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HomeMy WebLinkAbout0205 JONES ROAD - Health 205 ones Road, Marstons Mills - - --- — --- -- A= 047 025 r ®cA TOWN OF BARNSTABLE goo LOCATION ,2 O, Tow e S a! SEWAGE# ' LLAGE 177PAt l o yi� ASSESSOR'S MAP&PARCELQ INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NeVJ p— SOX NO.OF BEDROOMS OWNEROR,5 50l,o PERMIT DATE: 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 of leaching facility) Feet FURNISHED BY 0 0 a se a o Q TOWN OFBARNSTABLE 'LOCATION �� ��-S `�Zcq SEWAGE# v+5� VILLAGE (nOI15 _ASSESSOR'S MAP&PARCEL I149*AtC=FhRS NAME&PHONE NO. 0-r1 (-k ��a�,� SEPTIC TANK CAPACITY ICY-XO QJ LEACHING FACILITY.(type)e-�)t't- (size) UOU NO.OF BEDROOMS �Jcc OWNER rt2.G- o ko losk // PERMIT DATE: COMM=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 of leaching.facility) Feet FURNISHED BY I Jones d ater ervice i 32 24 D-box and pit were staked Property is too overgrown to measure from house corners t — ----------- - Fee /®� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for �Bizpogal *raem Conotruction Permit Application for a Permit to Construct( ) Repair O Upgrade O Abandon( ) ❑Complete System �i iv dual Components Location Address or Lot No. 0,5- Owner's Name,Address,and Tel.No. i Assessor's Map/Parcel D Y - - Installer's�Nti e�l+ddr�s,and Tel.��..rro.fag 280 7 7-6—Z Designer's Name,Address and Tel.No. Josr3 'lope of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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) J: !f-5 yll 0 ^6-ox to ear,va/ 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 Certificate of Compliance has been issued by this Board of Health. Sig ed or Date Application Approved by Date f GP C7-7 Application Disapproved by: Date for the following reasons Permit No. �� / `Icsr 614 Date Iss 1. ued . 6 '".� ^ ` Any �% G` _ J Fee C ' e Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS p PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zpprication for Mts;po!gar *pgtem Con.5 ruction Permit r Application for a Permit to Construct O Repair O Upgrade O Abandon O ❑ Complete System 9;Tnd'ividual Components Location Address or Lot No.Z 0s OHc_.S Owner's Name;Address,and Tel:No.,, As Map/Parcel Installer's Name„ Designer's Address an .No. Name,-Add ss,and Tel.No. Desi ' N Addd Tel (;��rr.-ays � Type of Building: # Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder (. ) Other - Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 1 gpd Plan Date Number of sheets Recision Date Title Size of Septic Tank Type of S.A.S. Description of Soil / Nature of Repairs or Alterations(Answer when applicable) ro.544/1 /V/.;. / Z "Z34?c /,w Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenanceo 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 Certificate of Compliance has been issued by this Board of Health. Signed s,t � ./� Date _ Application Approved by Date 6 Application Disapproved by: Date for the following reasons . _ Permit No. a SC Date Issued 6 �' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS i Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by J0.5s S at .ZA S ©/1F5' ,ros�S?Ot9S {'N.IIS has been constructed in accordance t' with the provisions�o+f Tuttle 5 and the for Disposal System Construction Permit No. Q 15 Z'� dated ty '' Installer Jos G.oh a_4 i�/'f'O� Designer #bedrooms Approved design flow gpd The issuance of this permit shall ot be construed as a guarantee that the syste anctiI-o ade igned. Date CJ !/ / lnspe(tor, _--_ ______ //_ --— --------------------- / ---- No. Fee 00 [ �`' (/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION=BARNSTABLE, MASSACHUSETTS 1=igpogal *p!tem Construction Permit Permission is hereby granted to Construct ( ) //Repair ( ) /Upgrade ( ) Abandon ( )All"-4�' 0 /Sax 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 S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of`� th p it.. Date Approvedby ��—�� COMMONWEALTH OF MASSACHUSETTS ID EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 4 DEPARTMENT OF ENVIRONMENTAL PROTECTION � � d t � e� 5� TITLE 5 OFFICIAL ]INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 205 Jones Road Marstons Mills MA 02648 Owner's Name: Marie Sokoloski Owner's Address: Same �/[_ Al a Date of Inspection: June 4,2007 Job#07-108 Name of Inspector: PATRICK M.O'CONNELL Company Name: ,SEPTIC INSPECTION SERVICES CO. co C-n m Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 026482�`� Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes X_ Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ,, Inspector's Signature: Date: 6/4/07 Ins p The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Distribution box is decayed and leaking,needs to be replaced. Leaching pit has 16-18" of effective leaching., ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 205 Jones Road,Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: XX Distribution box needs to be replaced. One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank:is less than 20 years old is available. ND explain: Observation ofsewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed XX distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 205 Jones Road,Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4,2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water t _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in.a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria.are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 205 Jones Road,Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4 2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface 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 If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 205 Jones Road,Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4,2007 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks _X_ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components, excluding the SAS, located on site _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ Existing information. For example,a plan at the Board of Health. X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 205 Jones Road,Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x 4 of bedrooms):330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 51,000 gal.=69 gpd. Sump pump(yes or no): No Last date of occupancy: One week prior to inspection. COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 1978 Were sewage odors detected when arriving at the site(yes or no): No r Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 205 Jones Road, Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: I" Material of construction:_X_concrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5' long x 5.2'wide—1000 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle:27" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Baffles are intact and clear,liquid level at bottom of outlet invert.Recommend dumping tank. GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): I Page 8ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 205 Jones Road, Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4,2007 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Box is deteriorated and leakine.Needs to be replaced. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property YAddress: 205 Jones Road,Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. _leaching chambers,number: leaching galleries,number: _leaching trenches,number, length: _leaching fields,number,dimensions: _overflow cesspool,number: _innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Observed liquid level 2' below inlet pipe with a high stain line 6-8"above current level. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 205 Jones Road,Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4,2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Jones Road Water Service .............. .................... .... .......... .............11......... Lj 24 32 D-box and pit were staked property is too overgrown to measure from house corners I ' Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 205 Jones Road,Marstons Mills Owner: Marie Sokoloski Date of Inspection: June 4,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water : More than 20 feet Please indicate(check')all methods used to determine the high ground water elevation: _Obtained from system design plans on record- If checked,date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: _Checked with local excavators, installers-(attach documentation) X Accessed USGS database-explain: USGS topo map and town GIS. i You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.55 and topo map shows property at or above el.80.Also observed small wetland adjacent to property which is considerably lower than SAS. i 'j-�•''' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI �� Ld T DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 4 '1 Property Address: 205 JONES RD. MARSTONS MILL-S_LOT.472 qq Name of Owner CAROL SANDLER Address of Owner: 76 ROOSEVELT DR.COTUIT MA.02636 Ela Date of Inspection: 6/6/99 AY 7 1999 Name of Inspector:(Please Print)JOHN GRACI W I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) � E Company Name: n/a �AITHp� ti Mailing Address: n/a Telephone Number: n/a 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 The inpection is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Ev luation By the Local Approving Authority performing at the time of the inspection.My inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature, Date:6/6/99 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a 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. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 205 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:5/5/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: nta One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.if"not determined",.explain why not. Wa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Wa 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 n1a 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 revised 9/2198 Page 2 of 11 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address.; 205 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:515199 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of 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 nLa_(approximation not valid). 3) OTHER n/A revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 205 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:5/5/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nLa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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 ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 205 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:515199 Check if the followin have been done:You must indicate either"Yes"or"No"as to each of the following: 9 9 Yes No X Pumping information was provided by the owner,occupant,or 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 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.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 11 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 205 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:5/5/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-=,g.p.d./bedroom Number of'bedrooms(design): 3 Number of bedrooms(actual):$ Total DESIGN flow: = Number of current residents:A Garbage grinder,:yes or no):]CES. Laundry(separate system)(yes or no): MQ If yes,separate inspection required Laundry system inspected(yes or no):JM Seasonal use(yes or no):YES. Water meter readings,if available(last two year's usage(gpd): WA Sump Pump(yes or no): NO Last date of occupancy: nLa COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: nta gpd(Based on 15.203) Basis of design flow: nta Grease trap present:(yes or no):JM Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):MQ Water meter readings.if available:n(a Last date of occupancy: nta OTHER: (Describe) Wd Last date of occupancy: nta GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS LAST PUMPED BY ARCO 6 MONTHS AGO System pt:mped as part of inspection:(yes or no):MQ If yes,volume pumped nLa_ gallons Reason for pumping: Wa TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nta APPROXIMATE AGE of all components,date installed(if known)and source of information: SYSTEM WAS INSTALLED IN 1978 PERMIT 78449 Sewage odors detected when arriving at the site:(yes or no): MQ revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 206 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:6/6/99 BUILDING SEWER: (Locate on site plan) Depth below grade L'U Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: nta Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: i Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No n& Dimensions: L 8'6'H 6'7"W 4'10" Sludge depth: 2' Distance from top of sludge to bottom of outlet tee or baffle: 3z Scum thickness: Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottorr.of scum to bottom of outlet tee or baffle: 1Z How dimensions were determined: MEASURED Comments: (recommendation for,Dumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND,RECOMMEND PUMPING SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) n& Dimensions: WA Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:.3& Distance from bottom of scum to bottom of outlet tee or baffle n& Date of last pumping: n/a 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.) n& revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 205 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:5/5/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: Wa Capacity: nta gallons Design flow: n(a gallons/day Alarm present: NQ Alarm level:jila- Alarm in working order:Yes_No_ NQ Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) D& DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:n& Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) llLa PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wa revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 205 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:5/5/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nLa Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: 1iLa leaching galleries,number: jVA leaching trenches,number,length: nLa leaching fields,number,dimensions: n& overflow cesspool,number: n& Alternative system: Wa Name of Technology: -n(a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY PIT HAD 2 5'IN IT AT THE TIME OF THE INSPECTION PIT HAS NOT HAD CESSPOOLS: _ (locate on site plan) Number and configuration: nLa Depth-top of liquid to inlet invert: nta Depth of solids layer: n& Depth of scum layer. n(a Dimensions of cesspool: nLa Materials of construction: Wit Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:n& Depth of solids: nla Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n& revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 205 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:5/5/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a ofck >oA A AA �°► A6 33 AC 1°a FA 1$ro M 0c revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 205 JONES RD.MARSTONS MILLS LOT 472 Owner: CAROL SANDLER Date of Inspection:5/5/99 NRCS Report name: n& Soil Type: n1a Typical depth to groundwater: n& USGS Date website visited: n& Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: - Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions Checked with local Board of health _ Checked FEMA Maps _ Checked pumping,records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS AND VISUAL-12+FEET revised 9/2/98 Page 11 of 11 No.......... .. ...... Finc.............................. THE COMMONWEALTH OF MASSACHUSETTS oa-b BOAR® OF HEALTH ------Town............. ........OF.....Ba,.rnatable...---------------------------..._.........._........ Appfiration for Big as al Workfi Tomitrurtinn Urrmit Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal System at: .....--•-------------•-..---•--Jones Road --------------.._._.Lot...4 ......................................................... 1 Location-Addres or Lot No. .......... .. .1..._...... 1................................. �•, Owner •--.-.Address a -----•........---•----..�2. `1-------------------------------------------------- --------------- M _ ...-- Installer Address 22 379 d Type of Building SAJ_ -A A Size Lot.___.....s-----------------Sq. feet U Dwelling—No. of Bedrooms................ Expansion Attic ( ) Garbage Grinder ( ) U •-•-•-------------• b '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures -------------------------------•------------------------------------------------------------•-----------------..............:.......................... W Design Flow...................51...................gallons per perso pier day. Total daily flow____330........._____..._._........._ to WSeptic Tank—Liquid capacity1009_gallons Length�...-�". Width.�--..'10 biameter________________ Depth.5 4---- x Disposal Trench—No..................... Width...t........_.___.. Total Length.._.....9.f _....._ Total leaching area-.....2�........sq. ft. Seepage Pit No.....1............. Diameter....l9_..._..._. Depth belowjinl � i_.�___ Total leaching area......_...._......sq. ft. z Other Distribution box (I ) Dosing tank )) d '-' Percolation Test Results Performed byCaPe-- OC.___Survey_-_.Consultant�ate..June 30, 1978 r a Test Pit No. 1....2.___.____minutes per inch Depth of Test Pit 12..._.._._... Depth to ground water none f=, Test Pit No. 2................minutes per'inch Depth of Test Pit.................... Depth to ground water........................ •----------------------------------------------------------•--------------------.--a•- ------ 0 Description of soil....•-0.5_.wood loam, 0.5 . ubsoil 3.U-. 2.3 m � . ................. ...................... U -------------------••-•-•-----•-----sand---------------------...-----------------------------------------•---- ---------•-••---•---------•----••------ .. .. . ........ ----- W -------------------------------------•--•------•-----......------------........._..-------------------••-----------------------------------------------------. o F�NYl1C --- . , UNature of Repairs or Alterations—Answer when applicable------------------------------------------------- ,.....B ------------------------------------------------•--------•-•---•----------------------------------------•---•-------------------------------------. M A at Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sys 'cgs. ith the provisions of TL Ili LE 5 of the State Sanitary Code—The undersigned further agrees not to 1 tem in operation until a Certificate of Compliance has bee ssued by the board of health. Sig ned..... -------------------------------------•-•--•--••----•-...... .._ Date Application Approved By. � ���/ _..... `'� `_�.�� "'tea -Date Application Disapproved for the following reasons-----------------------------•-------------------------------------------------------------------------•--•--•--- ................•......----•-•---------------•-.....-----.........---...----•--------•------•------------.........................................-------------------------------------------------•---- Date PermitNo......................................................... Issued....................................................... Date ' ETT 6- Fss............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town.._...................OF.....Barnstable_..---............................................. ..AVVftratWu for Dispati of Works Tonitrnrtion ramit Application is hereby made for a Permit to Construct (N or Repair ( ) an Individual Sewage Disposal System at: Jones Road Lot 42 .----•---•-----....-- --... _.............--•-•....................... .............. ............. Location-Addres or Lot No. I' {1./� M ?1 C Owner Address . .. _h...'.....................•----................-•-------- ....__.....•-•��'�f ...................................................... Installer Address UType of Building SA Size Lot.__22_t3?9.......Sq. feet ,., Dwelling—No. of Bedrooms...............3.........................Expansio}� Attic ( ) Garbage Grinder ( ) Other—Type of Building ............... No. of ersons..................._.__.___. Showers — Cafeteria p, yP g P ( ) ( ) Q' Other fixtures -------------•----... Design Flow...................�?1�...................gallons per perso er,�dday. Total d it o ......................._______............ _._._._ 5014, WSeptic Tank—Liquid capacity.___.._._...gallons Length................ Width.--....__-_...._ Diameter................ Depth......._........ x Disposal Trench—No......... ..... Width.................. Total Length........_ f....... Total leaching area......__ sq. ft. Seepage Pit No.................... Diameter..._10...._..... Depth below// nl�pj 6_._ Total leaching area..._........._..sq. ft. Z Other Distribution box Dosing tank )) '-' Percolation Test Results Performed byCaPeoQ Survey Consultant�ate_.`jun�___30� 19?� ,aa Test Pit No. 1..__?.........minutes per inch Depth of Test Pit.-12............ Depth to ground water..-riorie _ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---...... xDescription of Soil....sana.5_wood..loam, 0. - .0 subsci3T 1 3:O-�, * nisei t' �4 P` ssyc. •........................•-----•----•---•--•---------------------•--------------------•-•-•-------------------------------------•-------•----.....---- v Rtwrei ---------------------------------------------------------------------------------------------------------------------- ........................................... ;•-•--f---$:----------- - U Nature of Repairs or Alterations—Answer when applicable... ................................................. :. 0,, -----•--...--••--•..........................••----...----------...-------------------------•••-•- �. Agreement: is The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in �S eEN the provisions of iITt.; 5 of the State Sanitary Code—The undersigned further'agrees not to place the tem in operation until a Certificate of Compliance has been-issued by the board of health. Sig d• = _- -- ...... r► tf J---------------- f� Date = dy�!`6 ~ Application Approved By.._'- / ______.7_��`.':- Date Application Disapproved for the following reasons___________________________________________________•--•--------_-•--•--------------......_..:_.._..___........___ --------•-----------------•---=•---•--------------------•-------------•-..._..........---.....-----------...--••--------------------------------------------------------------------------••--- Date PermitNo......................................--................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS,; BOARD OF"HEALTH a . �I :..: '�/J.... OF.......... ........................ TatgftrFatr of TongiftFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (t,,-j or Repaired ( ) by........................................................................... --------------------------------------..........---------------------------------------------------- x /� f Installer at._.d._�........__..v-, -_ -` +,_-_t�:,- p t4*.. = ------------------- has been installed in accordance with the provisions of 11; F j of The State Sanitary. Code as described in the 17 application for Disposal Works Construction Permit N �?���r da.ted �`��' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..------_-5.-t �'-� ..................................... Inspector.... .._._.... ._.._...... ............. THE COMMONWEALTH OF MASSACHUSETTS __ BOARD OF HEALTH OF.......... . .. . .....--•-----.................................... r 1 N0............ _Pl FEE...... �tu�rou�tf Turku �onu� tiun r�antt Permission is hereby granted......... ._.xv.J4P1......................................................................................................... to Construct or Repair ( ) an Individual Sewage Disposal System a .�,. } at No.-: R'"" ..'b� ' - ---s:: a,&,e ------ . ................. � ------------------------------------------------------------ Street � 'g 7.as shown`on the application fori-Disposal Works Construction Permit�N)O..................�r�..._ Dated..,i7'.. .f.....��......... � ••-•------...... ✓•- „f_"Ya"e.z?- • ----__--_-----_--------- DATE - (/ Board of Healt . ...... = = ------------- FORM 125S HOBBS & WARREN, INC., jPUBLISHERS h. 2"PEA ONE �01 V B FILL 12-Mi%x Imo_ .,.. - T _•I r.e� 4' C.I D I S T 1 ,°. t y�UIFStt. BOX 24 MIN {.. >o MIN - 1000 1 1 o ,e.ral f000— GAL. d . E 'G. IAQ"a GAL. r. , , PRECAST - OR j T '3'7` �4W SEPTIC 6 �� 0�.0. BLOCK I`e ,{ _TANK i;' . ' SEE:PAGE PIT _.. _.._ •' 0 Np w4inx AL • o µ r o l 20` MINIMUM FOUNDATION • �` I i WASHED STONE—` x w t T[ v 4?4-EA ELEVATION SKETCH c' s, TEST BY a SCALE I 4.• --- p �.. . r TOWN INSPECTOR' BACKHOE OPERATOR � L z..• r TEST MADE ON ---- - ------ Z he er �+ e-ed--v�,try �lr�►� :�f,+� S°�vr�t��r� 3a�5/ S�Qa� hid orI zvvs 1©c o �'� � .e aG� -vlcld xao- e o n hoc n�,�g b� /a r�s.s r }1 f rPat.tY NU.2'4a°1 . � a • a y �'D SURD � a • ♦ �o N . - - - \I\c. - Q� 1 -� �,/f .-�•V. - �3dv-0/e4 A290Q40i ti S . +, • ++;4° a {•,, '�. "¢a�= 1:°a• t'nwP++. Fih+w.'I►X Al 444.1 ` ,R' 1 + y ` t - Y',h •, '. , �', a. fi { raja' .6 ^ 'J t } tf 1 d's Zo,apt" M. IQ4 , 8 .x;1fn.9o �o'aB,e.' ' 78,5` k x ';.G�a��,f� ��� �%'vie��all� � � =��.sg�l. y�/d��• � qt�/,o�A/.f'�'af '7"dlX►4'`m 54 R a �NW CK CHAPMAN E Lf VAT ION t SCHEDULE PROPOSED SITE PLAN 1. INV. { 'AT F.OUNDATFON = ' '.SEVAOE SYSTEM DESIGN 2. I NV., INTO < SEPTIC TANK' — 2� 7 I N 4.4rT *7'2 ,3�N >E{ ROAD 3. 1 NV. OUT .'OF SEPTIC TANK Y r MA 'ST4Nj In/l�°GS., MASS, 4. I N V. INTO DISTRIBUTION BOX- _ .• SCALE: I`I= Z 0. .3uiy 1918 8 t' 5. I NV OUT .OF' DIS-TRIBUTION B'OX 8 3, k. 6. INL INTO' SEEPAGE PIT d� ,0 CAPE COD SURVEY CONSULTANTS ROUTE 132 7 BOTTOM OF PIT - s.�• Q�l HYANNIS, MASS, A DIVISION ROST014 SURVEY CONSULTANTS, INC. B. iBOTTOM .OF STONE