HomeMy WebLinkAbout0009 BLUENOSE LANE - Health 9 Bluenose Lane
Marstons Mills 1 � :
. 4
A= 121,— 144- 004
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR
DEPARTMENT OF ENVIRONMENTAL PR L�CTI° 9
ONE WINTER STREET. BOSTON. N1A 02108 61 7-?9?-
9
Ik
Michael D ' etr O TRUDY COXE
NVILLIAN9 F.WELD . 6 `4 Secretary
Governor .�o�A_ _1,99
ARGEO PAUL CELLUCCI Iq `g DAVI B.STRUHS
J
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION �j Commissioner
PART A
CERTIFICATION 1 �
Property Address: 9 Bluenose Lane , Osterville , Address of Owner: 10 Highland. Way
Date of Inspection: '-3a-9 `/ MA (If different) Burlington, MA 01803
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 1 089 CentPrvi 1 1 P r MA 02632
Telephone NumberY 5 0 Ai; 7 7 S-87 7;
CERTIFICATIONL 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 see%age disposal systems. The system:
41 Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: e� k i Dater
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 1, B, C, Or D:
i
A] SYSTEM PASSES:
I 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.
C MMENTS:
B] S STEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upor
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indi ate 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; of
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) Pege 1 of 10
DEP on the World Wide Web'. httpJhvww.magnet.state.ma.us/dep
Z"j Printed on Recycled Paper
• I 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 9 Bluenose Lane , Osterville , MA
Owner: Michael DiPietro
Date of Inspection: /^ ,3 6—g C7
B] SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipets) 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 pipeisi are replaced
obstruction is removed
C) F RTHER 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 T 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 pricy is within 50 feet of a bordering vegetated wetland or a salt marsh.
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
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
A
PART A
CERTIFICATION (continued)
Property Address: 9 Bluenose Lane , Osterville , MA
owner: Michael DiPietro
Date of Inspection: 1-30—Q
D] S TEM FAILS:
You mu indicate ei:•.er "Yes" or "No" as to each of the following:
have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
f r this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
th 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 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.
)Thef
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] LARGEM FAILS:
You musto either "Yes" or "No" as to each of the following:
owing criteria apply to large systems in addition to the criteria above:
tem serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
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 perator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements f 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 9 Bluenose Lane , Osterville , MA
Owner: Michael DiPietro
Date of Inspection:/--go-7
9
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 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.
y _ 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)j
(revised 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address9 Bluenose Lane , Osterville , MA
Owner: Michael DiPietro
Date of Inspection: 30--9
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 3C o g.p.d./bedroom for S.A.S.
Number of bedrooms:]
Number of current residents:
Garbage grinder (yes or no):
Laundry connected to system (yes or no):2S
Seasonal use (yes or no):
A
Water meter readings, if a ailable (last two :2) year usage (gpd): 1998 90 , 000 gal.
Sump Pump (yes or no):_�2 1997 92, 000 gal.
Last date of occupancy:—�4
COMMERCIAU DUST IAL:
Type of establish ent:
Design flow: gallons/day
Grease trap 7redings,
(yes or no)_
Industrial Wding Tank present: (yes or no)_
Non-sanitaryischarged to the Title 5 system: (yes or no)_
Water meter if available:
Last datkocupanq,:
OTHER )
Last datancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
I&AI o
System umped as part of inspection: (yes or no)W,
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF YSTEM
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
s1Js
APPROXIMATE AGE of all components,.date installed (if known) and source of information: 29 Y ? do td
t
Sewage odors detected when arriving at the site: (yes or no)/t,
(revised 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 9 Bluenose Lane , Osterville , MA x
Owner: Michael DiPietro
Date of Inspection:
BUIL ING SEWER:
(Locate on site plan)
Depth low grade:
Materi I of construction: _cast iron _40 PVC_other (explain)
Dista ce from private water supply well or suction line
Dia eter
Co ments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:_✓
(locate on bite plan)
Depth below grade:
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: °� o
Sludge depth: S— 7 ' ' >
Distance from top of slud�e to bottom of outlet tee or baffle; 9
Scum thickness: —C,
Distance from top of scum to top of outlet tee or baffle: 4-/
Distance from bottom of scum to bottom of outlet tee or baffle:_
How dimensions were determined: Ci P T JZ
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.) ,
0
t.' =47' A- +�
GR SE TRAP:
(locat on site plan)
Depth low grade:
Materia of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimen ions:
Scum t iickness:-
Distance from top of scum to top of outlet tee or baffle:
Distan from bottom of scum to bottom of outlet tee or baffle:
Date o last pumping:
Comm ts:
(recom ndation 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 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 9 Bluenose Lane , Osterville , KA
Owner: MichaelDiPietro
Date of Inspection: l�6"q 7
TI HT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(lo to on site plan)
Dept below grade:
Materi I of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimens ons:
Capaci gallons '
Design low: gallons/day
Alarm vel: Alarm in working order _ Yes; _ No
Date o previous pumping:
Com ents:
(con lion of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_v
(locate on site plan)
Depth of liquid level above outlet invert:_(0
Comments:
(note if level and distribution is equal, evide, a of solids carryover, evidence of leakage into or out of box, etc.)
�r✓�
PU CHAMBER:_
(loca on site plan)
ti
Pum s in working order: (Yes or No)
Al sin working order (Yes or No)
Com ent5:
(not condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 9 Bluenose Lane , , Osterville , MA ,
Owner: iChael DiPietro
Date of Inspection: /
SOIL ABSORPTION SYSTEM (SAS):_✓/
(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 ponding, condition of vegetation, etc.) v
(� o,, L a
CESS OLS: _
(locate on site plan)
Number and configuration:
Depth-to of liquid to inlet invert:
Depth of olids layer:
Depth of um layer:
Dimension of cesspool:
Materials o construction:
Indication f groundwater:
in low (cesspool must be pumped as part of inspection)
Comments:
(note cond ion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:_
(locate on si plan)
Materials of C Dristruction: Dimensions:
Depth of soliIs-
Comments:
(note condition 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: 9 Bluenose Lane , Osterville ,. MA
Owner: Michael DiPietro
Date of Inspection: j 3aY- "
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permznent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
(revised 04/25/97) Page 9 of 10
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 9 Bluenose Lane , Osterville , MA
Owner: Michael DiPietro
Date of Inspection:
Depth'to Groundwater I s Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Qbtained from Design Plans on record
V Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Descr' a in your own words h w you established the High Groundwater Elevation. (Must be completed)r
(revised 04/25/97) Pago 10 of 10
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THIS PLAN IS NEINER INTENDED r r! • iw= r,.,
FOR, NOR" SMALL IT BE USED FOR Ra• o" .
MORTGAC& LOAN PURPOSES. �5--)l iL? FOUNDATION PLAN—LOT- t2
SLUENOSC LANE
BARNSTABLE, MASSACHUSETTS
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TOWN OF BARNSTABLE
LOCATION auto tJO� ZJQ SEWAGE # '39
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VILLAGE CAS+�.S ��t IIt 1vl ASSESSOR'S MAP & LOT I Z, A4-4-004
INSTALLER'S NAME & PHONE NO.
,SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) -pn--C..,zv5k size) /Oct?
NO. OF BEDROOMS PRIVATE WELL OOR PUB C WATE
BUILDER OR OWNERs%�'�'" -�HZ
DATE PERMIT ISSUED: /-- jo---010
DATE COLIPLIANCE ISSUED:
VARIANCE GRANTED: Yes No ��
1
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37
FIz$....71�.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................OF..........�,4rz•lgfRls t
----•...........................•-----------
Applir. for 13hipos al Works Tonotrnrtion JIrrmit
Applicatio is,hereby made for Permit to Construct (A or Repair ( ) an Individual Sewage Disposal
System at:
Loc t'on-tldd _ or i.�:yy'l
� �r ..l �>1 ....... /. fix. !v--------------
---- ----------------------------
Owner Address
Installer Address
U Type of Building' Size Lott_ Sq. feet
Dwelling—No. of Bedrooms________________ ________________________Expansion Attic (nl) Garbage Grinder (�)
`4 Other—T e of Building No. of persons---------------------------- Showers — Cafeteria
04
Other fi t es -----•--•---••-••••••••••-•••-•---•-•----------•----•••••••-••---•----------------------------------------------------------•----••-•----------------
W Design Flow............................................t� 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 ( ) /
~ Date /..Percolation Test Results Performed by..._-_.. Pk�E __._____:._._.�y�______ _ s z y
Test Pit No. �--_minutes per inch Depth of Test Pit........._ ------ Depth to ground wate............t------
GX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil-_-________/`°. 05y.`.. G vn.1 s __ 3`/V
..............................................................................
x ------------•---•-------------------------------------•---------------------...---------•-----------------.._.__....----
V •••-•••••••••-•••••----•--•--•-•-••••••...•••-------------•••-••-•--------......_:.••------•------•-------•-••••---•--••-•••---••---•--•----•---•-•-••••-----•-••-•••-•-•---••-••---•--•-•...-..._...---
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
--------------------•••-•-•-••••-•-••-•--••---•--•-•----••-••-••-•----------•-•••-•••--•--•--•-•-----•----••-••-------------••••-•--••-•--•--•-•-•------•----•••••--•••-•••••••••••-••••........--_-•••.
Agreement:
The undersigned agrees to install the aforedescribed In vidual Sewage Disposal System in accordance with
f"1 T!1 T'�
the provisions of TTLE 5 of the State Sanitary C dL
dersl ned further agrees not to place the system in
operation until a Certificate of Compliance has en boar o h lth.GSigned ---•---------------•-•------•-...-•--•--••-•• ----•-•-f .Date
A lication A roved BPP PP Y ... Date'
e' p
Application Disapproved for the following reasons:-------•-----------------------•----•------------------•-------------------------------•--...••-•-••--..._-••---
--•.....•-•-•-•••••••••-•----••-••--•-••----••--•••-••-••-••••••---••-•---------------••-•--••-----•-•---I••--•-•---•--•---•-•----•--------•--------•••••-•-------------••-•••••---•-••••--•-•-----•-----
q Date
PermitNo......... .-�//• ....................... Issued.......................................................
Date
. t
No..... .!.....�..1.•� Fes$........:.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... �'':'�:. -- ------...._OF.........�i9�.va
Appliratiun for Diupuuttl Works Tun,itriirtion "rrnti#
Application is hereby made for a Permit to Construct (A ) or Repair ( ) an Individual Sewage Disposal
System at:
._.. � ................................. ............................ ------------0-
ation-Address or.Lot No.
;r Owner Address
Installer- Address
d Type of Building Size Lot............................Sq. feet
g— ( )
- Dwelling No. `of Bedrooms___________________________________________.Expansion Attic (j Garbage Grinder
Other—Type of Building ........:................... No. of persons..........._................ Showers ( ) — Cafeteria ( )
Q Other fix�pres ........... ..........................................................
---
Desi n Flow______________ ___________________________gallons per person per day. Total daily flow.___.................�............._.._..
W g ., €.. P P P Y Y gallons.
WSeptic Tank—Liquid*capacity.............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. ..*.................. Width.................... Total Length.................... Total leaching area....................sq. ft.
�y Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
`"' Percolation Test Results Performed by.___.___f�'.....! . ........ .....'� ........._._....._.. Date__ z_`�
Test Pit No. 1----4 ___...minutes per inch Depth of Test Pit....... ....... Depth to ground wate............I--------___.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Q+' -----------•- - - ---------•----- �y
D Description of Soil .4 F........./ul&f ' n.Z s- Si'' .j
--------•---•-•-------------•------...--•--------------------------------------------.....-------------•----•-•---......---•-----
V ---•----•----------•-----------------•-------------------------•-----------------•-----•--___-------____--------------------------------
-------------------------------
•--------
•----------
•-••--------
W -----------------------------•-----•----------------•----------------------------------•----------------------------------------------------------------•--•----------------------••-----.....---------
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
---.........................................-..........................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed I fvidual Sewage Disposal System in accordance with
the provisions of SIT1E ;of the State Sanitary Code Th undersigned further agrees not to place the system in
OP eration until a Certificate of Compliance has been issue l by/�tl/e board o�h alth.
Signed........__ _.`....1,./(t. ri ...�.�
�1 Dat� .....
Application Approved By.............. 4:,�_,_,_A�- _ r
a -� -------��.' elDate }
Application Disapproved for the f ollouing reasons:................................................................................................................
---------------------------•---------•---------------------------------------------------•-•-•--------•--...------•----------••--•--•---•------------._...-•----•-----•-•----------------•------......_._
Date
- 4� r
t / ---------------------- Issued...------•---•--•----------
Permit No.--------•-•-•------ --•---�---- ----------------------•----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
:...............................O F........:° ............................................................
Tntifiratr of Tuntpliatta
THIS IS TO CERTIFY, Thatthe Individual Sewage Disposal System constructed (/) or Repaired ( )
�. t5 ,r7s.e0 C. sC,
by ....... ........ t,�1
at......................................................................................................................... 57..-----------------------------...---•-------•---.._...._..----------
has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the
application for Disposal Works Constriction Permit No...rfl:_._ _. <.-y___........ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
c -1
DATE.......................... -_''L...7d........................ Inspector............. ....................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
W n/................Oa,"
............... tip, .s
E5 YF T f<.... OF........<..:..................................
No...........:... :IL FEE........................
Disposal 19orkg TD.on#rudion f amit
Permission is hereby granted.-----=- -......--•-----------------..-----...................................................................................
-•---
to Construct (54') or Repair ( ) an Individual ewage Disposal System at No......... y ..._._.. V f'W f^V 3
.............'L..rl'"
street
as shown on the application for Disposal Works Construction Permit Dated..........................................
-------------------------------------- .................................................
Board of Health
DATE............../ ......................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
G
ONS MILLS
N 0 TES: MARST
'To
ALL SHP
WORKMAN ' I XND�' MATERIALS -S- HALL 'CONFORM D'E O.E.
W M*MWV OR AS WCAM,6W'PW :THE TOWN'' BARNSTABLE
-FOR -TH ' SU
TITLE 5 'OF
REGULATIONS E BSURFACEJASPOSAL OF SEWA LOCU8�
TS OF
'AND.'JHE RE0UIkElkN THIS PL N.
'ALL 'COVERS T SANITARY U ROuTt
kits 'SHALL WSROUGHT TO
2. ROUTE 28
BLUENOSE,
M= j"v
FINISHED' GRADE
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`�OR USGS -PROBABLE HIGH WATER ,LEVEL WAGNER FIELD NOTEBOOK # DESIGN CALCULA11ONS :
CURRENT ZONING- INTERPRETATION:
'MIN. FRONT SETBACK FEET '
NUMBER OF BEDROOMS
BGE DISPOSAL �UNIT
MIN. -,SIDE SETBACK FEET
TOTAL :ESTIMATED FLOW
MIN. REAR SETBACK ' FEET SO GAL /DAY, ,
�( 110 GAL./EIR./DAY, X SR.)
REQUIRED SEPTIC' TANK CAPACITY
�5 GAL
' ACTUAL,SIZE
000 GAL
OF. SEPTIC 'TANK
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AREA 2.5 GAL/S.F.
..� SIDEWALL
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IL --TES
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LEACHING CAPACITY
6
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ATION
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'EXISTING SPOT ELEVATION'
EXISTING�'CONTOUR
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PRIMARY, LEACHING PIT
RESERVE LEACHING PIT
WATER LEVEL '
TEST DATE
LOT 1
INDEX WELL
157 WATER LEVEL ,RANGE` ON 1 , INITIAL ISSUE
DEPTH To, WATER -LEVEL'fOR INDEX WELL DESCRIPTION BY
NO. DATE
-FOR THIS MONTH
-A
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PLAN, &
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WATER LE . T
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DEPTH TO HIGH WATER
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A' L
-REVISED
D MEYER ,
signer
Profes
gio I BOding De
P.O.Box'532
DRAWING NUMBER
.02664
�6-'Yarm6uth,MA
-5296
(508)394