v i SUBSURFACE SEYAGE DISPOSAL SYSTEM INSPXCTION FORM PART C GENERAL INFORMATION (continued) V SEPTIC TANK:• ari€,{ 6'!d 1 G' grada: ' .'� Depth below Material of Construction: concrete metal FRP_ her Ot ,i (explain)� ,- • , �?,;., Dlmisioos:Z,6:'Y f.,o' X S1 Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: 3 V Distance from bottom of scum to bottom of outlet tee or baffle: /oye Comments:•(recommendation for pumping,condition of inlet and outlet tees or, f3tles,depth, uid 1 m relation to outlet i ert,stru oral integrity,evidence of lepgc,et �! 1 GREASE TRAP: {� Depth 1�elow Grade: Material of Construction::concrete_metal FRP Other. (U hdn Dimensions: Scum Thickness: •,,� Distance from top of scum to top_of outlet tee or balYle: _ - '' Comments:(recommendation for pumping;condition of inlet and outlet tees or.•ba8les,>deplh o _.qji�tl-t. level in relation to outlet invert,.structura1.integrity,,evidence.of leakage,etc.) )a { TIGHT OR HOLDING TANK: Depth Below Grade: _ Material of Construction:_concrete_metal FRP Other(explain) Dimensions: Capacity: gallons Design Flow: aallons/day Alarm Level: t Comments:(condition of inlet tee,condition of alarm and float switches,etc.)_ }r? DISTRIBUTION BOX: Depth i f 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.) ' a Pump is in.worlaii►g order: Comments:(note`coridition of pump chamber,-condition of pumps and appurtenances,etc.) ` ^d�}ice {�'$�s::.�'�"I i�fi`�'-zi a'��»��N ��'��• . .xc �.....;, I �.-.:y �....@56,.. k...,, hy,.-•,u:;�t� ';�".y'�. h �4Yf t„ ; �,. s s•`'4;P " s ,i .. , :y' Yv 6:"2 k ` l �r i l ;y. 'SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SOEL ABSORPTION SYSTEM(SAS): (Loc m on{sit%plan,if possible;excavation not required,but maybe approximated by non-intrusiver`A methods) If not determined to:be present,explain: Type: pe: , .w i i !,� - - 'f Leaching pits,number:` �' 'Leaching chambers, number: Leaching galleries,number.. Leaching trenches,number;length: Leaching fields;number,dimensions: 'Overllow'cesspool,number:. Comm% is (note condition of soil,sig4s of by ulic -lure lev of pondin condition gf vegetation, Jt r. aCESSPOfOLS:�� Nwnber and configuration:" Depth-top of liquid to inlet invert:___ Depth of solids layer `Depth of scum layer: Dirnensi6ps ofcCesspool{ Materials ofconstruction: Indication of groun.dwater: Inflow(cesspool must be pumped as part of inspection)`' Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) 0. Materials of.construction:� ` ' Dimensions: Depth of Solids. Comments:(note condition of soil,signs,'of loAraulic failure,level of ponding,condition of vegetation, I t -G i ,V gSUBSURFACE SEWAGE DISPOSAL SYSTEM VISPECi'ION FORM- PART C { €, SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to atleast two permanent references, landmarks or benchmarks. Locate all wells.within 100 Feet. to t . t t O DEPTH TO GROUNDWATER: Depth to groundwater: 7 Feet 9 , / Method of rminado or App oximas'on: /� /D'X/ r f?N fy�"O�! u•5 -7- r a- q l - a,S THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Barnstabl APPROVED TOWN OF BARNSTABLE Conservation Department Appliration for Dispao al Works Ton ................. pAPPlication is herebymade for a Permit to Construct or Repair ( X) an Individual Sewage Disposal System at: --.....281 McS .R....Hyannis .. -- ----•---- -••••-------------------------•---------•-------......---•-•---•-...._......----............•----- Ann Riley Location-Address or Lot No. : -----•-••---•----- ...--- -----------------••••• .......... --.........-----•---•---------•------------...............--•-•••.... • Owner Addre W W. E. Robinson Se tic Service P O Box 1089 Centerville Pal Installer Address d Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms.......3...................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Buildin yp g ............................. No. of persons............................ Showers ( ) — Cafeteria ( ) dOther 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 ( ) aPercolation Test Results Performed by ----------------------- --------------- Date Test Pit No. 1................minutes 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........................ 9 ------------------------------------------------------------------------••------•---...........-----......................................................... 0 Description of Soil--------------szaad-------------------------------------------------------- ---------------------------------------------------------------------------------------- x U -----------------------•-------------------------•--•----------------------••-------........--------•---------.-----------------------------------------------------------...-•-----------•------------ w UNature of Repairs or Alterations—Answer when applicable............................................................................................... .......precast.stonapacked__nverf low............................................................................................................................ 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 Compliance has been issue by the board of health. a Signed .. ..... �----^.-'--- ------------------------- 7 — Date Application Approved By -------- -----. .......................---------------------------------. .......... Date Application Disapproved for the following reasons- ------ -------------- ---- -- --------------------------------- -------- ---------------- -------------------------------- ....................................... . .............................. ........ .. ...................... .... .............. Date PermitNo. .. .. ...-....?J-- �x...................... Issued ......................................................... 1 Date ,yfe. z q/ - a..5 N�..g:.fh.:..r,�•S(!a... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Big os al Workii Tonstrur bi/ - irfift' 2�� -5 Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: M 281 eahan Rd, Hynis ........ - - - .. ... an ...... ..................................................... ._.........-- -A - Location-Address or Lot No. ....... rin Riley---...-•---.--•.. ...................•----•----••-----•----...... ........----•••-••--......---•------....... ......._..----••--......-----•-----__.._...... W W. E. Robinaon Septic Service P 0 Box 1089 CentAr file -- a •••--...-•••................•--•-•-•--- - .......................................... .-•-•••-- Installer Address d feet 'Type of Building Size Lot......................_.._..S q. . . Dwelling—No. of Bedrooms._..........................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building No. of persons............................ Showers � YP g ------•-•------------------- P ( ) — Cafeteria ( ) Otherfixtures -----•-------------------------•-•-•------------------......--------------------------------------•-•••..............-- 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 ( ) .11 ~ - a Percolation Test Results Performed'5y.:---;a-=............................................................... Date........................................ . ............... ,.a Test Pit No. 1----------------minutes per inch i Depth of',Test Pit.................... Depth to ground water........................ 0:, Test Pit No. 2................minutes per.inch Depth of Test Pit.................... Depth to ground water........................ o . Description of Soil t _ZayA_.................................... ..................----------------------------------•--------------------------••-•--•-•-•---------------- V i � U �. ....---.--•-, _ ....----•-•-----------------------------------•--•-•------••--------------------...------------------------------------•--•-----........•. xL -•••------------ - ---------•------•-=-3--. ........ ...........-•-------------------•-----•-•----------•---------•---------•----.._..----•---------•-----•-•-----•---------•-•-......--------•--- U Nature of Repa� orlte>;attions Answer when applicable.-..... cf # ?t KF ...........................•---------------------•--•---------•-----•-•-------••--••--•--•-•-•-•------••--------•-•-......... Agreement: I C; The undersigned agr"M-io install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Enviro mental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedsby the board of health. !...... ----- �"------------------------------ Signed - /..�' 4................ - Date Application Approved By ---..-. 4-M^.. ...' .. •`•-, ----------------------------------------------------------------------------------- .- .2.- 1 -------- Date Application Disapproved for the following reasons:. ........................................................:.`. - -------------------------------------- ....I.........------------------------- Permit No. q Date .......--f.i... ....~ ��................. Issued ......- ..................-.-....--------------_----.......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V ertifi n'te of V o ttplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X ) by..W.E.---Robinson Septic Service ' -- .. --------------.......................------------------------------------------------------------------ 281 Meghan Rd Hyannis Installer at --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......?.s�•..........3.6..../a...... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. • 1 DATE.............----- ----------°... -- .........---...---.... ----.. Inspector .. v-------------------------:..-.....------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q TOWN OF BARNSTABLE No. / .: (�. FEE.$30..... .... Disposal irk %.141 an rrutt �. Permission is hereby granted....W.,_.R01, sorb__d�_Servic ..... to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at No...21 --------------- Street qq -" as shown on the application for Disposal Works Construction Permit No..&:3S b... Dated.......................................... r � .----- .. -- -- DATE-----------------. q .......................... Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE t ; q- I� LOCATION-z p , (; kb 4" /q Cl/ SEWAGE #'Z,4—J5 C VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 74 SEPTIC TANK CAPACITY / LEACHING FACILITY:(type) ,2� 16 (size) -6 NO. OF BEDROOMS J PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �, Y DATE PERMIT ISSUED: `l DATE COMPLIANCE ISSUED: 2:r 2L— 9--2-- VARIANCE GRANTED: Yes No w E q y� \ l � r Ld►CATION SEWAGE PERMIT NO. Zo VILLAGE 11yA/V�iS INSTA LLE.R'S NAME 6 ADDRESS GUILDER OR OWNER Lam/ bAcEY DATE PERMIT ISSUED DAT E C 0 M P L I A N C E ISSUED i i .® c ti h A'g No. 1.. ..-�� THE COMMONWEALTH OF MASSACHUSETTS BOARD O H TH ___ ........��0k...........OF.......... ....... ..... . . . ... ........................ Apliliration -for Bhip ial Works Tonitrurtioo Vrroiit Application is hereby`made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a_ t;� ----•--------------•--•---•-----•---•-----••-----• ......... ..................................... ,^ cation-A ress ..or Lot �.Y__ .-!L.`........ _ ---------•---------—------------------••------- Owner Address s ler Address Type of ilding Size Lot----------------------------Sq. fe t U _ Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder VLa) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------- -------------- - - W Design Flow....�5__P---_-___--------------------gallons per person per day. Total daily f1ow._..,_V.(0...........................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./f.5�--__- Diameter...:................ Depth below inlet-----_.............. Total leaching area------------.-----sq. ft. z Other Distribution box ( ) Dosing tank ( ) / / 11-1 Percolation Test Results Performed by-•----- ---------------------•-•----•••-•---•-•-------•-....--•-••-••---. Date........ k�-=--Zf°=- W Test Pit No. 1................mtnutes per inch Depth of Test Pit-------------------- Depth to ground water----:_-.__--.--__...__.- �14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water.-._.--..___--.------__. P-' --------------------------------------------------------------- - x Description of Soil-------------- .t ------------ ------ -- ----<--------- U ------------------------------------------------------------------------------------------------------......................................................... ................................. UNature of Repairs or Alterations—Answer when applicable..__-------------------s--------------------------------------------------------------.--------- ---------------------------------------------------------=-------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of health. -Signed •---- --------- " 'a-- � Date Application Approved By-------- y - ..2 ---__`t-?7 ` Date Application Disapproved for the following reasons: -------------------------------------------- .............•..•--•--------•-------•-------------------•-•-----------....•--••------••••••••-------.........•-••----•-----------------•----------------------------•--.-------------------------------- Date PermitNo........................................................ Issued........................................................ Date �--_ ---------------------- ..... ...... . No._•••-• ��.......... THE COMMONWEALTH OF MASSACHU.SETTS BOAR® OF t-a TH .��Iitt$�uri -fur: �i.��ru�tti �ark� ��t�°�rltrti�Yt �rr�tit Application is hee.rO' 'made for a Permit to-Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst aT ' ............................................ •. -...--•- - ------..... •--- . anon Ad ess or Lot W Ow r • Address ---------•----- ............ ••-- ••----------------------••--- ----------••---- r s er Address U Type of ilding Size Lot............................ Sq. feejt -, Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder (�H per, Other—Type of Building ---------------------------- No. oi•persons.--_____.-.-_____---______ Showers ( ) — Cafeteria ( ) a' Other fiIxtures .......................... ---------•-••-•-------•---------------•----_____--__------------------------------------------- W Design Flow_-_.1Ir________________________________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;leachmg•arcz._----.-:--. -_---_sq.-ft. Seepage Pit No _ r .t_._. Diameter-------------------- Depth below inlet____________________ Total leaching,trea--_-__ _ -___---sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by+:_:.-- --._ a -----------------•---------•--.._..--------..._---- Date-,=.......................---•---•----.. a Test Pit No. I----------------minutes per inch Depth of Test Pit..------------------ Depth to. round. water...:------------........ w Test Pit No. 2.................minutes per inch Depth of Test Pit-------------------- Depth to ground water_-_-..--___.-_--.--. . -- -• � -- --- -- O Description of Soil "'------ ------4` ----16, �..d�. x .;---t - 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 LI of the State Sanitary Code— The undersigned further agrees not to place the system in rl operation until a Certificate of Compliance has bee issued by the board of health. ti igned- _._.. . --•-• - y Date Application Approved By-------- = �' ------- '-- e Dat Application Disapproved for the following reasons:. ;.-- ------•-------•-------- •-------•------------•----•-•- -- ...._.._•---..._••--•- ---••--. -----•-•-•--------------- - -•--------•--- ----- Date Permit No------------------------------------------•-•-- ....... Issued---------------------- ................ ' - --...--•---- Date �g t r THE COMMONWEALTH OF MASSACHUSETTS L BOARD OF EALTH iY . r OF... d t ijirtt#P of frrutltttitrr r TH IS 0 CER"l F` . at t �Ivfdivid>aal Sewage,`Disposal :System constructed ( ) or Repaired*( ) $ - ------ •--------••--------•----•---------------•----•---••-•------•••--••...... I t111e liar=been installed in accordance tth the provisions of : 'I of." he State,Sanitary 06cle as described in the application for Disposal Works,Construction Permit No.: .3.h�1� THE:ISSUANCE OF•TH:IS CERTIFICATE SHALL IdOT#`BE CONSTRUED AS 'GUARANTEE THAT THE SYSTEM VJlLL FUNCTION SATISFACTORY DATL. --••••-• - Inspector iE COMMONWEALTH OF MASSACHU,SETTS BOARD OF H°EALTH •r' ' :. :.. ... .. a ................ OF..... .... j 4 O_ - ..... 01 FEEAA .... i o or Cnn�t��trtivit Vrruti# ermission eby ranted =" ,."y -------- "z ------- --------•--•-_---• --- rr ----- to Co t t ) or r ( an India , ewa is oral Sy e � �"" at No _ `". - ---- ------- ------ ----------- - as . ............... shown on the application for Disposal Works Construction r t No. ted _-_44'flo° �,�+' '; . ( Board of I ealth DATE -_._....--•--- •-•-- --------------------- FORM 1255` HOBBS & WARREN.-INC.. BLISHERS .� •[[i . .. r.a .....•- N .a �TOLCX'a 6�r . � I I /V 8/" G' q Uo N 1 o N 4 i � d 7S . 4 r d . i E 4m411';vyy . F 4 LO CAT ! ON S C A L E: r"_ D A T E ✓�.ve-_�� /97S rl R E P F R E N C E: z5E1Az g' A, v � _..moo y,a �°�.:.�,,��• . � i DATE R EE Y C E R T I F Y T H AT THE SUI LDING R E G. LEAN D 5 U R V E YO R 5 H O W IN O N TH 15 P L A N 1 5 L O C A. T E D O N H G R O U N D A 5 H O w N HEREON AND T 1-3AT IT CONFORM TO THE Z 0 N '• N G BY - LAWS OF THE TOW ,N.. O F w H E N C O N 5 T R U C T E D LOW, JR. 1 :' BA. RNSTABLE SURVEY CONSULTANTS, INC . r 4 � t(�<a WEST Y A R M O U T 1-i, PA A 5 S . ✓ �i� �Ur,�`1—�r4' A