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Home My WebLink About0015 MAIN STREET (COTUIT) - Health 15 MAIN STREET, COTUIT A=009 030 jLf r TOWN OF BARNSTABLE BOARD OF HEALTH / ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 1 Time: In Out Owner Tenant -Yu � 1 C Address �� Address Complian a Remarks or Regulation# Yes VNO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 2 5. Hot Water Facilities �- 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing fL 18. Driveway Width 19. Number of Tenants Observed PART 11 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) �--� Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here r TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 10 Time: In Out Owner mot_- tJ Jr 1 A?V 1 NVS UXAL,(jaMS Tenant Address �Q �� Address 03 MA I rti S ` Compliance Remarks or Regulation# Yes . NO Recommendations 2. Kitchen Facilities , 3. Bathroom Facilities kDCea -�- �- 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 3 tr2 17. Temporary Housing /v6 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 7 Number of Vehicle owed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspe or If Public Building such as Store or Hotel/Motel specify here TOWN OF BARNSTABLE L LDCAnO.'N <' /� J! SEWAGE # �r i VILLAGE n. � ASSESSOR'S MAP& LOT 1` p U 30 _ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY / 5r\0 d y �y LEACHING FACILITY: (type) 'OC4 4C' (size) NO. OF BEDROOMS BUILDER OR OWNER I PERMITDATE: 3' l ®Zr COMPLIANCE DATE: r Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ti QG� �1 y C ( � TOWN OF BARNSTABLE LOCATION (s /1-",4 , M S'>� SEWAGE # YII,LAGE C® �J d ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY G e-S S oe -, LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility+) Feet �i-�Furnished by /�> L ( -4 �. .; _ rt- iG �, �� _ 3� � �� Y� No. �o u of _ �U .v r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippIication for Digpooar *pgtem Construction Permit Application for a Permit to Construct( )Repair()()Upgrade( )Abandon Complete System ❑Individual Components Location Address or Lot No. Ma I/1 5 T C O T U/'! Owner's Name,Address and Tel.No. /�J ern/,4••17 cl K e 61 Assessor's Map/Parcel 9 30 /5— 1".4,ev S7 ('u 14jo T Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0-1r,e /c/ S;m,,hl-2 y S'e vi c- =�r e 06C n�vr;2 0��-+-e.�. e / iy��+4.ov c ejt?4S7iian —Ac4 E-A-S7 SA!!Dwr C6 Xnd— k jtj- Zo/O P33 2/ Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S'nI l e rya %iy No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 Vo, �c gallons per day. Calculated daily flow 3 tt4y' gallons. Plan Date Z -Zg-o/ Number of sheets / Revision Date /1 O e7-� Title Size of Septic Tank /SDU Type of S.A.S. Description of Soil S-e e P/413n Nature of Repairs or Alterations(Answer when applicable) Rev/4 C.e- 944-71.e p( e esZeod I S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by th is B d e th. Signed Date ? Application Approved byNL?/�, Date "2 o Application Disapproved for the following reasons Permit No. a C) 6 1 Date Issued —U 2 ..� �No. DU �,--'RO ,,._ � ,+w Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION = TOWN OF BARNSTABLE., MASSACHUSETTS "- Application for Dtgoml 6p.5tem Con5tructton Permit Application for a Permit to Construct'( )Repair Upgrade( )Abandon( ) C Complete System ❑Individual Components Location Address or Lot No. ry1 A(el 5 ( "C O 7 UI,7 Owner's Name,Address and Tel.No. .8ern4,f_d K e/ty Assessor's Map/ParcgL.: 91" y 3 p /S- /YrA I S'T fi o 7u/ T 1 i Installer's Name,Address,and Tel No. Designer's Name,Address and Tel.No. BUvSt'rP /c✓ 1^1 i fib2 SP/v/ c 7/vC, 9,5,e G ivv/;¢aNIaA v.v7d / IL( a-i74IV A w S4D1 CA lid w ��y Zoo P33 Z/ 77 Type of Building: Dwelling No.of Bedrooms 3 Lot Size—sq.-ft. , Garbage Grinder( ) i Other Type of Building SAS t-e- No.of Persons n�Showers(r ) Cafeteria( ) Other Fixtures ' Design Flow 3 gallons per day. Calculated daily flow 3V,0 tr gallons. Plan Date Z -2-5—0/ Number of sheets / Revision Date /1 O n -$_ Title Size of Septic Tank /5710 Type of S.A.S. /�,c��Gi• �6�J' (500) Description of Soil S-P e P,_(A4 Nature of Repairs or Alterations(Answer when applicable) ReVIA O_e 94'4 11,Q d e OSZ d I S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuf by thiWd e h. �. Signed Date 3 /$�� Application Approved by _ Date a Application Disapproved for the following reasons Permit No. �_)d c a —/ Date Issued 7 r /—U Z +. T - --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the n-si Sewage Disposal System Constructed( )Repaired (X)Upgraded( ) Abandoned( )by 230 rS ije /W t4oi;4�e e at /7 /Y),4,,1 S%— Ca has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 6,2 Installer fad✓3 1--/e / Designer T>Q C Y/ The issuance this ermit shall not be construed as a guarantee that the syste w' 1 fuft ioas/�esi Date Inspector 1' ------------------------------------- No. of o O -~ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mtgaar *p5tem Con!6tructton Permit Permission is hereby granted to Construct( )Repair QV)Upgrade( )Abandon( ) System located at /5' /09-4r-V -7 Po fvi '% and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe t. / Date: '�a ' 2 Approved by I ` df TOWN OF✓BARNSTABLE L LOCATION SEWAGE #;aQ2 "12'Q VILLAG ASSESSOR'S MAP& LOT 1 -0 � INSTALLER'S NAME&PHONE NO. &11-2106 "221-SVe— ale SEPTIC TANK CAPACITY f 7\\ d LEACHING FACILM: (type) ) � /C (size)—NO.OF BEDROOMS BUILDER OR OWNER $ PERMITDATE: '�-1 ®� 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by kll-540 0015. 00 3� Ci 0 V t , v V TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 760-1819 40 Old Bass River Road South Dennis,MA 02660 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property 1 .5 Al 0.I' "' S1� C o ;7L 11 Owner's name& e Mailing address Date of Inspection �3 S ao A L/C 5" 1995 N PART A fva CHECKLIST 14 Check if the following have been done: `� V ✓ Pumping information was requested of the owner, occupant and Board of Health. 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. N 119 As built plans have been obtained and examined. Note if they are not available with N/A. VThe facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. >/ All system components, excluding the SAS, have been located on the site. N�9 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. t/The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. V/The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. Page 1 of 7 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential ,3 number of bedrooms _number of current residents _/V,' garbage grinder, yes or no lE S laundry connected to system, yes or no /V a seasonal use,yes or no If nonresidential, calculated flow: Water meter readings, if available: 9�/ = 3.2� Last date of occupancy GENERAL INFORMATION Pumping records and source of information:: l 1 L RR / l/ l� ✓(hq'�, N 4 / h f�✓ Nia t Tl ti H. Q J / O\ / Y�s System pumped as part of inspection, yes or no If yes, volume pumped 1&yy Reason for pumping: C 11 e-1�k 14,E G ,w CI, Type of system Septic tank/distribution box/soil absorption system Single cesspool —zOverflow 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. Source of information: A16 Sewage odors detected when arriving at the site, yes or no Page 2 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: -A//� (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,recommendations for repairs,etc.) DISTRIBUTION BOX: N/14 (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, recommendation for repairs,etc) PUMP CHAMBER: Y, 4 (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber,condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) Page 3 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM(SAS): _�/ (locate on site plan,if poss.;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits and number leaching chambers and number leaching galleries and 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,recommendations for maintenance or repairs,etc.) D i v rn.� t tih.a �n .4 o � h l -c- CESSPOOLS (locate on site plan) : i/ number and configuration v n& « S a o depth-top of liquid to inlet invert 7 depth of solids layer depth of scum layer. 311 dimensions of cesspool 6 'C I n X 5- materials of construction C z 'C , indication of groundwater inflow (cesspool must be pumped as part of inspection) Al o ty e_ _ Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,etc.) k' ? o c. o J r cJ —22 A i 5 ol— r Ur p/d 614k- g o PRIVY: IV14 (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, recommendations for maintenance or repairs,etc.) Page 4 of 7 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �a� k 3i� �, c cswoo y6, 0aCV, a✓ DEPTH TO GROUNDWATER depth to groundwater _ adjusted high groundwater level method of determination or approximation: Li s f v $ t 1/�' rs.�.,._ of 2 1 ..►` �. /.,o C�S. .� c �f/ Page 5 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no or not determined (Y,N, or ND). Describe basis of determination.in all instances. If"not determined", explain why not) IBackup of sewage into facility? N Discharge or ponding of effluent to the surface of the ground or surface waters? A1111 Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6"below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? Number of times pumped /\(1A Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration?tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? within 50 feet of a surface water? _/ within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh(cesspools and privies only, not the SAS)? N within 50 feet of a private water supply well? Iless 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. Page 6 of 7 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector: Troy Williams Company Name: TROY WILLIAMS SEPTIC INSPECTIONS Company Address: 40 Old Bass River Road, South Dennis, MA 02660 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. the inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check one: _ZI have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature S Date 8/3 Original to system owner Copies to Buyer(if applicable) Approving authority PROPERTY ADDRESS: Col -• Page 7 of 7 L 4' LOCATION SEWAGE PERMIT NO. VILLAGE 1 INSTA Ll ER'S N E i ADDRESS 12 OR OWNER T DATE PERMIT ISSUED . Y3 DATE COMPLIANCE ISSUED ' � . ''� t:, ' ,. _ ,, `< o v ,� ��C �S r; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......................................... Appliration for Mipa ttl Works Tonstrnr#inn rrmff Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... ......................................... .... ...... -.......... Lo io .4ddress E o t .. •. .... ....................................... 44 - -••---- ---- ner Ad r s a ... ....___.----•---•.................:.... �. .-•--_-._•.-............. ... ....------__-- Installer Address Type of Building Size Lot. . ..........Sq. feet Dwelling&;'No. of Bedrooms.......................................:....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ............................................................... = ... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Rai --•-• a O Description of Soil.... r�.�_ ._ ram' ,. U -----•-•-----------------------•---•---••-•--•----••--•••------.._........._•-•-•...... W ------------------------•--------•---------•----•-----••------------•---•--------------•--..........----•-. -------------------- U Nature of Repai or lterstio s—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 is ued b the boar f health. i ---------------------------------- - . ...... .............. Application Approved B ......... __ � ......- PP PP Y ---------••-....__--•-•• Date Application Disapproved for h ollowing reasons:----••---------•-----•-••------•----------------------••------•-•----------...------------................•-••-- -------•--•.....-•-----•••-•--•-•••-----........--•-••-----•......................•--.._...................-•••-...........----•-•....-----•-•-•••-•••--•----••---_-•-•-•- •--••••---•-•----•-----•___--- Date PermitNo......................................................... Issued..:.. _�� ........................ Date • < No :".)� .... Fmc..... ...--••......... A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ........... .......OF................................_........................................................ ApplirFation for Diipniial 19ork.5 Tomtrurtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............... - ................ Loc o Address ....................................... •••-_.....F f� o t ............... •-•--•••-••••-••-----• ..... --- ...----- ....... ............ ier �.�h / Add W �. •/� ..... a lwy �rrR � Installer Address VType of Building Size Lot_,�Q,a_.10a0____Sq. feet Dwelling z;lt o. of Bedrooms........................................_...Expansion Attic ( ) Garbage Grinder ( ) per-, Other—Type of Building No, of persons____________________________ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 _____________ .... _ O Description of Soil..... � :. ---------•----------------•----•------------------•--•-••••-•-•--....-•--- U •--•---•---••-•............................--••••••-••••-----•-•••--•••-••----••-•••.•-••••••---••._.......--••-------•-•-----•-•••---•--•---••-•--•--....----••••••--••••--•••-•--....••---••-•••---- W ---------------- --------------------------•----•-•-----------------•--•---------------••---•-•----•...•---•-•------- U Nature of Repair or ---------- ltera io —Answer when applicable ._____._ ._ — d4 __. ---..__._...---•--------------------------------•----------•--••--------------------•--------••-•-•................_.._. -------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIL- 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 ued b the boar f health. ig .................................. ` .... Application Approved BY _ _----_------................................ Date Application Disapproved for a flowing reasons:------••--------------•-----•--•----•--•----•---------...-------•-----------•-••-------------•••---••__-••••-- •--•••••-••--•----••-•--•-...•-•••---•••----••-•---•-••----•..__..-••••••-••----••-..........••-••--••--•-••---•--•--•-•-•--•-•-•-•----•---•••---•-••-••-•-•---••-•••-•--••----••--•-----••-•••••••-...: Date Cap Permit No......................................................... Issued_._". . ... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............................................... ........................................ Trdifiratr of Toutpliatta T ; S TCE FY, That the Individual Sewage Disposal System constructed( ~) or Repaired by.. _' ._.../it. _ � . ..at.._ AV-- - ---•- f � .�''_---•------------------------------•----.. ...-•-- -. ........---------..._ has been installed in accordance with the provi IF 5 of The State Sanitar d as escribed in the Yrapplication for Disposal Works Construction P -� " dated____ _ ________�___..._._____.._.._.._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® GUARANTEE THAT THE SYSTEM WILL N ION SATISFACTORY. DATE.... _ .J.............................................. Inspector.....--- ••. ................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F..................................................................................... /� FEE. Se ............... �i��r�a�tt �un�#rnrtuan rrnti� Permission is hereb ranted---- -----_ G `g ..................... ........ , •• ........................ to Construct or epalr a ndr al .wage Dispo stem at No.. .� �'tr_ € f' �:� Street , as shown on the application for Disposal Works Construction Permit No____________ _ ated_..17_ .................. ...................................... -• --........................................................ oard of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON "'- ASSESSORS MAP : 7 J TEST HOLE LOGS PARCEL : �t�b SOIL EVALUATOR : I),��I�_ ✓ �ICS� /; , I C FLOOD ZONE : I ` ( C� �a �,��':C WITNESS : � � fit, L,�(��2 1 I � � ��, � � � , / _.. REFERENCE : �"� �-1 �C�� / / ` ? �� DATE: ��i co , 141►� ( t,.� �� -1^-�1 �t / PERCOLATION RA E: Z hi1 Z ;( �� ( ,� , � �i lit, �IAVOLA4 .� TH- 1 TH-2 I w jTc,�. n�--� LOCATION MAP(I47T6) 4,) orl L/� 4o rib l . I l SEPTIC SYSTEM DESIGN Av FLOW ESTIMATE BEDROOMS AT �O GAL/DAY/BEDROOM - GAL/DAY ° + I SEPTIC TANK fro _ 1•+" ��sj�j � �GA�/DAY x 2 DAYS GAL l ) USE GALLON SEPTIC TANK SOILBSRPTION SYSTEMILI 4 zif l �7 — iv SIDE AREA: -f I X. BOTTOM AREA. EPTIC SYSTEM SECTION ! � 4 100,00 \0110 IV 'f _ / �+ ✓/8 ✓VV(/�� W t/He ✓ w`I`^ (v�T W 9 l P 1 I - -sox g0,1�j } _ :? GAL b 5 wa= sir d � I� I SEPTIC TANK � -_ ,� qb' �3J� , �Z �)oIJ Jf, 61DV4r � SITE AND SEWAGE PLAN LOCATION : � 5 --- PREPARED FOR : KL� SCALE : � = DAV I D B . MASONJ�5 DATE : 2 7- 0/ z DBC ENVIRONMENTAL DESIGNS - EAST SANDWICH . MA 3 DATE HEALTH AGENT ( 508 ) 833- 2 177 Z