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.1,0CATION L/� SEWAGE PERMIT NO.
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I N S T A LLER'S NAME i ADDRESS
t BUILDER OR- OWNER
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DATE PERMIT ISSUED
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DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............:.......................OF......................................-..................................................
Appliratiun for Di4puual Works Tonutrur#iun "prod#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
....: a .....%5, ......................................
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X. •sJ_�J.X/. A3.....__•_^______________________ . ....0 f C.A_'� ••______ .:NG.a.� K.�-0 �
Laress
a •=-�FA-/•i-✓/ .J--••--- L/. ':L.-------------------------------
...1� ..._....� d........
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--____ �.........:....................Expansion Attic Garbage Grinder Wo)
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures .................................
Design Flow._........................g4:5......_gallons per person per day. Total daily flow..........`_....3_............_..........gallons.
1:4 Septic Tank—Liquid capacity,&W...gallons Length................ Width................ Diameter__._____-____- Depth................
W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area......._............sq. ft.
x Seepage Pit No.V.6O- ........ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank ( ) p D
Percolation Test Results Performed .............................. Date..f/ 2T. _....
Test Pit No. 1.�Z..._.minutes per inch Depth of Test Pit....13....__.. Depth to ground water-a .-.'.......
GT., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•--- - -------------------------------------------------------------------•----•-••-----•---.........
O
Description of Soil.......' yr•---.... Qt4W..'r.60 __•- --------------
W •---------------------------------------------•--•------------------•----------------._....------------------•-----------••--••----------------•--------•-•-------•-----•-•••-------•---•-•......---••--
UNature 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 TI'L U 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.
Signed... ..�.......................................... -...........................
.......................... ....
Date
Application Approved By---..-- i. :.. --••---•-•--------------------------•-•-- ..
Date
Application Disapproved for the following reasons----------------•------•-------------------------.............................................................
-
.......................................-.................................................................................................................................................................
Date
PermitNo......................................................... Issued-.......................................................
Date
Fss....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................... ....................OF..........................................................................................
Appliration for Roposal Works Tonstrnr#ion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.- .�" ' .... ../ZY-L......:...............................
or No.
...����.�..� =--%.................•^......_...._ ._. br --...... f. ress
Installer Address
Type of Building Size Lot..............................Sq. feet
U Dwelling—No. of Bedrooms....... .............................Expansion Attic ()(I,) Garbage Grinder (f/)
Other—Type of Buidin __.._._..... No. of ` ersons____________________________ Showers
C11 YP i g ................ P ( ) — Cafeteria ( )
G4 -------- ------------------------------------------------------------
Other fixtures ....................... . ... ......
Design Flow......................... t°1........::__gallons per person per day. Total daily flow..........
...__.............................gallons.
Septic Tank—Liquid capacity./_° I)•gallons Length................ Width................ Diameter................ Dept h................
x Disposal Trench—No..................... Width.................... Total Length-------------,...... Total leaching area...................sq. ft.
Seepage Pit Noy A_ ........ Diameter.................... Depth below inlet..................... Total leaching area.................sq. ft.
Z Other Distribution box (/) - Dosing tank (: )
a Percolation Test Results Performed by... $ _ s , .:::. Date_..
,.a w.
Test Pit No. 1_I_Z.____minutes per inch Depth of Test`Pit_____ __ ________ Depth to ground water._A.111... __.__..
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................
x _ -=----------------:...------......_........_.....:---------•-•-•-••••............... .........................................................
D Descri tion of Soil...... .__._t1� ,�' ,
x -------- P--•---•----•--- ... - -j .:... .. ....... � ..t �''j,lei >.:............... .- .........
U
W ••••------••--------------------------------------------------.................
•----------------
•------
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---•••-----------------
.......
._.•-•------------
•--------
U Nature of Repairs or Alterations—Answer when applicable.........................................................:.....................................
-•---------------------------------------•---------------------------......----------••---------------••-•-•-•-•--------•-------._......_.._._..---.........----.........--._.._.•--••..........--_-••--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of TITIS 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.
Signed... �!`� .._. ..�(:�:^_::^..:`.
........................_...
Application Approved By.............. :�... _: �a�y=.
•--^ --- --••--•-•----•-----•--•------•---------------^ ------• - Date
...---
Application Disapproved for the following reasons_______________•_____...._....._____......._..............._....____________________.....____.______.__.__.---
--•-•••-•••-•••.............•-••-•......•••-•--••••••--•••....................-•••-••----•.............---••••••----••-••••.......-----•••-•--.....--------...............---••----.......----......_
Date
PermitNo........................................ -._.... Issued....................................................................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Tertif utt#r of Tomplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
bY---------------- .r.t ec►... ............................................... --...
------...................................-----•---•--........---............_.... --..._
_ Installer.
at.......... f._... ?�: _e.�. x�.. �--��. ._..._.. - ---.......•---......
has been installed in accordance with the provisions of TITLEof The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......... dated__..._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A 0 ARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE... ..... ............................................................` Inspector-•-•- .................--••-----......
r�Y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. ...........................................O F........................................................................__......_....
No. _ ..:. t�6 Fn.... ......
Disposal Works Tons#rnr#ion rlern i#
Permission is hereby granted......... f:_f,_Lam.....................................--.................................................................._..
to Construct ( or Repair an Indio• ual ewage Disposal System
at No..........L_.4..... -- n M�.c ��n _ MM
......................................... ..-.--.----......_._.......---.._....................._...._....._._r..
Street �
as shown on the application for Disposal Works Construction Permit No..__.�'_____________.(ilated............. .... ...= ,tA�.�.
.................•-••`�� .__ Ott.: d .,.................................
_
_�� Board of Health
DATE............ . f -......-•-•-•--•----••••----•-------=••----•----
FORM 1255 A. M. SULKIN, INC., BOSTON
�z ber: Bgttle # C078 Date: 2/11/85
}04 BARN
BARNSTABLE COUNTY HEALTH DEPARTMENT
SUPERIOR COURT HOUSE
v BARNSTABLE. MASSACHUSETTS 02630
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�1As� DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2311
EXT. 331
Client: Steve Hannah Collector: Edward P. Meehan
Mailing Address: 35 Wing Blvd, W. Affiliation: Meehan Well Drilling
E. Sandwich, MA 02537 Time &' Date of
Collection: 2L7185, 1945 p.m.
Telephone: 888-1772 Type .of Supply: well water
Sample Location: Int 2 Newtown Rd. Well Depth: 771
Marstont Mills, MA Date of Analysis: 217/85
PARAMETER SAMPLE RESULT RECOMMENDED LIMITS
Total Coliform Bacteria/100 ml 0 0
H 5-4
Conductivity (micromhos/cm) 500.0
Iron ( m) 0 05 0.3
Nitrate-Nitrogen ( m) <0 04 10.0
d Sodium ( m) 20.0
I, Water sample meets the recommended limits for drinking of all above tested parameters.
II, Based only on results of the parameters tested for this sample, the water is
suitable for drinking but may present the problems checked below:
A. Water sample has higher than average levels of Nitrate. Future monitoring is
recommended (2-3 times per year) to establish any upward trends.
t B. The low pH of the water may shorten the useful life of the house's plumbing.
C. Water may present aesthetic problems (taste, odor, staining) due to
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D. Water sample has high levels of sodium. Persons on low sodium diets should
consult their doctor.
III. Due to one or more of the reasons checked below, this water sample is unfit for
human consumption: A. High Bacteria B. High Nitrates
REMARKS:
CC: Barnstable Board of Health
CC: Meehan Well Drilling
Laborator Director
7/17/84-
Explanation of Test Results
Total Coliform Bacteria
Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become
contaminated from malfunctioning septic systems,cesspools and surface runoff. A total coliform count of zero
indicates that your water supply is safe and approved for human consumption. A total coliform count of greater
than zero is most often the result of accidental contamination of the sample bottle through improper sampling
methods. For this reason, it would be advisable to retest any well water that is not approved.
pH +
.a
pH is the measure of acidity or alkalinity of the water. On the pH scale, the number 7 is neutral, less than 7
is acidic and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 3.0 to 6.5
Conductivity
Conductivity is a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos'cm are
generally considered unacceptable and may have a laxative effect upon users.
Iron
The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet
astringent taste, cause an unpleasant odor, often gives the.water a brownish color and cause staining of laundry,
and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of
iron in water may cause the problems listed above, it is not considered deleterious to health. Iron.may be
removed by use of an iron removal system.
Nitrate-nitrogen `
The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 10
ppm. Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to -
form potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial
wastes.
Copper
Due to the acidic nature of the water on.Cape Cod, copper tends to leach from pipes. This normally does
not present a health hazard; however, concentrations in excess of 1.0 ppm may cause a metallic taste'and/or a .
bluish green stain on porcelain fixtures.
Sodium
A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the
water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source
of drinking water or contact their doctor to determine if consuming the-water is advisable. Concentrations
exceeding 50 ppm indicate that there may be ocean water or road salt runoff water getting into the well.
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