HomeMy WebLinkAbout0025 BLACK OAK ROAD - Health 71
25 Black Oak Road
-� - - - - Marstons Mills P
/ 101 064
l
n 24a )
COMMONWEALTH OF MASSACHUSETTS
x EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
RECEIVE®
Q-1M Sys"
SEP 1 5 2004
TOWN OF BARNSTABLE
TITLE 5 HEALTH DEPT.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: �
qp
Owner's Name: �Q tJ tRCC:{ �
Owner's Address: Sc#4Vc2 :07
Date of Inspection: 55- -C9
Name of Inspector: (please printID6uglas A.Brnwrj
Company Name: Douglas A n Septic Inspections
Mailing Address: RO Flax 145
Telephone Number: A 02632
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 the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant�toSection 5.340 of Title 5(310 CMR I5.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
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 shculd be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
Sy s te-n ra e e J-s eu tti i�.k V e_% (z a ct V i r �a s s N S 5 ►�c�a(C�s c��-t I,�is ���.n e
7d.ere ks C 0t�Qk to" rom L� 5 0 t Pik -to .171he NOO,+C)N,
Ike- P.pe
****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.
Title 5 Inspection Form 6/15/2000 page 1 Jt?7-31/uxv
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: a.C-3bct_ s9L R�
AAcKrztoNs n�,l�t,
Owner's Name:
Owner's Address%
Date of Inspection: G—.1 —O L(
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Syster Passes:
I have not found an information which indicates y that any of the failure criteria described in 310 CMIt
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
5 1 ' itj a M u k tkk g tarZ, ( 5
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.
Answer yes,no or not determined(Y,N,ND)in the following statements.If"not 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 exfiltiation 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.
ND explain:
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
obstruction is removed
distribution box is leveled or replaced
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 .
obstruction is removed
Page 3 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: S'
.c • � 4
Owner's Name:
Owner's Address:_. �c,,,._,�
Date of Inspection: IR i pY
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
2. System will fail unless the Board of Health(and Public Water Supplier,N 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 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,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form
3. Other:
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address 2 S 13)t ckr-Cc&`
Owner's Name:_ (Cev A CANW- as
Owner's Address: Sc_Mitf
Date of Inspection: 2> 1 O'-i
D.- System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for AL inspections:
Yes . No
lf�Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
- ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_ ✓tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or ,
jMspool
'Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow
_ eftired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
_ ---11Hy portion of the SAS,cesspool or privy is below high ground water elevation_
portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply_
�y 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 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,provided that no other failure criteria
are triggered.,A copy of the analysis most be attached to this form.]
NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 GMR 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•
You must indicate either`yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinlang 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
Page 5 of 11
OFFICIAL INSPECTION.FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address S
Owner:
Date of Inspection:
Check if the following have been done.You must indicate`des"or"no"as to each of the following•
Yes No
_✓ Pumping information was provided by the owner,occupant,or Board of Health
ire 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)
i1 Was the facility or dwelling inspected for signs of sewage back up ?
Was the site inspected for signs of bre4k out?
1 ntC���s
Were all system components,, 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?
a/ 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:
Yes °
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 iCMR 15.302(3)(b)] ,
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: S Mock oak i
mck
s
Owner's Name: K ho (,Jk e,.yN Ct4 P
Owner's Address:
Date of Inspection: 9-'3- ( -p C�
RESIDENTIAL FLOW CONDITIONS
.
Number of bedrooms(design);_--':. Number of bedrooms(actual): 2
DESIGN flow based on 310 CVR 15.203(for example: 110 gpd x#of bedrooms):_{�
Number of current residents: 2-
Does residence have a garbage grinder(yes or no): At b
Is laundry on a separate sewage system(yes or no):_,.j�fif yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use: (yes or no):&n
Water meter readings,if available(last 2 years usage(gpd)):�
Sump Pump(yes or no)"
Last date of occupancy:Cy gTjF-
COMMERCIAL/INDUSTRLAL:
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
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/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no):
If yes,volume pumped: ____;gallons-How was quantity pumped determined?
Reason for ping:
TYP SYSTEM
eptic 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)
—Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:.
—LV�n�cs f�Ny 1uo `-L Owner's Name:Name: Lr o:c
Owner's Address: Sc,A e
Date of Inspection: _C7�-(
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction:_cast iron u40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grader
Material of construction:_concrete metal fiberglass,polyethylene
other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
_certificate)
Dimensions: I 000CkCiA
Sludge depth: .�n,�
Distance from top of sludge to bottom of outlet tee or bale:
Scum thickness: `—( (act.
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet itnvert,evid nce of leakage,etc.):_
-.3 G-k- -r 1 S t'%N%,e
GREASE TRAP._(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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: :2 T TS\,ac
Owner's Name:
Owner's Address:_ ,,�,`eIJ
Date of Inspection: ( — ®L-1
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: olllons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
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.):_
PUMP CHAMBER:_—(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or.no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: Z 5- 'TZZ)
n^c-! % -1-0 S A c .
Owner's Name: �eoko nA&. l t
Owner's Address: , e
Date of Inspection: e3-t -0�
SOIL ABSORPTION SYSTEM(SAS):—(locate on site plan,excavation not required)
If SAS not located explain why:
Type r
eachmg pits,number: 1 i 000 CJ Ck w tt�, SIN r
leaching chambers,number:
leaching galleries,number:
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.): . , , , .
toll
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 or no):
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.):
Page 10 of 11
OFFICMAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 131ratSr s �
Owner's Name:_ (t-c� AA
Owner's Address:_ S
Date of Inspection: PS s 1 Q L(
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. .
Q I
`7
Peck-
A 2-it
--`3r7 '
o Ole
0
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM I ORMATION(continued)
Property Address: $ 1, 1 c c k _
Ak %k-0
Owner's Name:
Owner's Address:
Date of Inspection:
SITE EXAM cc
Slope% l e v�l
Surface water% ,v oco
Check cellar: `�j
Shallow wells 3ont e
Estimated depth to ground water 17'feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-if checked,date of design plan reviewed:
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:
You must describe how you established the high ground water elevation: /
��'� d q ✓ U !Z
s
r �
7/8/964
2 Black _Oak _RoadT..--.— _ �t 'r 6
Ma.r s t o n y . i�i ll-s--------- ---- � �
On the Above dot^ I Inspected the septic system at the above address.
This system consists of the f7!!-:-,vino:
1 . 1 -1000 - gallon septic tank.
-2. 1 - Distribution box.
3. 1 -1000 gallon leaching pit.
Based on my InK;�action, I certify the following conditions:
1 . This is a title five septic system. ( 78 Code )
2. The septic system is in proper working
order at the present time .
3 - To repairs are needed at the present time .
l G N AT U R'r
Marne : J1
pion 111C
Add �frJ� c.
Cen tclrvill:e L1`Iass_ _U2632
` Phone:---54t �Z/ , 333 --.---------
THIS CE'ri'ClFIC/iiiUfJ DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
b t
JOSEPH P. MACOMBER & SON, INC.
TAn::d Costpovls-Loschflolds
:a Pumper 14 InsUll"
Tov�jj 5o,»ar Connectlons
P.O, Box 66- Centerville, MA 02632-0066
7 76-3333 771-6412
e
Commonwealh of Massachusetts
►:� �' ' +" -,r 1:n\iirnnmPnfn1 Affairs
of
., 1�011 ental Protection
1'r'llll:Lnl F• 'u+;U a+uJ� l.V w�a
feu ZaClotall/
iJ1vo Paul .i c+ LI—A 13. Struht
tt,GQ"n'44 coma"&"(
,...:_ .�L..'•i.'.�L'. DISl'09,\L SYSTEM INSPECTION FORM e
PART A
i:}?RTIFICATION
1'ruj:orty Addroaa: 25 Black Oak Read Marstons Mills `" aea� u1 Uwuer:
Data of Inspootlow 7/8/96 (If differoat)
Namo of Inspootor: Joseph P. Macomber Jr.
Company Name,Address and Telephone Numb•et-
J,P.Macomber & Son Inc. Box 66 Centerville ,Mass . 02632 508-775-3338
CERTIFICATION STATEMENT
I certify that I have personally inspectcd the sewaFe disposal system at this address and that the information reportod 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 oa•sita sewage di2p0c.al systeas. T.l:s sycta;r.:
asses
ConditiolLally Passes
Noads Further Eva]_.:tio� By the Lc:al ApprOvinZ Authority
Fails �i/�
In,pectoc's Slyaaturc: ' '�L� � Date:
Tho System Lnspoctor'w& submit a copy of this inspection mport to the Approving Authority within thirty(30)days of completing this
iuspoctioa. If the system is a sharod system or has a design Ilow of 10,000 gpd or groater, the inspoctor and the system owner shall submit the
report to the appropriate regional QMu of the Department of Environmental Protoction.
The origLaal should be sent to the system owner surd copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C, or D:
A) SYSTF-M PA99ES:
1.%
I have not found any Lzfortn:rti02 which indicates that the system violates any of the failure criteria as defunod in 310 CMR 15.303.
Any far U" c.-itoria not evalutLxl are indicawJ b:JONV.
D1 SYSTF-Nf CONDITIONALLY PASSES:
Ono or mere system cca:;4::ecU nos: to t;e repLrcNJ or repauvci. The system upon completion of the replacement or repair,posse,
Lvpc,ction.
Lndicata yos,,,Po, or not (Y, N, or ND). Darer:te basis of dowrmutntion in all instances. If'not deta mind', explain why not)
The septi:: to-,ik i� r.;a al, c a:l Cd structurally unsound, shows substantial infiltration or exMtration.or tank failure is
'I i:4 c,xi:tung septic tank is replaced with a po:forming septic tank a, approved
by t::e 3 c:cLrd c f :•?
;revised 11/03/95)
One Mntor Stroot 0 tior;o;,, Ma... FAX (617) 556-1049 0 Tolephone (617) 292.5500
SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (oontinued)
Property Add —,e: 25 Black Oak Road
Owner Paul McGovern
Date of Inap.ottcn:7/8/96
Bl SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or huh 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(a)are replaced
obstruction is removed
distribution box is levelled or replaced
ALD The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will peas
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
i
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 PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
AS The system has a septic tank and soil absorption system and 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 is within a Zone I of a public water supply well.
AW The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for ooliform 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.
3) OTHER`
(revised 11/03/95) 2
van°� Paul McGovern
Data of Iaspcotlon
7/8/9 6
DI SYSTEM FAILS:
•
_ I have determined that the system violates one or more of the following failure criteria as duf- ',a for
this determination is identified below. The Board of Health should be contacted to determine what
failure.
A Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
+�d Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or cloggod SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or was pool.
1. 'wk qr
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 trues in the last year NOT due to clogged or obstructed pipe(s).
Number of tunes pumped
Any portion of the Soil Absorption System, oeaspool 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.
,LD 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.
A C) Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no
acceptable water cuality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
ooliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large .rystenw 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 throat to public
health and safety and the environment because one or more of the following conditions exist:
A A the system is within 400 feet of a surface drinking water supply
�R the system is within 200 feat 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 weL)
The owner or operator of any such system shall bring the system and facility into full compliance with the growsdwater treatment prcr�r;:m
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further inrormi:tion..
(revised 11/03/95) 3
S
SUBSURFACE 9k;µ'AGE DISPOSAL SYSTEM INSPECTION FOILri
PART B
CHECKLIST
P► p-rtyAddr"&- 25 Black Oak Road Marstons Mills,Mass .
Owner. Paul McGovern
Date of InspeotIo--?/8/96
Check if the following have boon done:
Zpu.mping information was requested of the owner,occupant, and Board of Health.
i
None of the s Ftr:rr. comp
onents ponettts have btu n 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.
I
/As b* uilt plans have been obtained and.examined. Note if they are not available with N/A }
jThe facility or dwelling was inspected for signs of sewage back-up,
/TThe system does not receive non-sanitary or industrial waste flow
nspected for signs of breakout,
k'�II system components,eluding 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 bamas or
tees, material of construction, dimensions, depth of.liquid,depth of sludge, depth of scum.
_The size and location of the Soil Absorption System on the site has been determined based on existing information or F
appro:imatod by non-intrusive methods.
/The facility owner(and occ.-upants,,if different from owner)were provided with information on the proper maintenance of !Surface Disposal SYetem. Sub.
11I.
f
S � t
6
(revised 11/03/95)
4 ,:•
t l -•..�
I SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
25 Black Oak Road Marston 'Mills';Mass.
owilen. Paul McGovern
Date o!Irwl,w.;.. 7/8/96
FLOW CONDITIONS
RESIDENTIAL• ,-A
Design flow:_�ons pay- y s
Number of bedrooms dZ.
Number of current residents:
Garbage grinder(yes or no).A?p
Laundry connected to system(yes or ao): CJ
Seasonal use(yes or no):_a s
Water meter readings, if available: v
last date of occupancy: 74-91e
lv
COMMERCIAL INDUSTRIAL•
Type of establiahment:
Design flow: allons/day
Grease trap preceat: (yw or DoAg
Industrial Waste Holding Tank present: (yes or no)AA
Non-sanitary wuato diacharmd to the Title 5 system: (yes or no)�/9
Water meter read np, if available: J fA
Last date of occupancy: AJ
OTIiER: (Describe)_
Last date of
GENERAL INFORMATION
PUMPING RECJ "_` ::.? :'Ir1qP Pf information:..
System pumped as part of inspection: (yes or no)do
If yes,volume pumped: d&. eallons
Reason for,u:,n!:;: AO
TYPE OF SYSTE:=
ptic tan7jdiatribut:oa Las/soil absorption system
A>B S#r�gle atiur;,bl
Overflow cutiupooj
AAD Privy
,_A212 Sbarod syrtom ()res or no) (if yes, attach previous inspection records, if any)
APP OX1MA:'.:.. - _: J�Yd•::.ponents, date installed(if known) and source of information:
!"5 a
Sewage odors dotocted when arriving at the site: (yes or no)
(revised 11/03195) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C-
SYSTEM INFORMATION (continued)
Property Address: 25 Black Oak Road Marstons Mills,Mass .
owner: Paul McGovern
)ate of Inspection: 7/8/96
;EPTIC TANK:1&6 91 o10 ulf
locate on site plan)
N
)epth below grade:.f�
vtaterial of construction:�oncrete _metal _FRP _other(explain)
)imensions:
sludge depthi„•�;_ _ t/
)istance from top of lodge to bottom of outlet tee or baffle:,_
;cum thickness:—
)istance from top of scum to top of outlet tee or baffle:_2 a_ <
)istance-from bottom of scum to bottom of outlet tee or baffle.�A,!�_6
:omments:
recommendation for pumping, condition of inlet and outlet tees or baffles. depth of liquid level in relation to outlet invert, structural
,rity, evidence of leakage, etc.) P ` �, 2 Tea�s�Inlet & outlet tees_ are -in)
lace L uid level in t .
n time.
;REASE TRAP. A.44AAe,
locate on site plan)
)epth below grade:(P.0,t
Material of constn �,l�rtion .oncrete _metal _FRP_other(explain)
)imensions• Aid
;cum thickness:
)istance from top w.scum to top of outlet tee or Eah•le:-109
?istance from bottom of from in bottom or outlet tee or b'aftle:.
:omments:
recommendation for pumping, condiii^n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
nteg,r�i1ty, evf rice of leakage, elt.1
1.
revised 8115195) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 25 Black Oak Road Marstons Mills ,Mass .
Owner. Paul McGovern
Date of Inspection: 7/8/9 6
TIGHT OR HOLDING TANK&W
(locate on site plan) e
Depth below grade:11d
Material of oonstructioZ180oncrete_metal_FRF_other explain) -
A/
Dimensions: AM
Capacity: kfi gollons
Design flow: ons/day
Alarm level:
Comments:
(condition�Af inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BO&�
(locate on site plan)
Depth of liquid level above outlet invert:_
Comments:
(note if level and distribution is equal,evidence of solids carryover evidence of leakage into or out of box,etc.)
D=Box has equal flow;No evidence o� solids carry over;No signs of -leakage
in or out of the box; No repairs needed at the present time.
PUMP CHAMBERt,,�&,t
(locate on site plan)
Pumps in working order:(yes or no)-&'d
Comments:
(note condition of pump chamber;condition of pumps and appurtenances,etc.)
R/d LA svtwew1 -5
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (oontinued)
Property Address: 25 Black Oak Road Marstons Mills,Mass .
Owner Paul McGovern
Date of Inspection: 7/8/9 6
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possille;excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain: e
Type:
leaching pits, number:
leaching chambers, number
leaching galleries, number•
leaching trenches, number,length:
leaching fields, number,d---- 'ons:
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of nding,condition of vegetation,etc.)
Nogigng of hydraulic failure or ponding: All vegetation is normaT.
No r pair.s needed at the present time.
CESSPOOLS:"41e—
(locate on site plan)
Number and configuration: l _
Depth-top of liquid to inlet invert:
Depth of solids layer: Ain
Depth of scum layer: AJA
Dimensions of cesspool: hm
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection) /U
Commentz'-(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
�D �-Ok4WlL1✓)"S
4
PRIVY: �Glv
(locate on site plan)
Material of con: i// Dimensions:_ /j W
Depth of solids:4
Co nts: ce condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: 25 Black Oak Road Marstons Mills,Mass . 1
Owner. Paul McGovern
Date of Inspeotion: 7/8/9 6
SKETCH OF SEWAGE DISPOSAL SYSTEM: •
include ties to at least two permanent:oferences landmark or benchmark,
locate all wells within 1009
Centerville Osterville Marstons Mills
Water Company
428-6691
1
�' •' ' 0
0
• CCd ;
DEPTH TO GROUNDWATER
Depth Voundwater.-feet
method of determination or approximation: `
[revised 11/03/95) 9
-� // 3 Z
I � i
Z4 '
<
N —
(� (
L'
illOF M4
-
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N
ORSE H
9p I S T V�
D Zr S, I y I FFS IONAL�'a
v I 0�
I /38'-9v z0ty
`"V 1�
V � 0 a o�
,
Z-v 7- 3
LEGEND
EXISTING SPOT ELEVATION 0,t0 �tNUF `�'4„ CERTIFIED PLOT PLAN
EXOSTING CONTOUR --- O — -- ✓�� �'c;,, L D - G j34-A
ol
FINISHED SPOT ELEVATION ] ion R08ERT V_(�
/�
� M �' / M l L L5'
FINISHED CONTOUR 0 BRUCE A� E�oR-v �i� �
1N
APPROVED , BOARD ' OF HEALTH SA����
. ^"j SURV
DATE AGENT SCALES / �= 30'DATE , 7,/ z;/Yy
�.OREDGE ENGINEERING C2. IN 'Z /rA^/c-
CLIENT. I CERTIFY THAT THE PROPOSED
rE _j
TE REGISTERED JOB NO. 13 2 S� BUILDING SHOWN ON THIS PLAN
LAND CONFORMS TO THE ZONING LAWS
RV DR.By �_; OF BARNSTABLE , MASS,,"-,
712 MAIN STREET . CH. BY
•�•� ' �� ✓�
H YA N N I S, MASS. SHEETS OF Z DATE REG. LAND' SURVEYOR
SEWAGE PERMIT 140.
LOCATION / pp
VILLAGE
INSTATE 'S NAME � PISS
P 4
GUILDER OR OWN EP
&�kl
2-- !6 ti
DATE PERMIT I S S U D
DATE COMPLIANCE ISSUED"q-J_
vjf�C�
,07o-73 6 X
�o , 7—
t
•Y�
r,
r
Awe
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
Joseph P.- Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of thy;
General Laws. Issued by The Department of Environmental Protectio :..
June 8, 1995
Acting Director of the ion of Water Pollution. Cc:._ro.
.•.-wry.-rz:.��.�_z_�__._�•-�r...r...-.r.::•r .k'' „=.�:=n,r.-:„�-z:._--ter•:- _
n'i'OWN OF Barnstable BOARD OF
SUBSURFACE SEWAGE, DISPOSAL SYSTEM INSPECTION FORM - PART D
CFfITJ F1 CAT I ON
-TYPE OR PRINT CLEARLY- ' �.��.�,�"'_T""""'•—'+-T" -�:•-.•� .
PROPERTY INSPECTED
STREET ADDRESS 25 Black Oak Road Marstons Mills ,Mass.
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' S NAME Paul McGovern
PART D - CERTIFICATION -r
NAME OF INSPECTOR r Jr. ,
COMPANY NAME J.P.Macomber & Son Inc.
COMPANY ADDRESS Box 66 Centerville,Mass. 02632
Street To or City
COMPANY TELEPHONE ( } Stat• LIP
1;08 77 ` 3338 FAX ( 508 ) 790 _ 1578
CERTIFICATION STATEMENT _z
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate, and
complete as of the time of .inspection . The inspection was
performed
recomrner�dations regarding upgrade , maintenance , and repair are consistentny
with my training and experience in the proper function and maintenance of oIi-
s.ite sewage disposal systems ,
Zec one: ;
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately
protect public
health or the environment as defined in 310 CMR 15 , 303 . An
criteria not evaluated are as stated in the FAILURE CRITERIAf
this form . section of
System FAILED
The inspection which I have conducted has found that the system fails t
protect ttie 'I�tiUlic health and the environment in accordance with Ti
5 , 3.10 CMR 15 - 303 , and as specifically noted on PART C - FAILURE tle
CRITERIA of this inspection form .
Inspector Signature 7/9/96
Date
One copy of this rt.ification must be
( where applicable ) Bind the BOARD OF liEAIp,T°V1ded to the OWNER, the BUYER
* If the inspection FAILED, thle owner orsoperator shall u
prae
wit:})in one year of the date of the inspection , unless weddo ' thequiredm
allo
otherwise as provided in 310 CD1R 15 . 305 .
L O CATION � SEWAGE PERMIT 00
VILLAGE
I H S T A LLE 'S NAME � RESS
B U I L 0 E R OR OVYHERR
CJ
DA T E PERMIT ISSII VD
DATE C 0 M P L I A N C E ISSUED l/4��y
G3NG,�i o'r // JC�`��,
C_.--
2J... ,�r
i—�`/,�/i�"� �� � � � �
.4t�c� s�� �S
�T' o
e
No ..................` ► Fzcs..IJ...v�..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
.................. .. ....................OF..........................................------------............_..........._...........
Appliration for Diipoiittl Works Tonitrnrtion Urrmit
Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot #2 - Black Oak Rd. , Narstons Mills I t IVIA
..................................................••--•••--.....---•--...............--•-•-...... .................---•-•--••------•------------•......-•-•-•-----•--•-.......----••---.......••••--
Capricorn Reklty fist 765 Falmouth Rooda°; NHyannis
.................................................................................................. ..................................................................................................
W Steve Lebel Owner Address
,.� n. ...............................................I .. ..
nstaller Addddrere ss
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms ...........................................Expansion Attic ( ) Garbage Grinder ( )
A4 Other—Type of Building ranCh............... No. of persons............................ Showers ) — Cafeteria ( )
a' Other fixtures .--••-•--•-•-•-••---------------------------------•-•------------- ----------------------------...
W Design Flow_._._ .... :. b(}O...gallons per pergoggjr day. To 1�c�a0X�flow.........................................Yg Ions.
WSeptic Tank—Liquid capaclt,-.....-._...gallons Leng .............. Widt .........._..... Diameter................ Dep4...._..........
x Disposal Trenc4—No. .................... Wi 4.................... Total Length_..._ ?...........
Total leaching area sq. ft.
Seepage Pit Ng _.. Diameter................ Depth below inlet..6...._._....... Total leaching area.�.��...._...sq. ft.
z Other Distribution box ( ) Dos ilt�re�ig� Engineering 11-25-81
�" Percolation Test Re ult Performed by-----•------------•------------------•-- 1............. Date.--•--------•------•---•---------.-•---
a Z U n one encountg-
Test Pit No.,l.*A_.:_._.._._minutesperinch Depth of Test Pit DepthDepth to ground wat /ti_______________ e
f3, Test Pit No.i .....minutes per inch Depth of Test PY(.................. Depth to ground water........................
Descri Description of Soil 0-7----_-2-1---- f.................................
am & topsoil
x - ye ow sand-------------------•--•-----••----.....------•------•-----•-�-------
W •-•----5•Or--•-_---1Z-1-----fed. wWYii e---sari3�`tr�ces...o f raver/rio...wa era ---12
-----------•---------------------••----•-----•------•---•--•-----•-----•-•-----•---•-•-----••---••-•-----•---•------•------------•••-------------------•••-••-•--......................................
U Nature of Repairs or Alterations—Answer when applicable............:..................................................................................
. .•---•...•-•--------••••--------------•-------•-•---•-•---•-••----------------------.......-••....................----•------------•-•--......--•----•---••----••-••--•----------•-----..._..--•-.......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in or e
the provisions of iITLL 5 of the State Sanitary Code— The undersigned ftyyaer agrees not to ace t yst in
operation until a Certificate of Compliance s be issue "by the board of h th.
i ned . --•-.. _ ,/ ._. ..... r e ...r1 ..84
D
ApplicationAppro y-- -- • -•-----------------------------•-----------.-.-----•-------------------------..------
Date
Application Disapprove or a following reasons:...................................................................................:......:.....................
----------------------•--•---••-•----•-•--••-•-----....--•--••------•-•---••-•--••-----•---•--•-•--------.....................-•-•-----•------•-•----•------------------.•----•.._..----------•••---•-•-
Date
PermitNo......................................................... Issued_.......................................................
Date
e
No..?.` CO... y. FEa..,,ro;.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
......................O F.................-...........--...........---------------..-.-......._•-•------...-.-_..._
A ppliration for Bitipoiial Workii Cnuwuurtion "rruti#
Application is hereby made for a Permit to Construct x( ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot #2 - Black Oak--F �a iA
a. ViarstonsN �
••- ........... ... ...... _ .... _..---•--•-------•-----•_____.... ___._.......
Capricorn Re�ffty li4dst 765 Falmouth Rojj&91 NHyannis
.....................-.......................................................................... .......................•--____-__...._____-.-_______-______•-•--•-••....._-___....................
W Steve L e b el Owner Address
--••-• • ........ ......
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms 3________________________________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of BuildingranCh__---_____•----- No, of persons____________________________ Showers ) — Cafeteria ( )
p' Other fixtures ---------------------------------------- -----
W Design Flow------55_________________�ODO_..gallons per person,per day. Total daily flow.......330...........................-gallons.
to
WSeptic Tank—Liquid capacit .__.._..:__.gallons Leng Widt ... 0_______ Diameter________________ Depth...............
x Disposal Trencl —No. ____________________ Widgq.................... Total Length ........... Total leaching area--- _�_�_.___....sq. ft.
Seepage Pit N _____________ _______ Diameter._...._._..._.__._.. Depth below ....
._._..._._.___._. Total leaching area.__._....._.__..__sq. ft.
Z Other Distribution box ( ) Dosi t nk (_
VlareW Engineering 11-25-81
Percolation Test Results Performed by- ...................................... •••-____-•-•---------------•_._. Date........................................
a 2.0 i2' one encounte -
Test Pit No. 1__ _____________minutes per inch Depth of Test Pit__ Depth to ground wat _______._..____..__.__.
(z, Test Pit No. _A__._____._minutesper inch Depth of Test P ._A______________ Depth to ground water........................
----------------------------•----------....----...•••-•-----------........-•----------•••--•----•••.........................................................
O Description of Soil........O7.___-___21 loam & topsoil
---_ •-------__-•--
-
x 2 i0- -------Iviedium e low sand------------------------------------•---- -------------....._..-------------
1�.Y__.._..12.� meca_: while sand/traces o f---9r5:V&!1E6...wa�er-at---12'
U Nature of Rgpairs or Alterations—Answer when applicable...............................................................................................
-•----------------------------•-------...-----••-----•..._._..•-•-----•---•-•----•._._..............._._....------••---•--•--•----•--•-----•-•--....-----•--••-----•--•-----•----------...________•••---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL 5 of the State Sanitary Code—The undersigned fu er agrees not to place the system in
operation until a Certificate of Compliance ssuedrby the board
signed - ���'u' l ... 'G S_�__..
Application APPro y-- --•- _______________________ .....
l" - .._.....
Date
Application Disapprov f o the following reasons:-•-•------------••-•-------•---•----•---••-------•-•---------------------------•••--•----- .................
....................•--._._._.._..----._.___._...------•-----------•--•--•---.__.._..---•----•-----•••••----------------•----•--..._.•-•----••--...----••--------------•--•••----------••-...----•-_..._
Date
PermitNo....................................................... Issued_.......................................................
Date
THE COMMONWEALTH'OF MASSACHUSETTS
BOARD OF HEALTH
Town...................OF F.-...Barnstable
. ......................................................
Trrtif iratr of Toutpliatta
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ) or Repaired ( )
- Steve Lebel
by.. •••----•___________________ •----------•••••--•-•••--•---•••-•-•-...---.........-••-•••.....--_...•-••-•--•____.._._..______
Lot , 2 - Black Oak Road, Install9arStOnS Mills , MA
at -- ..... •----- •-•------ -•------- - -----
has been installed in accordance with the provisions of T rrjrf The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.___.___ "S___!_i"__((�p___________________ dated__--______-_________________-______________-____
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM.WILL FUNCTION SATISFACTO Y.
DATE............................................��j�.•--�-�....... Inspector.......A=---------•--------------------•--•-------••--------•-•---•---_-_____--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�,«/ Town Barnstable
No100-Y/__Y ...........................................OF...........--.-...---•-....................._.._......_...._._...-•------........._..
n .
FEE...... .............
Ui.nposal Works Tono#rudion "Prrutit
Permission is hereby granted Steve Lebel.
------------------------•--•------•---
to Construct ) or Repair ( ) an Individual Sewage Disposal System
Lot ; 2 rSlack Oak Load Marstpons Mills , MIA
at No. '--- -----------•-------......------•---A---------__------•--•-------------------
Street
as shown on the application for Disposal Works Construction Per ' o_____________________ Dated..........................................
Board of Health
DATE................................................................................
FORM 1255 A. M. SULKIN, INC., BOSTON
� . S? ' 3
0 Ok
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1 � Nly
76 39
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(� Tyd,, _ _ r IL
o h s ,Z L 4( log .39'
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1 I 14—Ibo'Ia Sco.9 V 3 L T
7 2� � \ DO o I (J S
.� M I o ORSE v
v o.1 9 1 O
o 7- 7— o Ago c�9s�P�\��w
Q 2-0, O Z,� S, L `FS ION�A-�a
0
0' /
�3 8�•q � �0 C- 1P F
w 7- 3 /
LEGEND
EXISTING SPOT ELEVATION 0„0 �tl� CERTIFIED PLOT PLAN
' EXPSTING CONTOUR --- 0 ,��-� /3G/t�/ V lq K JzD:
FINISHED SPOT ELEVATION o� RoaERT
BRUCE MA 5 TDAJ5 M/L L5'
FINISHED CONTOUR 0 eLoR ! IN
APPROVED .BOARD OF HEALTH
&D Sl7R�
DATE AGENT SCALE, ,/ = 3 0"DATE , 7/2-/�
.DREDGE ENGINEER'" CO 'NOCLIEb
------ 1 CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB NO, g3 2S(� BUILDING SHOWN ON THIS. PLAN
CIVIL LAND CONFORMS TO THE ZONING LAWS
G EN NEER RV DR. A `�'`' �' OF BARNSTABLE , MASS
712 MAIN STREET , - CH. BYE tk- .6,6 '
HYANN I S, MASS. Z
SHEET_L OF DATE REG. LAND SURVEYOR
/YO7Z / F47WZ Rt 7'N.rSEP7lC 7A.aI 3 D�
20 FT lo/N. L:�i4CN/AICs AiT'i4RG'r=. "ORE°..,7WA%V M..,
/� pT./►tsw rRAO1�F` 4 '"'A1AMA'7Z& CONCR`Fs?:�'C`O®!LxR
N-- SJVAL t �.� Df�PO .yT"17
TO 6R�A 0&-6A V'E,X`/'R A �.
PYC PlPPCONCZrAr O C0 � W,.4 Se-OiC
M/N. P/TCN JF/N 17R/1/EyVA y
�• EL.-77.�.
A cfve CO YER CLEAN .SAN.D';
LAYER
• ;- ION P/Pt10670
6A 1-
_ ' • , o o G1F � '3�8'
.P&M P7.. 54PY/C 7A)V.K D/ST. D'e 1• • • . • • • • • e , • iYASHFD STYJNE,
Box
., D ! !ems + • • e 3�4 = � �2;
Cl7VE
`-' - - •
tY r 4.•rf ;: t., �B�N 2. 48 .G4c�DAr s oe r
a!s!�a ae .4o ..eO .ee• •ee�:••:..•i► •Ba�d.•
wAsmED STGXE
d 98o e. e a 0el1 O•S-c 470 O•
� 8 ' ° -
" 7 s e o o e es n PRECAST"JS94
G
eeP/7 ORuV
/JN /eR1LlEt4,4?14N.4 y/7- Cs+ng C 66 .0 :
E
IMMER7 AT AV1101A/6 •74-o FT. 6 F7:DYi4/4t.
IA14LE7 ,.SEPTic 7 4/VIC. 7 3.7 Fr, 1_ fT. APIA*W C rsFF
�l/7LLaT.SEFiP/G�s4NK 7 3.-S FT. g=
®OX 7 Z 9 A7 . - .r•'E�`T/ON OF ; .. .-GROUND 3t{RTER 714 E
0V7ZETD1377t0AIJTI0N SAS 7 Z•7 fT.
IIV�T LEACNIJW ®JT 7 Z o FT f5'Ed+V.�Q/sE ®/Sr S.�1. SY.ST M 7A4WLr47/40/N
LAs4CHIIVG ®JT "
DIES/6N /TEi4/A DJMENs/ON A 3 1�'T
NUMASER OF EEZW04AfS
(S+R6A4GE0/SP0.S4L IAW7- IVo NE 50/1- /-0& ,$NO/d. TE�$T
ToTAC E3T/~rEG FLO rt/ y SOIL TEST.01 SO/l TEST02
PA -
MUMSER 4c tC111" P/73 �E[EY. 73•`�' �`-t[FY, Os�4TE OF SOIL TLrST
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