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0066 LOVELL'S ROAD - Health
66 LOVELI;S ROAD, COTUIT A= 040 069 r, F �1 r I I f No.......... J7 .......... . THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEA TH ---_.---/_ ......0F.... . -- - ............................... Appliration for, Disposal Works Tonstrn.rtinn Frratit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at• /) .. ,�`' v "�• ocation . ....... •--- o - '�• —•^•_• /W�• -_-- .._.. = . a 4 - _______Address f _____-••-•••-------- -•-•---•-• ---- Insta r Address / Type of Building Size Lot._Y_./. r q. feet aDwelling—No. of Bedrooms..._......-_r)..............................Expansion_At7 tic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.............._____.__------ Showers Cafeteria ( ) Other fixtures d W Design Flow.................... O__•_________•_--gallons per person per day. Total daily flow.............................................gall ons. 04 Septic Tank—Liquid capacity............gallons Length................ Width....._.......... Diameter................ Depth......_......... W Disposal Trench—No. .................... Width....................Total Length----- ....Total leaching area.__...._____._.�,.sq. ft. Seepage Pit No.......__t......... Diameter....../.0.__..... Depth below inlet.................... Total leaching area.__Z.a.._....sq. ft. z Other Distribution box ( ) Dosing t ( 4,1L 9 W Percolation Test Results Performed by............. . ____. 44w.Jul�—Date...���: la_ __.... Test Pit No. 1.... ..___minutes per inch Depth of Test Pit.................... Depth to ground water-__-/' .__ fs, Test Pit No. 2... iinutes per inch Depth of Test Pit.................... Depth to ground water... -............ x . .................... r..- --- -••----- -- Description of Soil.O.:' - �„� - 2�_ --------- =�-----••. z --/..-•- W ---------------------------------------------------- �� j . ---•--•- x = ..................-....... 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 TITLL 5 of the State Sanitary Code— The undersigne4heal r a r snot to place the system in operation until a Certificate of Compliance has been-ssu� y the board/� �V -_._... ._.__CJ. .. .....•••--•-•`Y..--....�0 Application Approved B Date PP PP Y----•-•--... � ......... . .• _ -a =---:........-- ----�.r�..._-�1!at���---- r D e Application Disapproved for the following reasons: ----------------------•----------------------------••----•••••••-• •••--••-••..._..--- ....................................•----.._...--------------------•----------�� . - ............................................ , �,/ Date Permit No. - Issued--------=----•-•-•_-"!..-.._................... Date Q.No................ FEB ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r. Appliration for Ditivviial lUorkg Tomitrurtion Vamit Application is hereby-made for a Permit to Construct O or Repair an Individual Sewage Disposal System at: c ......................... .. ..... ................................. �ocation-Ad4ras Zo ... ............ ow*nL*r... dress ........... ---- ------ --- ..... ..................Inn ja- r ................................ .............................................Addres.s............................................ Type of Building Size Lo 4 tJ._7 .Y6-e�ZSq. feet Dwelling—No. of Bedrooms.........J----_--_-----------------Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons............?--------- ...... Showers Cafeteria Other fixtures ...................................... Design Flow............... zM................gallons per person per day. Total daily flow.............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width_.____._.____.._ Diameter__._______..____ Depth_____________... Disposal Trench—No..................... Width_____..___...____.__ Total Length_.___.______._._.___ Total leaching area....................sq. ft. Seepage Pit No._......./---------- Diameter....../0./..... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing , ;�Percolation Test Results Performed by.________vtm_"� A ...................... Test Pit No. I.... minutesper inch Depth of Test Pit____________________ Depth to ground water_.__ I-A---;t-------- 44 Test Pit No. 2---en.L-11iinutes per inch Depth of Test Pit.................... Depth to ground water..__/./............. 2..... ............ ------- . ......... ........... ............ 0 Descriptl*on of ...........I ............................ ................................................. /.../---L- / z"" _ 4 A-:!- - .......................................... ......... .4.. �_----------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ....................:'t.................................................................................................................................................................................... Agreement"-. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITILL 5 of the State Sanitary Code— The undersigned further es not to place the system in operation until a Certificate of Compliance has been •jssugdj�y the board hea ...... ............................ "g./n &.. . . ....... ---- ApplicationApproved By........................................................... ......... ....................... ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. .....................................................................................7.................................................................................................................. Date PermitNo......................................................... Issued. ... . ................. Date ,d THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........,A.. .......0 F.... ................................. ...... ...... ......Tntifiratr of Toutpliana TINS IS,TO CERTIFY, 7hat the Individual Sewage Disposal System constructed ( -K) or Repaired b ....... ........................291 .L.,... taller y - ------------- ----------------- ---------------------------7-------------------------- fler at..-*1 ........................ . -------- --------------------- ...........................i....................... E ........... ................ -- - -------------- has been installed in accordance with the provisions of State Sanitary .2dr. ;V/(ksV0&.in the application for Disposal Works Construction Permit No........................................ dated__..._______-_._..___.._...._._._............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. ........ Inspector.::7----------------------- ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS 3. BOARD/OF HEAL 7XNo......................... ......................OF...... ......................... 349 FEE........................ Disposal Vorka,�vnytriwtivtt "anfit V Permission is hereby granted..... "0. . ............................................................. ................... to C o n s�r u-t ,_po r R e a' ari Indivi ual rage kiivoosal System .....C ,,Street as shown on the application for Disposal Works Construct rmit Da 2ed.. 2:�--------------- 10' Board of He th DATE.... ...................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS n ►s t1� � . ��.'�'xa$ �kt x�,.., �f is _ _' .. .. '�' �!�'Y ;rs, _ r Ah ®A4�� ! 1 y e V 5, t 3 p Cl a`, a 30 r f f Ps f0 y � , '� i6r� 1 •"1 l Tt'n x b .. F f -S - l "r,;,,,,, _ +, {'t'♦! �,v Y"'.' f��`'fit�' o-ei wll , r tii °dt � Ei ti ,cLEGENDa+ •M�s CERTIFIED" PL�T. � PLC rjXOGTONG d. .SPOT E,LEVATI®.N ®A® �0•970N® ®h�TOI�R --,- ® = — —' oa ROBERL � g. _. c a I 1HOSHED SPOT ELEVATI®ICI ( P. Y�aao-9 Z® ONTOU1 - _ moo Ev--BUNIKI5 p No.22162 APPROVED Q0A'RD' O HEALTH �90 ��/�T,E�6� DATE AGENT SCALE: .�.��� � � � ®ATEQ'D� /11`91 u -- ---' --- - C L I E N 1 CERi'IFY THAT THE D E®ISTERE REOOSTB�RrD H®. ��GyQ BUILDING SH®C IS ON TH01 PLC CIVIL LAND C®P9t�®RIBS TO THE ZONING LA I' :E R URVEY®R DR.BY OF BARNSTABLE , MAC ® 1 j k_T 712 MAIN ST. CH. BY . S = 1� HYANNIS, MASS HEET- ® ®ATE RE®. LAN® 9U FZy ; .4 7.7 7�-g;ig'OR MIN iio v -03M a" � �, I A14MOMM" FIR -Al ak, ;p 'o Qw. �11 r -A , - LIQUID L"4M --CAXAN SAND S—) 77" 4"CA ST IROAI PIPE 0 "IM P17CH jl,*"PZR P7, IVA( - a 60 7A Css z XE.071C ® C MR&AAA 77o") ACHINC7,1 ORCIIND ;VA7'Zff rASLE I syc off DISP SE AC A-!L- r 3 FT. C so//- I-OC7 SOIL 77SS701 SOIL -r TRS zumvp soap. 9 7, Af /Amf/ boat. 0 PERCOdArMAI RAW 02 MIN DEWSM 6M17'ZRIA oz VRA 7'ZO NO PR)rr DD57A&M pk1c PIPE a -// 7 IAVIT D=ftqwAp F"w 6A.L.IPAY 1/1 li e h7 .�4 S,EC770JV X-X N04IMMIN MA �VA evp A'Mdr 7 OM-1 Nor .- 1,41 • "N' pegs fa 07� -3- A :7 n- -2 C LolCWS)OWN OF BARNSTABLE LOCAT14 9U \iDQ f`\XSV SEWAGE # q VILLAGE C('ik\31k ASSESSOR'S 0&9k l Q INSTALLER'S NAME&PHONE NO. 1 V Uy SEPTIC TANK CAPACITY LEACHING FACILITY: (type)��e� � P (size) 1060 NO. OF BEDROOMS. a BUILDER OR OWNER �lS � PERMITDATE: COMPLIANCE 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) F Feet Furnished by .� o'"i( �' 7 ^ ` (°�A LO�� A 3 A6 al QC Q Ac 39L A� 57 3� alsial - a . COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION N 8 PART A CERTIFICATION � R Property Address: 66 LOVELLS RD. COTUIT C)LIO 9A v Name of Owner PAUL SISSON Address of Owner: 46 CHURCH ST.W.BARNSTABLE MA.02668 15 Date of Inspection: 4/6/99 "rl��gfq Name of Inspector:(Please Print)JOHN GRACI . Grp ysj r99y I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: John Graci Title V Septic Inspection �4-r Mailing Address: P.O.Box 2119 TeaTicket,Ma.026364 G Telephone Number: (608)664-6813 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: X Passes The Inpection is based on criteria defined in Title V - Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Evaluatio By the Local Approving Authority performing at the time of the inspection.My inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: k Date:419/99 The System Inspector shall ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. • I revised 9/2198 Page 1 of 11 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:4/6/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: _ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: na One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. na The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)Indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. na 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 na 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): _ broken pipe(s)are replaced _ obstruction is removed t revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:4l6/99 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)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 surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nle_(approximation not valid). 3) OTHER nta revised 9/2/98 Page 3 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:4/6199 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n&. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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 ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level In the SAS is over the invert pipe,is In Hydraulic Failure. E. LARGE SYSTEM FAILS: 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: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:4/6/99 Check it the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The 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: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 11 5.302(3)(b)J X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. i revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:416/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):I Total DESIGN flow: 22I1 Number of current residents:i Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):JLQ Seasonal use(yes or no):JIQ Water meter readings,if available(last two year's usage(gpd): n& Sump Pump(yes or no): NQ Last date of occupancy: Wa COM M ERC IALII NDUSTRIAL Type of establishment: n/A Design flow: n&gpd(Based on 15.203) ' Basis of design flow: n& Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) nLa Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS LAST PUMPED 3 YEARS AGO. System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nt& gallons Reason for pumping: n(a TYPE OF SYSTEM _ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool a Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: 1983 Sewage odors detected when arriving at the site:(yes or no): NQ J revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:4/6/99 BUILDING SEWER: (Locate on site plan) Depth below grade: V Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: Wa Comments: (condition of joints,venting,evidence of leakage,etc.) Wa SEPTIC TANK: X (locate on site plan) r _ Depth below grade: 9_ Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) n1a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No n/a Dimensions: L 8'6"H 6 7"W 4'10" Sludge depth: a: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle:6_ Distance from bottom of scum to bottom of outlet tee or baffle: lu How dimensions were determined: MEASURED 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.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) n/a Dimensions: n1a Scum thickness: Wa Distance from top of scum to top of outlet tee or baffle:-WA Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n& 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.) nLa revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:4/6/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: nta Capacity: n/a gallons Design flow: nLa - gallons/day Alarm present: NO Alarm level:jV& Alarm in working order:Yes_No_ NQ Date of previous pumping: Wa Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Wa DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQUID LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances:etc.) nta i revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:4/6/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nta Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: j31a leaching galleries,number: 1]La leaching trenches,number,length: nLa leaching fields,number,dimensions: nfa overflow cesspool,number: Wa Alternative system: WA Name of Technology: 1ua Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONING PROPERLY.THE PIT HAD V OF WATER IN IT.PIT HAS NOT HAD MORE THAN X OF WATER CESSPOOLS: _ (locate on site plan) Number and configuration: Wa Depth-top of liquid to inlet invert: n& Depth of solids layer: n/A Depth of scum layer. WA Dimensions of cesspool: n& Materials of construction: n& Indication of groundwater: nLa inflow(cesspool must be pumped as part of inspection)nta Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa PRIVY: _ (locate on site plan) Materials of construction:nLa Dimensions:nta Depth of solids: Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nta t ' revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:4/6/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a g I� peek a4 a7 K 3y b AD 59 f3a 3'i VC a revised 9/2198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 66 LOVELLS RD.COTUIT Owner: PAUL SISSON Date of Inspection:4/6/99 NRCS Report name: n& Soil Type: nla Typical depth to groundwater: D/a USGS Date website visited: n& Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS AND VISUAL-12+FEET revised 9/2/98 Page 11 of 11 I Commonwealth of Massachusetts ®�f Executive Office of Environmental Affairs M �� Department of <0 Y_ Environmental Protection -w 1996' >1 William F.Weld Q Governor Trudy Coxe Secrelery,EOF1+ n s David B. Struhs - commissioner Qyl� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 0 PART A CERTIFICATION Property Address: 1--1-, p c )_ / ,;-� ,•��` Address of Owner: ' Date of Inspection: _ `i J (if different) Name of Inspector. i;; Company Name, Ad re s and Tplepho a 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: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Si ure: ,- Date: 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 flow of 10,000 gpd or greater, the inspector and.the system owner shall submit the report to the appropria!e regional office of the Department of Environmental Protection. The original should be sent tL• !r.e system owner and copies sent to the buyer, if applicable and the appro�ing authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure'criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or rnnore 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). 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 8115195) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 i? Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addrq"':� (� <<�V��-t< `� Kc"h•I i�� t'^" Owner. I ( �(�,.Si SSDY� l Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in thedistribution 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 inspection if(with approval of the Board of Health): broken pipe(s) are replaced 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 determine if the system is failing to protect the i public health, safety and the environment. t} 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 priory 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: _ l hp wstem has a septic tanK ano soii absorption system and is within 100 feel tc a 56 lace water supply or tribu;ar r to a surface water supply. _ The system hay 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 systerr, 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 necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 1 cw�l I l'., ' Property dress.: ��� Owner: —1-ai, ,1 6'5SC>n Date of Inspection: D)SYSTEM FAILS (fontinued): 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. E)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 200 feet of a tributary to a surface drinking water supply the.system is located'.in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone 11 of a public water supply well' 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. y I (revised 6/15/ml 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.B CHECKLIST csProperty dress: bu toVe-'t.S eU- , Owner: :(.�iSS OY1 Date of In ion'! 7 Check if the following have been done: tZ Pumping information was requested of the,owner, occupant, and Board of Health. Ii None of the system components have been pumped.for at least two weeks and the system has been receiving normal flow rates /during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. to/The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow ,/The site was inspected for signs of breakout. ZA11 system components, excluding the Soil Absorption System, have been located on the site. 1V The 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 approximated by non intrusive methods. he faci:it)" G'•:c„ ;Jnd occupants, if di!tere^, from ov<ner) were provided with information on the proper maintenance of Sub- Surface Disposal System. j; r (revised 6/15/95)` 4 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / ) J SYSTEM INFORMATION Property AddMs: �Y P` 0w- s i '[ e (' Owner: -S� '5 Date of Inspectiion: FLOW CONDITIONS RESIDENTIAL: Design flow: 0 al ons Number of bedrooms: Number of current residents: Garbage grinder(yes or no): Laundry connected to syste (yes or no):� Seasonal use(yes or no): Water meter readings, if available: f�J Last date.of occupancy: ' its�(vv--(-- COMMERCIAUINDUSTRIAL: 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 Y: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_ If yes, volume pompr& gallons Reason for pumping: TYPE FSYSTEM 1/t 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: Sewage odors detected when arriving at the site: (yes or no) (revised 6/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property dress: �,Q ]6V19 � Owner: Vilop"ct Date of Ie io4t. SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Sludge depth: ' Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth.of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) , GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _,FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom 0i prum to hottom of ottiet tee or battle 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 8115/95) 6 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspectifrp / TIGHT OR HOLDING TANK:— (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: . gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) r✓ DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note n level and distributw1, o equal, e�.urnce of so;id: ca.r�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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM IN ORMATION (continued) Property Addressb lfte,4�5 alui Owner: //��,(� r Date of InsiAl SOIL ABSORPTION SYSTEMAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching.galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation,etc.) 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 groundwater: 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.) c: 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.) (revised 8/15/95) B .e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C J ISTEM INFORMATION (continued) Property Address: Owner: cC Date of Ins eAkV SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all.wells within 100' (7 r DEPTH TO GROUNDWATER Depth to groundwater: feet " method of determination or approximation: (revised 8/15/95) 9 No...... e ozZ - V(gq Fizz.. �............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable Gj... OF.................... Appliratiun for Disposal Works Tonstrnrtiun Frrmit Application is herpby made for a Permit to Construct (g ) or Repair ( ) an Individual Sewage Disposal System av - .. - .. ------Cotuit Ma.. - ---•..............................•--------------•---------•-------..........---.............---- • Location-Address or lot No. •.Theo Construction Co. � _Inc, 24 Great Pond Drive, S. Yarmouth, Ma. _ ----• .................. Owner Address a Theo Construction Co. Inc, 24 Great Pond Drive, S. Yarmouth, Ma. 14 Installer Address 25 6 5 0 Type of Building Size Lot.... ....................Sq. feet Dwelling—No. of Bedrooms.........3, ................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ...................................................... W Design Flow............ ..............._--10..0.gallons per person per day. Total daily flow........330 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 ( ) 0-4 Percolation Test Results Performed by... ?orman Grossman P.E. Date_....9/16/82 a 10 '-8" none ,-.a Test Pit No. 1......2........minutes per inch Depth of Test Pit .................. Depth to ground water........................ (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................... •---------------------------------------------•-•------•------------............. 0 Description ofSoil0��-6"loam, 6"-18" subsoi.l, 18"-66fr gxave ,b6n=Y .►.._sari3......... ..... ................•--••---.....-------------------------•---------------••-----....-------•--............---•------------- x U --•--••--------------••------•-••-•-....-•----------------------...................----•-•----------.....--------------------------•----•---•-----------•----.....-----------•----•-....---------------- w x ----------------------------- •---•-•-----------•--...------•--------------------------------------•-------•--------------------------•-------------...-----------...........--------------------------- 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 i I:'E.;. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is pd by the/oar&of he Signed. . ...............Y.................... ..................... Date Application Approved BY �� 106 .............. Date Application Disapproved for the following reasons:-------•-------------------------------------••-.---.--•---------.-------------..-......--.. ......_------ ......................................•----------------------.........•-----------------....-•----------..__....•-••----•-••----•---•---•-----------.................................................... Date PermitNo......................................................... Issued....................................................... Date No...... �.��... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable OF.......................................................................................... Appliration fur-11hipoii al lgorkvi Tonstrnrtion Frruat Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ...Lot 1 Love1is Road.c...Cotu t_-............... .....................••-•••---•-•--•-•----------------•--------------.............--•.........-•-- Loc tion-Address r t No. Theo Construction Co. , Inc. 24 Great Pond Tyr ve, S. Yarmouth, Ma. .................. -- --._.......... ............-• ---•------•--•----•------------- ••..........._..••---••-••••...........------•-•------•-......••-•---•-------••---................ Owner Ad ress W Theo Construction Co. , Inc. 24 Great Pond Dr ve, S. Yarmouth, Ma. ......... ............ a Installer Address Type of Building Size Lot.....25 650 Sq. feet Dwelling—No. of Bedrooms._._.....3.................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -----•--•--•-------•----•---•..............••• - W Design Flow.................................H.H.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. Other Distribution box ( ) Dosin ank ( ) 0-4 orm8n Grossman P.E. 9/16/82 Percolation Test Results Performed by.......................................... _ n Date...._...._...__.._..._.__.... 1.4 ],� ----5- ----•••-•--- • none--•----._.. 1.4 Test Pit No. I......2.......minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------ p fl�_6Ioaiia------ Descriptionof 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:IT E 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. Signed.........................................................................•-•-•••..._.. ..........•...•................ D to Application Approved By--•-------••••. /---•-- ' f; f --•------------------------- -----1,11A.. .................... / .............................................•-•--•....••-•----•.Date•-••• Application Disapproved for the following reasons:..........................: ____._._ --------------------------•-------•--......--•----•------•--.................--------•--•--------•--.....•••-•••.....••••••••••••-•-----••------...•-••-•--•-••-•----•••-•••----•••-••••--••--....••.... Date PermitNo__________________......................................................... Issued----------------................................................... Date •- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH k Town Barnstable ............I.............................OF............................................*....... .......... ........... (9rrtif iratr of Tuntplin THIS IS TO CERTIFY, That the.Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................5. . .........r`........-•-•••--....._..-•••----••----•--•••---•--•---••-•----••••.._..........----•---.........•--••.........---•........-•---•--•--............. Y Installer at.............. .- ......./�:........... ....-------•--------------•------------------------------•---...------.....----•--------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for,'Disposal Works Construction Permit No..-! _ ",ram .................. I da.ted-------------------_............................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A A GUARANTEE THAT THE "SYSTEM WIL FLJACTION SATISFACTORY. DATE... =11..� -------------------------------------------- Inspector.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ` .......OF.............................................•--••----............................... No...�.?.._.. --. FEE. ................. Disposal Worho TonstrONn rrntit Theo Constructi . , Inc. Permissionis hereby granted..............................................•--...-••••-•-••-•------.....••-•---•••••-••••-••-••••-••••.........-••................... .... to Cons u t X or R it It v Se e Disposal System (1 )Love l s (Ro)a , built, "` i. p y atNo- ---------------------------------•---._.............-----------....--•--•--.......------......-------------•----•--------•-------•------------•---•-------•-----------..........•----..... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Vardco:riyea,t-h- FORM 1255 HOBBS & WARREN. 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[70 1� _ rhl O O �L r�csrlFiED WHEJ.� T►Bd TEMN�S tVEAi��ST T:1L �rl f 13 V 0 0 O CJ ® Q cnMc�ETloa �.,o Pe,o2 Ta OAc�ct=,�L.�uG. z" ram" }--- Q � 'Ta•--- V►..tt_...ES� OTNE2�ISE t�ioTED, AL.i SYSTE►� v c r yarJ,r,�e� ( COMPba1Et'.1T5 5►-11J.t.L h I 0 G O C) O �i (D �� YJE Iw►S 7 f ACC-O�DA.JC�• W 1"Sl-d TITLE ST T� TvPICA,L. pI5T2.laurl0" E50K 0 co O C% 0 ►1pT T® §cAtLE �' VJHICI-I MA*► Ain�Ly �CYfTc i=!LTeta6vT,o.A Soo& A."p- 1000 FiA!_ TYp K/►�- K400 Tli PI CAL L SAC N 11.1 Ca P 1'>r Qap&t VA770 t/ P/T3 CEAk-1FOPLAEC> SErr-,,c -TP-. W- ey A .%4FetcA.I.1 PC_Ccs.ST ►k:PT _n scoL_E mar-Vo Scr•,E O� ic0UA.L l�t(`RF : TrWKS RTcq.OFcacC..ED THftO�C.NoiT PF.t COLA T/O N .P.�tYW = 2 /�n..s /11Fc h wrTH EIE�CT�,L wE�-pED vs,¢c w�rlU O,00r,ek-AT/oM5 oy: �cahy°ti�rV I rem vt 0 � �'`..•.T- 24 -44 ' StAssoovo SQL_ eafls 1'.1 ^14W ^.► rrt�►nlHct.r� -to /►.!c:. 1' T" �/'' C.C-+C SOS.lO alc I �1 L dry �R 6o rTo►�1- Co+iC. 6 00o 4 PSte- TEST Ta Ml+E SOILT uP Tamrauac W% be e.Avu PL ru IyN s wr AL ZV W lop Fovy DATO�.I, A%47L' > i ,x :Cs+ E LCv. ' F1*41SW F IMIS►f bv` C AL FirritSH GC�►saE• �/.Yd oilLt 'T�►s�,K• -`�C�a,� <I�fiCCf`1lltsc � = 1.i�RCH��16 . Si7,�'� (r i L n7 -- . � �c�Feu. 2�• t of .: v 064m 1»�• p m r0 o �Tn•ts eeuJfoeu� uey.le• ptST t�rc p 0 00SwTrom ' J St:PrIL TAry • p Fc%-xv-A K$oT Tasc...L05, LLEACNIM& �If f a - � N cv, A l rAt r ''►�.' t, ,Jd - - r � `,��_ �_ r LAG E�c/� oEs 1Gw Gei7-Ee/,4 r : �'__A4N PR O PO SED D V/M L L I Kl G LO CAT I O t, AJNM I E� OF dE0.eGooM S �, Fr- ' Ex/Ir ear' Ec-d- � R � PROP045MD SF—WAGE 0(SPOSAJ_ 5Y�-'EMt Z4f R08ERT \ y ` AgrXfOA(.5 ACKC AlL P eooM 'L �itdil. .;ioT ELAi \ !•©f� � j 198 ZXAeN/.VG Ae,'W fro✓IP&O 4 LI r-YO J"- .� PROPOSED LEACHING PIT } - b.PP'L.ICJ�►1►iT: � ER1611Jfi�.2: x ,f.'t`, :.�;. J `T �/,J' :=t%t.1,�7�''LC-"*iG(••�..d l/-' �.�l.C��'/'` �' �c'r�i jf'+-••i,?✓.1/^ (oo % EA PA KI s 1 o n! y � " _ G ,P�7 fLJ�� G'9�.�✓� 3 ,t`! _'TiC/.�'��,C i.�_,; t r L - t� ROBERT 37 RAYMOND 1` iGA{f t: DATt ""'gT f/'-F� f ac 21583}�l f �� �� r (f! ]' �.t"`�,, .�f ? 70 rq L_ O*AWN Gr: CI4KC •r: *A" ev: PL" M