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Home My WebLink About0591 WAKEBY ROAD - Health w 591 WAKEBY Marstons Mills A = 028 - 022 r No: Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLAtion for bisposAY *pstem Construction VErmit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon omplete System Individual Components Location Address or Lot No. `s wner's Name,Address,and el.No. Assessor's Map/Parcel I tall er's Names dress,and Tel. o. Designer's Name Address and Tel.No. Type of Budding: Dwelling No.of Bedrooms Lot Size 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. Nature of Repairs or Alterations(Answer when applicable Date last inspected: Agreement: , The undersigned agrees to ensure d maintenance of the afore described on-'site sewage disposal syem in r � accordance with the provisions of Titl of the Environmental C e and not to place the system in operation until a Certificate of NL S- hf v Compliance has been issued by this Heal igned Date ��t Application Approved by Date Application Disapproved by r Date for the following reasons �• Permit No. !20 jCj--28 - Date Issued / ��` � � x No. Fee .-..y__ M,.... THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer:. Yes ' PUBLIC HEALTH DIVISION -TOWN OF, BARNSTABLE, MASSACHUSETTS' a. ftPhtatlon for Misposal 6:pstEm,ConstrUction Permit £# Y Application for a Permit to Construct Repair( Upgrade Abandon , 0 ete S'stem Individual Com onegts' Location Address or Lot No. \ Owner's Name Address,and Tel,No: �� ' MARS i $Witt,1 - : _\07- Assessors Map/Parcel Installer's Name,Address,and Tel. o. Designer's Name,Address,and Tel.No. Type of Building: � �... �` \� <� �-Q �' _` Os�- , Dwelling No.of Bedroom'sL Lot Size Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �V►�1" gpd Design flow provided �i�- . gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. -�eseriptionrof-Soii=- _ — k Nature of Repairs or Alterations(Answer when applicable Date last inspected: Agreement: The undersigned agrees to ensure the-construction- d maintenance of the afore described on-site sewage disposal system iri • accordance with the provisions of Title"5 of the Environmental C de and not to place the system in operation until a Certificate of N u S•q J Compliance has been issued by this Boardo4Healt t gned DateC �l } L Application'Approved by _ D"ateX Application Disapproved by PDate for the following reasons Permit No.�� q 2 8;? Date Issued THE COMMONWEALTH OF MASSACHUSETTS, BARNSTABLE,MASSACHUSETTS Certificate of Comb lianr>e E THIS S TO CERTIFFY,that the On-site Sewa.a Disposal,system Constructed( ) Repaired( ) Upgraded( ) Abandonedby C D I S K C H U n . ={ at 511 VJA ,t3 G A'2�510N5 th r LAA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No7,01` 7 ? dated Installer IlJ`� Designer N/r� #bedrooms /VA- Approved design flow All* gpd The issuance of this pernot shall not be construed as a guarantee that the system will nctio as designe . Date. L (� Inspector C_ . . ----- -------- ----__-- ._______.-:____._.___.. _._.:____. ___._____ ___.__ __.._ a No. �!J _ 2S _ _ Feeq�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposaf *ystem Construction Permit Permission is hereby granted to Construct( ) Re air( ) Upgrade( ) Abandon System located at t Lt is and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with t Title 5 and the following local provisions or special conditions. Provided:Co traction must be completed within three years of the date of this permit. ,asDate 2/ZO 1 Approved by �r f LOCATION /� � r gO: %4a6E pffRmOT NO. (---c) : \ w�► ��0 -'�� '-� - l is` dILlLAGE Ib $ TA LLER'S A ® ® RffZ5 D U0L ® ff R OR 0=0 OA T E PERMIT ISSU E D ® AT E C 0 M P L I A 0 C E IS5UEO � t 40 (3 (C�GGL` (.%L r -- t SL` e ul I��,tA S�J`►t COMPLi TE THIS SECTION U COMPLETE • ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sig uu item 4'rf.:Rey3t y t r:-` eliver�re s dgsi[ d. X /1 '— ❑Agent ■ Print your`n, es addres �n`thb reverse �% 0 Addressee so that we c � the card to you. B. 5qcelved by(Pr► t Name C. Date of Delivery ■ Attach this card to the back of the mailpiece, l ' or on the front if space permits. �0—IC'E � "'`e 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: 0 No I�'I 3. ps!ervrc,e Type 13 Certified Mail® ❑Priority Mail Express' I ( �titi E3 Registered 0 Return Receipt for Merchandise o-&'[Or ❑Insured Mail 0 Collect on Delivery `t d 4. Restricted Delivery?(Extra Fee) p Yes 2. Article Number (rraosfer from service►abeq 7 014 1200 0001 0358 4 411 - 70 PS Form 3811,July 2013 Domestic Return Receipt UNITED$TATES'Apfl> First-Class Mail Postage&Fees Paid USPS . v Permit No.G-10 � _ I • Sender: Please print your name, address, and ZIP+40 in this box* Town of Barnstable Health Division 200 Main Street " Hyannis,MA 02601 f oF�HE r Town of Barnstable Regulatory Services BAMSTABLE, v MASS. g Richard Scali,Director i639' �� ArEDMA�a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail:7014 1200 0001 0358 4411 December 27,2016 Patrick Murtha 591 Wakeby Road Marstons Mills, MA 02648 Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Humans. Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable on December 22, 2016 conducted an investigation of a dwelling unit located at 591 Wakeby Road, Marstons Mills, MA. The owner's name of this dwelling unit is Patrick Murtha. The tenant(s)name(s) Patrick Murtha Based on the results of that investigation,the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410..831 (D), (E)the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanizer or Impair Health or Safety 410.750 ( C )—Shutoff and/or failure to restore electricity, gas or water 410.750 (H)-Failure to comply with security requirements of 105 CMR 410.480 410.750 (1)—Failure to comply with any provision of 105 CMR 410.600, or 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests 410.750 (P)—Garbage and filth throughout home. - Q:\Order Letters\Condemnations\591 wakeby rd marstons mills 12-23-16 Based upon these findings any and all occupants are hereby ordered to vacate within(24)twenty-four hours and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated they may be forcibly removed by the local Board of Health(Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. You may request a hearing before the Board of Health if written petition requesting same is received within forty-eight(48) hours after the date the order is served. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from$104500. Each day's failure to comply with an order shall constitute a separate violation. Note: This is an important legal document. It may affect your rights. PER ORDER OF THE BOARD OF HEALTH Tpmas . McKean, CHOW Director of Public Health Town of Barnstable :\Order Letters\Condemnations\591 wakeb Q Y rd marstons mills 12-23-16 Town of Barnstable B"MAS&M ' Regulatory Services A'FGMl►�A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 December, 22 2016 Patrick Murtha 591 Wakeby Road Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1 The property owned by you located at 591 Wakeby Road Marstons Mills„ MA was visited on December 22, 2016 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint filed with the Public Health Division. The following violations of the Town of Barnstable Board of Health Regulations, Chapter 54 Building and Premises Maintenance were observed: &54-3 (A) Outdoor Storage Large amount of items were observed not to be screened from public view. As stated within said Town of Barnstable Ordinance Chapter 54. Items included but are not limited to: broken fencing, broken landscaping tools, ladders, lawnmowers, old pieces of wood, car parts, tires, automotive tools, etc. and other assorted debris. You are directed to correct the violations within fifteen (15) days of receipt of this order letter by disposing said items or storing all mentioned items from public view or in an enclosed structure. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORD R OF THE BOARD OF HEALTH Trom/as A. McKean, R.S. Director of Public Health Town of Barnstable f Oft11E>Or` The Town of Barnstable Health Department t 'A"STAIM & 367 Main Street Hyannis, MA 02601 039 i679• � �0■rt a" Office 508-790-6265, Thomas A. McKean FAX 508-775-3344 Director of Public Health DATE: October 6, 1993 '2 TO: All Concerned Parties (� FROM: Dor_na Miorandi, Health Inspector i RE: Murtha Residence, 591 Wakeby Road, Marstons Mills Donna Miorandi, Health Inspector for the Town of Barnstable, inspected 591 Wakeby Road, Marstons Mills on the morning of October 5, 1993 at the request of the Centerville-Osterville-Marstons Mills Fire Department. Other inspectors present were Buddy Martin of Building; Gene Pelkey, Wiring; along with Lt. Glenn Wilcox of the C-O-MM Fire !Department. The conditions existing at the above location were as follows: No electricity due to shut=off by Commonwealth Electric on April 14, 1993. No heat due to shut-off ; dwelling is heated by electricity. No water due to shut-off; dwelling is supplied by well water and pump is inactivated due to shut-off. No operable smoke detectors due to shut-off; smoke detectors are electrically wired and therefore inoperable. One smoke detector present at top of cellar stairs. This condition could be remedied by a back-up of battery-operated smoke detectors. All of the above listed conditions are listed in the State Sanitary Code, known as Article I & II and 105 CMR. These conditions come under 105 CMR: 410.750: Conditions Deemed to Endanger or Impair Health or Safety. cc: Building Wiring C-O-MM Fire Dept. O L0CAT ION �''' SEWAGE PERMIT NO. . : VILLAG:E>. ftn INSTAL'IER'.S E A ADDRESS s U I LL D E;R. OR -OWN ER. pro -------------- DATE ,PERMIT ISSUED �� ¢ DAT E C. OMPLIANCE ISSUED WCLL lip 4o� I , loon Pee c Off' o _�fnc rrriK �Z CA t000 pe-c^5rt PtT w1.:?�� w/ Pig s�aNE LOCATION 6-71 SEWAGE PERMIT NO. VILLAGE INSTA LLER'S E i ADDRESS I B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED t sz `t . �000 E�� •�lr �s tc rnNK 42 OCc 1000 6A,-- IAT wr 2�af 1 Z C4 . ��. kPICA No----------- _0 b ,; Fina............................. THE COMMONWEALTH OF MASSACHUSETTS a " BOARD OF HEALTH ..........................................OF_....................................................................................... ApplirFation for DiipugFal Works Tonstrurtion amit x Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..... __.. c .l................................................. ...................._............................................................................ Location-Address or Lot No. ...................�}T..!I.-SUE... ... 1.7 U?�Mlaq.................... .................��vt3CJ�'�!�..... u).......... � 2�!ls............ Owner Address iWa _. ----•-------------•--..............--............. Installer Address Type of Building Size Lot-It a___ AC I........Sq. feet v Dwelling—No. of Bedrooms.............2.............. .__..Expansion Attic ( ) Garbage Grinder (Na) U Other—Type of Building P No. of persons.........._�______________ sShowers Cafeteria ( ) dOther fixtures ...........•.....6 7,q.---•01 ......... ............................................... W Design Flow...............S. ................gallons per person per day. Total daily flow...........,, Q......................gallons. WSeptic Tank—Liquid capacity../."_gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No...../.............. Width........ .......... Total Length....F .......... Total leaching area.....2.010....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_____-____--_--_---____. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ -•-•---------•----•-•-•••------•--....-•---•--•---••--•.................................•----._......._.....--------•-----•------•-•......•---•-------..•--- ODescription of Soil........................................................................................................................................................................ U W ----------------------------------------•-...........-------------------•----•------•--•-•----...-----••-----------•-•---••••--.....-•-•-•-----...---•-•-•-•••......-•--•-•--••-•-••------------------- UNature of Repairs or Alterations—Answer when applicable.._____________________-----------------------------------------------------_................... Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 'the provisions of iI'i U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeri issued b the boar f health. Signe .. ..................................... .................................-•--�-•--�----.- Date Application Approved By.............. 1-------- __ .. _ .................... ------- Date Application Disapproved-f o" the following reasons:.......... ...............•---•-•----•----------•-••---•--....-------------•--••----•---------•------•--.......---..__....._...---••--•----•--•--------•-----......-------------------,--------............................ Permit No.-_Q4 ----- �- 1--------- Date �- --. Issued_---------1�'=- �---� -�- i to -r �--= No. ;F. �..„ 510 THE,COMMONWEALTH OF MASSACHUSETTS r - BOARD <OF- HEALTH ...._....--- .. .........:.......OF.................... .............................................. Appliration for Disiiasttl Works Tonstrn.tiun rerunt Application is hereby .made for a Permit to Construct'( ) or Repair ( ) an Individual Sewage Disposal System at: `. dress................... - - .:.:._.._.............. - ------------------ Location.Adress- or Lot No. t, ••-- ------•--- ---- --- ��' :: !r1.-------- -----•-.... ... Owner Address rWa ............ c .•. �. . ._ ................................ ................... ?A .f;..4.C__71)(...----•-••-----------------•-•----•---... I..c_.. •�, - Installer Address _ .Type of Building Size Lot. 5.. gl..__.....Sq.1feet Dwelling—No. of Bedrooms.............7............. .............Expansion Attic ( ) Garbage Grinder k 4) 4 , Other—Type of Building 4�'6�!- � �� yp g �_.___..__`1...__� .^No:., of persons_..._._...�..............�Showers Cafeteria ( ) d Other fixtures ...............ep Ts,�-'•'�t�:/.......° --••--.=tee ?��[/!?!Iz.....�a (�!v(�'..... = W Design Flow.............. 4r..._.._._.._..___gallons per person per day. Total daily flow.._......�A.0.......................gallons. WSeptic Tank—Liquid capacity./DW..gallons �f ength................ Width................ Diameter................ Dep't'h................ x Disposal Trench—No..../............... Width....... ...... Total Length... ............ Total leaching area....a�------sq. ft. Seepage Pit No--------------------- Diameter.................... `Depth below inlet.................... Total leaching area.................sq. ft. z Other Distribution box ( ) Dosing tank,`( ) a Percolation Test Results Performed bY...............\......................................................... Date........................................ .1r Test Pit No. 1................minutes per inch Depth`',of Test Pit.................... Depth to gropnd water................... . Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to gro{:ind water------_.................. - .....................................................•-•-------........_..------•-------•--------............--•--•------------...........---•--••----_•••... Description of Soil ............................. r� } .I -•-----------------•--•_----• =-•-•---...-••---....._..... #. --------......... -------------•--------------- U t . IT W ------------------------------------------------------------- '° = . . .................=-----------------------------------=-•--------------._.... . x 4- -----7 V Nature of Repairs or Alterations—Answer when applicable.._________________r ___ r at _____________ _________________________________________________________________ _ ____..._ ........_ .............._.... ........ . ... Agreement: , �xrl xaxr+ 1; The undersigned agrees to install the afore'tTes`ribed Individual Sewage Disposal System,in accordance with the'provisions of TITLE 5 of the State Sanitary Code— The undersign9d further agrees not to place the system in operation until a Certificate of Compliance has been issued b the bar of health. - N' Signe ! V •--•- •.-----•---•-------------- •--•------••-••-._............. j r! ✓ :r• ✓ZDate ate Application Approved BY `�� ----•--•---- - � ---- a Application Disapproved4 f or the following.reasons:------- ='•.••-•--•-------------•-•------------•--•----------------------------•------•---•------•••••-••- ..• .............................................................=............................................_..................----....------•-----•-----••---• .............--......................... �• ••-••- ----••-- Date Permit No.. �"." .�. � __._. Issued_........ ate 3' -. r- THE COMMONWEALTH OF MASSACHUSETTS ice' t r3 y'h�1 tfz L f L EEC BOARD OF . HEALTH 04 U5i �3 J N G 1 .I p(`� HnAN +OLE COVE - *6 • .....................................oF..............................................t.....................................W 0h'IN (9rdif irate- of Tompliaure NA r A n�, THIS IS TO CERTIFY,, ha h eIridivid 1 S wa e Disposal System, constructed ) or Repaired'. ( ) t bY•---•----- • - ............:...�•-------- --- - ----•-- -•---•--•-------•---_,........ •-•-•_.... ...•••••••._....._._..----•-•-••-•_-•-- Installer at.-----------/�67 L -� .... ' flt. ----------�-TP----------------_....1 "1:�3RSTG�t1..........._.,! ,,..-- -------------- has been installed in accordance with the provisions of .TIT 5 of The state SanitaryIdas e cribed in the .. . application for Disposal Works Construction Permit No__________ ___,!t.._ ..__.__..... dated__-. _. _-..-..................... THE ISSUANCE,OFTHIS CERTIFICATE SHALL NOT;BE CONWRUASAN EE THAT THE" SYSTEM WILL F N TION SAT S CTORY. DATE......• = ._.._..... •-.........••--•-- .................... Inspector........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1� �'�i 7 f� .............................OF................................_._........,.._.............._....................... N ............ ........ � FEE:...... ........................ Disposal Works Tonstrur#ion rrutit Permissionis hereby granted..............................................'............................................................................................... to Construct ("I r Repair ( ) an Individual Sewage Disposal System atNo.= .......I ----�... K Y�+ r��` - ---------------------•--------.....----------••-------•--..._. Street as shown on the application for Disposal Works Construction Permit—No..................... Dated.......................................... /DATE....... .............................................. Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON _ Department of EnvironmentaLMopagement/Division of Water Resources WATER WELL COMPLETION REPORT II -WELL LOCATION J Address LD Ll)crt�bG �YJ . City/Town Mt7-r �V,, 1lf\1 G.S.Quadrangle Map Grid Location Owner 1 ' S , - Address 0B5c 1 t,Pnrns hzb ie iM oa(nfo S' VIJ WELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled A er 1) From To 2) From To Date Drilled /12_19—8 3) From To -- 4) From To CASING It Depth to Bedrock Length a a Diameter Type glas-A-ie- UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Sand: fine medium coars ❑ Feet below land surface , e Date measured Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot# i1o_length 3 from—to— Yes ❑ No Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slog length from to Chemical Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days4hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 m ,M DRILLER Firm l geh= u) 61i1 'Dr 1,11 f rl.! j 1IA., Address Po \ City Fores'fda(e � M11 Oafo Registration No. J14 c� Aerators SignaturT Please print firm y CUSTOMER COPY 15M-2 84-176471 c Lot 1 JO /ky m N 8 V�1 4J of T 4:. wc,�s, lS r rt� fhi ISc)r.:cae r !!{� huh o� �POPOSa~D LE�c-V -, 21� �? ,rq�,LiT ( LS wlr'+L11.1 lS6CtT a�T1l>; 't�fc'OigO4ED W=L :. piSt•BoX 1 �� IooOEtA�.Co►K.�1�" .; rz'4p5o�loPuG � ZROPO � ®F �/qs O. �� S9�y WATER E. _! SMITH,JR; x • , #15128 GISTER��`��`4 FSSIONAL REGISTERED CIVIL ENGWEE , ` P/Aj �CL- iSt�OSA,L PLAhJ �EM PTc�a.� I�IGKc:i;ZSotJ �STE4Z,\/1 LLE �^3-7 7 Jo2.5 `17.5 10 C I prsT..g� 1o• ' - _./c�(60 q0 Z I4' 2'�� IV— Y2.#? Ls�ltd s��r 10 0 CD C-Wl. Cone. 97•7 Aa oo �oFr• D��yivf. ScP�1� Ton l� 98.0 A o naGc�.1c• e AAA/ l..�AcF1�1.1CY 'Prr 4 40 LJ 61664 2�<� • d��, a e A. A'i �lnsA,d s ne bl-O CRO dND TO P50 SvEso,� p E5 �R.Co�,,caTl �N RATS.: Z M/N f>Jc DRo P TEST PERFORMED CT-, 241`��4 �1S-S 3�`' 3 6c.DF�oon.tS �C Ito C-IPD = �330 C Pp LEAcNI14C, C�AH No C- "RSAC-4E DISPosgt_ USE I000iGAL:SEF1'rrcT,I �.1 .. /. CAPAcITy Pp-0vIp � p :. �aT`r'ou� TJ—s-2-x SIDE -5 T1ox 5 � ' � c = 71 .ZC Pp 4,S 8 2 LCgPACIT r +�0VIp 4EST Pr r S 9 , 7 C p i7 SEfliuM N oTt; — D tsPoS,qL SNjSTcr,4 Dc sI '�`�D% ACCORDANCE V`11 Tf-I PRC) >SoNS O.F S nn,a�� ST6ti� TITLE S o� T!-I . N�I 'ROhJA E:NTAL GO17� . kEM pro"J (LN/clCE�so�� Q / ,r. LO-F I CN1Pp/Nc srn 8�'(O 178 lW)Gr�ZDUND WA`l J? 51Z -3-78 7 =. n� I <-r-0 t, A APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS ')CATION jC . NO. P- 37 a - LLLAGE '73a h, i _ DATE /0- 1- - Sal PPLICANT kie mD4n L Lk_eg-_soAj _ FEE_j o "' `-)DRESS Z -r4uS LA9 &-4 TELEPHONE NO. (Non-refundable ) NIG INEER 4JD5 CDO&P— p c, tN C- -TELEPHONE NO. 4-7]-23 ATE SCHEDULED ! o_ 2- Lj - ey - opo Applicant' s signa ure ) • . • . . . . . . . . • . • . . . . . . . . . . • . . . . • . . . . . • . • . . • • . . . • . . . . . . . . . • • . . . • • • . . . . • • . . . . . • . . . . SOIL LOG 'JB-DIVISION NAME DATE_ b Z TIME ',PANSION AREA: YES ✓`NO .ENGINEER ')WN WATER PRIVATE WELL L/ p do i'D rj BOARD OF HEALTH O EXCAVATOR ":ETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and percolation tests-, -locate wetlands in proximity to test holes ) NOTES : 1'1J 1< X� kP �s 6z� _!'RCOLATION RATE: ZAwl/V1//1 ap _ �!�:ST HOLE - NO: _ ELEVATION: (9-.,- TEST HOLE -NO. ELEVATION: /0/. - 2 2 �7 056I _�SotL 3 3 4 4 6 - &�,A e P � ------ - �p(_c 6 8 8 10 .. . - 10 11 _..__.._. 11 12 12 13 ------- 13 14 -- 14 15 178 �l 15 17� 16 16 1ITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD 1/LEACHING PITS LEACHING TRENCHES pig ;SUITABLE FOR SUB-SURFACE SEWAGE . REASONS: )TE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION !'.IGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH )PY: RETAINED BY APPLICANT