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HomeMy WebLinkAbout0022 AUDREYS LANE - Health 22 Audreys Lane, Marstons Mills 1, r 1 Town of Barnstable ppfF1E 1 Regulatory Services Barn `' do Thomas F. Geiler,Director A"mericaCity Public Health Division * BAMSrnsLe. 9 MAW. Thomas McKean, Director Zoos `bAr 1639. a`` 200 Main Street Ep p�21 Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 21, 2009 Gertrude &Nelson ODonnell 22 Audreys Lane Marstons Mills, MA. 02648 RE: Assessors (map-parcel) 028-059 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 22 Audr_eys Lane, Marstons Mills, MA. 02648. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2009 fees included. j Please cbntact'me to schedule inspection of the property as soon as possible. If there are tenants preseiitl'y`occupying the property please provide the contact information being sure to include a daytime phone number for all tenants. For your use an occupant's permission form has been included to allow for inspections to be performed in the tenant's absence. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each. day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4072. Thank you in advance for your cooperation. Teresa Wright _ e- Division Assistant . ..l— li✓! y /ti� Health Division,` Direct#508-862-4072 G r77 > r COMMONWEALTH OF MASSACHUSETTS . lIi1P EXECUTIVE OFFICE OF ENVIRONMENTAL AFF e ' DEPARTMENT OF ENVIRONMENTAL PRO I RFC 11 ONE WINTER STREET, BOSTON. MA 02108 617-292-5500 J 19 1104V , y��YTTge `9T � FP CE WILLIAM F.WELD a9 TR M,, OXE Governor Secretary ARGEO PAUL CELLUCCI ID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: 22 Audrey s Ln, Marstons Mil1S Address of Owner: Geri O'Donnell Date of Inspection: .,0 —.7 / Y -7 (If different) Name of Inspector: Wm E Robinson Sr I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: WM E Robinson Septic Service Mailing Address: PO Box 1089 , Centervi 1 1 e, MA 02632 Telephone Numbers 5 0 8 7 7 5—87 7 6 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: 1_/Paasses _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: eAj L 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 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. INSPECTION SUMMARY: Check A, B, C, or D: A] SY TEM PASSES: 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. COMMENTS: 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. Indic a 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, 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 conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:11www.magnet.state.ma.usldep j Printed on Recycled Paper. L 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 22 Audreys Ln, Marstons Mills Owner: O'Donnell Date of Inspection: BJ SYSTEM CONDITIONALLY PASSES (continued) 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). Describe observations: 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 public health, safety and the environment. 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 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 APPROPRIATE) 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 to 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 (approximation not valid). 3 OTHER (revised 04/25/97) Page 2 of 10 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 22 Audreys Ln, Marstons Mills Owner: O'Donnell Date of Inspection: /O—,7- g 7 D] STEM FAILS: i You m t indicate ei;t;er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis or this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct he failure. Yes o 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. 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 112 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. EJ LARGE SYSTEM FAILS: Yo must indicate either "Yes" or "No" as 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 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) The wner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requi ements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (reviaad 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 22 Audreys Ln, Marstons Mills Owner: O'Donnell Date of Inspection: w oet/- C1 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or 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. lar,,� 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. _ 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. All system components, excluding the Soil Absorption System, have been located on the site. 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of / Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) (revised 04/25/97) Page 4 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 22 Audreys Ln, Marstons Mills Owner: O'Donnell Date of Inspection: 10-Al-q 7 FLOW CONDITIONS RESIDENTIAL: Design flow: 13® g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: Garbage grinder (yes or no):ovze Laundry connected to system (yes or no): Oe S Seasonal use (yes or no): 4, O T N/A well Water Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):ivy Last date of occupancy: COMMERCIAUINDUSTRIAAL: 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: GENERAL INFORMATION PUMPING RECORD an source of information: System pumped as part of inspection: (yes or no)_,j�,-o If yes, volume pumped: gallons Reasori for pumping: TYPE OF STEM 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) I/A Technology etc. Copy of up to date contract? Other J APPROXIMATE AGE of all components, date installed (if known) and source of information Sewage odors detected when arriving at the site: (yes or no) U (revised 04/25/97) Page 5 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 22 Audreys Ln, Marstons Mills Owner: O'Donnell Date of Inspection: 60--Al—4 -7 BU DING SEWER: ca (Lo on site plan) Depth low grade: Materia of construction: _cast iron .40 PVC _other (explain) Dista a from private water supply well or suction line Dia ter Co ents: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on.Bite plan) 1 ) Depth below grader Material of construction: oncrete _metal _Fiberglass _Polvethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:17 Scum thickness: 3"S ° ' Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffler! ' How dimensions were determined: ;- 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.) c �" m ci L�(0 GREAS TRAP: (locate site plan) Depth b low grade: Materia of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dim sions: Scum ickness: Distaric 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 I st pumping: Comm nts: (reco mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural inte evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 22 Audreys Ln, Marstons Mills Owner: O'Donnell Date of Inspection: /0 ol^c HT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (lo to on site plan) Dep below grade: Mat rial of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dim nsions: Capa ity: gallons Desig flow: gallons/day Alar level: Alarm in working order _Yes; _ No Date of previous pumping: Co ents: (co dition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_V (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if le el and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) (5 z—,eo!5 PUM CHAMBER:_ (locate on site plan) Pump in working order: (Yes or No) Alar in working order (Yes or No) Co ments: (n condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/2S/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 22 Audreys Ln, Marstons Mills Owner: O'Donnell Date of Inspection: /6—a-/—Q 7 SOIL ABSORPTION SYSTEM (SAS):1� (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: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of pgnding, condition of vegetation, etc.) f G 6 PJ t> or a ) �.� AS A� 'l"A e. CESSP OLS: _ (locate o site plan) Number an configuration: Depth-top o' liquid to inlet invert: Depth of sol ds layer: Depth of sc m layer: Dimensions of cesspool: Materials o construction: Indication f groundwater: flow (cesspool must be pumped as part of inspection) Comments: (note condition f soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: _ (locate on s' a plan) Materials of construction: Dimensions: Depth f solids: Comm nts (note c dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 22 Audreys Ln, Marstons Mills Owner: O'Donnell Date of Inspection: /L7 X/— g r� SKET OF SEWAGE DISPOSAL SYSTEM: .nclude ties to at least two permanent references landmarks or benchmarks to to all wells within 100' (Locate where public water supply comes into house) i � 0 i )d O (revised 04/25/97) Page 9 of 10 r' s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 22 Audreys Ln, Marstons Mills Owner: O'Donnell Date of Inspection: /p k Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) DD termine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. 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R �� •H - tY t � t ' -.w¢o�Ht',r�.'. .Y�„a'D�i �✓- 4 3 j..a `_ 1 '.t ` f. - r BOARD OF HEALTH :;a ( C�4'E`M:—Ml1-�nL-n+—. d000hvcr� .•. - --- - . L 0 CATION/6�t SEWAGE PERMIT NO. VILLAC D° INSTAL 'S NAME g A DRESS f ® U I L D E R OR OWNER DATE PERMIT ISSUEDEL DAT E C 0 M P L I A N C E ISSUED r .. �, V �d � �'`., p •.:� � �� � ��`"� �: � �. at- Fxs....(1..... ............a THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................OF......................................--------------......----------....................... Applirativit for Dispaoal Workg Tonstrurtiun Prruat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........., �/> .l/;= -,� � r--�- T 7....... �'.��_.. .yam.... ' ...,.._.............. ........... ' A Location-AddVy �p or Lot No. GI] X. �—r�—�� .� n � a' Address - ....... r.... ... .r`.._ \/) �J _..Sk-.-a.................... `....................Y�-d!E'.. .. ----.........-•...........•...............................................•..... Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms-----3.................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers a YP g ---------------•------------ P ( ) — Cafeteria ( ) a 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.---.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water...................----. a ••••-••••-•-••--•-------•---••••-••-•••-•-----•-----••---•-•-•-------------------------------------- 0 Description of Soil........................................................................................................................................................................ W V .....••••-•••-••-••••-•-••......•-•---••.....................•-••-••...........••-•••-•--••••••---••-•••----•-••-•••••..............------•-----------.........-----•-•--•-.....--•••---••••......••----. 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ApplicationApproved By..... --• ••... .............•. •-•......................••................... ••-• /Z .......... Application Disapprove or f ollowing reasons:.............................................................................................................. .............................................•--...--------.....-•-•------•-----.....------•----.....-•---•-••••---•-••---••••••--•----•••-••••••••----•---•-•••-•••••-••-•--•--••-••••---•••--•--•-•--- Date Permit No.........•-•----•-•_. Issued......... -•• § ` r _. ........................•._... Date No. ...: .:... FEE....'................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t, ...........................:..............OF.......................................................................................... Appliration for Bitipusttl Works Tomtrurtion amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: p ` ........................-_...................................................................... _................._...._..........._....._............_......_._.._........_...............-_.._. Location-Address s et Np , Address w ........... "�. -r���� --- ------------•-------......-------------------- Installer Address U Type of Building Size Lot............................Sq. feet ai �., Dwelling—No. of Bedrooms______ __________.......................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buif din No. of persons____________________________ Showers — Cafeteria 0.1 Other fixtures .............. ---•-•--•-------- WDesign Flow............................................gallons per person per day. Total daily flow................................_...........gallons. WSeptic Tank—Liquid capacity............gallons ' Length................ Width................ Diameter---------------- Depth................ 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.( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.......................... 44 Test Pit No. 2.........._.....niinutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------------------------------------------------------------------------------------------------------•-••-----•-•••--•-----••-----------•••--_----- 0 Description of Soil--------------------•••-----------------------------------------•-----•---•---------•-•---•----•------•-----•-•-•-•-------•----------------..._.._._._..---------•--•-- x W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ITIZ 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. "Sin . ' / D'ate Application Approved BY viz-d<.ta...... ..--.......................... -----........ Date Application Disapprove'or tuft, ollowing reasons__________________________________________________________ ................................ ......-----•. ---------------------------------------------•---------------•-------------------•----•-•----------•----------------------•--•---•----------•---••--••-----=-----------------•----••-•---•••-----•...--- Date PermitNo.......................................................- Issued._.._.._....-•--------------------••......----------••. l Dater THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Tntiftialr of Toutplitturr TIC IS,TI�' ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Y nstaller at................... a -----------__---------------------------------------------- ------......................... s = has beenc-,-n�talled in accordance with thef rovisions of TIT _F 5 pf The State Sanitary Code s Tcribed in the application for Disposal Works Cons�tion Permit No......................................... dated---'� .................................. THE ISSU NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM 1 NCTION SATISFACTORY. DATE.- .l l___..----•-•............................................ Inspector--- ......-------------------•---•------------.....-------------------------- THE COMMONWEALTH OF MASSACHUSETTS ~ BOARD OF HEALTH No......................... FEE........................ Disposal, ;r�kb To strudion Vanfit • . Permission is hereby granted to Construct ( orA epair _.an' d-vi�lua =evi�age Disposal System G ...--------•--•-----•------••------.-•-----------------•--•-•-•---•-------------------••----••---------•----•-•-•---••••---•-••... yr Street as shown on the application for Dispos Works Construction Permit N .-___ ____________ Dated.......................................... -----------------•--- ----- -----•-------•.......................................................... Board of Health DATE........................... ..... . ......Ay................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .^.«.. 7` t SECTION SEWAGE t =SEPTIC TANK — "D."BOx - LEACH_ Pi �o S ,t TQa.o)yNacdN qq fi q y, �. Fi.II! . (MJI../ - 3 i ' '� • ` /.,lt n N''^f�` _"S �.{ WAS"ED STONE �0 rn OUT- IN Ra' SEPTIC I E"L TANK ✓ ,C.. n .., t� I+.� " % - jR•, `*+ „. ram. ��`'\� ELEV. ELEV. F g v C� ' ELEV. ELEV. j ' \\\\ i 17. OF yW'- ly:" r7 WASI fEp STONE {\J� �/a, \ 'podgy �• ✓(i`/•Cj/!•/ TEST HOLE LOG., Tt tN �IT1es T } TtW13Y �,.—FA119 I` 19 � WITNESS 1` TlrsroATEa.� L DESIGN _ BEDROOM HOUSE I k T.H. � 1 T.H. 2 °� r 44 E.,LEV./�i5 ELEV, r NO li�r PERC RATE G%Zdfif< MIN/IN. DISPOSER DISPOSER FLOW RATE ��A (GAL./DAY) ��Q •r V r,` y1 � ' i I- y s6,5 4 Y SEPTIC TANK fliS)= 4�5 ` REQ'D SEPTIC TANK SIZE LEACH FACILITY i7tU/Il SIDE WALL 1Y�td� ►SC �$ (2rp 1 t. Gft�. 4 --'"� BOTTOM `13'� A Cyr ( ,93) a G/t3, - TOTAL _ T X USE: ome LEACHING 'I?' - WATER ENCOUNTERED NOTES: t�1NLESS OTHERWISE NOTED)a. I T W \ r y .'DATUM (M$L) L TAKEN FROM_ „:�v�,y��3»--- �_GiUADRANGLE MAP Z.MUNtCdPAL"WATER. N _AVAdLABLE / \ ',9 PIPE PITCH Y14 PER FOOT ^ DESIGN LOADING F'OR ALL'PRE•CAST UNI'TSi�AASHO. - I� -eta 4• i 5. MIN..GR�1tfND COVE"R OVER AI.L$f WL1GE FACILITIES (1) FT. �.E wATeR.TJGHT Of DISTANCE AS CERTIFICC) I 7.4 CO ToRUCT ON'DE TAWS TO F3E ACCORDANCE WITH COiAm.OF MASS. STATEFNVI DNMENIAI,COPETiTLES q" ARNE BIN I� � IHEREBYOEf�TIFYTHAT THE BUILDING --- SITE PLAN SHOWN ON THIS PLAN IS LOCATED ON THE h f? AL, GROUND AS S:MOWN HEREON &THAT IT (OCUS: LOT 7 AUOR6)e,5 LANE' 1,A,416 SY v 63 K CONFORM TO THE ZONING BY LAWS OF THE rri9T4+Jr MA�i'dTDd'11•N1lLL ` TOWN OF • � � �' 3 �$ f0 d FEt WHEN CONSTRUCTED, DATE E6'" p SU S sSt -u• - a,�'�°' ,(,/ ^� REF. ... Z7G� R5 —_ . 4d�G�✓h .Icd 4?, @/1 /fteer1*7 PREPARED:FOR: MR, lNi Al 'Cl/V' CIVIL ;ENGINEERS 1 r8 Rr MA 02�49 URV . .` BOARD OF HEALTH 1 — —— LAND S ' EYdRS' •-•� _...:-... �...� fix/S I X 6 Q # CONTOURS ..(e ISTING).- - ;-, - REG.LAND SURVEYOR ** I .-,. .�•_.. (P OPQSCO)—0 O.Z.:O- o--. APPROVED DATE MA Yarmouth&Orleans,MA SCAtE / - DATE �'