Loading...
HomeMy WebLinkAbout0050 RUSTIC LANE - Health Hyannis 1 A= 288 — 062 I i i p f i 0 0 r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE_SEWAGE DISPOSAL SYSTEM FORM +` PART A CERTIFICATION 1 Property Address: 50 Rustic Lane 1� P Y Hyannis Owner's Name: William Bird Owner's Address: 123 Abbottsford Drive Nashville,TN 37215 Date of Inspection: January 18,2008 Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 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 xperience in the proper function and maintenance of on site sewage disposal systems.I am a DEP ap8pxoved sy tem inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: e�J Passes Conditionally Passes 4 Needs Further Evaluation by the Local Authority Fails r a C,j ' Insp-ector's Signature: ��". Date: / a 6 k�The system inspector shall submit 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. Notes 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. Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 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: One or more system components as described in the"Co 991tional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or r pair,as approved by the Board of Health,will pass. f Answer yes,no or not determined (Y,N,ND)in the i�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 exfiltradon 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 crfbreak out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,jsettled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ` broken pipe(s)are replaced obstruction is removed f` distribution box is leveled or replaced f ND explain: fi The system required lumping more than 4 times a year due to broken or obstructed pipe(s).The system will, pass inspection if(with ap roval of the Board of Health): / broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 C. Further Evaluation is Required by the Board of Health: Conditions exist which requ/een valuation y the Board of Health in order to determine if the system is failing to protect public health,s enviro ent. 1. System will pass unless Bolth etermines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning ir hich will protect public health,safety and the environment: Cesspool or privy is wi of a surface water Cesspool or privy is wi 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'within 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. r _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 nitratemitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of thegnalysis must be attached to this form. i` f/ 3. Other: / • Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or Pon-ding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ," Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z 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 SAS,cesspool or privy is below high ground water elevation. _ Any 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 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.] �t (Yes/No)The system fails. I have determined that one or more of the above 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 fac' ty with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the follo g: (The following criteria apply to large systems in additio o the criteria above) yes no the system is within 400 feet of a surfac drinking water supply the system is within 200 feet of a tr' utary to a surface drinking water supply _the system is located in a nitro n sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water sup y well If you have answered"yes"to any estion in Section E the system is considered a significant threat,or answered "yes"in Section D above the larg system has failed.The owner or operator of any large system considered a significant threat under Section or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner sho d contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No -Z- 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? 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) _ 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? _✓_ 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? _/_ Was the facility owner(and occupants if different than 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 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):Q Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): F?.A-ry Number of current residents: Does residence have a garbage grinder(yes or no):k_)!) Is laundry on a separate sewage system(yes or no),.�- [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):12j a- Water meter readings,if available(last 2 years usage(gpd)): Qz)a-7 = G z Sump Pump(yes or no):j2g_-3 Last date of occupancy: <L . Q-_>c=�11 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): d Basis of design flow(seats/persons/sq. ft. etc. Grease trap present(yes or no): Industrial waste holding tank present(yes r no): Non-sanitary waste discharged to the Tit 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 inspection(yes or no): ',C,-S If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _12Septic 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): Ap roximate age of all components dater' stalled(if known)and source of information: , Were sewage odors detected when arriving at the site(yes or no): i Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 BUILDING SEWER(locate on site plan) Depth below grade: 0 ` t cj" Materials of construction:_cast iron Z0 PVC other(explain): Distance from private water supply well or suction line: 4�2 G Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: locate on site plan) 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: g k Z(. -Y L(: Sludge depth: f''It, Distance from the top of sludge to bottom of outlet tee or baffle: Scum thickness: \1 Distance from top of scum to top of outlet tee or baffle: 0" Distance from bottom of scum to bottom of outlet tee or baffle: I How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of lea kage,etc.): 4 J.G `�;r.6�2ii —:'t-�. �n,...c ,,,,r- .•�' �,�c,T ���� 'i v. �.9\3. GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_met _fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of o tlet tee or baffle: Distance from bottom of scum to b om of outlet tee or baffle: Date of last pumping: Comments(on,pumping reco endations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evi ence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete metal fi rglass_polyethylene_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/da Alarm present(yes or no): Alarm level: Alarm in workin rder(yes or no): Date of last pumping: Comments(condition of alarm and fl at switches,etc.): DISTRIBUTION BOX: V (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: d" Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Gc�.\�f St"�c►�y.;'C.1..a C.'�l..,G..r-- c�1J`�.�t�� ` ,1�� ��' `l�O <.3a.(.f nor-..�� �` SG J` 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.): i f Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 SOIL ABSORPTION SYSTEM(SAS): locate on site plan,excavation not required) If SAS not located explain why: Type �eaching pits,number: C K C leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): J...c.AC�� �.Ti��w�'at`T�-1 �4� \`�fvr'�. o� � �`CC V GS�r..• T+` �.� t�.�-^a 3� .QQ� 5�<b ez, ��i�� CAA' � de l z w o .� 6(' _-C_ P� �^'�•�r�a c�l:L ��\v.� a �.'.ye.r-- pv�s �c���..s-- Y" G-c�� �r��A�e CESSPOOLS: (cesspool 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 inflo (yes or no): Comments(note condition of oil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (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.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 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. A 33 , 6 « Page l l of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Rustic Lane Hyannis Owner: William Bird Date of Inspection: January 18,2008 SITE EXAM Slope,.� Surface water ' Check cellar✓ Shallow wells Estimated depth to ground water feet Please 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: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators,installers-(attach documentation) _�ZAccessedUSGS database-explain: You must describe how you established the high ground water elevation: �A ! , w.o--r_d-f— CS o\Az' � f • Town of Barnstable OF THE Tpk Regulatory Services BAMSfABLE Thomas F. Geiler, Director 1639. `0$ Public Health .Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with.any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Pen-nit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. I TOWN OF BARNSTABLE r ''tri it�"ATIdN S O t2 c��°c L�,,, SEWAGE# r VILLAGE 1�,�,,,�,5. ,, ASSESSOR'S MAP&PARCEL 6 6' INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY .LEACHING FACILITY:(type) L z�G�, P:T (size) _ tf -c..r NO.OF BEDROOMS n OWNER PERMIT DATE: 1ZQoZ AY COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility >-�3 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) f1/l Feet FURNISHED BY`—� .-\\A--, j[, �,,,�j � Un. t ` \ �' ©g rc V _ v M T Y 9 0 4- d `Y �Q (� ro M LOCATION® SEWAGE PERMIT NO. V 1-t L A G E INST ERIS NAM a ADDRESS S U I L D E R OR OWNER M DATE PERMIT ISSUED ® DATE COMPLIANCE ISSUED ,,�, /�_ etp< 4 W (�C i; pi tip. � Y No�y.�J"...... FEs... THE COMMONWEALTH OF MASSACHUSETTS" BOARD OF HEALTH ............OF........f5.A.- i fV. .l... -1'iL ir.......................:. Appliration for Disposal Works Cfnnstrurtiun Prrutit Application is hereby made for a Permit to Construct (VKor Repair ( ) an Individual Sewage Disposal System at: ` Location Add ess Owner ddre .....................•••-••.�1....,�. 1..ram.--------_--------.-----.-- .------------------------------........../s ` Installer Address _./ d Type of Building Size Lot_-__-7/0 .........Sq. feet Dwelling—No. of Bedrooms...-....-2r......... (/..........Expansion Attic d Garbage Grinder P4 Other—Type of Building .._�� ?d......... No. of persons......I................... Showers Y� ) — Cafeteria a Other.fixtures .....-••--••-•--•--••--••------• T W Design Flow............ ........................gallons per person per day. Total daily flow............��� ��.....-............mallons. WSeptic Tank—Liquid capacity_.i allons Length....iO..... Width....(Q......... Diameter----- Depth... ........ x Disposal Trench—No. X:... Width.................... Total Length.................... Total leaching area.....................sq. ft. ..... Diameter.................... Depth below inlet.................... Total leaching area -..6.4....s ft.Seepage Pit No............... P q• i Z Other Distribution box ( Dosing tank ) / ~' Percolation Test Results Performed b /(2.e eW,5 -.--- '? ! t............. Date........ a Test Pit No. L.-_-._-minutes per inch Depth of 'est Pit.................... Depth to ground water...A ?Ad _ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .... O Description of Soil...--d-~ 'r � `�`^-•---- .... �s ..S .. x VNature 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 further agrees not to place the system in operation until a. Certificate of Compliance has been issued by the board of health. gned...... -t. �k ?2..................... ... ...... Application Approved By..... ------ --• ...O,l....--.••••. Date Application Disapproved or t, following reasons:.............................................................................................................. -------------------------•------..............__....-------------•--.....-------------------••••-•........ Date PermitNo.......................................................... Issued....................................................... Date -- ----- -- -. - ---- - - - - - - --------------------— -- .,q- s i No................. ...... FEB... ................... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH .............. , . .........OF........1 .�c.rU` } _....� , Appliration for Diivuiittl Vorkii Tontitrurtion ramit Application is hereby made for a Permit to Construct (VKor Repair ( ) an Individual Sewage Disposal System at: r� !� ,)< r J < ram. .. t ........................................ 1 // Location Address l ............................�-A•:.......::.............................. Owner Addiess ......................................�... Installer Address Type of Building Size Lot.... ' ...........Sq. feet U Dwelling—No. of Bedroom ..................................�............... . .....Expansion Attic (ky` Garbage Grinder (/v�)' Other—Type of Building ._.��-�4._...__._.__ No. of persons ................... Showers — a yp g p (� ) Cafeteria (d/u) dOther fixtures ------------•-- ----------------•-•-------••---•--•----•-•-•--------•---------------_._-------••---------•----•---------..------------•--•--------- Design Flow._......_... ..............................gallons per person per day. Total daily flow............................................gal Wlons. WSeptic Tank—Liquid capacity_.!c:(X_jallons Length_...1�.2..... Width...., !%....... Diameter-_-_.fir__.... Depth... ......... x Disposal Trench—No._.l�ti. Width.................... Total Length.................... Total leaching area.................... ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..:- L_ ....sq. ft. Z Other Distribution box Dosing tank ( )0-4 / Percolation Test Results Performed by ..r.. . ....f^_!' � ............... Date �........................_ a v Test Pit No. 1..-<1...2.....minutes per inch Depth of Test Pit.................... Depth to ground water......)........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------•-----••--------..................--------•-••- ........ .-.----------------------- ----------- ----•-----•-•-- O Description of Soil...... :! r r r• l --•----•........ ....:.--•`-- S -t-•--•-•------------•----•-•--- U ................................... •.....-•.....---•-••---------••-•-••--•-•--•---•....._---• -•-•---•--•-•--••----••-•--•-•••----••---------•---•-•--.....•••-•---.....----•-••---•-•-•-•--•---• W •-- --------------------••---------=�-�- --- •--- '-__.---•---�•t_�.�----Z �t ...----•-•-••--•--............-•---......--••---•---•-----•--•-•------•--•--•-----•-•--••-•----..... VNature 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 further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. I --••--...-•-•----•-----•...................••-•••-.....----•----•• - Application Approved BY-------. ---------•-_..... ••-•Z= ._. ....... Date Application Disapproved f r th following reasons:-----•------•--•-----••-•---•--•----•-------------------------•••-••----•--•------••---•-- -----------------------------•---•----------•------•- -•---•-•---••-------------•---•----•------•-•---------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.. ti ...............�... ..............OF...........!,? ,r,��t........................................................ (9rrtifiratr of Tomplianr t THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �r Repaired ( ) by / / /�,-r s a_/�'----------------------------•-----------......--------....--------...--•---•------•--------......---..............----------•-•-••----.....--- ,.... ......._.. _ Installer has been installed in accordance with the provisions of TI `/ e State Sanitary Code s /'ri-i in the application for Disposal Works Construction Permit N'o.._ .__.�._ ................. dated'Z/ .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT FACTORY: /� DATE.................•----•-•---••••-......�2 � �/.......... Inspector.............1--Z.:.�_................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L`..� . ��� OF.. '..2.7;; �. ,�... ............................ �/� No...- FEE..-! ...................... Uiiipoottl Workii Tonotrur#ion rruti# Permission Is hereby granted. '..f........r..-------------•--------------.._.........---•--............---•--...................---• to Construct ( -) or Repair ( ) an Individual Sewage Disposal System at `" Street as shown on the plica ' n for Disposal Works Construction Permit Ng���.--.... Dated.......................................... .................. --•----j�---•-•- ---•......................................................... 1 Board of Health DATE... . ..-....L- -- ----•-----•----------------- FORM 1255 A. M. SULKIN, INC., BOSTON +1 q LEak ncu,�ir j ff D/S BOX `l lV zS — Z /// N 6' Ll 35 Lo.?''✓w.. . I lJ �b9Gsf o ry 02j t © .+ r n� 07 .¢9 Aj Z.O Nt 7� AL T l,.�o u c3 ;.> -)KJao " U RSE o p:NO.10951�O qp FGIST�� cFSs E3Ve-A—P 0 NA1 - LEGEND ND EXIS"TING SPOT ELEVATION Ox0 CERTIFIED PLOT PLAN EXISTING CONTOUR - - - Q FINISHED SPOT ELEVATION L,0 = Lc�r Sv vs7-1 c G�►�E � r-� FINISHED CONTOUR 0 ! IN APPROVED , BOARD OF HEALTH A ASS DATE AGENT A; , :L«� SCALE.. =3C" DATE o- _. a ys �r� — r'EL DREDGE ENGINEERING CO INd) -- —.f CLIENT —, :. . I CERTIFY THAT THE PROPOSED M' — _.... — EGISTERE REGISTERED JOB NO. _ 3�: .: BUILDING SHOWN ON THIS PLAN CIVIL LAND . A-, CONFORMS TO THE ZONING LAWS ENGINEERS DR.BY • SURVEYORS OF BARNSTABLE MASS. ' ' la ,'. Ii, cil N TREET CH. BY: r HYANN I MASS. DATE REG. LAND SURV EYOR" SHEET OF 20 or i►/iN. /YO TLC /F EiTNER THE 3EPT/C. �-aNK OR LE�4CN/ivG PiT A V&r °/YORE TN`^N >2"BXlOyN, GR�►`DE, 2�'D/AM ETER CONCRX7—AF COYEir -smA.LL QE eAvI q v7 TO GmA va /AN ,F,X7 A 4 O~c* P/PL `' CONCRtTE "e,4VY CAST/I?ON'CO I�ER S/yAL L'QE USER COMERS M/y. P/TCX /BT•P£Q P7: /F/N L7R/✓EWA y _ p�L MiN. CONCRETE A O7�AOE C:G rER CL EA/V .SAAIO`. ` . . •BACXF/LL�j 2 . AYER 4« NAST J o o QF / '_•�/d' o a : M/N.P?Cl/ 40 o D GAL. ' e 1 • • • • •-,s a *a' WASNED 5MME %¢'PER TT. SEPTIC TANK D/sT, o . ,i I • . , "• , �, s a • BOXIr OfAff v ,i ® . • • • • .�.q . ' t o « s:` _ .r r • • Dl7PTJ+►:• • ' • v e -WASHED STONE *70 _ ` , •' . • • : •. i 1 p p PAECASTSEf�4GE s..e a a • • !T k�r . !A/f�eRT ELL°SY�lT/OWS �/T C.4PA G�� S4 p • 3 s L'9 • a • e ` Y lNYERTT dt>IL.D/N6' S 9�D FX: 'G�'T. D/AM. JIYLET ". PT>C.'T.4lVK `�8<� FT, !D .FT.. 'O>i4M CC.SRE7�{Sl/L.4T/ON�. dt/7LE�T$EPTlC TA/VK INLET DJS dT/DIV 60X 9 16'g FT. SECT>ON'OF V � GROVNO JtG4TER TAQLE n at9tJTdE SIR ip"'m ON"X ITT_ ". r °' A PASA 'sr6S7 n H .SEi�1I GE .DI3' lIVLF'T/.EioC,N/Mt� o r °�fT 7�1�1lL.ATID/V• • a M °LEACWNO� <w 'Ot/r_IEN.�tO/1/ 6 y �N fT.: .;. p,. -D • DES/6I�f C!�/TER/�I - _ N/J/MQER OF 6rEDrROOMS Z D/ME/YS/ON C FT. •�/ GAMS GOAISSAOMA.u.V,17" SOIL. LOG TOTAL !'.?T/I►�lriTED FLAi�I Z ZO PA we SO/L TEST #/ SO/L TFST*2 .�'O/L TEST /�3 NUMBERQf iLEACR/NS P/TS / ELEY. �9•Z EtFY, GATE:OF SOOL TEST S/OE LE•40H/N6 PER P/T l8 S' ,SY� fT. ►r - RES[JLTS'IVIT/VLaSSED BY/R BE ✓•a cold/ ^` 40TT01N`L+6AON/N6r PER P/T 7 ,SQ. �T. O Z Z PERCOAAWON:RATE j1 1 s L��` 'MlI1iShJlfGN TOTAL IZACN/NG AREA SQ. .c LD.�� 8� /�sxCp�lT/ON RATE RESERVE LEAC NINE AREA SQ. FT. Z 'i - /2' r5O/.L T ,5T P-z74_9 tip CF b1.ys� P�613F V ! S1 C LN r- cc �� oz A SANr� l-1?'s�i IV IVIS• Pon- I ROBERT BRUCE o ORSE y = ELDRED "' No.10951 O Q r ELDREDG&ElV►G//VE 1P�/V�s.""'•sj~C' 1 t2 MA I N .3'F� HYA N At 1.5 MA SS. ��.�TE�p Sc�DNAI�a NO GROUND ;,VAr&R EJVCOU/VTfREO D tip' 11 AGM0 1JN,0 Lti/�fTEq',AT.46L�EY. . h t :• t si