HomeMy WebLinkAbout0004 BRIDLE PATH - Health 4 BRIDLE PATH
MARSTONS MILLS
TOWN OF BARNSTABLE
t .t�
ATION y 8rJV— ?G*(N SEWAGE # -
LAGE Mary-Sib" I 't t 11S ASSESSOR'S MAP & LOT IYO �a
' NAME&PHONE NO. M:c,b-6, 1.Q&* S 7 6 D$ I
SEPTIC TANK CAPACITY O o !;OA
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet leaching facility) Feet
Furnished by ` -1) iL,6 t75
SY
36
e ox
No.
Fee
THE COMMONWEALTH OF MASSACHUSETTS ""°Ent&d6 in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for Dtgogar bpgtem Construction Permit
Application for a Permit to Construct( ')Repair(h)Upgrade( )Abandon( ) El Complete System &Ittdividual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel J /� ,
Installer's ame,Address,and Tel.No. Designer's Name,Address and Tel.No.
.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(140
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) /Y eip�!/�'� �D* �DX
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b this o d o ealth. - Q
Signed Date 7
Application Approved by Date
Application Disapproved for the following reasons
Permit No. '` Date Issued )
Fee
THE COMMONWEALTH OF MASSACHUSETTS b °� ibd in computer:
Yes
PUBLIC'-HEALTH DIVISION - TOWNOF BARNSTABLES MASSACHUSETTS
ZIpplication for Migonl *pztem Con4truction Permit
Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) `'1 Complete System Lf Individual Components
Location Address or Lot No. , Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. ' /7 Designer's Name,Address and Tel..No.
T -
Type of Building: "
Dwelling No.of Bedrooms �Lot Size sq. ft. Garbage Grinder
Other Type of Building 4"H No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) "ee-& )?O#e6l
1
I
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b this o d ofHealth.
Signed Date 3/S1R
Application Approved by Date
Application Disapproved for.the following reasons
Permit No. r Date Issued J
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CER IFY,that the On-site Sewage Disposal System Constructed( )Repaired(tom )Upgraded( )
Abandoned( )by / G �5
at ll 0W5 has bee constructed in accordance
with the provisions of Title and the for Disposal System Construction Permit No. dated
Installer Designer
The issuance of this permit shall p4t e construed as a guarantee that the to ill functio as�es gnedf
Date Inspector0 *,WdL
PAW v
----- ------------------------------ —
No. air Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
lwigpogal *pgtem Con.5truction permit
Permission is hereby granted tof ons ( )Repair ✓)Up r d e( )Abandon( .
System located at
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Constrfictiog must be completed within three years of the date of hr'1 t.
Date: Approved by 71/ ' FD %r . v
Commonwealth of Massachusetts LZ
Executive of EnvironmentalAffairsnFP
D epartment of
Environmental Protection
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: y •:,,�, �
.Address of Owner:
(if different)
Date of Inspection: �\
Name of Inspector: !a,(Vc--A
Company Name, Address and Telephone number:
.
CERTIFICATION STATEMENT L'„ ` "D
I certify that I have personally inspected the sewage disposal system at this address and
that the information reported below is true, accurate and complete as of the time of
!inspection . The inspection was performed based on my training and experience in the
proper function and maintenance of on site sewage disposal systems. The system
4 Passes
--- Conditionally Passes
--- Needs further evaluation by the local Approving Authority
---- Fails
I nspector ' s S Date:
The system I nspector 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 or the Department
of Environmental Protection.
The original should be sent to the system owner and copy sent to the buyer,if applicable
and the approving authority.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: y h�-•�\� ��
Owners :
Date of Inspection:
INSPECTION SUMMARY:
Check A, B, C, or D
A) SYSTEM PASSES:
- I have not found any information which indicates that the system violates any of the
failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are
indicated below
8) SYSTEM CONDITIONALLY PASSES:
---- One or more system components need to be replaced or repaired. The system, upon
completion of the replacement or repair, passes inspection.
Indicate yes, no, or not determinate (Y,N, or N D). Describe basis of determination in all
instances. If "not determinated", explain why not.
.--- The septic tank is metal, 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.
---- 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):
----- broken pipe(s) are replaced
----- obstruction is removed
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address : 5 ,�aa- th
0 w n e r : �, �e% k
Date of Inspection:
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
---- Conditions exist which require further evaluation by the Board of Health in order to de-
termine if the system is failing to protect the public health , safety and the environ-
ment.
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 of water
---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small
marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC-
TIONING INAMANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY
AND THE ENVIRONMENT.
---- 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
of a public water supply well.
---- 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 analy-
sis 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 notrogen is equal to or less than 5 ppm.
D) SYSTEM FAILS:
--- I have determined that the system violates one or more of the following failure criteria
as defined in 310 CM 15.303. The basis for this determination is identified below.
The Board of Health should be contacted to determine what will be necessary to cor-
rect the failure.
---- Backup of sewage into facility or system component due to an overloaded or
or clogged SAS or cesspool.
.j
i t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: o�cL QM
Owner:
Date of Inspection .
D) SYS T E M FAI LS (continued)
--- Discharge or ponding of effluent to the surface of the ground or surface waters
a due to an overloaded or clogged SAS or cesspool.
--- Static liquid level in the distribution box above outlet invert due to an over-
loaded 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 N 0 T due to clogged
or obstructed pipe(s).
number of times pumped
--- Any portion of the S oil Absorption System, cesspool or privy is below the high
groundwater elevation.
--- Any portion of cesspool or privy is within 100 feet of a surface water supply
ortributary to a surface water supply.
---Any portion of a cesspool or privy is within a Zone I of a public well.
--- Any portion of a cesspool or privy is within 50 feet of a private water supply
well
--- Any portion of a cesspool or privy is less than 100 feet but greater than 50
feet from a private water supply well with no acceptable water quality ana-
lysis. 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.
a t'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: y 9�ca,aSLe_
Owner: 'P.
Date of Inspection :
E) LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above :
The design flow of system is 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 :
-- 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 I I of a public water supply well.
The owner or operator of any such system shall bring the system and facility into full compli-
,ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00.
(Please, consult the local regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: �^�,
Owner: r,c,:— ;��
Date of Inspection:
Check if the following have been done :
-�-Pumping information was requested of the owner , occupant and Board of
Health.
X None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during the period. Large
volumes of water have not been introduced into the system recently or as part
of this inspection.
Y As built plans have been obtained and examined. Note if they are not available
with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
-V- The system does not receive non-sanitary or industrial waste flow.
- The site was inspected for signs of breakout.
-x 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 sep-
tic tank was inspected for conditions of baffles or tees, material of construc-
tion, dimensions, depth of liquid, depth of sludge, depth of scum.
- The size and location of the Soil Absorption System on the site has been deter-
mined based on existing information or approximated by non-intrusive methods
• . The facility owners and occupants if different from owner were provided with
information on the proper maintenance of Subsurface Disposal System.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner:Date of Inspection:
RESIDENTIAL:
Design flow : .30 C gallons
Number of bedrooms : c.z
Number of current residents: C}
Garbage grinder (yes or no) : vv
Laundry connected to system (yes or no): �.
S easonal use (yes or no) : N G
Water meter readings, if available:
Last date of occupancy :
COMMERCIALANDUSTRIAL :
Type of establishment:
Design flow : gallons/day
Grease trap present: (yes or no)
Industrial waste holding tank present(yes or no) :
Non-sanitary waste discharged to the Title 5 system (yes or no) :
Water meter readings, if available :
Last date of occupancy :
Other: (Describe) ............................................................................................................
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information :
.4 ...........................................................
System pumped as part of inspection (yes or no) :...lL1..........
if yes, volume pomped : .................... gallons
Reasonfor pumping :............................................................................................................
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: IF,Zs,",
Date of inspection:
TYPE OF SYSTEM
-kSeptic tank/distribution box/soil absorption system
--- Single cesspool
--- Overflow cesspool
--- Privy
--- Shared system (yes or no) (if yes, attach previous inspection records, if any)
--- Other (explain)...........................................................................................
APPROXIMATE AGE of all components, date installed (if known) and source of information
...0iA ►.-.?�.�r':.S...jcr1 v.„=:...4'f-` -.:.'.�.=c+�c
�.`.�.A.�.7:�.-'. ;. ..� ':; .:v - .....G:b.aw. �.. rc:.� .... '>. r :�`,�.........................
................................
Sewage odors detected when arriving at the site : (yes or no).............:
SEPTIC TANK :
(locate on site plan)
Depth below grade: ..:,
Material of construction: ...?. concrete ......... metal ........ FRP ........ other (explain)
................................................................................................................................................
Dimensions:
Sludge depth :....>.�?.`.'.....
Distance from top of sludge to bottom of outlet tee or baffle:.......OO..................
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:_0....................
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.)......................
F,3.�tiy�ll�n4i ...ZXAN: ?%iuiry... ..�s2(';�G�h.`Z4:.rxlfi;�..1!?� .).(.�Y (��s. 1 �x.a:a..:.w;►ttC..1.�.>
f
y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: y „G
Owner: -c-\�
Date of inspection: :Z�.�1M`
GREASE TRAP : ......
(locate on site plan)
Depth below grade: ...............
Material of construction: ........concrete.........metal........FR P........other(explain)....
....,......................................................................................................................................
Dimensions:...............................
Scum thickness:........................
Distance from top of scum to top of outlet tee or baffle:.......................................
Distance from bottom scum to bottom of outlet tee or baffle:...............................
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.)........................
................................................................................................................................................
................................................................................................................................................
TIGHT OR HOLDING TANKS:...N.C...
(locate on site plan)
Depth below grade:...............
Material of construction:........concrete........metal.........FR P..........other (explain)..........
................................................................................................................................................
Dimensions:............................
Capacity:....................gallons
Design flow:...............gallons/day
Alarm level:.............................
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
................................................................................................................................................
................................................................................................................................................
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAR T C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of inspection:
DISTRIBUTION
(locate on site plan)
Depth of liquid level above outlet invert:...................
Comment:
(note if level and distribution equal evidence of solids carryover, evidence of leakage into
or out of box, etc.)... ?.... lx, -
wc...
................................................................................................................................................
PUMP CHAMBER:...l���..
('locate on the site)
Pumps in working order: [yes or no)...............
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)....................
................................................................................................................................................
................................................................................................................................................
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: ......Z. ...!��� `
leaching chambers, number:........
leaching galleries, number:...........
leaching trenches, number , length:.....................
leaching fields, number, dimensions:...................
overflow cesspool, number:..........
Comments:
(note Wndition of soil , signs of draulic failure, level of ponding, condition of veget tion,
etc.)... ftnx, A. ....t�:Lc:,.�� 5,�.�... .........
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property address: LE 4_-,6&, Q �
Owner: ,
Date of inspection: 3A
CESSPOOLS:....
(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: .....................
Indicator of ground water: ....................
inflow (cesspool must be pumped as part of inspection)
.................................................................................................
.................................................................................................
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)
................................................................................................................................................
................................................................................................................................................
PRIVY : .....PJC'..
(locate on the site)
Material of construction: ...................................
Dimensions: ......................
Depth of solids: ................
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.) .
................................................................................................................................................
................................................................................................................................................
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address : .L�
Owner:
Date of inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks locate at
wells within 100'. - 1
Lk Z
3's t
'T �•'"� j �� 1 bcn�cil 5
rA5-5Z � 5 - L`J1
5
DEPTH TO GROUNDWATER:
Depth to groundwater: ..�.C}.feet
Method of determination or approximative: n
4F..n,. ... -. .. :��........%T....yy...z.......................................
r
ANTLANTIC ENVIRONMENTAL
P.O.BOX 2384
MASBPEE,MA 02649
Attn: Commonwealth of Massachusetts s Date: 02/06/96
Town of Barnstable
Board of Health
367 Main Street
Hyannis MA 02601
From : Mr Michael DeDecko
Po Box 2384
Mashpee MA C-2649 ;
Dear Board of Health Official;
I certify that I have personnally inspected the sewage disposal system at the following
address : 4 Bridle Path,Marstons Mills, Ma.
The information reported is true, accurate and complete as of the time of the inspection.
I have not found any information which indicates that the system fails to adequately
protect the public health or the Environment.
If you have any questions regarding this inspection,please contact me at this number:
(508)477-14-20. Thank yot
Sil cere y,
Michael DeDecko
phone 508 477-1420
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE ORRICE pr ENVIR0NA2ENTPl AFFAIRS
DEPARTMENT QF EIVVIR NXZNTAL Pac)TECTION
on WV"n STRUT, 80¢TON MA 02109 (617)2/2•11 W
TRITDY COM
AR020 AUL ClUUCCI DAYID 11.MUMS
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CaNttpafgr Marra: �rm�c.�t�.g
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talepbat.lbseron .. -
I soWr OW I have Personally W49eetud'tho"wage dl$Posal aretem it this address and thot'the information roponod below b true,wr,Rrata
and oanwp rta of of the thew of inopesthun. This inspecdon was perforrt►ed based on my training and esfOdense,in the pope►function and
moimenaess of on-$"*swap dhaMd systems, the system:
�. ►aseaa
CendMianagy Ilasss
Woods further Evdosden by the Losel Approving Authority
Fab
brepee*w•a i1/ea: s Ores:
Tom Mwom,tnspocter shah submit a espy of this inspection espen to the Approvirn0 Authorhy'lboard of lleolth or ClPiwhfein"ty 1901 dove of
eer�elagng tfd*fhopagOon. It low sysam Is a,shared system Or has a design flow of 10.000 gad a rsster, ohs inapostw end the syatnm lrwna
.00,atrbedt*8 MOM to tllo oppepMte 00e11/1 OMICV of the OePtlrtmewrlt tlPft UorahWVld f feteetlon. The ONO W shwAd'he sent wtdta
systurn owner and aopias sent to the bmrypr,If apPlleabie, and the approving suthOrlty.
fy04tb AND COMMW46 1 k.; I! b O V. W� G P 0 YV% a�C7+ —1
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I km rat awe ern,klferwaiien~IedOotes that env of 0"fot m sendhlens dip-, VA e0 in 310 CM 1s.303 saw, Any flo ►e
siMoAs not evehrued we of moo ed Blew.
oofwo•nr. --
a nrs�oowpRio�wur visas:
�/ Orre��eYelerrr e�ntl>steerKa�desertMd In the'CondHienol f ors' seetlon need to W reUleeed a rspeMed. TM egtarn.",,den
....sue— �re�S,Non N tM rNw��sr rerMr.ee MMo�el►the ttieerd N Meeltl+.wdl pes.
tedlefde Y�s4Ae.of not dmwff*wd rf. Desseft book N dowwAnad"In OR tnetdnoes. N'not 4UnWro d',0040 VAY live.
f)[V the"Pal ank ig rat,w%ee uw owner or eeereto►has aovidW she OYMM 0 OP 11 tv WO a My of o CeFda"te of
eenyflonp lateen►»N Mtdieet ON the W*vm infamed wNhin twerAY(20I"we OAW to go dote of on""New of
OW ee/tie teak.erMlHve or net WAW.Is otooheed.s If"di.ealstlnp ONY d'a tonke
1@60 Is UTA*AM G ?WSW a n�Obeed wNtottlaeodeons�M���tenk
lrown Men!(tMe ine�o0t)er►
"Vowed by go(Ieord of Mtodft
00 Sewye be~t,brookan at high steal wobr level observed in the dlttributien bee Is due to trrohen Of eMaaead a WSI
or duo 0 o bras.,.eetdod or uneven dstekaWn boa. The system WHI pees Wdo"Non It With opo►o+rel of 00 of
tteeMl• ,
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eMOrlrtdon is rerrrwed
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fares""►MM"od ttnn foillMMo t 1 due N ttreMMs M eiboveveod/Ipel�). The�e1nn rAR1>�Ilt••
Inopoetlen if tww OW90 of 00•oord of ttomh
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MAMS he".som and ON enlflrafM�wp•
tl OVSM WU pAn%pMrS GOAND OF n-IgM=N ACCOMAM OVUM 310 MOR 15-M ISUM TMA?TM 1YfTM
a ow Pin-M1 M 1 M A'IMAISM Y'l1OMT THS M>c 10"'M AND SAFM AM T1tt
W01"Of s toovt Vireo•w•itw
Ceeo/eM or angry is f0 to"of a ke►dsAnf rofetstod worirtd Or o rate IRMeh.
MCTloufrto
TM•yslsrn hes•�a tank awW osn Maer yearn IfAtil ene the=A>t a wieMn 4001s•t Of Sur""wear supply
nr
tr{twtay to a awf las wear evppy.
T"9,-MM ials a$*Poo Vine Sow •years+end the fAf i•wflAin*tone;of s MiNe water nroAy Wet.
w ?to f low"me a SOW tor*and n system and the$Af is.wtkin 60 fart of a pe/waa waar VJPOY wet''
The system hen a.o�eis tank and ars- Orlon system end the W Is Was piers 100 tree ttet 90 feet or nndlce w Carat t#v
pmvoa wear"i+y won.wr{ o was wow a{eelyeb tIN astlrorm bootsl8o and votesaft Iseo or'less
owal
VAN is flee fren►14�^ tact/es"oaf Oa praeanee of srnnur M nlaown
t{w+i opm. ow4ed deeartMol.0 d etams, IApa�aOon net eutlA.
in OTtft�
revised 9/2/99
the.�•t to
•u11i1111FAC6 011 A6 olopo"L SYST ii1M MINWIM Pam
PWM A
�II9lIOAt10N MeslMi4re�
Oftwo Adlreea: �r 6 ti`,Ie, 1 C.-A y!
0---m T i1+Nack
Ova ad hupoo@M
0. $V111MM#A".*
You must w4kase amw "Yes"N'Kt' to each of the hNwenl:
I hose dateredwed Met wo or more at the fob w by fdtten eardtions exim do In 310 CMR 15.303. The Desk for this
determMoeron is me now below. The gewd of Mod"ahmm M soMooted to whet wfl be necassKy to correct tna taws.
Too Me
• � Ssalnep Msawalu YrsNeelbly■or+lseefn oastrensffs�rsts oraleggedflAiaweagt+d• .�•-�"'".`
Dissltar/s u pwwilro6 of aft"to the sarhos Of UN nd or surface wanes due to an ovesMaded or sloped SAS:a
Stet 94"level In tlw dtemk en foe soave t Mown dme to an ovemoMW or cleglad SAS or casspod.
�iwld IepM iR gawped @ lass than i' ow itrtrwt or avaMfM vekenoe fs less thaet i/2 dry flew.
fte**Od eurndMRl mere ttoan 4 to*A lost vow Are to slow"or afstrueted Owel.
Pitrntfle►of 1Mna IMF
Any Osman of*1$61 s swan."mpel at privy is Maw ft high groundwater alovOw.
Any putian of a it or play is wttltin 100 feet of a sdrhsa water eupply at tributary to a surface water*LVOV.
s
Any pofllon of seapoi or privy is.wtMin s tons l of a FAA wed.
Any of a ussapsd of Ofty is wilmn 6o fast of's private water supo r well.
A wtlon of a 41stepsol at Otsy is iaa�ltan 100 test but greeter then 60 feat from a own"wow supply wall VVIth no
a Wow IM+edty enuysk. It*a wed hoe Men puiyted to be ee:ospteble.m MyM
ach copy of wed Wow wu for
sNo Motu". rota*@ Of""lesornpowwo.&WNWa NO Olen end nitrato Nere6en.
tME
L LA 111110l FANS!
you From indwrts either'Yes'of'liki to oath of 00 foMewwp;
TM fdiowtne whario eppiy w lugs systems in the oftwis spout:
00
top system wrvw a feslder sri0+a design clew 10.0 opd or greater(large System!end top system is a significant ehreet is pumm
hedth and safety and top fsewlre
aTmrM am at mops of 0%fdlsa'wtry eondtions adst:
Ta Ne
the system Is whom A00 of a wr?"s,drinking wave«MNy
top elraeois+irMM sast�sribuls�Mw @apply... .�.. _. �,.. .. .._ ..
ttre system►b aced in•Nae6en a•*+a 11YKerim%Vopmed hsasdon Area=rtiMlA)or a mopped tons 11 o1 a iwdMa
'~ water wsiq ,
The ofMeretu of y each t,tstern dnd wippedo Ito sysewn in seserdanse with 31 o CMR flows lows sonsuk to local 1,4 61OW
oNlee of top for frrlhsr'M puler►'
revised 9/2/98 hp 40.0It
e1�Yw/ACe el[NAdi 0NloeA�eYta�ul!raree�oN POW
MAY•
Ole011�leT
t�tdpee Adlrwo: 8 r i �a
o. ,nno a
eheak x Mai lfYows►y hwa seen.dne►:YOU"At fethe'Yes' w'No' as to afeh the tallswlrN:
Yjr � ►rnipne Inseeteateen woe�oed/ed by�awne..sefee/a1M.e'eoe•d of Neelth.
,.r None N tleo aYOMi aaatM AaiwAaere atJeael.+worms"&VAIM room 4aade�soafol�pwesrl'r Jieeer
... ratae dwMee#M Ila ne
daL Lwp vaede Of wale heee net bwn intredueod hNe the fYf/MN�aaeMY e N#�of r�
As Mink pim hove been obtaMead and aasedned.. Now It they we net avogue with NIA.
_ The batY a dw-Aline was inaroead to Mea of$Mrap rook-UP.
TAN symm dea IN nelmwe nen•ef*Wv a Ormusu a wash err.
_ The fife Was a.rpsad tv"in V tR•+«n•
_ Ad 8180M s«t,fe.na".a.wdlnd the Sal Ab.i,pftn;=wtom. have ban ksetled on the sm.
X _ "Of;took ospMo tank*jan ale&wen wneo veM.Maned.end the ,,ta
p r of pee was Inopoetod for eeedtMnn of retw
The eo
w teas,wmww fit wall Me0 M.dwWwwno,doom at vwd.depth of audp,depth of min
The Nso end kt"44"of the fed AbWptlan eystene eRthe she has Aeon dotal Wed Aooed On—
gain"Ii ties eeadiin.per am 01 nee et e.o.N.
Wwo dimd In thl wad of any of the te+hue pgorta rabtod to►art a is at roue,aaMoekteatlon Ot aeta++N ki toneeee/taMlel
1M laeNp awaeo{,a/.aafes>waa.
N/Ihraes 1wt�wN►f.waeaaN .wMb Iadnrsaa+e 'o'M
"" ee,eewtsso QoNn1eM eYelenee.
revised 9/2/88 larsi.tlt
t
YMAC�•lwA� tYSTM pWaCTMQp I n m
KW C
O�s�1�OIrATf07r
lMo/MV
Otretw:
Orly of M�I/wMa
ft"C0mo"""
Dooble���•�'��'n.
t+l�rrot N MrMMs 1�a=.a3. 11wP�M�N N�►aans 1001�}�
Tod WNW_3wL rr—
Il ra"N of"a rodam
inter vmdn Wm M INN: _
t.owov NBOWWA owMn! im M rtol: fl ps,oovwes.mwwdM'"wed
of(no}
•0000rnl tNo ITM o►tts1:
wow wam rMar+M•C altot ter®po►'•mass �1 ti : 98 t� D P.J• 7 J ®� I•P
I"�11�M Of M «.�f'A
Lost dM wpn W:
Tps of MMMotmm.
�osls N tlad/t Mw
wwusow who IM/n/
Msn•Mr(hry atiaoM iaelterlN (o This I syllarn: fit" M n*I— _
Wow rRMM too�nlsi M �•••,�•
►adt do"N
OTIM. ' }
tat ..............
MM suponol,---- A�11A1 slOIMlATIOM
NIm ms A0f>I�i sow " fA°
•gown/MMMi M MR•1 ins ~-.IV"a nN
It nw,eel .........,
moron/o►
soolk W*id$ bisl$ if otMolMSM SVSM
�' ear oMeNM
frrirlr
•t+toro0�RtMw!tN or Me IV po,Gumm Pis WI •Mmpetlon!wo►ds.It MAY}
VA ToslMrtdMt ots.ASMON oW of up to hM oNr OWetrrttsnortoo oeaaat
Two ,,,,,. Cop'f of OV AM/Mow
0" -AMO Offir_IM �...,�f��
OWATSAN so o*mW$nM.doM U%6'�y INOW! t�irlN �� �r i ie�.��.. • rr......+�
P
M4 o,ftM MMCtoA when 1nlebq at to dto:I"s M M})Q
•
revistd 9/2/98 wn•�Ir
en►et mwos�.srsseni itr rnw POW
POWC
ers�e�IIi011i1wTfD1e 1.aetbtwt�
some
VAUMI UMM
(Loom a ON pent M
CerA mbw Vole�.[ nn Men �0►vC ofJwf I��Melrt!
foondom
p�weoe��wttirf+MM1/tn�M erre�on 91tte.�..�� .
.. �w..
�K TAB
phew ert oAe MMi f
r
meow of dltetteNib erttetel.,,� ...� �otitefle>tslelftl
4 W*M POOL ws _ �. rofMY�ml bOr of CenWee�o irttelflol
. o�++ateletiof �
ler+wMiMa .. -
�.�.,#mm 1mp of m teftit of Vimwe ert~.butQ
ol`taw w of omen So to*1 4~IN or beh.:1,._
pietma f m totwfft*(ewe►Oo bvvft,%New"
flew&VAf*e s was d@Wg*ud-
Cef,eaerfto: love".IV rt� rxe a. r.
tf«. •nerwn fm"
eviolwto1 ofM0• •1
O�OIE �+•
NeooM on oft owl
Oe/dt amber/ro/e:.v.. �fNitoN�RdaMl
•WartOle I
Ole �� somm u I~of ou," �`�•—.•
Go No po"Ov.�fee��•�l el kow ad mot tow a botSoc M*of Mpid level In 101000 t0 60"intrert,etrweerw�l'Mt�fl"
0400 oe of Nehye.ote•1 .ter•
revised 9/2/99
I ,
l61�A1�MA�il�I1Ap •�f�l�f�710A��
`1►ART C
f1�Ir 111o11�0A1fOM Iaa�sA
OMAR Yww CAL
a.air fst�aa�awt l \� `q��
tllilT fIM NOf�tYNt:�,9r«�nrwt w ew��mar a�ar at wM�.wrsaasnl
fMaaaa am dr/Mai
pa/Mt below raft
(MawAd ai anatn�stlan:,�aanMla«�I`nMaar,��a►f�� �,.�ia:prat
OMwwleear
AOM POWN..—
Oslo 0/PoMMu pi m":
Gn�Mtts:
towwmm of low we,a of iaafm aw float awotolioa.saa.l
OIi11�IfNOM
flaeaa- as aha 0
�' \K
pooh of so"arai draw outlet MhIaR:��.� VCAI
OWN ��M ALAI,o�iw of odl�a aon�orw,;owianeo of met Mt w aut f roe. 1 — r
aM ' %Il •:
pMW ,.,..
loom An of OW
ftop it wa k"«far,teas M ii1a6�....
AWM IN wOkW4 onfw ram..
calwomom. a"
Owl
low"son~of PWO
i •
Ap•sf o1
revised 9/2/99
r
SAC!gMA{li OrigiAL*V Tom=I sc lm1 pow
owe
sriTa Mli01NAAT10M Neeeslwne4
MOM
otw�s: n►o�
sw dM*Arete
SOL ABNmrnw errs�a velar b
Ireeoe so e1M OWL k l ester g*m eves ajqpaY8 le®aeien emir M appnelnweeN by nen4FNnelw nwlhehl
!f MR M�q/+Ml�ns
Tt�e:
bg*Ara atomboH.OWIAW:—
yMMM t►aMtMe, -0 10 e.WW&*
�Rew tepgeM.eeN�tr..,,� '
NM�e N TsMMMMi�1r:
Ceeeset
4eteae tlwe N eM. "et h�wW e.se..l N tiendni. e",eseNlsleo of XPEZ .encJ ..b2c—
rwom an do OW
f!A/OOf1�=o
omplo
of%NM to""t M►r.rr....
Dwh N Dab h►ree:�..
Depth of Som low! ......
pUeoenMtMw N eesw�:-----■—s
Mein 1�11 N Ntat�:
In�eNsn M «' `� ei0 hnMee�^I
WAI*w MOM-10 p �a/�
`' �elNllri w
{fie esll,�of M*tNt te9oere..Ndd of .aen~Nme«Aaren. No.l
Pw"t
&$am on eft OW4
Depth e4 goft
�►N NC M0luft%an*,N"of Mom•e�len of w/MetNnr owl
®�
revised 9/2/99 w�efotu
M1�pMMSAOf MwAM O110OMt sYs�SIMI N 011 IOIMf
MIT C
sysm MIOIMM?m iwpolmao
sr
oxff m 0 offorom 0N'OMAL n"1All:
makft on a at low we pallo m oeimwm Weeln�aA�•a k�
ka ft an waM w0do 100'(leoea who*Pl*ffs WON WSOV 0.0nm Ines NOWO
e
c
b
(ot
37
� 1
ttJ �e- e.o:�ea-S t V% 9 r o 'C
revised 9/2/98 ►ptoofIt
M�lNIMACE MNAet>�AL�Mw'f�•glRC'T10M f�01M
rMT C
OVO M■wars" 1 Of weldn"4
ftepow ysr��� �7� '►
Owt�:
Oir sf�oiws , `a,p`q°c
OM TYM^
T"ftd*00 w �,
NtaM Oow■okMn tlotwr
WON
Ow�Ow�►Ma fir'' N1or«oa
ntrt �Wow
�k Color ,
•lhfrw w4
bil is or eo/r+w eraudIA N 1 M1t'at
•boon w4hoki M flh weds w••to OrowWurot«NwoMon:
oko«ared•lu iA�wtlYA MoMoro►.w«red4n haft,bw~SW*r<e.}
Dow edM A Imm loud sM1Alfolll� 1
Choked wMh Nod Surd of math
Choked Few"We
Choked"W*"
C1�ookoM Nat .hhtM on
I�used Los"Don
Ooa+l m NOW TOW ostoMWhed fed NO dfOwWwm4f W�otlon•l�be eanNetN!
1 e,'ca-4
revised 9/2/98
LrC� A� 1,ON SEWA G E PERMIT NO.
VI'tLAGE /
illy .S�G� ���/ S
INSTA LLER'S NAME & ADDRESS
B UILDE R OR OWNER
DATE PERMIT ISSUED /G _ev„ -7 -
OAT COMPLIANCE ISSUED
y NO
0
C/
Y__
No.._..... FEic
THE COMMONWEALTH OF MASSACHUSETTS
BOA OF HEALTH
—.Fo-.w..N.............OF.....
Appliration for Disposal Works Tonstrurtion rnmit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
..... ............................................(: ................................................
--T75—cafridn-Add IQt No.
Owner P.. 11.
A /-.&s ----------- .........77.1-:L....M-4.1 4/".... 'jail-0........................................... ...CAXA.E...W.6.1 . ..........A
Installer Address d9
Type of Building Size Lo ?
Dwelling—No. of Bedro A.&J$)..Sq. feet
U .3 oms......... ....................................................Expansion Attic (W) Garbage Grinder OVO
Other—Type of Building ............................ No. of persons......:3.................. Showers Cafeteria
Other fixtures ......
--------------------------*............. -------- ----------------------------**------ ......*............. ---------
Design Flow_.-2-;N�.o---S.S..........gallons per person day. Total daily flow....... .. ..0......................gallons.
04 Septic Tank J-.Liquid capacity,61W..gallons Length................. Width................. Diameter._._._...___.... Depth...-_........__.
Disposal Trench—No..................... Width............._...... Total Length............_._..... Total leaching area....................sq. ft.
Seepage Pit No................ ... Diameter..........__.__.___. Depth below inlet.................... Total leachW, ar ................sq. ft.
z tA Other Distribution box Dosing tg
Percolation Test Results Performed by-.___ ....... ..................... Date___..__._.._____._._._...__...___._.....
Test Pit No. I................minutes per inch Depth of Test Pit.__.__ ............. Depth to ground water......____.._.......___.
O', Test Pit No. 2................minutes per inch Depth of Test Pit.._.._..........._.. Depth to ground water-___---.................
P4 .................................i;.......... *,,,,,,,,,-"-,-,,,--"I.............................................................................
0 Description of .......k�............ ........... ..... .......(JAy------
�4 q ...Li...QAA.Vj0_j............................................................................................................................................
to ----------------------------
Wv
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
.......................................................................................................................................................
.................................................
Agreement: I
J L The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TL IT�U 5 of the State Sanitary The undersigned further agrees not to place the system in
en is-operation until a Certificate of Compliance has b en 9 u ed by the.L—w4-4-4ealth.,
Signed........ ................... .717..:7......
Date
ApplicationApproved By............................................................................................... ........................................
i
Date
Application Disapproved for the following reasons:.................................................... .............. .....................................
.................................................................................................................:...................... ...... ..............
AZ Z, 2L
PermitNo......................................................... IS97OP2
�DQ�
No........ !..`. Fps. . �:a.....
THE COMMONWEALTH OF MASSACHUSETTS
t
BOA! F HEALTH
Appfiratilan for Bi ipos al Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
system t C` AA41 G""
.. ........__......_ ...,.... . •. ..................................... ........._....----............ ---.... --------•---..... r ....
r 7*j�co,.Ad�e '. NY�_� -; = I C�3 tort 1 &Al(j.
.... •--
W 0 ,� t see
Installer Address
Type of Building Size Lot��.3..X_q._._Sq. t
aDwelling—No. of Bedrooms.......................................:....Expansio� Attic ( Garbage.Grinder
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' ure
Design Flow _:. „ ..gallons per person per day. Total daily flow __._ gal
W _ 3 _ ------•----. Ions.
W Septic.Tank—Liquid capac>t -gallons Length._..._ ..... Width__ .......... Diameter...... ......... Depth................
-
Disposal Trench—No ................. Width.................... Total-',.Length..................... Total leaching area....................sq. ft.
S,` page-Pit No ........ Diameter........ Depth below i t. 1 1_each,4,dr .......sq. ft.
Z Other Distribution box ) Dosing tank
Percolation Test Results Performed b ..._._.
Y "10-4 Date
a Test Pit No. I............. .minutes per inch Depth of-Test Pit....................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Dt 1 AEG
_jr f O EA Description of S I --___
...........I --------------------------------------------------------------------------
.•.---•-•••••------------•------------------•--••----
U Nature of Repairs or Alterations-Answer when applicable ____________________________ _,___..........._..........................._._........
-•-•----------------------------••----..........------............-•--_.. .... ....... .......................................................
Agreement
'The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITTE 5 of the State Sanitary o = The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has en i sued by the ealth.
Signed __..._.-.. �- ...... ...
Date
ApplicationApproved BY .......................................... - --------------------------•------
Date
Application Disapproved for the f ollowing reasons: .................................... :.......................................................
_
-------------•--.........-----------•--.....-----••-----•--..........--------._......--
,;.
ate
Permit No.........................................................
... Iss, ------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOAR 'OF HEALTH
......... .......1<'x......... F..... ............................
(Intif iratr of f�nrnt��t�nrr
THI S 0.CE IFY, That the-Individual Sewage Disposal System constructed ( ) or ReTT
po red ( )
by c
� u
--------
---------- .....
.................................r
Install i
at...--JkG 1C �
_ _
i M
has been installed in accordance with the provisions of TI`t' 5 Qf �jie ate Sanitary Co ac.-A ,} ear in the
application for Disposal Works Construction Permit No..............................�.... dated.--._..___................_..__......_......_...
THE ISSUANCE OF THIS,CERTIFICATE_SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION ^SATISFACTORY.
DATE....--Z ._ .................................. Inspector---- ---=------- ---- ---
THE COMMONWEALTH OF MASSACHUSETTS
BOA OF HEALTH
No.........................
C
FEE ........_.............
i �ta1 1 nrk n rnrtio vamit
Permissionis hereby granted......................................... ------•-•-------------•---•-----------------------........---•--..............----
to Cons t Wt ) or r ( ) a div ual ge Dispo
10
-----•--• • --- --............•••. ............................... --- ... •....._._
Street -7' 77
as shown on the application for Disposal Works Construction Perm' ________ "_ jd.__.._. ......._..._.___._._..........
... •------•--•----- --- -- +'
Board of Health
DATE-------•-------- --•-•..................•--•----------------
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS...
a
BSAm S
L
CERTIFIED PLOT PLAN '
OF
,`r ��► ass �����- LOCATION �li� .S%!vS
e' THOM yG� O ,T OM" 'yN SCALE .� �`, Q. DATE
J E. "
PLAN REIFPE�eENC,E/,�'
CIS
f'�01tALf'`
THOMAS E.KELLEY CO.
ENGINEERS-SURVEYORS
5
346 LONG POND DRIVE �"`�
CERTIFY THAT THE . . . . . . . . . . . . . . SHOWN
SOUTH YARMOUTH,MASS. ON THIS PLAN IS LOCATED ON THE GROUND
02664 AS SHOWN HEREON AND THAT ITCONFORMS TO
n 1
F7
THE ZONING LAWS OF THE TOWN OF
G�i2.9G� �/17�c✓ ��ff� . . . . . WHEN CONSTRUCTED. r
7.e.�iuV/S �!�#S.S. o2.G, DATE_.
PETITIONER :
F
i REG. LAND SURVEYOR g
Lora? k:
L.
TOP OF FOUNDATION
CONCRETE COVER
CO"YCRETE COVERs
,.,, ,;,,7n,7r
o, 4'i CAST IRON „� , . T;
e° .10 MAX. 10"mAX. .,: 7,.
GIST
PIPE (OR 4 OR.ANGEBURG(OR EQUIV.)
p' EQUIV.)— MIN.
PITCH 1/4"PER. PIPE- MIN. LEACH `
PITCH 1/4"PER.FT PIT PRECAST t
p,r — ;
-� LEACHING
INVF„(2T Q .
e EL...Y(p.•DQ 1NV INVERT o w a,� PIT OR `
SEPTIC TAN Ka DIST. EQUIV.
,e IN ,EE�TEL
BO.X .. —� ��. .
o; EL. m7•.?"q•. �.� GAL. IEL R INVERT . ;•' �. w w �: ;,,' 3/4"TO 11/2
o � EL , '08. U-a �: WASHED
o w STONE
' jT*'"
DIA:
/ZW D IA.---�-� /4/0
1'
c•e/.p PROFI LE OF GROUND WATER TABLE i
SEWAGE , DISPOSAL ,SYSTEM
NO SCALE
SOIL LOG WITNESSED BY : k,
DATE ..49 7.7..."TIME. ../4'.30 9 BOARD OF HEALTH
TEST HOLE I . •�/�f1s• , ENGINEER
ELEV. . .7e S . . . tiEt� .
9
wcop LmAK
DESIGN DATA
►4An�EJitiXr NUMBER OF BEDROOMS
30'� 'PEV!,TEST @ TOTAL ESTIMATED FLOW �7QQ. GALLONS/DAY
S fWoyCoLAV 4S�� BOTTOM LEACHING AREA /�?.' � . SQ.FT. /PIT
(00 SIDE LEACHING AREA - � Q SQ.FT./ PIT
Cia2AVEC. . GARBAGE DISPOSAL '� .}.(50 % AREA INCREASE) s'
TOTAL LEACHING AREA ;" �� �,�, SQ.FT
CoAl2Sr SAiuD
A,6r-e,gvc� PERCOLATION. RATE . : . � MIN/INCH
/IN/IN/CH x
AA�� LEACHING AREA PER PERCOLATION RATe� -•�f�Q.FT. ���
�Y.D..,WATER ENCOUNTERED
NUMBER OF LEACHING_ PITS
APPROVED GAL � BOARD'OF HEALTH
"DATE ... . . c'
AGENT OR INSPECTORzo
F
2 m
No.YIYN ;
fs'S/ANAL