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HomeMy WebLinkAbout0020 BLACK OAK ROAD - Health WL20 BLACK OAK ROAD, M A i,3 76", ✓Yl I)S ' I A= 101093 V�V COMMONWEALTH OF MASSACHUSETTS JAA1s 1999 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI // DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 20 Black Oak Road, Marston Mills, MA Name of Owner: Ralph Cahoon Address of Owner: Sarre Date of Inspection: December 30, 1998 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the infomiation reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes Needs Further Evaluat' By the Local Approving Authority ails Inspector's Signature: Date: January 4, 1999 The System Inspector shall submrcopyy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(30) days of completing this inspection. If the system is a sham system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I of II Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 Black Oak Road, Marstons Mills, MA Owner: Ralph Cahoon Date of Inspection: December 30, 1998 INSPECTION SUMMARY: Check A, B, C, or D.- A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: 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. Indicate yes,no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due,to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if.(with approval.of the Board of Health) broken pipe(s) are replaced _... obstruction is removed distribution box is levelled or replaced 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): T broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 Black Oak Road, Marstons Mills, MA Owner: Ralph Cahoon Date of Inspection: December 30, 1998 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank-and soil absorption system(SAS)and the SAS is within 100 feet 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 1 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 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 Black Oak Road, Marstons Mills, MA Owner: Ralph Cahoon Date of Inspection: December 30, 1998 D. SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have detennined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion,of a cesspool or privy is within a Zone 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. If the well has been analyzed to be.acceptable,attach copy of well,water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You 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 owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 20 Black Oak Road, Mar3tons Mills, MA Owner: Ralph Cahoon Date of Inspection: December 30, 1998 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. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ _ As built plans have been obtained'and examined. Note if they are not available with N/A. ✓ _ 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 conditions of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge,depth of scum. . The size and location of the Soil Absorption System on the site has been determined based on: ✓ _ Existing information. For example, 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)l• ✓ _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of SabSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 20 Black Oak Road, Marston Mills, MA Owner: Ralph Cahoon s Date of Inspection: December 30, 1998 FLOW CONDITIONS - RESIDENTIAL Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): 3 Number of bedrooms(actual): 3 Total DESIGN flow n/a Number of current residents: 3 Garbage grinder(yes or no): No Laundry(separate system) (yes or no): No ; If yes, separate inspection required Laundry system inspected(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available(last two yeargi usage(gpd): 1998-55,000 gals.; 1997-56,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd(Based on 15.203) Basis of design flow 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: TES .`i:.;:0; OTHER: (Describe) Last date of occupancy: GENERAL.INFORMATION, PUMPING RECORDS and source of information: No pumping records on file per treatment plant. System pumped as part of inspection(yes or no): No If yes, volume pumped: _gallons 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: 1984-per as built card. Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6of11 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Black Oak Road, Marston Mills, MA Owner: Ralph Cahoon Date of Inspection: December 30, 1998 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron �40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting,evidence of leakage,etc.) SEPTIC TANK: ✓ - (locate on site plan) Depth below grade: 18" Material of construction: ✓concrete metal Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 8'x S'x 4'6" (1000 gal.) Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 29" Scum thickness: 4" Distance from top of scum to top of outlet tee or baff,e: 9" -• -• --- - Distance from bottom of scum to bottom of outlet tee or baffle: 10" How dimensions were determined: -Measuring Stick -----•---- 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.) The baffles were present. The liquid level was even with the outlet invert. There were no signs of leakage. Recommend pumping of system. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to.outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Black Oak Road, Marstons Mills, MA Owner: Ralph Cahoon 1 Date of Inspection: December 30, 1998 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to, or 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/day Alarm present: " Alarm level: Alarm in working order: Yes_ No_ ,.• �,, . 4" ..,, Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) DISTRIBUTION BOX: ✓ (locate on site plan) Depth of liquid level above outlet invert: 0" Comments: m.. M ... .._.. (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box, etc.) The box was level and there were no signs of solids carryover. PUMP CHAMBER: None (locate on site plan) e. Pumps in working order: (Yes or No) _ Alarms in working order: (Yes or No) Continents: (note condition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Black Oak Road, Marston Mills, MA Owner: Ralph Cahoon Date of Inspection: December 30, 1998 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible; excavation not'required, location may be approximated by non-intrusive methods)' If not located, explain: Type: leaching pits, number: 1 -6'x 6' 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 ponding, damp soil, condition of vegetation, etc.) There were no signs of failure or ponding. The bottom of the pit io grade was 9'. CESSPOOLS: None (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulizz failure,level of ponding,condition of vegetation, etc.) PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: . (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Black Oak Road, Marstons Mills, MA Owner: Ralph Cahoon Date of Inspection: December 30, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) I I I as 6 ay 30 3�V• 30 y7 b revised 9/2/98 Page 10of I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Black Oak Road, Marston Mills, MA Owner: Ralph Cahoon Date of Inspection: December 30, 1998 ` NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 37 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions ✓ Checked with local Board of Health Checked FEMA Maps Checked pumping records Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. Must be completed) Using the Barnstable Water Table Contour: map and topographic map, the maps are showing approximately 37' to groundwater at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page I of 11 LOCATION SEWAGE PERMIT NO. ` VILLAGE INSTALL R'S MAFAE A ADDRESS BUILDER OR OWNER DATE PERC31T ISSUED to is DATE COMPLIANCE ISSUED. It) VS S� z . �2 :b Fns..... ... .....�.`T THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ......... .. ..........................OF.........................----.............--•--............---------...................... • Appliration for'' Disposal Works Tilustruttion autit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: Lot # 52 - Black Oak Rd. , Marstons Mills it MIA ......... -.............................•-------••-•---.......................------------ .................----------•-----•-.....---------•--•---•---------........._..-------•-.......... Capricorn it r rust 765 Falmouth �tc�Adj Hyannis ....---- _,- •. ............ ...................... ...........................-----•--•--....--•-••••-•-•--.......__..._......------.............._.. W Steve Lebel Owner Address Installer Address Type of Building 3 Size Lot............................Sq. feet Dwelling—No. of Bedrooms............. ._....._...__.Expansion Attic ( ) G bage Grinder ( ) a ranch p� Other—Type of Building ............................ No. of persons............................ Showers ( — Cafeteria ( ) Q' Other fixtures .......................••-•••. -• 330 W Design Flow....................I............. . all per person daY. Total 1 ggw.._...-•---•--.-------.------------.---.. WSeptic Tank—Liquid capacity.__ _ allons Length.. ...._._ Width._. ...... Diameter................ Depth................ x Disposal Trench iNo. .................... Width_6.,.............. Total Length----------6.�......Total leaching area........2.6.6...sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing takd6hge Engineering ' 11-25-81 Percolation Test Resul Performed by............................................. , ... Date.........•_....._.._._._ a �.0 1•Z ""-'-""""""""" none"""�ricounter� Test Pit No. 1..../ ..--""minutes per inch Depth of Test Pit__. /__.._._.._ Depth to ground water...... e fT Test Pit No. 2_. __.__..minutes per inch Depth of Test Pit...Tr A Depth to ground water........................ O Description of Soil------------- -�---...Toxin--�---to ............................---.....---------------•-----•---••---------...----•--•-- x Z" YO I��'eaiuin"yeTTo rr ant1..................---"""""-"""""--""""""""""-"-•"•"---"-•"-""---"---""-". ............................................ �, _ 12* mecl: white... it/'traCeg_-_o f---gravelfna--va-t-er"--at 12' -------------".."-------------------------------------------------------------------.."--------------------------------------------•---------------•----------------"------------------ ---------- V 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 they agrees not to place the system in operation until a Certificate of Complianc as n iss Td by the board of lth. S' ned •-- - +Q ... .... .. 2G �...Pre s., Q� ate Application Approved .....................�1......... ��.:. �ke �b� ............. Date Application Disapproved for the following reasons:--- .... .......... ................. . . ...........................•••---•-•-....................._..............-•-•-••-•----•---.............•.••--....._................................•--••--•-......-••••-••-------•••--••--•....------•-- Date Permit No......... .................. Issued.........I.D.- t g /._.3. Date J Flss...... �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ......... . ..............................OF.........-----.--....................------...._................._.....................-- Applirmtion for Disposal Murks Timstrurtion" rrmtit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at Lot # 52 - Black Oak tic].. , Yla'rstons Mills it 1AA ----------------- ......................................................... •....-•-•-•-••.._.......:..--•••••••---•-•--------••-••--•••--•-•••-••---•-•-----................. , Capricorn Re�tl-t.V Trust 765 Falmouth Rdeds Hyannis ••-••------------ - .... ----------------------------••••-• ..............................................-----•••-----•••••••........_........................ W Steve L e b el Owner Address ,-a .......-- ........ ... Installer Address m S feet � Type of Building 3 " Size Lot___________________________ q. Dwelling—No. of Bedrooms.__.___.__.. Expansion Attic ( ) Gage Grinder ( ) a randYi------------- - p-, Other—Type of Building ............................ No. of persons............................ Showers ( — Cafeteria ( ) Q'' Other tures ..__.._.._.. Design Flow................ allons per person gr&y. Total V1 69,w-------------------------------------------- WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__....__:_..... Depth................ Disposal Trench No..................... Width. .*............. Total Length a..... Total leachingarea s ft. x p -I No � g � 2'6-6-.. q. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box Dosing t osin e ge Engineering 11-25-81 ~' Percolation Test Resul Performed by............................................. , Date....-........._..__ .0 12 rfo"ne--encounte a Test Pit No. L.N� _.___minutes per inch Depth of Test Pit.... ....._ Depth to ground water......X/k-.......... es (s, Test Pit No. 2................minutes per inch i Depth of Test Pit__-____._________-_- Depth to ground water........................ 0-..... ---2-1----......1:vain._ ...`topffuli..................................................................................... x Description of Soil-------------7 - ...-_...1p-1-------IVlerdj- --y-ej3-ow--Sand-------•-----_-__--•-------------------------------------•--_-___-___-_-- --•-----:_____------•----__.:1fl_11--------Z2+-------me-d:---Whj:te---sand/traces----of---gravelfna---water--at 12' ----------------------------------------------------------------------------------------- VNature of Repairs or Alterations—Answer when applicable..................................................................................,.._.......__. •---------•----------------------------------------------------------------------------•-------------=----------------------------------------------•------......--------------------.._............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT I-L5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. . Signed............................................................................. Pr Pres. . ......... ................................ �-."...—..� Date Application Approved BY '.._.. -074'......................... ........... -------- 4 Dat Application Disapproved for the following reasons ,______________________________________________ _...-•-•-•-----------------------•------......_.._....------••--------------------------••-•------------•-•------------------•-------...---•----•------------•------------...--------------------•-_.... Date I7 p Permit No...........I�--— --Q --------------------- Issue(L............r•0 ----�-o-f .. ...--- te THE CCMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ...........OF..................................................................................... Trrtif iratr of Tomtplitturr THIS IS TO CERTIFY, ��eVee Iudixidufl Sewage Disposal System constructed ( or Repaired ( ) eDe by .....•. ••.•••...- Lot # 52 - Black Oak Road Installer Marstons Mills ,, MA at...................................................................................................................................................................................................... has been installed in accordance with the provisions of TI1Iy 5.4 ThkState Sanitary Code as described in the application for Disposal Works Construction Permit No.__.......`.��""_:_-_ _-'--______________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTIO SATISFACTORY. DATE..-•-•••_-_..� ...9..... .......-C............................ Inspector.......... -----_-- f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ..........................................OF..................................................................................... _a� No. ! .__ FEE,��, 's_ ...... Disposal Workii %Tonstrttrtion rrmtit Steve Lebel Permission is hereby granted.......................................................-------------------•-•--------------------•-----------........---..............--•-•••- to ConstrucLotr)' r2R�ayl(��j a>V m�dit` 1dSewage MIaspos of s Tills , i'+iA atNo.------...L.O.t...•-------------------------••--•-----•----.---------------------......--•--.--------- -------------------•----..........-------------------•-•---------•---. •••••••- Street as shown on the application for Disposal Works Construction Permit Na�-el.., _iirDated.... `_________________ ---- ----•---••----- �J Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �Y 0 IQv i, q g s, Nna, ` p pQi� rw �rc� ,0 V\ E. 5 J \�.... 1, ` I/ G ` r 00 7- ��N F A1 ass Of`.1 GOn/� TLf o� A fSr> Fa (%iu, n�•: ORSE 'P(Hoc/1/10951 O i EOA � !C.�� �� � ..'l r��•1�o L.EGEN® XISTINS VPOT ELEVATION QXO CERTIFIED PLOT PLAN :Ei:IB'TIN$ CONTOUR --- ® ... �f.M ISHED SPOT EL-EVATIONi . 'I! 1 ® CONTOUR 0 L_0 T S 2- Ijc: r�1 vA it r). Nf7T The location of any existing underground sewerage, ------ :wells, or other utilities shown on this play is .approx- IN imate only as determined from records and/or verbal .,:information. The contractor is responsible,for the verification. of the existing locations in the field. SCALE� / /(=' 30 r DATE T)REDGE ENGINEERING Ca Wa) i-i�•��`�cv C11EAIT.. _ I CERTIFY THAT THE .PROPOSED I$TERE REGISTERED Jog NO.93 2 S� BUILDING SHOWN ON THIS Ft- AN is CIVI6. LAPO CONFORMS TO THE ZONING LAWS OR BY ,q ESEE RV ----~-- OF BARNSTABILE , . MASS. 712 MAIN STREET CH. eye R, 6 ��'' IiYp►IdN I , MASS. SHEET-LOF ?�. A E RIEG. LAND SURVEYOR O FT M//V.' IV 07'F' /F E/'7-NER 7"NE SFP C .7-AN.k OR — — L� ?*''/d/A/G ®/7" ANE :lyOl�E . 7 fAtgN / "s�RLOn/ • /® FT: IW/A/. CONCRE're C° P/P!? h°E.4Vy C�957 .'� c�fY CoV�i� h��iL L BE U -f� MIN. i0/TCAd i r. L AO-=F CC) KErw CL Er4N .Sr�fN® eA CA VqVID 2 LAYER •43"CAST , o Q o G1F I8 @OAP P/Pg bMIN.P17-Ci/ _ Al } o 0 0 • ® ® e o • ► a e40 ©sy"pd•f�P'!: SePT/C TAAIX DJST. ° ♦ s o a e o • • o • • ` • e o WA t/PD STONE e ♦ 34 / 4_ �' e♦ p o • •E.FFECTOVE ` • • e 1V.4S1/ED/STONE • ° e • • D�PTt/ ° e • + • 7 Fr'x i - _- �'__ s ass , • o .e ♦ b e • °°p PRECAST.SEGO E l�T ���lYAT/Df/�r t'�' C RAc�iY lN� S4 GdFG/O�t st •o • • e o. ® ♦ • • • e a. P/T. OR >t! �^ At �L 6 7.0. o � D/, M. C' SEE T�su�aT)D�> 0V74.=_7 SEPT/C TANK 7.3 b Fz_ — /Al4FT D/ 7A'l,6V '/0JY BOX -73.4 j&7 ��. �r�U?�.pN® W,47',EX 7AALE SEGT-/OA1. OtITLETD/ TR.� +T 1t.'1!t B 73 Z FY. 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