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HomeMy WebLinkAbout0089 OAKVIEW TERRACE - Health 89 Oakview Terrace Hyannis ,p A=268 - 289 COMMON TH OF MASSACHUSETTS EXECUTIVE OFFICE OF EN-wRo_NVIENT- = 'FAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION o _ 1y Sv•ti. 4INP 02 02 F9 Lod cf� fie,-.n,f- A0 S'9/ TITLE 5 OFFICIAL INSPECTION FORIVI-NOT FOR VOLUNTARY ASSESSME'jN'I'S SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A Q CERTIFICATION ? Property Address: t✓ Te✓��,G� `�.�� Owner's Name: 4�,,i , wl Owner's Address: -� GHHIf Date of Inspection: oZ oto2 0 w. �'� tr /J // `' Name of Inspector: lease print Gt� o !fi � �`�; w r- Compan, 10 Mailing Address: p 0 C g { Da Telephone Number: _ u1 r 7 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant 7toSectjion 340 of Title 5(310 C M 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date:- 02 02 02-0,6 The system inspector shall subrmt a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable; and the approving authority. Votes and Comments- ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLL.TTARY ASSE-SS'-vIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A Q CERTIFICATION(continued) Property Address: zfV 6 1lvoec✓ ee9,aC� (a hit, Do1.60/ Owner: Date of Inspection: —p?oZ—O ,6 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syst asses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: A—XOne or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water IeveI in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).Tne system wry pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: r+iocam_,<i,�i�nnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNT'_ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A Q CERTIFICATION(continued) Property Address: / �Gt ly-k/eG✓ Tet1l0 <j--- Owner• Date of Inspection: .6 C.�Further Evaluation is Required by the Board of Health: ' Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(i)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is vrithin a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria 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 provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: I T;Fio G tncnnnr;nn Pn- 4/if/7nnn 3 Page 4 of 11 . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �� �G�✓�/E�,/ ��'�ri Cam_ �/IGNNrf i �rZ� OJ Owner: �✓� Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No 4/_ backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or logged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool V Liquid depth in cesspool is less than 6"below invert or available volume is less than%z day flow _�equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number Hof times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation- A— y portion of 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 1 of a public well. any portion of a cesspool or privy is within 50 feet of a private water supply well. (/Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no he 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-IWP A)or a=peed Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CIR 15.304. The system owner should contact the appropriate regional office of the Deparnnent. 'r,'H- ; r—... 4 Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSTVIE\TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: e/Q nnk-t-leu.- / el-lr4 � / Owner: / I✓rvl Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No / , _✓Pumping information was provided by the owner,occupant,or Board of Health `- Were any of the system components pumped out in the previous two weeks ? _✓ Has the system received normal flows in the previous two week period? t--- Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) r/✓ Was the facility or dwelling inspected for signs of sewage back up? ✓— Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? v _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _v — Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 C,NM 15.302(3)(b)] Tula S tncnarfinn Gnrm r,i1 4;1onnn 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLLT-N'T_A_RY ASSESS-VIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART C q SYSTEM INFORMIATION Property Address: / a ll-v!Qt / Owner: I wt Date of Inspection: � O f, g0_ T9� RESIDENTIAL FLOW CONDITIONS ��-P✓w�� Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 C1 15.203 (for example: 110 gpd x#of bedrooms): v �� Number of current residents: 9, j Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):/f/V [if yes separate inspection required] /;0 Laundry system inspected(yes or no): AIV _ Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): 4,10 Last date of occupancy: % A( COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgtetc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspe�//_ l:" If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP F SYSTEM Septic tank, distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy —Shared system(yes or no) (if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank —Attach a copy of the DEP approval Other(describe): Approximate age of all components,date pi talle (if known)and ourc�'of information: /0 - hC Were sewage odors detected when arriving at the site(ves or no)�V 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-INFORMATION(continued) Property Address: SQ/ C�GI�✓l/!�(„/ 7-evzGGr Owner: L-t 4t, I vl Date of Inspection: 02— a,2—0& BUILDING SEWER(locate on site plan) Depth below grade: � Materials of construction:_cast iron _L40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) n /I Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: 5n /J0 0 0 Sludge depth: 3 Distance from top of ludge to bottom of outlet tee or baffle: a1,0 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 b�flle: How were dimensions determined: ole /K a �✓evl C Comments(on pumping recommendations,inlet and outlet or baffle condition,structural integrity, liquid levels as relate j-to outlet invert, evidence of leakage,a c.): 1.1 Soo fnK /Oti T e fh d4 v ti a 'LeG�S GREASE TRAP: locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORIM-NOT FOR VOLUNTARY ASSESS-:-VTEN TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner lr✓� ©�G�/ Date of Inspection: TIGHT or HOLDING TAI K:X (tank must be pumped 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(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: i (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: /(/ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, tc.): // -- / l �g'' �O X �-o oc �t'c�_ SI�I G�vE G v� PUMP CHAMBER:��/ (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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORINI-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Q Q SYSTEM INFORMATION(continued) Property Address: �J / �G1�✓l�le t/ / toy//'ace- Owner• T�✓t Date of Inspection: p2- a J-o f' SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type eaching pits,number: leaching chambers,number: leaching galleries, number: f � � t leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool, number: innovative/alternative system Type/naive of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil, condition of vegetation, etc.): off C-i,-'1- r hf o , rrz, CESSPOOLS: /lam (desspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool_: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY:A��(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level ofponding,condition of vegetation; Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNT_ARy ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: v 6),5:;1,1117eL,/ avt✓i,r Owner: iy L11 �✓� Date of Inspection: oZ — 02 13L-0 6 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. C l � , 0z - 0Ly Trio : r o f r �ir.irnnn 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 12 e�rq C4e- - Owner. Date of Inspection: SITE EXATM Slope Surface water Check cellar (� Shallow wells Estimated depth to ground water C� feet PIease indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: O.b.set"ved site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: ?M6i%5- Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: , to (2 p O (0 LOCATION SEWAGE .PERMIT NO. LET✓._._' ��` �-,C ��.. , ��, <W `_ .r VILLAGE l is INSTA LLE 'S NAME i ADDRESS BUILDER OR OWNER cep DATE PERMIT ISSUED DATE COMPLIANCE ISSUED m � -.. a �" ' I. Z THE COMMONWEALTH.OF MASSACHUSETTS BOARD qF HEALTH /..-. W.-A-) oF........... ..A.1 . " ........................ Applira#ion for Disposal Works Touldrurtion ramit Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal System at: P oc Ad, sN; �� ...0A - �� -. ...- _..-- �. ddress a ............................. —t ... ------••----•-------•--•--•••---.............----......--------...............----••-----•--..... n aller Address / U Type of Buildin __7.00..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No, of persons___.___._.__._._. Showers ( — Cafeteria ( ) Othertures --••-------•-•• ••-----•------••---•-___•-•-•-•--••-.._..-•-•••••--------•------•--••-- -•-------•____--•-- Desi n Flow.....___ ...,.___.gallons per person per day. Total daily flow_._.______ W g .............. g P P P Y• Y �- -- -------------------gallons. WSeptic Tank4t!!!�'Liquid capacity gallons Length................ Width................ Diameter................ Depth.............. x Disposal Trench—No .................... Width.................... Total Length.....................Total leaching area............ ____sq. ft. Seepage Pit No........ Diameter...../___P.... Depth below inlet.......(:p........ Total leaching area__ ____sq. ft. z Other Distribution box ( ) Dosing to ( )' `,�,� 4 -��,� Percolation .Test Resu�lts.� Performed by... 1.(?.�'_�o.l..__._ c�,tLJ_f.�(� Date.__7__,__`�`...� �. .a TestjPit No. minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 1._...:_. LTr Test Pit No. 2..l.... ___�inutes per inch Depth of Test Pit____________________ Depth to ground water........................ 0 O y_..._._ ... ---- Descri tion of Soi to ...._._ 1 �":. ��- ! _r'. ...1C��x e__ --/ -- 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 TITM 5 of the State Sanitary Code— The undersigned furthe ot�the s tem in operation until a Certificate of Compliance has ben i ue byP th oa of health. . ... ....... ... ..... . ............... _ Sign -----•:.��1!fs��-L►"'-'�! =---�=-•-•�� Dato Application Approved By... _ ._ ...... __ ....... _.____ ___ .. ___ ate Application Disapproved for the following reasons:................................................................................................................ ...........••---••-•..........-•-•-•••••--•-----••••--____•-••_...__••-•-...•••-•--•-••••-•••••••--•...•--••._.._..--•-•••---••-••-----••••••-••-•-----•--•----•--•••----------•---------•--••...._.._. Date PermitNo......................................................... Issued. - Date No........Vf THE COMMONWEALTH OF MASSACHUSETTS ,. BOAR® F- HEALTH ....... .0.WjO......_OF.......... �"�,`._..._._.. r� ApplirFation for Disposal Works T"us rn.rtion ramit Application is hereby made for a Permit to Construct A or Repair ( ) an Individual Sewage Disposal System at: s� c �,•w-* ,V R �°} ----- ............. --- oc Ad dr s or t N 4 Owner ddress ----------------- 'v��zp1 ....................................................... •------•------•---........----------..._... ----••------..........----•--•-----•------•--- Installer Address �} 'Type of Building' rj Size Loti„_3_t..� __.Sq. feet �-, Dwelling t No. of Bedrooms....... .................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons...._.�-------_--_ Showers , — Cafeteria 04 04 Other s ................................................. -..... 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 ( )- Dosin tonl� ( ) �"' aPercolation Test Rests Performed by.__ ��� _._ _�. ' ... Date../___..._ .. rO. P4 Test Pit No. 1__-_---. minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2... inutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ''_ i O Descr• tion of f'7 w ....................•-•--------- UNature 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 Sanitary Code-.The undersigned furtheyagr -s-riot to place the s stem in operation until a Certificate of Compliance has b en is uedd b�y,,th .boa �of health. ' ySign .j -l�'`_`--`�-`�'"=--'==-�'" a Application Approved By..... .__ --•-•.....-- ---- .. „- --- E " _ Application Disapproved for the following reasons---- .........................................-------•-------------------------•-----••-----•--------------•---- ......................•----•--------......--------•------•----....--•------•-------------...------------'- Date PermitNo............................:........................... Issued---------•-----------------------------•-•......---•-•. Date �a THE COMMONWEALTH OF MASSACHUSETTS .-----`"' } BOARDJ, OF HEALTj aw Tatif iratr of ToutpliFanrr IS I TO E TIFY, That Ind' idual Sewage Disposal yste struc.t 'K) or e�aired ( ) py ... � .�::: - :� --- .--..... ................ Inst ller _ at_ t9 1--.'.T._. 1 Y_t! __l# lrl/ "' r ........ = r f application Ibcation foreen ed Disposalosalc��lorkse with the provisions ofConstru t'on Permit �o -._ � �The State Sanitary Code describ i the r f ff'.1 PP P • ' -= dated /Q I I THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE .CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE 1.�.�` I g D.... Insor- "c: t :.M THE COMMONWEALTH OF MASSACHUSETTS BQARD�,3)FHEALTH hJ L... t .......................OF...... .1....... ".,1...... ...__.'.............. .....' --.. ' No....-. FE .. -... ' �t� orko �C��n�fii`itr�ioaT rani# Permission is hereby granted-.,.. . ---•--- d-° `'"' :-----•-------------------•-------"--"----"- ........................ to Construct()_S o/r, Repair ( as 'Individual Sewage D' sal ystem t at No._4..#: �l u I 'x 'a` = .:�. - 7 •. .......... ---- s' treet ` as shown on the application for Disposal Works Construction Pe No .:(_/_) ...(/./�./__ ated-- _d ........... , , ." Board of Health `�� , DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - �- P• _ ' k ytf lh; 1 { r'/ � �br^i-^L.. x� \ f f � ��� •^"°r<.� �t:.. • µi K. L (� a ZI 13, 0 `ram}�r;tti a s3 4 ROBERt outri;�rs ui X LEGEND l EXISTING SPOT ELEVATION OxO CERTIFIED PLOT PLAN ,;y4 EXISTING CONTOUR --- 0 -- - FINISHED SPOT ELEVATION• � ` FINISHED CONTOUR 0 1 N y : APPROVED BOARD OF HEALTH n , DATE AGENT SCALE, rJY 1n ' DATE LDREDGE ENGINEERING CO. IN ` '` �• %.f� CLIENT I CERTIFY THAT THE .PROPOfEO i. EGISTERE REGISTERED JOB NO. ��u c) `�-�' BUILDING SHOWN ON THI PLAIMI D . CIVIL LAND • CONFORMS TO THE ZONING LAWS- ENGINEER SURVEYOR DR.BY= `1- OF BARNST BLE MASS.- 33 N0. MAIN ST. 712 MAIN ST. SO. YARMOUTH MASS, HYANNIS MASS: "� � e ' SHEET- OF DATE REG. LAND SURVEYOR �D FT. M/N. /VOTE /F E/TNER THL=SFPT/C TAN/C OR L6ACHI P/'T A/tE /rJOR!E Tf+lAN /Z11ffz"w /O /rr. M/IV. GRAOE,p A 24'O/AME7EK CONC'R.ETE CODER ti - SJNALL St.F BROu6HT Ta 4RAvE. .4N q"PVC PJPt CONCRETE M/N. PITCH Ne-4Vy CA ST PeO/V CO f/fR SNALL BE USFJ i =�- : l •' COVERS ",Paw /F/N O1e1 vR VA y e '• Av FT. :'o: P Mia. CO/VCRL�T.E 4vE CO✓ER CL EAN SAND BACJe, ILL 2/tPU/D LEVEL + 4"CASE - - a LAYER - �r IRON f°/PE j %�s/4L. o •o o • o o e OF b MIN.P/TCN —•, e • • • ° • • • • a 4 WASNFD SMNE. %4'PC/�t r'T SEPTIC TANK DI o ° b • . . . . . • • • e t 4 R ?`:: BOX p • � e • a • •I : .°° • o e • o • IEFf ECT/✓E • • • ° 3� = �2•.�- `.:;�•. - ... .: • •°v • • e DEPT: � , • � /o c e WASHED STONES-- '` e a. e • • • • e • •• • p e�o PRECAST Sl' J4GE o °o • • • •, • • • • • e o P/7 OR EQi ✓. /NVeJIT ELE✓AT/ONS• � INVERT AT BUILDIMC, ' r'FT. 6 D/AM. INLET SEPT/C TANK �,G C�SEETt9Bt/t.4. 'JON�� OUTLET SEPTIC TANK FT. !, INLET 419/57R161/7/ON BOX 0 FT. 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