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HomeMy WebLinkAbout0606 FLINT STREET - Health 606 FLINT STREET, MARSTONS MILLS 26,-0. _q. 29-4. AJ 2'-4 -10- B'.q• d I m IX19T.oo4 IX ©© 19T.BEDRLOY'1 b KITC. 4 i �• LINEN MASTER E 19T.DECK BEDROOM c 1 � _ DN 7 m NEW BREAKF.4YT 1 D ByR COUNTER DT G.C. I � {' {• `.• � II i „ RNL CLOSET C1oBET 3 MST.01wNG Rn. I 6'-3• 6'-6' ✓H'n'T_ /\ 'I I I 1'-O'KNIEYIALL I r- O_ ^ 24K 24 I C L.,NG Rhl. I DlIAW ________J m LIVING RM I (VAULTED CLG.) p 1 F 2B -2 7'-O' �'-O' f'-2' 3'-1 q'_O• 1A'-O' (EXTEND OF NEW ADDITION) . FIRST FLOOR PLAN /' ECOND FLOOR PLAN Iiiiiii9i=OWN AOBRION AND REMOVA71OKS ro sN¢r No. II®CNIu�C/ao Df9GN BOB/i1Nf 3f. YAR3fON9 1mJ8.YL °� . _ € T TIt1oBONC ROAD •ILL 02B{{ 1-Oft)BBo-m K'' 'y` �G CommonweoM of Massachusetts C1 -� _ _ 0}U1CrYa Executive Office.of ENronmentoi Affairs D�;E�P. 'Fide V�Septic Inspector ; �epartntent of ` P.CBox 2119 . -Environmental Protection Te 508) , -6 13 2536 � _ y (508) �64-6813 -SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 606 Flint SL Marston Mills Address of Owner: Date of Inspection:718196 (If different) Name of Inspector:John Gracl Lynn Wetherby:76 cooleyvllle Rd.New Salem Ma.01355 Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes _ Conditionally Passes _ Needs Furtqer Evaluation By the Local Approving Authority Fails Inspector's Signature: ? Date:. s The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A. B,C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] 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 determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", 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. (revised)11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 - - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART A CERTIFICATION (continued) P ro pe rty Ad d ress: 605 Flint St.Marston Mills _ Owner: - Lynn Wetherby:76 Cooleyvllle Rd.New Salem Ma.01355 - Date of-tnspection:718196 _ Sewage backup or breakout or high static water level observed in the distribution box is 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 leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The _ system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT 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 of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 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 analysis for colifcrm bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ Backup of sewage in 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 cesspool. SAS is in hydraulic failure. (revised 11115195) 2 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ --- _ CERTIFICATION (continued) Property Address:_606 Flint St.Marston Mills Owner: Lynn Wetherby:76 Cooleyville Rd.New Salem Ma.111355 , .Date of Inspection:719196 D] SYSTEM FAILS(continued) Static liquid)evel: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). Numbers of times pumped - Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance 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. (revised 11115195) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM_INSPECTION FORM i PART B F CHECLIST Property Address: 605 Flint SL Marston Mills i Owner: - Lynn Wetherby:76 Cooleyviile Rd.New Salem Ma.01355 - Date of Inspection:718196 - —- - Check if the following have been done: - - 's X 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 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. _ X 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. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X 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. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION P-_[operty Address: 606 Flint St.Marston Mills Owner: Lynn Wetherby:76 cooleyvllle Rd.New Salem Ma.01355 - Date of Inspection:718196 FLOW CONDITIONS RESIDENTIAL: Design flow: 0 gallons - -- Number of bedrooms: 2 - Number of current residents: 2 - - Garbage-grinder(yes or no): No _ Laundry connected to system(yes-or no): No - Seasonal use(yes or no): No Water meter readings, if available: nia Last date of occupancy: n/a - COMMERCIAL/INDUSTRIAL: Type of establishment: n/a Design flow:a gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: n!a Last date of occupancy: rya OTHER: (Describe) nla Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)Yes If yes,volume pumped: 1500 gallons Reason for pumping: cesspools TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions 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 information: 25+years Sewage odors detected when arriving at the site: (yes or no) Yes (revised 11115195) 5 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION (continued) - -_ Property Address: 606 FIlnt St.Marston Mills -- Owner: Lynn Wetherby:76 Cooleyvllle Rd New Salem Ma.01355 Date of Inspection:718196 _ - SEPTIC TANK: (locate on site plan) Depth below grade: nla Material of construction:X concreate_metai_FRP_other(explain) Dimensions: r9a - Sludge depth:nla _ - Distance from top of sludge to bottom of outlet tee or baffle: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance form bottom of scum to bottom of outlet tee or baffle: n1a 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.) nla GREASE TRAP: (locate on site plan) Depth below grade: Na Material of construction:X concrete_metal_FRP_other(explain) Dimensions: nfa Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:n/a Distance from bottom of scum to bottom of outlet tee or baffle: nla 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.) nla (revised 11115195) 6 r# _ SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM. - . PART C = SYSTEM INFORMATION(continued) Property Address: 606 Flint St.Marston Mills _ - - Owner: Lynn Wetherby:76 Cooleyvllle Rd.New Salem Ma.01355 - Date of IInspection:718196 - TIGHT OR HOLDING TANK-.- (locate on site plan) Depth below grade: n1a - _ - Material of construction:X concrete_metal_FRP_other(explain) Dimensions: n1a _ Capacity: n1a _ gallons - Design flow: Na gallons/day - Alarm level: nia Comments: (condition of.inlet tee, condition of alarm and float switches, etc.) n/a DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Na Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) Na (revised 11115/95) 7 .�-�.R-:n.,�-•,�,.,.....�m..,�,,�,�,�.---,a,.-..r�,,.e�-�..,.. ---- -mom s�.--... F t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - _ PART C SYSTEM INFORMATION(continued) - Property Address: 606 FIIntSL Marston Mills Owner: Lynn Wetherby:75 Cooleyvllle Rd.New Salem Ma.01355 - Date of Inspection:71SJ96 -- - SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain_: _ rda - Type: leaching pits, number: 1,000 gallon leach pit leaching chambers,number:n1a - leaching galleries, number: n1a leaching trenches,number, length: n1a leaching fields,number, dimensions:n1a overflow cesspool, number:n1a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Sas is functioning property and is structurally sound CESSPOOLS:x (locate on site plan) Number and configuration: one Depth-top of liquid to inlet invert: 1' Depth of solids layer: 2' Depth of scum layer: 1' Dimensions of cesspool: 6x6 Materials of construction: block Indication of groundwater: none inflow(cesspool must be pumped as part"of inspection) Na Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Main cesspool and all components are structurally sound.Recommend pumping system every two years for maintenance. PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n1a y Depth of solids: n1a ' Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) nla (revised 11115195) V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I PART C - SYSTEM INFORMATION(continued) Property Address: 6.06 Flint StMarstonMills Owner: - Lynn Wetherby:76 Cooleyville Rd.New Salem Ma.01355 Date of Inspection:718196 SKETCH OF SEWAGE DISPOSAL SYSTEM: - include ties to at least two permanent references landmarks or behotimarks - locate all wells within 100' g g�c q l:/ O AA 3 6` DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS MAPS AND CHARTS (revised 11115195) 9 _�..7 7 -777 7.-a 7 �es ...�w,�.� a.w a 0,/0}QI DCGE BOA 2xJ?RAFTERS �L 16" O.C. (2) 2x6.HEADER 51-2 1/6" SK i FIELD 10-5.5/4 VERIFY 1 R.O. Ib O.C. I � 2-2x12 HEADER 2-2xla HEADER 1/2" R.O, 1'-1" q'-I 1/2" R.O. 1/2" PLYWOOD SHEATHING 2-4 2x4 STUDS \ ® I6" O.G. a PoMLE 2x4 JACK 5TUD5 Q BEGIN TUD - ® O.H. DOOR OPENING r' 5PAGIN 16" O.G.FF Koh THIS CO GA, FRONT FRMlWq MIEVATION 5GALE: 1/4" = 1'-0" 24'-Om DEEP 24,'-O" WIDE I y R I � 2x4 BACKr—k 6LD(K a I NT. Pd4 Art T/o1J 16" G. 12 I" 5HIM �12 2x10 RIM J015T ll (2) 2x6 HEADER 1/2" PLYWOOD 5HEATHING 2x16''S0 GD5 FIELD ER PY 10'-6" R.O. in Ix4 LET—IN BRAGING ® t� 51DE AND REAR GORNE _0 BE&IN 5TUD 5PAGINC7 ' c9 I6" O.G. FROM THIS CORNERLL BEAM 5UPPORT P05T — --- TOP OF 5LAB REFER TO �5' " DETAIL FOR CORNER BIZ FRAMIP5 ElLiVATION 5GALE: 1/4" = 1'-0" 24'-O' DES' 9'4'--O' WIDE i I 2x/0RID6E WAR s 2x6 CEILING J015T5 a 16" O.C. CONTINUOUS 2x6 i (2) 2x6 HEADER 2x4 BACKER BLOCKING a INT. PARTION (TYP,) 2x6 BLOCKING FIELD VERIFY R.O. � 2x6 RAFTER TAILS I 2x8 LED6ER BOA 5/4" T$G PLYWOOD 2x10 FLOOR JOISTS Ly x4 5TUDS 0 16' O.G. - - 1/2" PLYWOOD 5HEATHIN6 Er IN STUD 5P/,NGING / 16" O.G. FROM 1 LIL I 1-15 CORNER - LEFT51DE FRMIN6 1LEVATIM 5GALE: 1/4" 1'-0" i y�g 24'-Od DEEP 71 —oo MDE i ti! 12 12" --7TYR 12 12 nU�TY P. I, J aao a 0 EMT ELEVATION 5GALE: 1/4" = V-O" 24'-0° DEEP 2�4�0° 4^Ii1 12 �4 --- - Ix8 FASGIA 12° TYP, 12 12 D 12" - TY OPTIONAL WINDON MR NATION 5r, E= 1/4" = 1'-0° 24,-01 , 24-O" WIDE ----------- �S FAgClAf RIGHT SIDE ELEVATION 5GALE: 1/4" = V-0" 24'-Op DEEP 24'-0' HIVE COA,177 vuays I l ell 7- LEFT SIDE ELEVATION SG E. I/4" = 1'-0" 24'-0' DEEP z 0-0'° ONIDE — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — --� I0 - - - - - - - . - - - - - - - - - - - - - - - - - - - - -� 4 I I I I o ( I I I I I OPTIONAL I o THI5 BREAK LINE ELECTRICAL RELATE-5 TO THE OUTLET LOGATION OF THE OPTIONAL BREAK LINE FOR LIGHT FIXTURES Q I I ALL DEPTH OPTIONS I (8" NP• ' � I I ( 12 TYP. Q I PERIMETER FOOTING \ I of 10 — I N Lu BLOCK DOWN FOR I I O Q I OPTIONAL DOOR - I I N � I I I i I I I I I - 4 THI5 AREA Q AR I REGE55ED I � RAIN LEDGE L- - - _ - - - — — — — — — — — — — — — — — — — — --I o _ ° - - - _ - - - - - - - - _ — 6-. 11, 8 2'_I„ q'--1 1/2" �" G'--7 1/2" 2'-1.. 24'-O" J FOUL ®ATION PLAN 5GALE: 1/4" = 1'-0" �2 x V `r @ y b" o,LoE— QDe E-� ��jfGf � PE2 LU�LG 4"CONC.SLABW/6X6 1011OWWM z ° • n ' 6 MIL POLY VAPOR BARRIER 4"SAND CUSHION OR CRUSHED STONE � g SLOPE GRADE AWAY ° n 1/2"EXPANSION JOINT o w FROM FOUNDATION 8" LL O° IN FIRST 8'-0"(TYP.) 8"POURED CONCRETE WALL U a W/#5 REBARS VERT.A 4'-0"O.C. 0 Ov ° W/(4)#5 REBARS HORIZ. 3 O Y m w 0 v a #5 X 18"DOWELS @ 4'-0"O.C. ~ 0 • n 0 2#5 REBARS CONT. DETAIL R — CONCRETE STEIN WALL 2 X 4 STUDS @ 16"O.C. 2 X 4 TREATED MUDSILL(LINE UP OUTSIDE EDGE OF SILL FLUSH WITH FACE OF FOUNDATION) 1/2"DIA.ANCHOR BOLTS(REFER TO FOUNDATIO PLAN FOR SPACING) SILL SEALER • II JACK STUD L� / '•.:�.. BLOCK DOWN FOUNDATION •i. : - ..•:t� �s_ @ PERSONNEL DOOR OPENING • es'c,?,°+�'r` OR GARAGE DOOR OPENING ;�- Y CONCRETE GARAGE FLOOR SLAB CRUSHED GRAVEL BELOW SLAB NOTE: IF THERE IS A CONFLICT BETWEEN THE ANCHOR BOLT LOCATION AND THE STUD LOCATION, RECESS THE NUT AND WASHER INTO THE PLATE AND CUT OFF THE ANCHOR BOLT FLUSH WITH THE TOP OF THE PLATE. DETAIL E — FOUNDATION AT DOORWAY { NOXOOs®O" 1O?75 o® E7L1STt1VG ® �® DWELLING � PROPOSED ADD17ION Q 1OZ75 NOXOO'®OOE FLINT STREET 606 FLI N i MAP 102. PARCEL 051 E'ER TTFIED PL 0 T PLAN m FLAT ST t CE#?71PY THAT THE iD4fE UNG 6 LOCATED Cw 7HE LOT ABLE; PEA AS VOW THE DwgMG 003 NOT MEET GilRRW ZO NIG Irt" DAM 'AL 2MSETBACKSa3G � PERIMEMR o _ 'LAND SERMES; INC. P_0. Box 1188 r 41 MeeUnghm se Lone i i . NO3'00'00"E 1OZ 75 KRISTA E. DELOREY 606 FLINT ST. MAP 102 PARCEL 051 00 0 0 0o EXISTING o 0 R^ EXISTING SHED 0 0 2 DWELLING z 5.80 . 4.72 14 PROPOSED U ADDITION 4 N 1OZ 75 NOX00'00"E FLINT STREET CERTIFIED PLOT PLAN 606 FUNT ST. I GER7IFY THAT THE DWELLING IS LOCATED ON THE LOT BARNSTABLE, MA AS.SHOWN THE DWEWNG DOES NOT MEET CURRENT ZONING N OF Mqs� DAB A'e. 200 WAwn+: Res SETBACKS. � ROBS cy� SCALE t=.W EL it SYKESy PERIMETER wR LAND SERVICES, INC. 06 ,ps /STER J�, P.O. Box 1188 — 41 Meetinghouse Lane ROBE SWES. P.L DATE ��NA( tANOs Sa amore Beach, MA 02562 (93 e,3 .1 LOCATION SEWAGE PERMIT 970. ~ VILLAGE y INST It A Jz ADDRESS OR -'OWNER b sa Te�2k& � r DATE PERMIT ISSUED 110 DAf E COMPLIANCE ISSUED J--.,Y... si 1 i t '7 ` , V 3 S - . .EPTIC TANK MAINTENANCE your septic tank everti•2 -4 years SEPTIC TANK could be overflowing to the leaching I',rrilit}• :e MAINTENA.NCli now. causing damage Ihal %c ;ive re g ill rccluirr r�=�.»,. ; �-r-•sue.-ru pairs, gate signs of fallure immediately H , ` `�• ',- a� W draining of toilets and sinks .tl odor, patches of green grass. pcinclecl ter, or melting snow near the leaching tent A n o ze h•ater use in the home ss water ' W 'S �, .� ''�` ��;• • �. • used. the longer the retention ,� '• it•L�'tJ,..�• ti, .� it (fie tack and the more solids [lie baclrria %'' _� t M•° p sc. f�7 t >• ¢ +�M��y��i° 5 l}f1, iispose of lfte following wastes p� '4 v v es w el L l bags. Use of disposals adds massive _ _ Junts of solids to the lank. _ Cal O itary napkins, colored toilet paper, I V! Losable diapers and tissues do not (,et� yyrl k Impose, ae king oil, fat and grease can pass through Vt3�S >eptic tank and clog the leaching facility. v icides, disinfectants, acids, medicine, 0- E 'rp3r7 t thinners, etc, will kill the helpful y 0 Pln xut y °lo of Cups Cad's per eria in the tank and contaminate the y V disposes of its wastewater through in, ndwater• on-site sewage disposal systems. if } = H operated and maintained, an on-site syst provide many years of trouble free scr Nneglected, however, the system it likely NOT USE CESSPOOL CLEANEIt,9 creating public health hazards tool cx A repairs for the homeowner. This ps no known chemicals,yeasts, bacteria, ell. p� E describes the principles of septic other substances capable of elintinnting nI• Cl av the sludge and scum so that perinclic clean- 0 q c = operation and explains the maintenanr Gti a q .� ;,necessary. Many of these cleaners contain cedures necessary to inspre lung life p� d ncentrated organic solvents that are rated P. system. A hunteoa'ner's ntatinlenuncc re suspected to be cancer-causint;by the EPA Cfx77 rn } o ltrovidecl oil the back. anal Cancer Institute. They are not lain• ~" D T e and pose a serious potential threat to C>ri V E h n•,a Prepared by: nd public water supply wells.The use or C102W , ;, Cape C'od Planning Sc Economic Uevclolrnr ucts is not necessary for the proper funcno- o " Commission a septic system. r I SI Distrirt ('rntrt Flnnen LOCATION SEWAGE PERMIT NO. (ce & Z--- V --- 14 -4. I N S T i ADDRESS OR OWNER aydmAr f2&&4 regq14=714& 1) A T E PERMIT ISSUED OAT E C0MPLIANICE ISSUEb W� � � � � V �� :�� �` -'. I.. _ _ Fmc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Installer Address Type of Build' Size Lot1Q.JQqA......Sq. feet Z Other Distribution box Dosing tank �� Description of __ ---'``---------------------------`---`--`----------'------''--------`------`---'------'' Z U N The undersigned agrees to install the uforcdencribed Individual Sewage Disposal System in accordance with the provisions of THTHE 5 of place the system in � operation until a Certificate of Compliance has 6 ` Sbgood -' ----'--------.-- ��-...��---'��'.�� ' 3^!P— � Application Approved "�------------.-----------'-----'--'---------------'- ---................. Date Application Disapproved for the following reasons:................................................................................................................. . _----'_--'___'-__'--_—__'___---______-----_-'_---'___-'-------'_--_-_--_--__----__- -_' Permit� Date ' -- FE �No... .. $.... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ....................OF.......................................................................................... Appliration for DhipaaFal Workii Tnnstrnrtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System •----•.......................... � � ....- -------------• ----- .--.- ` c ion-A%ess or I.ot No. .., .... •-•'........................... .. �ress . . ..... .-- �•- ne Y, -•......... ............ .._ .. . .... ._....'•-•••..........................._ ------- ..... 1_.. Installer Address dType of Building,,.. Size Lou/_r0---0'0_Q.......Sq. feet U Dwelling - No. of Bedrooms... ................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures ---------------------------••--• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-___-_-__-___--_--_--__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •••-• ............... ............. ................ .--- --------------- ...----------- -.......... .-----. ----_ O Description of Soil - x W •--••••----•----•-•••--••---•••••••••-•-••--••••••-----•-•----••••--••--•--- ...... ..............••---••---• .---••••- x _ df------------------- U Natur of Repairs or Al rats s—Answer n applicable. ........: . . ...... ................................ ... ....... ................ ............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE L p S of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ss d b th b rd iealth. Signed .- Application Approved By..... Date Application Disapproved for the following reasons-----------------------------'----------------------------------------------------------------------------•.... '--••-.........•-•••---••-•........'•-••••••-•-••••••---••••-•-••.............•-••-•---•--••-••••---•----I---'•-•-•-••••--•-•••--•-••--------•••-•••-----•-------••--•---'•--•-•------•-......-•-•--•••-- Date PermitNo......................................................... Issued -`1�� `........................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................................... Tn#if irFatr of Tlatnpliatta TH IS CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by-------- .. ... .. .................................•--•-----------------------------•-------...--•-----------------------.........................-•--'-......--•----'-' :. r.-........................ ........................................Installer at..-•'-•.••.�Q .......�-, � has been installed in accordance with the provisions of T I�' �' 5 1§,die, State Sanitary Cede r ed in the application for Disposal Works Construction Permit No.........................................' dated__:.S___._.__ ................. THE ISSIJANC OF THIS CERTIFICATE SHALL NOT BE CONSTR A GUARANTEE THAT THE SYSTEM WIL F CTION SATISFACTORY. DATE...//s.... = Inspector'-•- -' --••-•-••--•-•-•- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.......................................... ....................... No..�'......-•-•......... FEE................... Permission is here Y granted s° =�' _� ------ to Construct ) o ep &,n Individual age Disposal System .at No. '� ............. .--••••_-•••--••-••-•--•-•••.... Street � as shown on the application for Disposal Works Construction Permit No...................._..dD :......................................... -------------------------'--"-'•• .............................- oard Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS