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HomeMy WebLinkAbout0111 SANDY VALLEY ROAD - Health 111 Sandy Valley Road Marstons Mills A = 101 106 R�C�UD COMMONWEALTH OF MASSACHUSETTS O E C 2 2003 ' D EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS T0�%N OF 0A.i,1:YfA,3LE DEPARTMENT OF ENVIRONMENTAL PROTECTION / y \'1 V� MAP PARCEL : TT" RC OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: fSSWt,3&, fj +11S Owner's Name: Owner's Address: Date of Inspection: 1 — 7—&2 Name of Inspector: (please printlDouglas A.grown Company Name: Douglas A n Septic inspections Mailing Address: R0 8ex 14S Tele hone Number: enterville A 02632 p4^^ _.-, 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 maintenancq 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: V Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ol Inspector's Signature: Date: //- 7-0 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 annrovin- Notes and Comments 110V,e ;5 v4.e-c j W t+•1 S Cc"M bov.E I- t Conn bo l;1rOrv\ 1 ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inmectinn Form 6/1 inonn Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR V(II..II.NT411V 4 ccFcc ire ►�V��� ri�-� ��vv�+��LYbruSAL bYS`l`EM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: i S Ali Mo Owner's Name: C ira; 5 L u{S aN Owner's Address:. Date of Inspection:_ ! i - 7 - o Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syste asses: I have nM fne�ntl anv infnrmat*nxs whirl*iri.iira�Pc hit a?w•v nFthe f�ilne,w r tAricn Ate ,,a 7+n nr or m s 10 l;MK 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: f c.�f e bo 1- 2' tom B. Sy m Conditionally Passes: one or re system components as described in the"Conditional/Pass" eedn need to replaced or repaired.The sys ,upon completion of the replacement or repair,as ahe B of Health,will pass. Answer yes,no or not de ' ed(Y,N,ND)in the following statementsed"please explain. The septic tank is metal an r 20 years old*or the septic tanktal or not)is structurally unsound,exhibits substantial infiltra or exfiltration or tank failure is stem will pass inspection if the existing tank is replaced with a comp septic tank as approved by thealth. indicating that the tank is less than 20 years of 's available. ND explain: Observation of sewage backup or break out or hi c water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven ' to on box. System will pass inspection if(with approval of Board of Health): broken pipes) a replaced obstruction i emoved distnbutio x is leveled or repla The system required pumping than 4 tunes a year due to broken or o ed pipe(s).The system will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed f Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: i i 1 S ,.�c1 if of,if�I? d Aft,.!S�riN�- M►�Z.�r Owner's Name: _ Owner's Address: 3 Date Inspection: l C. Fu;Conditions Evaluation is Required by the Board of Health: exi 'ch require further evaluation by the Board of Health in or eternime if the system is failinprotect public h ety or the environment I. System will pass unless Board of H e names in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a in 'c rotect public health,safety and the environment: _ Cesspool o is within 50 feet of a surface water �e o or privy is within 50 feet of a bordering vegetated we or a salt.marsh 2. em will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is T ioning in a manner that protects the public health,safety and environment: _ the system ha ptic tank and soil absorption system(SAS)and the SAS is thin 100 feet of a surface water supply or tary to a surface water supply. _ The system has a septic tank AS and the SAS is a Zone 1 of a public water supply. _ The system has a septic tank and SAS an AS is within 50 feet of a private water supply well. The system has a septic AS and the SAS is than 100 feet but 50 feet or more from a private water supply well**. ethod used to determine distance **This system-passes if the well water analysis,performed at a DEP certifi aboratory,for coliform bacteria'and volatile organic compounds indicates that the well is free from po ' n 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. r: r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:Il 1 S�ll�i v Owner's Name:_ C rat S i,o rs cry Owner's Address: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool — Wischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓Liquid depth in cesspool is less than 6"below invert or available volume is less than'/s day flow t/Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _I,,-Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of 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. —..y rv.uva.va"c,.wOokw 1 va}r+av y a, "1""l IV awa va"Ncavau,WCAWa oiijVyay vwwaa. _ 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.] Al (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. Large Systems: To sidered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must jindica er`yes"or"no"to each of the following: (The follog criteria ly to large systems in addition to the criteria above) yes no / the system is within 400 feet o ce water supply g uPP Y _ — the system is within 200 fee a tribu a surface drinking water supply — the system is 1 ed in a nitrogen sensitive area Wellhead Protection Area-IWPA)or a mapped Zone II public water supply well If you answered"yes"to any question in Section E the system is consid a significant threat,or answered " in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 111 S, , 04 VkCley Ie- Mwc -ion &Wks. Owner: C' fG tc l„e fS,W Date of Inspectiioo 1 t- -r - 7 Q Check if the following have been done.You must indicate`des"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks V Has the system received normal flows in the previous two week period? _ VHave large volumes of water been introduced to the system recently or as part,of this inspection? v _ Were as built plans of the system ootainea ana exammea! tll 111Cy WCre WL aVall4UiC 1i1/ic a5 iI'") Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? \ Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior.of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ 4�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: Existing information.For example., a plan at the Board of Health. t/ 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: As Owner's Name: � C Owner's Address: Date of Inspection: RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 C1VIlt 15.203(for example: 110 gpd x#of bedrooms): _ Number of current residents:__ Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):lNppf yes separate inspection Laundry system inspected(yes or no): tq required] Seasonal use:(yes or no):W Water meter readings,if available(last 2 years usage(gpd)): Sump Pump(yes or no); 6)p Last date of occupancy: U a ,, j CO RCIAL/iND_US TRIAL: Type of ' anent: Dsgn flow(ba 10 CMR 15.203): . d Basis of design flow(sea ons/sgf3 Grease trap present(.,p .,,,�• ..uwwusu wane nolcnn present(ye no):_ Non-sanitary w -charged to the Title 5 s Water m Y (yes or no):— dings,if available: La to of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):&)n If yes,volume pumped:__gallons--How was quantity pumped determined? Reason for pumping: TYP&OF SYSTEM ePnc talk,distribution box,soil absorption system —Single cesspool _Overflow cesspool Pri Shared system(yes or no)(if yes,attach previous inspection records,if any) obtained from system owner) v+ �`, �d �".......a...�.,, uu„ auu iu:,i;urrwucx conaact(to be —Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: �rJ�NOw� Were sewage odors detected when arriving at the site(yes or no): Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address% t i t 1�Afif��ror.�c A��1 T Owner's Name: C r'e<<c, tsar•. Owner's Address:Date of of Inspection: nr+rl%W..uw.r.K....e.,,.. Depth below gra ` Materials of construction: 40 PVC_other(explain): Distance from private wa p 11 or suction line: Comments(on c on of joints,ventw , dence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: I( Material of construction:_✓concrete_metal_fiberglass,polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: S 7••X �(�`� K`/p 1 CC)o b CA Sludge depth:_n Distance from top of sludge to bottom of outlet tee nr baffilP: n .J..utti 4LL.eWGA`y. '� Distance from top of scum to top of outlet tee or baffle:C_ Distance from bottom of scum to bottom of outlet tee or bale: How were dimensions determined: ►o 'I 1n a C,ANC W j! p f— p Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert evidence of 1 a zget etc.): GRE :_(locate on site plan) Depth below grade: Material of construction:_ crete_metal fiberglass_pol ene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet t T1iM9�..n F►nm 7�N.�.r....F..., .._L_.+.--+, �. ,�._wt.-,�e..,..,..,0.. ..ixa.. Date of last pumping: Comments(on pumping recon4n6ndations,inlet and outlet tee or b condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Property Address: AAML Owner's Name:_ C Mte Ursa%3 Owner's Address: f Date of Inspection: 1 l --:1 —per TIGHT or HOLDING TANK: (tank must be pumped at time of' ocate on site plan) Dep low grade: Material nstruction: concrete metal AL.OgiL___polyethylene other(explain): Dimensions: Capacity" ns Design Flow: �y Alarm present(yes or �,Date ints umping: C (condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage intq or out of box,etc.):_ N0 -%%rnirr CCLLtNc"ef ND 11)y © P CHAMBER:__pocate on site plan) Pumps in workm no Alarms in working order(yes or no): Comments(note condition of pump c be ,co n of pumps and appurtenances,etc.): l_ Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: lit S. D s Owner's Name: C tC��Gcsc�.1 Owner's Address• Date of inspection: -7 —p:�$ SOIL ABSORPTION SYSTEM(SAS):_(locate on site plan,excavation not required) If SAS not located explain why: Type beaching pits,number: 1 (, �►l- leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovativetalternative system Type(name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): . GSSi LS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configurat<o . Death—ton c)f lirnaid to inlet i ,jctrui of bunu, layer: Depth of scum layer: Dimensions of cesspool: Materials of cons n: Mato oundwater inflow((yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: pout site plan) Materials of construction: Dimensions: Depth of solids: Comments(note conditi soil,signs of hydraulic failure, of ponding,condition of vegetation,etc.): Page 10 of 11 OFFIC IAL IN _INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: I I 1 Owner's Name:_ C v-W; Owner's Address: Date of Inspection: ( l -7 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. --� \CSC A A `3g A2 yI A 3 A y -55 dz �LA �3 O Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEr4 INFO TION(continued) Property Address: Owner's Name: A.A.l..-,,-. _ Date of Inspection: — '7--411 — SM EXAM Slope:. S>10PkNS Surface water:. 'VC�N'e Check cellar: Ury Shallow wells N©N e Estimated depth to ground water 1 o'Z feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 1 l�wa� �5erbes,�e P ��` t0 12' No Wc,��PF �c�vPf�cJ Y" L 0 C`A T ION pp --/ SEWAGE PERMIT NO. i VILLAGE INSTA LJE 'S RIAME ADDRESS B U I L D E R OR OWNER N10 A ` DATE PERMIT ISSUED , DATE C 0 M P L I A N C E ISSUED fA .C.►.a � i •Y No.... ..".Z1...� Fss..... D....... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ...................... ....................OF......................................... Appliration for Diipuiittl Workii Tonfitrurtion Prrutit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: :Ljot "t37 Sandy Valley Rd. , Ylarsto,ns y1111s I;;A .. T .................. .................. .. •--....----•---..._....----.......... .............--....---•-------••-----.----- -------•-••----•--................. Capricorn R� tl r"ffillst '765 Falmouth ti�a t�N°��yannis .....--•-••....................................................................................... ............•......•--•--......._.._.......................-----------.....----.............------ w Steve Lebel Owner Address V Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ranch.............. No. of persons............................ Showers (2 ) Cafeteria ( ) 04 Other fixtures -------------------------------•----.....- . w Design Flow........55................••---00....gallons per person ger day. Total daily flow........0.q..........................�llons. W Septic Tank—Liquid capacitv1.......:--gallons Length_______________ Width................ Diameter__._.._._..._._. De pth5..._._..tt...... "4t 9 Disposal Trench—No.................... Widt .......- Total Length......__ Total leaching area.._._.._____ sq. ft. Seepage Pit No.............,.____... Diameter._._.._........_._.. Depth below inlet__.................. Total leaching area....._...___.-.___sq. ft. Z Other Distribution box ( ) Dosin annkk 1dredde Engineering 11-25-81 Percolation Test Results Performed by....•---........-•••-•.................• ---••---......---............ Date 2 Test Pit No. 1.2l 9 0...._..minutes per inch Depth of Test Pit..12............ Depth to ground watePonJe e�ncOunter- !-A....._...minutes per inch Depth of Test Piti4Z ........_... Depth to ground water'X/ .........._. . e GL, Test Pit No. - 04 .................................................................... Description of Soil.... Of ? + loam & to S.oll x 2 - ib ffediu_m ye low sand U -••---•-------- .......................l��----_--1�•'-----med. .while sand :ra.ces--o f------• -- , W / gravelfno wader a 12 ...----...--•......................••----------•••-•. •-•-•---------•--•-------•----••-------•-•--------------•--••-••-•••---•--------•--•-•-•-•••-----------•--.....--••---------------•--••--........ U Nature of Repairs or Alterations—Answer when applicable...................................•......_.....__..........................................._. ............................•........................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i oecoXnXvwith s the provisions of L ITI U 5 of the State Sanitary Code— The undersignesfyrtiier agree oft a stem in operation until a Certificate of Complia e h een isZ§ ed b the board ealth. e ....... ....... ...........Pre s. 9�..2.1 . ApplicationApproved By... ... ---- .............................................................. .� j --- �.......... - Date Application Disapproved f o th f ollowing reasons:-------•---•........................................•--•-----.....:.. ......................... .......-•-•---•----------•-------•--•--•----•----....----•.................................•---.....-•-----........._............-----------•--------------••---•-------:.-----•......•-------•---•-•--- Date I PermitNo......................................................... Issued....................................................... Date -- - - ��. --- ----- ------------- THE COMMONWEALTH OF MASSACHUSETTS ^ BOARD OF HEALTH �1 ...........T oi.vn..................O F......Barns tabl e..................... Trr#gfiratr of Tourph tta THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ) or Repaired ( ) Steve Lebel Install Lot f Sand Valle Rd %arstonS Mills , !�A at--•----------------------37._..............y----•----..............--......--------•-••-------F---•-.....-•-...----------•-•--------.....------....----........- has been installed in accordance with the provisions of TIT �j f State Sanitary Code s,d� i in the - � -----.... dated �� ......� �.. application for Disposal Works Construction Permit No................�._ �-----•----•.-•• THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. , DATE...........................•---.....--•--.....-•----.._......................... Inspector..........---...........-------•---------•-•--••----......_.............--•------•--. 1 1 r t �`... �d No. �3 � FEs............`............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ..................................... ....OF............................-.-.-......... rlirtt#ilaat fur 'Uiipuiial Works Corm rnrtinn Fermi# Application is hereby made for a Permit to Construct �X ) or Repair ( ) an Individual Sewage Disposal System at: Lot # 37 Sandy Talley Rd. , Marstons Mills i,ii ------------------------•---..........---.............--•--••-------..........••-•-.........••..-• •--•••••---•---••--••---...•-••-••..........--•-••.................-•-.................-•-•-•--•-- Loc i -Ad ess Capricorn Rea y gust 765 Falmouth : Gaidt N°1r annis . • --••--.....• --•-•--•......................••-....... ........................................................ Steve W Steve Lebel owner address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-_3.......................................Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building Z'3T1C________________ - 2 � No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ W Design Flow........55................................000 gallons per person p6er day. Total,daily flow.........333......................,.�ions. WSeptic Tank—Liquid capacity.-_-_--.--:.gallons Length............... Widtl�'....-.0._.._.. Diameter------.......... Depth_...........-- x Disposal Trench—No. .................... Widt1}_�------.-..-.-._.- Total Length._............... Total leaching area... ._. sq. ft. Seepage Pit Nol-------- ------ Diameter.....b............ Depth below inlet....b........._.__ Total leaching area...2b6....... sq. ft. Z Other Distribution box ( ) Dosing 'ad' ( ) Percolation Test Results Performed by......ldredge Engineering 11-25-81 Date a 2.0 p p 12' p ground one encounter- --- Test Pit No. 1.--``....-..._._minutes per inch Depth of Test Pit................... Depth to ound wate>n_._.. .._..__..__..--. e f Test Pit No. iL............minutes per inch Depth of Test Pit���............. Depth to ground water..r.�ti.. ...._--- •---•--------------------- •----------------•••...-----..........._•-•--...-•-------.......--•-----..........•••--...........-----.........-•-•......._..---- O Description of Soil.......... !_.__-...2'_........loam_•& topsoil x 2' - 10' T�'iedium --yellow _sand-----------------•---------•----------------..-----------------------.-----•- --------------------------------------------• ------------........-•-- W 10' - 12' med. white sand traces of ravel no water at 121 •---•-•-------------•-•--------•-•----•-•••--•..... V 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of Health. ned-.....• Pre s. 3 .... .................... ...... ;.. ._..._ Application Approved By.... ='�= Date Application Disapproved f o the f ollowing reasons:----•--------------------•-•----...----------------........---...--•-•------•--•--------•. -••-------••-•••-- -•---•-•-•--•-------------------------------•------•---------------•------•-•---------•--....------....-----.........----------•-•--•---•---•------------•-------------•------------••-----•----•----•-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. a ..............o}vn.................OF.......�Kni table ............................................................ C�rr#ifirtt�e of falam�littnr� , THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,K or Repairedby ( ) .................................................. teve Lebel ........--•---•--•.............•••••-------...........................-•-•••-.....•-•---...... Lot _' 37, "andy Valley Rd. i Install%rstons Mills Ix •la at ... •-------------------------------• ---------•-----------...........----•-... ---------- has been installed in accordance with the provisions of TI ^j �T�,�State Sanitary Cede s1i� in the application for Disposal Works Construction Permit No.....................1_.f�'--......... dated.......................- ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE 1 SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ( .....T°wn.......................-OF....Barnstable.................................................. yU No...11-.. "�E/...:. FEE............... Dhipostt1 Works Tunstr ion rrmit Steve Lebel Permission is hereby granted --- -----•.................... to Construct ' ) or Rpair ( )) an Individual Sewn�a� Disposal System at NO..._.T:ot...�r.3.7..i___ ,�an y Valle�i Rd. , Mars ions Mills ._ •-- ------------•-•--•-•••--..._.. .._...---- X71 Street .---- as shown on the application for Disposal Works Construction Permit!X . ,_ ._........... Dated.......................................... ....................... ---- ---------•--------•----------- .......................................... Board of Health E--------- -------------------•---......-••--•-•-------•-----•------••••.....---• l { 1255 A. M. SULKN. INC., BOSTON I A T { \�{ _�9 I �(Y) 00 40 V /aoo G4�, ��/• �l -5 F0TiC, /! I / 1X �� co � ap 1 i - �' 7 P� — Olt 000 S-,F I i �N' 48 ° 3 2- �� � —60 �a e ' 6� L� _T.. 3 OFM�s9 ZONE 72 N°Tl / /o`' ' .z1 car E CXt5711l1q Tdf'oGcAn� y N j� �� So Feo.✓T. RCprpvuccn frto� x��^/ b o ORSE rn 3 f , PAT--p DEC,-V, 19 7B No.10951�p � 13A X TE- - d_ /✓yam F oc G/STEM LEGEND FS`c/ONALEN�'\ �» CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION Ox0 .'' EXISTING CONTOUR ——— 0 --- ,"'. °%p� La 7 3 7 54n//?Y I/A o FINISHED SPOT ELEVATION 0.0 ROSERT :� `g ` A AZ--TONS FINISHED CONTOUR 0 `'' ER ;cE EMRE Drp Z, 'a ` IN APPROVED BOARD OF HEALTH DATE . AGENT s;� i SCALE, / =30 DATE , 1o�6�Fr3 ,-ELDREDGE ENGINEERING CO. IN CLIENT_ i CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB N0. �3 zS� BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY OF BARNSTABLE , MAS 712 MAIN STREET CH. BY, �- HYANN I S, MASS. / z —� --- SHEET— OF ATE REG. LAND SURVEYOR IOTF Erl-rHL-4TA,y,rC OR ! THA;•� /2" .9ELOrt/. O Pr. M/�1I. 'O/.t.N • CONC A-ra 4C P/PL SHALL BE BROuGNT TO G.qA o.Z h'EAVY CA S T /RON OR/VEi1/AT i De � _ LIQUID LfYEL . = ' .• + '�- - . . .�" it /Aam PIPE /OOO -2'4-*YE.4 " M/JV.AtTr.M , GAL: _ • •. . � e � CR �i8• -�,a . . l � ASH • • • •EF1=ECT�YcAD ��.'_': f S�x Z.$`- 1 O • • i i • • • / WA5.Y F. •; STiJ,YE dk V77 Cam. ?. c/T r- I • 040 • • • • • • • • • r o • AS PRECAST SEfP.4GE . .. . • • . . . . •. ,- .. ' . a/T C.4 FQ U/V_ JMYF.RT AT U/tDlIV� IMt.ET .�PTi1C T,o4I0lK `"'"' `6<2,0� ;: _, • C t T. AP/AM. 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