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HomeMy WebLinkAbout0651 WAKEBY ROAD - Health 651 WAKEBY ROAD, MARSTONS MILLS A= 028 025 L• ^i { X it �1 1, { I r If t it 'li L CATION f SEWAGE PiR BT NO. T"VLAGE iHSIALLEi 'S NAME ADRRE5S urz Co ` G UILDER OR OWN ER pip. milt" ISSUED DDT E C0MPl I A N C E ISSUER A Gt� r e c's { DATE:_ 4/29195___ PROPERTY ADDRESS:_.551-Uak.aby--�ae�------- ����� ® -_ Marstons ML 1 1s_— --_— MAY 5 1995 HEALTH DEPT. Mass_02648 _ TOWNOFBARNSTAmE On the above date, I inspected the septic system at the above address. This system consists of the following: A. 1 -1000 gallon septic tank. B. 1 -distribution .box. C. 1,-1000 gallon leach pit packed in stone. b. Sch. 40 4" pipe through out system. Based on my Inspection, I certify the following conditions: A. This is a title five septic system. (. 78 Code ) B. The septic system is -in .prop.er. working order at the. pr.esent. time. C. The septic tank was pumped' . 5/1 /95 SIGNATURE: -�- Name:_ ------- Company:_J_P_Macomber_&-Sores.-Inc. Address-Rox 66 _____________ Centerville,Mass . 02632 -------------- Phone:__5 Q$.=ZZ5---3.3.3.8-------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 6775-333 tervi77, MA 2632-0066 AlZgl95 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property Owner' s name. Date of Inspection PART A CHECKLIST Check if thee`following have been done: Pumping .�,information was requested of the owner, occupant, and Board of Health., -None of. the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period.., Large volumes of water have not been introduced into the system recently or as part of this inspection. Q (As built)plans have been obtained and examined. Note if they are not availa$a.4?:.with N/A. ..� The facifity' .or dwelling was inspected for signs of sewage back-up, ✓ The si•telwas:. inspected for signs of breakout. All system, components, excluding the SAS, have been located on the �r site.. . The septic tank manholes were uncovered, opened, and the interior of the septic.. tank. was inspected for condition of baffles or tees, materia'h''::of construction, dimensions, depth of liquid, depth of s1udgei";:,(epth of scum. ✓ The siz:e :and' location of the SAS on the site has been determined based on existing .information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. P,c.Y.Eo ,. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number' of, bedrooms i *, number..'of current .residents ' garbage grinder,: yes or no' YES laundry, connected to system, yes or no n10,.,.sesonal.:use.;; yes or no :, ' I�yf nonresidential, calculated flow: Water meter'readings, ; if available: t Last date: of� occu anc y . rkt: n GENERAL. INFORMATION Pumping records and source of : information: �• System ` Y' pumped as part of inspection, yes or no ' f` if, yes.,,., volume pumped: t Qp 6,,-u,us s �. . Reason. :for. pumping: M i TYPe of system ". Sept, • `tank/distribution box/soil absorption system Single.-cesspool Overflow .cesspool, ! a :Privy , 1;v Shared system (yes or no) (if yes, attach previous inspection ' records, if . any) Other (explain) ' A.pproximate` age - of all ' nformation: • Source components. Date installed, if known F.. " 'i 1=a Sewage, .odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,"FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: 1�00 G�4.on�5 (locate on-: s.ite plan) belo. depth P W .grade 1 material of -construction: _concrete metal _FRP other explain) dimensions:`_ sludge' ,'-depth distance- fr:om top:of sludge to bottom of outlet tee or baffle ,.� scum . thickness distance from top of scum to top of- outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle. 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, recommendations for repairs, etc:) - I"LE ezT A N.tT LeT T ncay_s [�c'Y�.7 VCct3VV% % V*Un � �� . n�n9�'� ..� 121y\3v D a►u �2l=�14t9fT•4 tie-u YN t • DISTRIBUTION „BOX:_ ,_ (locate on site plan) oL7TL• epth . of .liquid level above outlet invert. twEZT`' - Comments (note if level','and .distribution is equal, evidence of solids carryover, evidence of leakage . into or out of box, recommendation for repairs, etc.) ' 2 E e PUMP •CHAMBERd_I� , (locate on site;'plan) Pumps. .in=-working_-order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM PART B INSPECTION FORM SYSTEM INFORMATION continued SOIL •ABSORPT � ION SYSTEM (SAS) := (locate on site plan, if possible; excavation not required, but may be . approximated by non-intrusive methods) y 5 t.E If' not determined to be present,.,. , . . nt ex . . ,. : . .,.. P plain. . Type leaching pits and number leachin chambers and number N 9: leaching, galleries and number leaching trenches, 'number, length leaching fields; number, dimensions overflow cesspool, number Comments v.;. :.. ' (note condition of 'soil, signs of hydraulic failure, level of ondiri' c �pondition of vegetation, recommendations for maintenance or repairs etc. ) O F Lt C. AP 2Ec.OVA wt C �- elsa2¢ tpvaz •Tz>\.&.2(TN*(hj %V, 6F JP6 , CESSPOOLS..: (locate:-.on. site plan) :-- --• - num ber rand configuration depth-top: of liquid to inlet invert depth of solids layer . depth of., scum layer dimensions of ,cesspool materials: of :construction indicati0 ` o,f groundwater inf.low..,�(., ss ool .mu P -must be " u •._ �. m ed a part.:.of..:.inspection) P P s Comments: "ondi ion' On `Of soil, signs of hydraulic failure, level 'of and condition ' vegetation, recommendations for maintenance or repai ing, P rs,etc. ) PRIVY: ''(locate on site* plan) . materials of construction dimensions de �th o f s . . P of ids_. , Comments notecondition .,. ... . . . co • . nd( i t i 0 n of . soil, signs of hydraulic failure, - level of.ponding, y condition of vegetation, recommendations for maintenance or repairs ,etc. ) ,,� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCIj. OF..SEWAGE. DISPOSAL SYSTEM: indlude ti&s to at least two permanent references landmarks or benchmarks locate all wells -within 100' •� .,e I' DEPTH TO GROUNDWATER depth to' groundwater method of determination or approximation: • t r '12 SUBSURFACE SEWAGE DISPOSAL SYSTEM "INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) F 40 Backup; of,.,sewage. into facility? lip Discharge' or ponding of effluent to the surface of the ground or surface waters? �o Sta't c,"I'i" Id level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert. or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number` of .times pumped aO Septic tank ' is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy:. , �o below the` hi h roundwater elevation? ' 9 9 1�0 within:- 50 `feet of a surface water? qO within ..100_ feet of a surface water supply or tributary to a surface water.. supply? N® with;i:n.,.a::,Zone I of a public well? , 50 :feet of a bordering vegetated wetland or salt marsh ' (cesspools .and privies only, not the SAS) ? 1Ao within- 50 feet of a private water supply well? , qo iess :,th6n `-l00 °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 Qrganic compounds, ammonia nitrogen and nitrate nitrogen. A Pi& S Mn tAAa WA �0 s G /o fs,S Eq9 o ��ol 111111 i .� 4 IV p rAL, SBOt/GTA�'K ap PA OAo(00 I$s< Ay /� 1 Poi �ysr fi Ao LOT � t S 3 tKI r ) o M II M Zda/F A cRC/50 I C pl ST rr,^, 3 GMio' 3* "J Sc T d i c ft s �i /taE3E3� Of W � 1 I . SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART D CERTIFICATION Inspector: Peter Sullivan PE Location : 651 Wakeby Road, Marstons Mills Date April 29,1995 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. _,j,Vaq truly you s d Peter#1ula PE Distribution: Original to system owner ►T or Buyer Board of Heath PETER SUuIVAR Pa. 29733 ST6a�? �dPIAL LO CAT IO SEWAGE PERMIT NO. VILLAGE INSrALE 'S �,MA/ E i ADDRESS BUILDER OR eR . DA I E PERMIT ISS E D 1l ® �h DATE COMPLIANCE ISSUED - � � � r. (LEAK �'R.ONT Lv� & 8y • T'7�, THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town .......OF...............Barnst�b�.e................................................. Appliratilau for Bi-qVuiia1 Works Tomitrurtion Urrmit Application is hereby made for a Permit to Construct (X�) or Repair ( ) an Individual•Sewage Disposal System at: Lot 9 Wakeby Rd, Marstons Mills, Ma ................__.............................................................................. •............•----------••............----•-•-----••••------•---•-----------•---............--••-- Location-Address or Lot No. Wianno Construction Inc. 450_.Old__Stage__R ,___Ceey�, le,__P? R,••,••,__,____ Owner Address a (� 11.F1�._......441/L6-ap................................ ------fzftsyo-lu5_ I�'1_.l z---••----------•---•--•----•--•---- Installer Address e Q Type of Building Size Lot...21.,tM..........Sq. feet ........................Ex Garbage Grinder Expansion Attic (NO) Dwelling—No. of Bedrooms................... p ( ) g aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures -------------------------------•-- W Design Flow...............5_6....:_..�...._...___gallons per person per day. Total daily flow......................3�.0..........gallons. WSeptic Tank—Liquid capacity _gallons Length.__-.'_ Width.A--f Q_ Diameter................ llepth. x Disposal Trench—No______________-_-- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------i----------- iameter.......... Depth below inlet......4........... Total leaching area...�:?�;.)..sq. ft. Z Other Distribution box ( ` Dosing tank ( a Percolation Test Results Performed by. ?A =`9'-hA...--..._�'-•�19 6...Ce '�' Date__. �1..1-� _______________ Test Pit No. 1......Z- ...........minutes per loch Depth of Test Pit.____.� ______ Depth to ground water.._.'-............... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------........................................................ Description of Soil ' ' l.- - .CA- --------------------------------------------•------•-••--------•--------------- x ' lvlflX ,� L4�---••-•-•••---•-•----••-- V W ----------------------------•--.._...........---•-----••-•-•-----------------•-••-•-----•••------••-----•--•-••-----------•--•---------...---•-•----------•---•---•-•••-•-•-••......-•••----•--••----•-- VNature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------------------------------•------------------------•----...........---------------------...---------------------------------------------------------------------••-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accoreance with the provisions of:iT .7 y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of lie,41th. _ � Date Application Approved By. ••-----.Q �'=- --------------------------------------- Q Application -- Disapproved for the following reasons:-------•------------------•-----------------------------------------------------------------------........--.••- ---------------------------••---------------------•------•--------------......----------------------•-....--------------------...----...-----. ---------------------------------------------------------- Date oL". ' Permit No................................-........................ Issued..... ------�=-�-------•-----------• Date ` THE COMM NWEALTH OF MASSACHUSETTS "y 4 BOARD OF HEALTH ..............Town...................OF.... ...Barnstable.. . . -'---............................................ Appliration for UhipasFal Works Toaastrurtinat Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Lot 9 Wakeby Rd, Marstons Mills, Ma. -••-----•--•--....----•---...---•---•----•-•-••••--••---•---.....•...............•-•-------------- -••-...-_--------•-----_.....__-_----------...-----_--._..-...........-••...-•-_-...........---••- Iiocatio -Address or Lot No. Wianno Construetion nine. 950 Old_ Stage Road. Centerville. Ma. _ ...................--........................................................................ Owner Address /L E.D i1_L .& ..... �/ Sr ,S. 1 cs Installer Address Q Type of Building Size Lot..21.,_2$0...........Sq. feet U Dwelling—No. of Bedrooms................3.........................Expansion Attic ( ) Garbage Grinder W) 04 Other—T. e of Building ............... No. of persons....-___._......_.__.__.___. Showers — Cafeteria dOther fixtures ..................••---•--.....•--•----••••-•-----.....-•------•---------......----------••--••---••-----•••--•-----•----••-••--•••--•-•--.-.....--•-- W Design Flow................555.....................gallons per person per day. Total daily flow...................... .' (D _gallons. d i WSeptic Tank—Liquid capacltyI'" 3-gallons Length__.^� -.- Width_A ! q.-1 Q. Diameter................ Depth.--. .N-_. x Disposal Trench—No. ...................• Width.................... Total Length.._____._........._ Total leaching area--------------------sq. ft. Seepage Pit No---------L.......... Diameter.........(!`-.___ Depth below inlet...... .....----. Total leaching area...,,-ram..sq. ft. Z Other Distribution box ( �} Dosing tank ( ), I ~' Percolation Test Results Performed by 1?? i �^ .byp.......•-_ .:,-: dt l -._ .. Date..' • 11-to.___.....•._.. ,aa Test Pit No. I_... ....minutes per inch Depth of Test Pit-------1. ....... Depth to ground water-------4_......._____ G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 m ....-•-.r-...S.•-••--------•--•-��•�••�-1-•---...._.t•�----•••••------•:•-.-------------.-s•f•--•-----....--•-•-----......................................................... ODescription of Soil...... •••-• •_•---_•_-___-•--------------------•_-_•___._--_-----------------------------•- . ! 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'TTLE 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,,ealth. Signed' -{" �. Date Application Approved BY------ ' fir= - � --•--•-•--•--•---•---------------•----- D�e Application Disapproved for the following reasons:--•--••-•----•----•---•--•---•--.....•---••---•-....-•-•••••-•----•---.•--••-•-------••---•--•-•••-•••••--•---- ...................••--------•-•-------•--•---••--••-••--••--------••--••--•--•---••----------------••-----••••---•-•-•---•---•---•-•--•--••----...------------••---•-•-•-----•---------•-•-•_....--..._ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF...... .N.... L�.e ........................ Trdifirtttr of TwOutph attrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed Q.-*,) or Repaired ( ) bY........At......... uezz.e A...-•---•--------•------•-----•--•-•---------------------•-•-•-----------•-----.•.....----------•-•----•---------•---------•--•........-_..•....- Fa-;".. Installer at..-. p.T ---------Lt..r.R/+ �3-�'...... / ''=-�...._..5----•-----•----------------------------------------------------•----------- has been installed in accordance with the provisions of T _.- T' r of The State Sanitary Code as described in the application for Disposal Works Construction Permit N datedF f - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIO SATISFACTORY. DATE..... ..`...'Z .. . .. --.•...................... Inspector...-P..ez......-- ................................................ THE COMMONWEALTH OF MASSACHUSETTS • BOARD OF HEALTH............O :.... � AJ.� a E . No.� �C ........................... . ..... -- .- FEE -_1P--------------- Disposal Workii TMInotratr#iort Vamit Permission is ereby granted.... 9'!......... 1 -----------------•--••...-----•....._....•-•••-••---•--••--•----------•..............-_-_.... to Construct ( or _Repair ( ) an Individual Sewage Disposal System ° at No....A97 ....... ..... �1�1��"��.......... .Wt n✓ as shown on the application for Disposal �t�orks Construction Perm No S—_ Street 'L•- r- Dated.._.� .....-•-•--• y v of Health DATE.................................. --_. ------•.........-- r FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - - USA- tOCXo E,A, PtT - (--)SF-- 1DQo GOL. ICJ v.IAL.L AI?-EA = lcjo 1=�o St+ ,c 2.S • 3 7S G.P.D. �5$CA SD 6F� SU s.RD. TO A L -T' >ESIl�1J TOTA L. L7A t L..-( �fi1C_pL�TIOtJ SZQTE I"tLj I_MjtJ OTZ 45 t -re T r7��111-1 �'L-n Zr ioY' P-wo4. 2'�L 4'Pp� DrST 1W. COAL. r '_ tuv t $oX 9, I000 �3 S tuy. UWV. •t. GAL. �40 94•Z :. ?sT W 1 T-W t'- t��t� WAfNQD 7�ti 17 STOwJE �T•�j ; r ( C�tZTtFtED PLC ,— `• �'f"��. (mac,�r��(�tj . C-MRTIP-4 TI4A-r T14G_ C-ovktl.;�,kTIOS. IPAa�AJQ h E=V_et'.1cC 4.16_Q L'-br,l Gcw�Pt..�l5 w 1 r" T► ;�:: 51 D t_1►J� AWta SCTU�ACK, I;GQUICeAAC--WTy OF Taff 'tOwU oc= CJA.Tr-- REGtS rQ_f:ED 11, I.•G SUti�� Y��I TWI-5 OSTEVV%LLG o t�(AS`i• APrjt_tGANT ' �•�>T' E',[": U-,C•� ie, t�r?��G�:Mt�JI`: t�T l_t1..1i,��,; - , y No (p......�..1 ....�J...... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD -1 HEALTH�Lafi/v�✓.................OF............. .. d✓ . . .......................... ApplirFatilan for Klhipao al Vurks Tnnitrn.rtiun Prrutit t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individu Sewage Disposal System at: ..Y1. 1 Im . '`zZ ...... '� ��..�'.2. . s sv�.... .!�... . ................. •--..... ocation- ddres ors t N .............��6 caner/� .dress Installer Address d Type of Building S*ze q. feet aDwelling—No. of Bedrooms___...._._...........................Expansion Attic Garbage order ( ) P4 Other—Type of Building e— . ............. No. of persons.......... Showers ( ) — Cafeteria ( ) Otherfixtures ........ -1.-=--------------------------------------------------------------------------------------------------------------------------- W Design Flow_.._.____._ .........gallons per person per ay. Total daily flow__-_-3. ...........................gallons. WSeptic Tank—Liquid capacityO.,O:k..gallons Length _. ... Width.J1.'_7:A;�_. Diameter__._........ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area............ __- sq. ft. Seepage Pit No.--.._-•____�_____ Diameter........6 ...... Depth below inlet.....:_ Total leaching area... j�.sq. ft. Z Other Distribution box ( ) Dos'n..fepth _ (� �; �" Percolation Test Results Performed b __... _<__..___._...•................�.''_�....... Date.......... .: ll.....L aTest Pit No. I---------------_minutes per inch of Test Pit.................... Depth to ground water..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------- ----------------------------- O Description of Soil....................3...._.. ..._.r ?2��. -- --- --- ------ -- - - - ----------------- -------------------------------------- W -------------H...--------------------------------------------------------------------------------------------------...-----------------------------------------------------------------------------..-- 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 iITi 1Z 5 of the State Sanitary Code— The under igned further agrees n lace the system in operation until a Certificate of Compliance h een iss d by the boat of heal . �/✓��`�_ It Datq Application Approved BY :-�:....[�- l2 1 ' .._. Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ........................•-•-••-•••-••.........--•••••--•-•-•-••••--w----•-•--•-........_...••-•--•••--•--••-•--------•----•••------••-••••---••••---•-•••---•------•--------------••-••-•••-••--•••--- Date Permit No.......... ..... ........A......... Issued-...------------------------ ------ Date VL No .....l FIms .... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH � /-,(................OF...... .. ...��: ?...�!-- --....................... ,�pliliratioaa for Disposal oaks Tomitratrtivaa rrrmit Application is hereby made for a Permit to Construct ( } o epair ( ) an Individual Sewage Disposal �Systenyat - --... r Lot •- • ...................... 11� n-Address io 1 . -----....---- - lL ..� ........... �::� r... --------_ -•- ... ..... �U Owner p Addre W ..__....... . G . 1� Gc 2 ..L.' YL...__...._�. _ �?._....��J__...... .... = a ---------- ------- Installer Address / Q Type of Building Size Lot... ....__._ feet Dwelling—No. of Bedrooms.______.__�_____________________________Expansion Attic ( ) Garbage Gr ( ) aOther—Type of Building .__ ..... ---------- No. of persons......... _______________ Showers ( ) — Cafeteria ( ) Otherfixtures -------•------------------------------•----•----------.---•--•••---•--••------•-•--••-•--•---•-••••--••-------------------------.......-••------------ lJW Design Flow.............. _=......................gallons per person per da Total daily flow........, _v______________________gallons. WSeptic Tank—Li uid capacity/,,- allons Length_-: Width---LI_.-,l6Diameter__.__-"_____ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length........ ._._._ Total leaching area.......... .sq. ft.. Seepage Pit No______ ___________ Diameter........ ...... Depth below inlet........_ Total leaching area_ZG......--sq. ft. Z Other Distribution box ( ) Dosing Percolation Test Results Performed by..... e4: 1%, ••••-: ••-•-..._ ! Date Gl. 'fI__......... Test Pit No. I................minutes per inch epth of Test Pit.................... Depth to ground water_____..______________--. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -•---- O Description of Soil-----�� --•-•-• .......�-�?!v -•----•------= --------------------------------------------- U ------•••-•--••••-•••--....-•••••-••-••--3.. .... •!� 1�-� � �� � L�� �Q. VW •-••••-----•----------------•--•---•-----•--•-••---••-••-•••----•--•---•••--••...-•----...-•----•-------•-••----•----•------••••----------•••••-•--•----•-••-•--•-•---•---•-•-•--•--••••-•....-•--_...__ 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 TITHE 5 of the State Sanitary Code— The unde • ned further agrees not to place the system in Operation until a Certificate ofsompliance h en • ed by the bo d of he lea . ____ Signed �a - - •-•----------------------- �2h Application Approved By.......................................................... —'- t .... C� f D te. --•--•----------- Date Application Disapproved for the following reasons-----------------------------------•----------------------------------------------------•--•••-•-•••••-----_--••- .........................•--••---••-•----.._._---{:-••-------...-•-----------------..._...----------•--...-----•--------••-------•-------------------------------------------------•--------------------- Date PermitNo.......................................•----------------- Issued....................................................... �I Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH ...OF................ ......................... Cwrrtifirtt#r of Tootpliottrr THIS IS tOF.- RTIFY, Tha he Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.. .... //%.)..® ? ............ ... Gc..2__..:..._...... - --------------------------- -......._---------_. -------- ________--- In all at--- //�'.c.e �i� �'�••: � 1�=-f=A''------ ---)----------------------------------------••------•-----------------•-- has been instayed in accordance w the provisions of T yo State Sa.nitaryodel G Id�e�scr bed in the application for-Disposal Works Construction Permit No------- -----_�___ ......... dated__..._1_...__-_____`'_ _________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEA+,WJLL_L FUNCTION SATISFACTORY. DATE................ f ...................\,........... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ► �` �� Q.lf- .......OF......... .. ��I..IZ�.:..............................••••-••••-•-•-. No....:.�..: ........... FEE..~-'......-•--•--- DispouFal o ko Ton atr#ioat rruti� Permission is hereby granted.......... .._.�r�_G_Z�' G� ---------•-•-----•---• .................................................. to Construct ( ) or Repair ( ) an diivi�ual ST,ag,Disposal System { at No. f .. LG� -••-_..._ a c_ Street —� l J JV as shown on the application for Disposal Works Construction-Permit No ______ ._ �/ I Z ^ Board of Healff DATE----- lt.. , 1_ k........ .................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - Log Number: Bottle # E008 Date: February 7, 1986 ,BAR~SA BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE VBARNSTABLE, MASSACHUSETTS 02630 o • �1As8 DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511 <s Ext. 337 Client: Barnstable Holding Co: Collector: Edward P. Meehan Mailing Address: 100 W. Main Street Affiliation: well "driller Hyannis. MA 02601 _ Time•&-Date-of - - - - - Collection: - 2/4/86 2:30 p.m. _ Telephone: 771.-4460 Type of Supply: well Sample Location: Lot 9 WAkebv Rd. Well -Depth:- 681 Malrstnns Mills,MA Date-of Analysis: -2/5/86 1:15 p.m. PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coiiform Bacteria/100 ml 0 0 Fri _ 55.4 Conductivity (micromhos/cm) 70.0 500.0 Iron ( m) 0.1 0.3 Nitrate-Nitrogen ( m) 0.4 10.0 Sodium ( m) 8.0. 20.0 I I . X 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. 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 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 ( I CC: Meehan Well Drilling Laboratory Director 1 /7/85 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 pH is the measure of acidity or alkalinityof 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 5.0 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. e. 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