HomeMy WebLinkAbout0117 ABLE WAY - Health '!A? A6le Way --- - -
Marstons Mills P
A = 046 110
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
n i n
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not David D. Coughanowr, R.S.
use the return Name of Inspector
key.
Eco-Tech Environmental
Company Name
43 Triangle Circle
Company Address
Sandwich MA 02563
City/Town State Zip Code
508 364-0894 1328
Telephone Number License Number
B. Certification
w w �
I certify that I have personally inspected the sewage disposal system at this addressand that the
he
information reported below is true, accurate and complete as of the time of the inspection. Thei inspe on
was performed based on my training and experience in the proper function and ma0, nancerofion s;1t
i.
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15 40 oCil,
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fail
v�
❑ Needs Further Evaluation by the Local Approving Authority
(Lor� (�\. JR—S December 24, 2012
Inspector's Signature Date
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.
****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.
t5ins•11/10 Title 5 Official In ection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 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:
Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer
Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5. The
scope of this inspection is limited to health and environmental compliance and the septic system has
been evaluated according to the conditions observed on the day it was inspected. No estimate or
guarantee of system longevity is made or implied by a passing determination.
B) System Conditionally Passes:
❑ 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.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
1 determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and.if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
u v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is Marstons Mills MA 02648 December 24 2012
required for every ,
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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.
❑ 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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
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 ponding 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 an overloaded
or clogged SAS or cesspool
Liquid depth in cesspool is less than 6" below invert or available volume is less
❑ ® than '/2 day flow
l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
I -
Commonwealth of Massachusetts
4 W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is Marstons Mills MA 02648 December 24 2012
required for every ,
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® 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 within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent 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
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ 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 II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
117 Able Way
Property Address
US Bank, NA
Owner
Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® 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 iinspected 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 from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ 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(5)]
D. System Information
Residential Flow Conditions
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
M u Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Original Design Plan of 1977 calls for 3 bedroom design.
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage 79 gpd
9 ( Y 9 (gpd))
Detail:
2011, 2012
Sump pump? ❑ Yes ® No
Last date of occupancy: undeterminedDate
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
GSM , 117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is Marstons Mills MA 02648 December 24,
required for every 2012
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: agent
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is Marstons Mills MA 02648 December 24 2012
required for every ,
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Age: 15+ years. Certificate of compliance for new leaching gallery was issued 8/19/1997 (Permit#
97-416 at Health Dept).
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Sewer line appears structurally sound with no evidence of leakage or backup into dwelling.
Septic Tank(locate on site plan):
Depth below grade: 0.5
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 10.5 x 5 x 6- 1500 gallon tank
Sludge depth: 8 in
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
GSM 117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 26 in
Scum thickness trace
Distance from top of scum to top of outlet tee or baffle 10 in
Distance from bottom of scum to bottom of outlet tee or baffle 14 in
How were dimensions determined? Design plan calls for 1500 gal tank
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumping is not required at this time. Maintenance pumping is recommended within 2 years and every 2-4
years thereafter. Tank and tees appear structurally sound and functioning as intended.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
II
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24 2012
page. Cityrrown State Zip Code Date of Inspection
D. System Information cont.
Y (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert at outlet inverts
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box appears structurally sound with no evidence of leakage in or out. Few solids in sump.
A bucket of water was poured into the distribution box and was observed to pass through in a rapid
and unobstructed manner, and could be heard splashing down into the leaching gallery.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24 2012
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
® leaching galleries number:
1
❑ 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.):
Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush
vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into
leaching gallery stone and no effluent contact staining was observed in the stone or overlying soils.
No standing effluent was observed to a depth of 1 feet below the top of the�peastone layer.
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 inflow ❑ Yes ❑ No
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°^M
117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, 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.):
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
No. — Fee ,
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE,MASSACHUSETTS Yes
ZippIication for Miopooi 6p! tem Construction Permit
Application for a Permit to Construct(-11&pair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. //7 {�/fj/f GC/i�Y Owner's Name,Address and Tel.No. 42
/%S
Assessor's Map/Parcel
Installer's Name,Address and Tel.No. L/7 7-0 5 5'y Designer's Name,Address and Tel.No.
�oScp� 0, po1S�I /
by �/
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) r/ 5 6q Lr i
.SfJO
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 issue by this oard of ealth.
Signed ✓ �� Date
Application Approved by Date %— 7
Application Disapproved for the folfdwing re ons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that�he On-site Sewage Disposal System Constructed( (�-Repaired(, )Upgraded( )
Abandoned( )by t/O.Se,24 & l 5
at // U-/ tovz 5 4fllls has been constructed in accordance
with the provisions of Title 5 and the fo Disposal System Construction Permit No. dated "
Installer d-a ZLA0-,'os Designer da S —/s�idd^y G S
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Q I - �f i Inspector —�
--------------------- -----------
No. //, �,� Q Sf G / l/O —-—Fee <^lJ
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal bpstem Construction Permit
Permission is hereby granted to:Construct(L)rRepair( )Upgrade( )Abandon( )
System located-at //'/ 646�e ui/4G/ !�/nrsT0.iJ dLli/�S
c
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 permit.
Date:�_� -2, — / 7 : Approved by Q .�
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
c,M 117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 40+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
Barnstable GIS Department records
You must describe how you established the high ground water elevation:
Approved design plan on file with the Board of Health shows that no groundwater was encountered in
a witnessed test pit March 16, 1977. Town of Barnstable GIS Department records indicate that the
property is over 40 feet above the groundwater table.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
T,tle .5 iDffi �al' In . ectron Form
.p
y Subsurface;Sewa a DisposAf�System.Form Not for Voluntary Assessments
9
�� ..•' 117 Able Way
' �operty,Address P `
US Bank,NA
Owner's,Name;.
information Is
required:forevery Marstons,Mills MA 02648 December,24,2012
page.. CltylTown State, zlp Coder Date of.lnspec(ion
D S,ystem lnformati:on (cone )
Sketch Of Sewage Disposal System Provide a,view of the.sewagal isposal system; Including ties to;
at least two permanent reference Landmarks or benchmarks'Locate all, . s within'100 feet..Loeafe.
'.'Where-.,public water'supply enters=the;building Check one of=`the=6oxes'below
hand.skefch in th:e,area'below_ -
0 drawing_attached separately
`. p
1
d S�'p ► lG
3
4 4-�•
E
iA
t5: 111.10; TIIIe!S,QMdbl lhsped r Form iSubsuriaee Sewage bisposal System Page'15 of t7'
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 117 Able Way
Property Address
US Bank, NA
Owner Owner's Name
information is required for every Marstons Mills MA 02648 December 24, 2012
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
TOWN OF BARNSTABLE
LOCATION / l7 /� �/�1G1 SEWAGE # 97- kf/G
VILLAGE '!�1/.y!0006. & ASSESSOR'S MAP&LOT O`/G- //0
INSTALLER'S NAME&PHONE NO. JnSzA4 D.t 6sgNro.S Z/77-J5' '9'
SEPTIC TANK CAPACITY /000
LEACHING FACILITY: (type) 2 -f-00 LF,d CAt4- e) .2 s'X /3
NO.OF BEDROOMS 3 ,
BUILDER OR OWNER
PERMTTDATE: g— / —97 COMPLIANCE DATE: B - /9 — 97
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) /10 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leachi g facili ) Feet
Furnished by
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No. — Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
0(pprication for Migo!gal bpotem Conotruction 3permit
Application for a Permit to Constructt1(E�jRepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. //'7 14 wo� Owner's Name,Address and Tel.No. y 2
Assessor's Map/Parcel
Instgaller's Name,Address and Tel No. ,/ 05 9 Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) S, �� <. iZ j
T14Zw 2 — s2o ZF4C4 c���;�>�,��s �,�� y�sro',1= )%ia4w�
Pi-w s roh-c
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 issue by this oard of ealth.
Signed Date
Application Approved by Date —9 7
Application Disapproved for the folf4wing re sons
Permit No. Date Issued
No. Fee 1 i
THE COMMONWEALTH OF MASSACHUSETTS'� Entered in computer:
PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLES MA�SSACHUSETTS Yes
Zipplicatio4i for Migoar 6pgtem Construction P&mit
Application for a Permit to Construct( 41,fepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location'Address or Lot No.' 1-7 &liG 0 Owner's Name,Address and Tel.No. 4 2
` I x7 o' s1,00 S 614i��S
Assessor's Map/Parcel 1
Installer's Name,Address,and Tel.No'.y 77 O 3 9 y Designer's Name,Address and Tel.No.
JOS tp 4 0-c 90 ram►0.5
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( ) ;
Other Fixtures � z
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date—' Number of sheets Revision Date
Title
Size of Septic Tank -Type of S.A.S.
Description of Soil Sl4 d
Nature of Repairs or Alterations(Answer when applicable) 4111 ev.5rlNz- Lr12,17
Ti',IT&al/ 2 — SrID ,�� Z"' -Li C,f9,res b.�s"S Gf%t.?l, �1'Sto.yi_ XeOy`r
� P Pee S toti-c
i
Date last inspected:
r I
Agreement:
The undersigned agrees to ensure the construction and maintenance '[li-vafore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not 0place the system in operation until a Certifi-
cate of Compliance has been issue by this oard of Health. '
l Signed Date ? -/-I 7
Application Approved by Date
Application Disapproved for the follVving re ons
Permit.No. Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( [..)-Repaired( )Upgraded( )
Abandoned( )byO SGp/i � l>?.�yvaS
at re U tav!5 S has been constructed in accordance
with the provisions of Title 5 and the fo Disposal System Construction Permit No, dated
Installer _Aite4 ,d-a ,,?i4,-eaS Designer 05 eo O-e 4&A+X-0_5'
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date 19 - 1 q - q 1 Inspector V -. �.
---------------------------------------
No7 /�n°/t7 0!f 6 �Jfr t�f'f7 Fee f�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mwi5po5ar *pgtem Construction Permit
Permission is hereby granted to,Construct(L.�rRepair( )Upgrade( )Abandon( )
System located at jWY4&
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 permit.
Date: /� - �T / 7 *-Approved by Q
TOWN OF BARNSTABLE
LOCATION 17 /_1 SEWAGE # 97- kf/G
VILLAGE A/w,-5/2-25. ASSESSOR'S MAP& LOT Oft
INSTALLER'SNAME&PHONE NO. 116sT_6
SEPTIC TANK CAPAC= /Doe)
LEACHING FACMITY: (type)
NO.OF BEDROOMS ,
BUILDER OR OWNER P"
PERMTTDATE: 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 of within 200 feet of leaching facility) Feet
Edge of Weiland and Leaching Facility(If any wetlands exist
within 300.feet of leachi g facili ) Feet
Furnished by
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TOWN OF BARNSTABLE
�FTHETO
OFFICE OF
DAH37TAn i BOARD OF HEALTH
MAN` ej
°O i639• \{� 367 MAIN STREET
HYANNIS,MASS.02601
August 19, 1997
Paul O'Connell
117 Able Way
Marstons Mills, MA 02648
Dear Mr. O'.Connell:
You are granted variances to construct an onsite soil absorption system (S.A.S.) at 117
Able Way, Marstons Mills, Massachusetts. The variances granted are as follows:
• 310 CMR 15.220: To utilize a sketch plan prepared by a licensed disposal Works
Installer showing the proposed soil absorption system (S.A.S.) location in lieu of
submitting engineered plans as required.
• Part VHL Section II: To install a S.A.S. 120 feet away from on onsite well and 130
feet away from neighbors private well, in lieu of the required 150 feet setbacks.
The variances are granted with the following conditions:
(1) The soil absorption system (S.A.S.) shall be installed in accordance with the
submitted sketch plans, by a licensed disposal works installer.
(2) The existing leaching pit shall be abandoned in accordance with Title 5, the State
Environmental Code. This means the installer shall either fill-in the leaching pit
with sand or remove the leaching pit.
The variance were granted because the existing leaching pit was malfunctioning. The
proposed system meets all the requirements of Title 5 the State Environmental Code.
Sincerely yours,
WSOVIr
Susan G. Ras , R.E.
Chairman
Board of Health
Town of Barnstable
SGR/bcs
oconnell
PH6 E CALL
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SIGNED 4003
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Town of Barnstable of'THE
Department of Health,Safety,and Environmental Services
Public Health Division
9117
P.O.Box 534, Hyannis MA 02601 sn>E MASS. .>E,
v nss $
s639. ♦0
ArED M1►�l A
Phone: 1-508-790-6265
FAX: 1-508-790-6304
Fax
To: De)D ._J 1 �1 From: . p =5 M ► )e f\
Fax: J4;10--oAi Pages(including cover):
Phone: Date:
Re: CC:
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
•Comments:
NO.
DATE
SARMA13M
MAW
E059. Town of Barnstable
REC. BY
Board of Health
367 Main Street, Hyannis MA 02601
Susan(i.Rask,R.S.
office: 508.790-6265 Brian R.Utsdy,R.S.
FAX: 508-775-3344 Ralph A.Mwphy,M.D.
VARIANCE REOUOT FORM
All variance requests must he suhmiticd at Icast fifteen 115)days prior to the scheduled hoard of Health meeting.
NAME OF APPLICAN Qom,. nne �_____ TEL.NO. 426-1450 T , �,��
W �
ADDRESS OF APPLICANT 1 l y e du
a.
NAME OF OWNER OF PROPERTY
E D
ASSESSOR'S MAP AND PARCEL NUMBER
OF REQUEST 1171 A �Q- %
LOCATION Q
SIZE OF LOT SQ.FT WETLANDS WITHIN 200 FT.YES
NO
VARIANCE FROM REGULATION (List Regulation) g O,
re 1a�iibr, �m&
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tJt re �►ro-
REASON FOR VARIANCE (May attach if more space is needed)
PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING
VARIANCE REQUEST.
VARIANCE APPROVED_ Susan G. Rask, R.S.,Chairman
NOT APPROVED Brian R. Grady, R.S.
REASON FOR DISAPPROVAL Ralph A. Murphy, M.D.
SENDER:
V ■Complete items 1 and/or 2 for additional services. I also wish to receive the
H ■Complete items 3,4a,and 4b. following services(for an
d ■Print your name and address on the reverse of this form so that we can return this extra fee):
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UNITED STATES POSTAL SERVICE First-Class MailPostage&Fees Paid
LISPS
Permit No.G-10
® Print your name, address, and ZIP Code in this box
1
S LL.S
i
tive on October 22, 1974, after publication in the Cape Cod
s ` Meg.
TOWN OF BARNSTABLE
t
♦e OFFICE OF a ,
s�►assTtEL
BOARD OF HEALTH
NAM 397 MAIN STREET
� ONpYM�� HYANNIS, MASS. 02601 _Qc o�x_-1�----_19-4
iY
LEGAL NOTICE
In accordance with the provisions of Section 31 and Section 127A of
Chapter 111, of the General Laws, Regulation 2, of Article I and
Regulation 3, of Article XI, of the Sanitary Code of the Commonwealth of
Massachusetts, and for the protection of the Public Health, the Town of
i Barnstable Board of Health adopts the following regulation:
The installation of a private water supply and a private sewage
disposal system on a lot containing an area less than 40,000 square feet
of buildable land is prohibited and in no case shall a private water
supply and a private sewage disposal system be located within 150 feet
of each other.
Variance to this regulation may be granted by the Board of Health,
�a after a hearing, during which the applicant proves that the installation
of the private sewage disposal system will not adversely affect surface
=; or sub-surface public or private water resources of :
& 1) The lot subject to the application
2) The adjacent land (whether developed or not) or
i 3) A defined aquifer recharge area
In granting variances, the Board will take into consideration
population density of the area, the size and shape of the lot, slope,
. the suitability of the soil for drainage and percolation, existing and
known future water supplies, depth to ground water and impervious material
and area reserved for expansion of sewage system and relocation of water
supply in case of failure.
This regulation takes effect on the date following publication, but
does not apply to preliminary or definitive sub-division plans filed
prior to publication. After publication this regulation supercedes the
previous 40,000 square foot regulation w:Ibleife
ent into effect April 12,
1974.
L. Ch ds airman
rk Q AA 0 F,-JA fin I 1.2)A-
-b
XAnn rAEahba h
VV r t
erald W. WA"rd,, We' D.
BOARD OF HEALTH
THE COMMONWEALTH OF MASSACHUSETTS
�---- �B...O. A R h . ._.%�
OF..................................... ... ._..._......--.._.......................-_.
Application -fur Btspoiitt1 Workii Towi#rurtion Vrrufil
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syste at�---- - � -
�°Use� u 7 --- ------------------- -��-----��� .�-------
tion-Ad es or L t Io.
--•• •••-- --- --•-••......---. ---------------•-------------------.. l22------- �. ••. -`--•--------
Owner L Address
Ae
a ...................... to
.... ---......... ..............-••••-........................... ............. ---- ------�i.......... • .-'-`•.....................
Inst er Address
d Type of Building Size Lot_ekd--!�6___________Sq. fe t
V Dwelling—No. of Bedrooms----------- ------•______________________Expansion Attic We) Garbage Grinder
aOther—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_M gallons Length---------------- Width......---------- Diameter----------.----- Depth.___--__._-...
x Disposal Trench—No. ... ... Width ------------------ Total Length.................... Total leaching area-------.------------sq. ft.
Seepage Pit No%4.. ...-_meter.................... Depth below inlet.................... Total leaching area------------------sq. It.
Z Other Distribution bo ( ) Dosing tank ( )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date-------------------------- --------
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_-----_____--__-__._.
f� Test Pit No. 2_______________minutes per inch Depth of Test Pit.................... Depth to ground
- ------- .. � water__-____-______--______-.
- - -
w � � 9----- --
0Description of Soil-W001DL-0 "_ . K --- ......
U -------------------------------------=------------------ •-•......•••••--••-•-•••-••••-••-••-•-•--------------------••••......----••....... '.
�� v�----
VNature,of Repairs or Alterations—Answer when applicable.-_____________-------------------------------------------------------------------------------_.
-•-•-•----•---------------------------------------•---------------------------------•-••----.---------•---•-•-•--------------------------------------------•----------•-----------------•-----•--•--
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
e provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued by e health.
t
Signed-- --•--- ---- ......- •- -- ---- -•--_----•--•-••-- •-• ------------7
QApplication Approved By----------_----- ---------•--••-••••• --------
Date
Application Disapproved for the f of ing reasons----------------- ----------------------------------------------------------------------------------------------
...•-•••••-••-•-••---•-••-•-•...•-••••••-•••••----•-••---------•----•--•-•-••••----......-•••-••-•--•---••------•-----•-•••••--•••-•••.........••-•....•-•-------------------------•--------••--•-••••-
// Da
Permit No. ..` Issued L`,- 7Date
- to
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOAR-e-tF HE LTH
............ .
.........OF........'-;;$- ..................
Appliration -for Di_qVvisal Works Tonstrurtion Vrrniit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
Slyst at:jr
......... -------------------&'5 ................................... ... . ........ .. .. . . .... ....... A---------
at o�. 0 t -0* V.... •......... . .... .......ls�v _�_' ..................................... 10VAL , 0--- ............... . .... ...... ... . . .......... ...llwt............
Owner Add I Ws
W Ag.........................W...... ------------------------------------------ ---------_----- ------ koo...!......................
Ins Address
Type of Building Size 1,44-.�rk...........Sq. feet
U
Dwelling—No. of Bedrooms----------#3------------------------------Expansion Attic , ) Garbage Grinder
-1
a4 Other—Type of Building -----------------_-------- No. of persons----------------------__---- Showers Cafeteria
P4Other fixtures ------------------------------------------------------ ----------------------------------------------------------------------------------------------
Design Flow--------144%...........................gallons per person per day. Total daily flow............................................gallons.
W
04 Septic Tank Liquid capacity/M.P..gallons Length________________ Width---.....--.-.... Diameter-_--...-.._-_._ Depth-_--____--------
! -----------
:V Disposal Trench—N Width-------------------- Total Length------------__-_---- Total leaching-area--------_----------sq. f t.
I _X,I'K'm,...Seepage Pit No eter-------------------- Depth below inlet.................... Total leaching area------------------sq. f t.
Other Distribution b"fo "
#k-t
�2; Dosing tank
Percolation Test Results Performed by-------- -- .............................................................. Date----_------------------------------ --
a Test Pit No. 1----------------minutesperinch Depth of Test Pit--.-..--_-_-_.-__--- Depth to ground water---------------_-------.
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.,:•................. Depth to,ground water----....-__..--.--------
........................................V........................ ...
0 A V_ - ,A - i- " 6 ---------------Description of Soil.WQ0_'6__ 1 1,---- . .. ... 0mot .. a vvf_ SAND' 1D-. IGOT
U ----------------------------------------------------------------------------------------------------------------------..............................................
----------------------------------------------------------------------------------------------------------------------------------------------------------A..........................................
U Nature of Repairs or Alterations—Answer when applicable................................................................._---------------------------
...................................... ..................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued by he*l5q-ar-d-9,f health.
Sign d ...... .................
Application Approved By.............. .. .......f
- -------------- ................................
Date
---
Application -----------
Application Disapproved for the fol wing, r*easons:------------0..............................................................................................
.............................. ..........................................................................................................................................................................
Date
PermitNo......................................................... Issued..---------------'----..................... .........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
%.._..;..... ..... ....0F Sr B "E ........................
ITTrtifirate of Tompliatta
ZLUS is T CERTIFY, That the Individual Sewage Disposal System constructed /)' or Repaired
by....9JD--------- CAC-Cy. ......................... ........................................................................................................................
Instalter
at----
---------- ...............................................
has been installed in accordance with the provisions of Article X1 of The State Sanitary Code as described in the
. ... ... ......... dat .................
01-1-o A"4
application for Disposal Works Construction Permit No.. f
ed..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT,BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATt............................ ...................................................... Inspector......................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................
..................OF.
No._-- .... FEE........................
Permission is hereby granted---0--*.-_LAC- --- -----------------------------------................................................................
to Construct (� or Repair an Indivi4ual Sew!a e 1sposal System
S a A 14
at No.. . ........
UJAystr-eet.... --------------------------------------
as shown on the ap
plication for Disposal Works Construction Permit No_____________________ Dated. -- ----------7
......................................................................................................
Board of Health
DATE.........................7------------------------------FORM
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° EQUIV.)— MIN. PIPE- MIN.NGEBURG LEACH
° PITCH 1/4"PER.FT. PITCH 1/4"PER.FT PIT PRECAST
° LEACHING
o' INVE T a
INV RT INVERT o . o `e PIT OR
SEPTIC TANK DIST. 83 a w EQUIV.
INVERT EL. ,`.�.�.✓T3 . . BOX EL`/....G. >x . .
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EL... .... u-0 m:
WASHED
w :`'� STONE
I�—/v-
PROFILE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOI L LOG WITNESSED BY :
DATE!`? !-,!l.?.7 TIME. . ... . . . . . . PSG C, /�'lve2,gy BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 ENGINEER
ELEV. . . . . . . . . . . ELEV. .. .. . . . . . .
s 6„ DESIGN DATA
NUMBER OF BEDROOMS 3. . . . . . . . . . .
TOTAL ESTIMATED FLOW 33o GALLONS/DAY
BOTTOM LEACHING AREA SO.FT. /PIT
/88,Sv SIDE LEACHING AREA . . . . . . . SQ.FT./ PIT
a
GARBAGE DISPOSAL !IQY497. . .(50% AREA INCREASE)
0
a � TOTAL LEACHING AREA 267.0. . SO.FT
PERCOLATION RATE LESS xv,gv Z , MIN/INCH
LEACHING AREA PER PERCOLATION RATE .. . . . . . SQ.FT.
!V-q. .WATER ENCOUNTERED
NUMBER OF LEACHING PITS . . . . . � . . . . . . . .
APPROVED . . . . . . . . . . . . BOARD OF HEALTH
DATE . . . . . . . . . .
AGENT OR INSPECTOR
OF
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SITE MAP
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1.0 B GFO6KAPNIL INFORMATION Sys ENS UICI
f' ,y SCALE: in feet
/ ,/ '0 46 AC-- �� \ — /` 0 1 INCH 3060 FEET 60
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