HomeMy WebLinkAbout0496 SANTUIT-NEWTOWN ROAD - Health 496 Santuit-Newtown Road, Marstons Mills
� yr
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�VY1 .. .. ... ..TOWN-- ---.._. OF...._BARNS TABU------------......................................
Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot # 11 Newtown Rd. , Santui t
..........................................................,....................................... ..........................-----................................................................--,.
Jordan Realt�°li"US�ress Hanover, Mas§r Lot No.
W ............................................................. :...�&-'
.. Hanover MBSSAddress .....-........................... ..._
..............................:........................... . ... ... .....-......._......_......---..........................
Installer Address O 000 m�1
of
TypeDwellind1ngNo. of Bedrooms Expansion Attic Size Lo12Garba Sq. feet
g— .............. p ( ) Garbage Grinder ( )
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
a Other fixtures -------------------------------
Q
W Design Flow..............................50.........gallons per person per day. Total daily flow.........3QQ...........................gallons.
P4 Septic Tank—Liquid capacity-la-O.OAllons Length.....$!.__._. Width...4.!........ Diameter________________ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......1........... Diameter------6!.......... Depth below inlet........6-!....... Total leaching area..................sq. ft.
Z Other Distribution box (x) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1...... minutes per inch Depth of Test Pit........:::........ Depth to ground water______--_-_-_-__-_----
,. y
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......................
----------------------------------------------------------------------------------------------------..........................................................
0 Description of
Soil...Note::-----Sub-dv�_ -1. n--- ----rlat ion-_teas. onfile =at• - t - --- -- .•----_----•-•••••••-•--.--
healthoff ice-.--------------•-----------•-- -- --------------- ---•••-...._•-•--•-- -••-•--- -----•-- -------- --•-•-•• •-••••••.0
W
UNature of Repairs or Alterations—Answer'when applicable.----------------t_-_____-_-____._._____--_-_____-______________.___-._.--__________---_---__-_.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not-to place the system in
operation until a Certificate of Compliance has eeeisj�U�rl b -tl e� and �4ealth.Signedyatt3�` • ... - .•e--_...
• at ..............
Application Approved By........... D
_: •------- = ...,� - 1�
Application Disapproved for the following reasons:. •--------•-=-----------------------------------------------------------------------------------
........-•-•-•--•-----...-•------------------------------------------------------------------------------------•-------•----•----=---------------------------------------------....--=•------------.._..
Date
PermitNo......................................................... Issued...................................:....................
Date
1 16,
7.
0' 6 x
Q •le C�a ,• aPT T • . ,,,
, r rfri/.
3Q
�q Howe
NOV
• .`� ,w+S�� sty. � rt •
V1. _
.v�tt o w try, RoAn
No. j
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ . TOWN--- ----:-- OF.......BARNSTABLE..................................................
App iration for 43itivaiial Works (fous#rurfi.o n Vamit
Application is hereby made for a Permit to Construct (g ) or Repair ( ) an Individual Sewage Disposal
System at:
...Lot...#•-1 .... ewtown-_Rd_......Santu t .........••••--.......-•-••-•••-•-•••-•-•••-........--••-•••••••••••.............................
Loca ion.Address or Lot No.
.............................alty.., st. Hanover,....Na$s.:.................-... ..........
Owner Address
Zianoverz...l..ass,...
Insta Address
Type of Building 2 Size Lot20±000 M/l Sq. feet
!-, Dwelling—No. of Bedrooms.......................................................................Expansion Attic ( ) Garbage Grinder ( )
0.4 Other—T e of Building No. of persons............................ Showers — Cafeteria
44 Other fixtures ...................................................
W Design Flow...............................50..•______gallons per person per day. 'Total daily flow_...._.._..0.0---------------------------gallons.
WSeptic Tank—Liquid capacity.a..,OCOIlons Length...... Width... }!........ Diameter................ Depth--------------..
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......I........... Diameter......6 ......... Depth below inlet........61....... Total leaching area..................sq. ft.
z Other Distribution box (X) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date...................................
a Test.Pit No. 1.........)--:minutes per inch Depth of Test Pit.................... Depth to ground water__________-.___---
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
GY -----------------------------------------------•----.--...........................
•............. •-----•-••------------------•-------------------------
O Description of Soil....dote.:•-•--•Sub—-ieissSon•-p-etaolatioh---tests...on..f Ile._at---------------------------
x
v _•.............................h4WItb---off'f-i—C.e...-------------------------------------------•-----------------••-----------------•-----------•-----------
W ••••••-----•----•--------------------------•-•-. -••----•--•-----------•--------------••--•.=•••••......-----•------. .......................................................... ......................
VNature 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 Article XI 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.
. r-
Signed -- -. x,. '•----•-----•.
s9 � : l' /Z .'p Date
Application Approved By---- J 4 --------- •----------- D e
t.. .7-
Application Disapproved for the following reasons:.--.---------------- ---•--- ------------------......----.....--•---------......................•-----...•----•--
............................••---------•-•------------------•----•-------•-----.._........----------••-- ------------......---------------...----•------.----..----...................................
Date
PermitNo.....................:................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................T.0W.N......O F.....BARNSTABLE................................................
T'Iff ifirate of &-intpliattre
THIS S TO CST y That the Ind' ual Sewage Dispo System constructed OO or Repaired ( )
ind B Buiders
by........... - ----------- - ----- -- - -------------------------------------------------------------------------
�i taller
Lot ## 11 Newtown Rd. , Santul is`
at----•---.•------------------------------------------•-•--•---•--.------------------------- ------------------------------------------------•-•----------------------------••-----------------------
has been installed in accordance with the provisions of Article XI of The State Sanitary Code a5 described in the
application for Disposal Works Construction Permit No.....................;. dated........ ,.r�.__ .__-_--_-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT HE
SYSTEM WILL FUNCTION SATISFACTORY.
f
DATE................ ................................ Inspector.........,..... ,, y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
. ..... FEE..... _.....
PermissionAs hereby granted. .............. •-----...•..................--••---•--.....---.............•••-•--........
to ConstrtEbi # c![1Re a*jp njj4idiv idS jj�}fie Disposal System
atNo.....................................................................................:.......... ..... �, ............................ .....................
Street
as shown on the application for Disposal Works Construction Permit No.._...... .......... Dated....
� .,/�� ..................
.....'""„
Bordo a'
DATE ----- ----•--..:.,;... t r `
FORM T255 HOBBS P< WARREN, !NC.. PURLJSHER$ a >'
40`'
r
i6,
r
Lof
I ,
(� 6%K LtAcA fit.
O y r
0 1 GZA . pr, TA
Home i
40'
.�c
130. o
t 4yt o w m Roan
e -
UDC ~ TINN Z � �rrv,�_ SEWAGE PERMIT NO.
2_
1I 1 L L A G E list`•
INi jA LLER'S NAME A ADDRESS
3®x
BUILDER OR OWNER
1?0,f la A
•��
DATE PERMIT l.SSUED A '�
DATE COMPLIANCE ISSUED `/ a
- �
e . ..
oc�ry
' �
k ,,
_ _ _ . . _ 6 .
l"�l
�' �
�5 .
;! TOWN OF BARNSTABLE r
LOCATION SEWAGE # f
VILLAGE 0&51061 &l VIASSESSOR'S MAP & LOT 0.33
INSTALLER'S NAME & PHONE NO. VoA Al irk 011L)E /Il
SEPTIC TANK CAPACITY ,gyp' 00
LEACHING FACILITY ype)-r A r (size)ff
Q
NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER-�C
BUILDER OR OWNER
DATE PERMIT ISSUED: Ott
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
I
10
Commonweafth of Massachusetts .John Grad
Executive Office of Enviror imrttoi Affairs D.E.P. Title V Septic Inspector
Department of P.O. Box 2119
EnAronmental Protection Teaticicet,MA02536
(508) 5G4-6813
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI 4\R M 7
PART A
CERTIFICATION /VfD
,R
Property Address: 496 Newtown Rd. Marstons Mills Address of Owner:
Date of Inspection:�7197 (If different) �997
Name of inspector:JohnGracl Bissett W
TA.RIF
Company Name,Address and Telephone Number:
0
CERTIFICATION STATEMENT y
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 This Inspection Is based on criteria defined In Title V
_ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is
performing at.the time of the Inspection.My Inspection does
_ Needs Furt er Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the
Fails septic system and any of its components useful life.
Inspector's Signature: ` 1,4V Date: 2127197
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B,C,or D:
A) SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair,passes inspection.
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not.)
_ The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revlsed•11115195)
One Winter Street 9 Boston,Massachusetts 02108 9 FAX(617)556-1049 9 Telephone(617)292-5500
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Add ress: 496 Newtown Rd.MarstOns Mills
Owner: Bissett
Date of Inspection:2127197
_ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken,
settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
_The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water
supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 11115195)
2
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 496 Newtown Rd.Marstons Mills
Owner: Blssett
Date of Inspection:2127197
D]SYSTEM FAILS(continued)
_ 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 1/2 day flow.
_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems In addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area(interim Wellhead Protection Area (IWPA)or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11115195)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 496 Newtown Rd.Marston Mills
Owner: elssett
Date of Inspection:2127197
Check if the following have been done:
X Pumping information was requested of the owner,occupant, and Board of Health.
X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
n1a As built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected
for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge, depth of scum.
X The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 496 Newtown Rd.Marstons Mills
Owner: Bisset[
Date of Inspection:?127197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: nla
Last date of occupancy: 5 y�a9°•
COMMERCIAL/INDUSTRIAL:
Type of establishment: Na
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present: (yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: n1a
Last date of occupancy. Na
OTHER:(Describe) n1a
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped In the last two years.
System pumped as part of inspection:(yes or no)No
If yes,volume pumped: 0 gallons
Reason for pumping: n1a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
1088
Sewage odors detected when arriving at the site: (yes or no) No
(revised 11115195)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 495 Newtown Rd.Marstons Mills
Owner: Bissell
Date of inspection:7J27197
SEPTIC TANK: X
(locate on site plan)
Depth below grade: r
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions:L g'B"N 5'7"W 4'10-
Sludge depth:2'
Distance from top of sludge to bottom of outlet tee or baffle: 25"
Scum thickness:0
Distance from top of scum to top of outlet tee or baffle:2'
Distance form bottom of scum to bottom of outlet tee or baffle:9
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.)
Septic tank and all com onents are structurally sound.Recommend pumping septic system every two years for maintenance.
GREASE TRAP:
(locate on site plan)
Depth below grade:Na
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: Na
Scum thickness:Na
Distance from top of scum to top of outlet tee or baffle:n►a
Distance from bottom of scum to bottom of outlet tee or baffle:n1a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Na
(revised 11115195)
l3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 496 Newtown Rd.Marstons Mills
Owner: Bassett
Date of Inspection:2J27197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: n1a
Material of construction:_concrete_metal_FRP_other(explain)
Dimensions: n1a
Capacity: nia _gallons
Design flow: n1a gallons/day
Alarm level: nla
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n1a
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: rda
Comments:
(note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.)
n1a
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
n1a
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 496 Newtown Rd.Marstons Mills
Owner: Blssett
Date of Inspection:2127197
SOIL ABSORPTION SYSTEM(SAS):X
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
n1a
Type:
leaching pits,number: 1,000 gallon leach pit
leaching chambers,number:n1a
leaching galleries,number: n1a
leaching trenches,number,length: nla
leaching fields,number,dimensions:n1a
overflow cesspool,number:n1a
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The overflow was empty at the time of the Ins ection.
CESSPOOLS:
(locate on site plan)
Number and configuration: n1a
Depth-top of liquid to inlet invert: nfa
Depth of solids layer: nla
Depth of scum layer: n1a
Dimensions of cesspool: n1a
Materials of construction: n1a
Indication of groundwater: nfa
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: n1a Dimensions: n1a
Depth of solids: nfa
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
n1a
(revised 11115195)
8
r -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 496 Newtown Rd.Marstons Mills
Owner: Bisset!
Date of Inspection:2127197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
GCk Q4,445(
A
1. I
O
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9
No..... ,.... /ate Fizs.......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...................OF.... /U .......................
Atip iration for Disposal Murks Tunstrttr#uan truth
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal-
System at:
.pay/c �t.,j/0 PI
P , sro ` �iCLs . s-
Lr_.�4.................. ............. .... ............................. ..............
........ .... ._. .................
N..�(...__.._..-_--.._ _...----..:7r.
Locatio - ddress or Lot No.
Ow Address
------...--•...................................•----..............--•-------------------••----••-- ............................................�` : ---� -----.-_--.-----..........---
Installer Address 4F�
Type of Building Size Lot.l-_.44 .........
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (1V0
Other—T e of Building No, of persons............................ Showers — Cafeteria
Pa Other fixtures -------------------------------- .� _
W Design Flow.................................. 5.6 gallons per person per day. Total daily flow..............._..........33 ....gallons.
WSeptic Tank—Liquid capacity./D.00�gallons Length___ _ _ . Width..Y.? Diameter________________ Depth......
x Disposal Trench—No. .................... Width........0......... Total Length............... Total,leaching area....................sq. ft.
Seepage Pit No..................... Diameter.......1.`V--- Depth below inlet.sJis........ Total leaching area-�V.57.sq. ft.
Z Other Distribution box (;-I Dosing tank ( )
Percolation Test Results Performed by. Date........................................
,aa Test Pit No. 1 ....._._minutes per inch Depth of Test Pit.../' Depth to ground water........... A7F�
f� Test Pit No. 2....0.........._minutes per inch Depth of Test Pit.................... Depth to ground water........................
WO .%5�5 r.:T... -----....Q'"_�3_�`.-...... 1�121,?�< t�1 4• __43 Q o..t.
Description of Soil......................-•------•------------- 4 ( ...-^-15/` "-------�wW_/ )/ ...---�1 ).............
W fik.0 t�6rT« .
U ---------•----•-•---•-•............................. --------------------------......................................-.........................................................................
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 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 iss by the oa of health. ,.
Signed------------- - lf - y/ �j
O -- -- •------• -•-------.
Date
y- -
Application Approved BY -/� - ---------------------- --1_3.......
Date
Application Disapproved for the following reasons---------------------------------------------------------------------- .......-................................
.........................-...........................-.....................................................................................................•-----------•-------------•---•----.....--•---
Date
Permit No........
-. Issued-
Date
No.....PU... FEic........ ............
THE COMMONWEALTH OF MASSACHUSETTS 4
BOARD OF HEALTH
..................OF.... ........................
Appliration for Disposal Works Tonstrurtion Permit
Application is hereby made for a Permit to Construct (j,,,)0'65r Repair an Individual S'ewage Disposal
System at: =4
Ale ' - / ea
................... ;. ........................................ ... .....................4L C-1---7----- �!--/ .............
-
--n Location-Address or Lot No.
..............X.a4vk2L/J........ ...................... .......... /a
0 Xp,4 Z AA Address
.............................................ook .............................
................................................................................................. fz_�4-z
Installer Address
Type of Building Size Lot. .........eC6C,--f=fS
U
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (AM
04 Other—Type of Building ............................ No. of persons..___..._..._..___._..,::_... Showers Cafeteria (
Other fixtures ..........................................................................................................
------------------------*.......
Design Flow..,..............................—I.- lloni'per person per day. Total daily ?in;_.galIons.
--------_------j .el
9 Septic Tank—Liquid'capacity./V(Z gallons Length...F.. Diameter �ppth..... ......
Disposal 1_re
.r Tat'a. ....... Width......................Total Length...................... leaching area....................sq. f t.
Seepage Pit No------------I....... Diameter....... below Total leaching area0?.,64.6_-.sq. ft.
Z Other Distribution box (W) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. lAt.:Z........minutes per inch Depth of Test Pit... .... Depth to ground water../dd .W .re/2,
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_ ..._......__.
-Z
04 ��...... ../........ -------/4)(XIe')4_44 e.....q,n"
0 Description of Soil......................................................... "..—.+/ ,..V_.V.........t.�
..............
U ..................................................... ...... ................................................................................................................
..................................................................................................................................... .................................................................
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 TITLE: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliapce..has been issue il by the oyd of health.
ell
Signede!,fn .. . . . . ........ I.........
.....�Xd IL .. . .
Date
ApplicationApproved By..........;.'A.............................................................................. ............. .t-f-J........
Date
Application Disapproved for the following reasons:................................................................................................................
.......................................................................................4.............................................................................................................
Date
PermitNo--------7_3...---I? -Z-1..................... Issued-.--------------------------...........................
Date.
THE COMMONWEALTH OF,MASSACHUSETTS_
BOARD OF HEALTH
-7r,
al ..................OF... ............
Tutifiratr of Tompliaurr
i.
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed j.),or--Repaired
by---------------------------------------------------------I...........................................................................................................................................
Installer
at__ ..........
........................ . ........-------------- .........
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit ......:. dated--,...-/, ..................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILVfU CTION SATISFACTORY.
DATE.....li! .................................................... Inspector------.... ......................................................................
ti
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Ok,'° HEALTH
.7........201J..10................OF.....7Re7.e el)s .........
ev
.............. ........v........
No. FEE......
Disposal Works 0.0111notrurtion "permit
Permission is-hereby granted ....... ....... ......................................................................................
to Construc eyair an Individual Sewage Disposal System
t or R
at No.......4:__ ........... ... ............ ....... .
0 .. ...
Street
as shown.6n the application for Dispospl '"Torks Construction Perniit/No.�3n.......... Dated.._..... ----------------
............. .....................
Board Health
LOT l C) it `
OT-
Y
710
pot
I-
D yv "I QG --
sop
Eon � � 66
As,A.r`c y
r
�>
68
EL SS.3
5GA►.1 _ �'`_ 9-�' MWiMuM OOLthl d 5SF _
IVOIJT
O F
�EV�LW QA_I4 / ANMOL rFN �— —
, a --! —
WITWIN f,� sN aaAo 4. 2ONFOOT OF 15F-4 GRAM '/0
ER LEA H AREA
i4"/ _ w. Cc7skaR sox r.
��'+ ��K. - 1�2t.,Ev&L PREv`�NT ��aJEs i�ton�t
4�Ca�T►RoN _Se'—nn� 2-�,���M/v�iN. �N. �H P4 , D In1Fi E,'ifRA�1►Jra htE
Olt �c►+.•4o pyt �" �Lav-T �i in]E 44� � -
to`MrN. iNUN. /Friar }_ y / rcN
J' , ll 4 FApr
!, .9 0 Q Q _X I G3.Sa o -- %ZOW,
/
(NRT LEACH �WASNEO
�3.75 GALLON 4�nruN
SE P I G 1 TAN K 43.33 4fi p1q_�V. �: ., 3,S' /o►R Jr4D
WA'TE 11` •RT Plf'Fr 6 2.80A,�' O i I
GARSAaie GgjI ,JVER i >, I4►,;v�
-- 20`M I M.
ySTM �-TI _ ,
s>✓PTI G sYSTEnn coN 5YR UG?1aN
5 ALL CONr-!'OR/ "Tb `rHF M�4S2. S
v 1 R ONAAeNTAL CODE -rij-1.E-y .� NuM13g of E�i✓o gooMS; -- a_--- --
REv 15ED 7-1-77 ?4 I'H 't'bWlt4 �s° CRAIG�
t3aARO OF t41E iAL t'4 iz&A J i^ATl otJS °�'° D °�1 Ga ICI -'L.01 / . 30 ?
SEPTi c.TRN#C, VI 5TR I aU'ti LEACN►NCa RAT'oN poll � �a.�����
ANq ACMIM& ?IT ro I3E of t REQ 'O. LEF„AG1-i. C.Or AGITY2 3,fr,F?L
aM ' PROPoS L GH CAPA 17Y
mil• 20000 P51 3l2 /83 2.5 3.S "YC�2� � .0 7`/
M 14 LOAo!I�C�
MVEWAy Nor - o DE LOCAISC)
Ovelt wolre.`lr` U1jL OSC-1 n^ r Sir,K, YQ 4,
�DE�1 GiN L4Atai1�la u��U ." :Q .�3,,... .;
LA
ALL PI PP.9'i'o t3e WATgg'tj eqN-r '' . ;
Ir rO f�S Osi FI- '_ • fit../ 'I` • s -'y r'4'�, V RV�V���V�r `.ram�r tTI�� -_
@ARNk5 R&A OF 17F.Et7S
'fIaE 5 CAgr RaJ c= Fga-Cd.�S'f o
o ENGINEERING
DESIGNING BUILDING
NEAI.TN AGE " APPROVAL. INC.
DENNIS, MASS. 3 85 a 2 00 31