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HomeMy WebLinkAbout0738 MISTIC DRIVE - Health 738 Mistic Drive, Lot 74 A = 079—073 f Marstons Mills 1 (I f� �I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Y TITLE 5 0�73 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ,/3�•6 Property Address: 738 Mistic Drive T Marstons Mills Owner's Name: Dan&Leslie McDonald Owner's Address: Date of Inspection: 5/21/2007 Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 off Title 5(310 CMR 15.000). The System: Passes Conditionally Passes Needs Further Evaluation by the Local Authority /Fails Inspector's Signature: Date: �J3 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 738 Mistic Drive Marstons Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: K l �C.s�vww.rG•.�c�. TLC ar��J c.�A ♦ � ��,t� � C�►��P�`aA� . 5���vw 1�cy B., System Conditionally Passes: One or more system components as described in the"Condi onal Pass"section need to be replaced or repaired.The system,upon completion of the replacement or rep ir,as approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the r the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* r the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltrati or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic as approved by the Board of Health. *A metal septic tank will pass inspection if it is s cturally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old ' available. ND explain: Observation of sewage backup or eak out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,se ed or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required ping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with app val of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 1 f " Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 738 Mistic Drive Marstons Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 C. Further Evaluation is Required by the Boar of Health: Conditions exist which require further a luation by the Board of Health in order to determine if the system is failing to protect public health,safety or th environment. 1. System will pass unless Board o ealth determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a an which will protect public health,safety and the environment: _Cesspool or privy is wi 50 feet of a surface water _Cesspool or privy is w' in 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 any)determines that the system is functioning in a manner that protects the public bealth,safety and environment: _The system has a septic tank and soil absorption System(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _The system has a septic tank and SAS and tl'e SAS is within a Zone I of a public water supply. The system has a septic tank and SAS the SAS is within 50 feet of a private water supply well. _The system has aseptic tank and SA and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method us d to determine distance **This system passes if the well wat analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and�iitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy the analysis must be attached to this form. 3. Other: f i Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 738 Mistic Drive Marstons Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/Z day flow _ _jL Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ V/ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is 50 feet of a private water supply well. _ _L_/"Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] ,l-30— 'Yes/No)The system fails. I have determined that one or more of the above criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must se a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of a following: (The following criteria apply to large systems ' ddition to the criteria above) yes no _the system is within 400 feet of surface drinking water supply the system is within 200 fee of a tributary to a surface drinking water supply the system is located in nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public w�a{er supply well If you have answered"ye�'I`to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat undef Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system'owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 738 Mistic Drive Marstons Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health _ AWere any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? _ Have large volumes of water been introduced to the system recently or as part of this inspection? _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ,Z_ Was the facility owner(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No _ Existing information.For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 738 Mistic Drive Marstons Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):q Number of bedrooms(actual): _ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): J q Number of current residents: Does residence have a garbage grinder(yes or no):-ygS s Is laundry on a separate sewage system(yes or no): ¢if yes separate inspection required] Laundry system inspected(yes or no): - A Seasonal use:(yes or no):.;.2P .r- Water meter readings,if available(last 2 years usage(gpd)): = l'7 j � p, r��• �� -; Sump Pump(yes or no):A2> Last date of occupancy: c v COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.2 gpd Basis of design flow(seats/persons/ .ft.etc.): Grease trap pre/' available: o): Industrial wastk esent(yes or no): Non-sanitary wed to the Title 5 system(yes or no):_ Water meter reilable:Last date of ocOTHER(desc GENERAL INFORMATION Pumping Records z n Source of information:�j �tc,e„?.� ��..,-r��G Was system pumped as part of the inspection(yes or no):QC:7� If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP7 OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Ap r c oximate age of all components,date installed(if known)and source of information: �^ Were sewage odors detected when arriving at the site(yes or no):fU(Z:� r Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 738 Mistic Drive Marstons Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 BUILDING SEWER(locate on site plan) Depth below grade: 2 P G " Materials of construction:_cast iron '�0 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of le age,etc.): SEPTIC TANK:-Izoocate on site plan) Depth below grade:Q i s Material of construction: . concrete_metal_fiberglass polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: e q-5- � �o© g a�—T�•�`G Sludge depth: ri Distance from the top of sludge to bottom of outlet tee or baffle: -3 Q�l Scum thickness: `T '° Distance from top of scum to top of outlet tee or baffle: t; Distance from bottom of scum to bottom of outlet tee or baffle: ' How were dimensions determined:_ '.N©*-- •- Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): �V�.C��•p V 4 �+i�'�j'C S":J �a ti°\�� Gsac.��l�� c'�`;��.`;��1 �4.. .�'Y �Sua.c.�`� v GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal /berglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top /ns,,inlet baffle: Distance from bottom of scum to et tee or baffle: Date of last pumping: Comments(on pumping recomme and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidenctc.): I Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 738 Mistic Drive Marston Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 TIGHT or HOLDING TANK: (tank must be p ed at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene_other(explain): Dimensions: Capacity: 9float Design Flow: Alarm present(yes or no): Alarm level: Alarm ir(yes or no): Date of last pumping: Comments(condition of alann hes,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) �r Depth of liquid level above outlet invert: Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): G!� R .►ce '�♦ J� PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chambe ,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 738 Mistic Drive Marstons Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 SOIL ABSORPTION SYSTEM(SAS):__%G(locate on site plan,excavation not required) If SAS not located explain why: Type _AZI—eaching pits,number: C x 4--( leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): -On' �-• ask s-d:►.. �\w ��i...�. n�,r�..n.a.,,� �d P�:'G �.s�,�sl "— CESSPOOLS: (cesspool must be pumpe7 of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow es or no): Comments(note condition of s ,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions.- Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): r 4 � i i`� Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 738 Mistic Drive Marstons Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Li G a O . � a 37 t � s� 15 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 738 Mistic Drive Marstons Mills Owner: Dan&Leslie McDonald Date of Inspection: 5/21/2007 SITE EXAM Slope Surface water Check cellar C/ Shallow wells Estimated depth to ground water ya feet Please indicate(check)all methods used to determine the high ground water elevation: —,Z—Obtained from system design plans on record—If checked,date of design plan reviewed: ( /L? Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators,installers-(attach documentation) �"Accessed USGS database-explain: You must describe how you established the high ground water elevation: -• .�..$�GSS C.�� �cif-..s t G Y c� �-�S ��1.T�.r r"'c�y.:�o ti,v..-.S� `�n�� (y�.e�L1��hc �1 U TOWN OF BARNSTABLE - LOCATION 't3�? 1�s�,c. �r;v� SEWAGE 3C_C— VILLAGE ('�sa�.��c ,,ASSESSOR'S MAP&PARCEL 0 7":t—(t�"73 INSTALLERS NAME&PHONE SEPTIC TANK CAPACITY ` SO® (ZA k, LEACHING FACILITY: (type) L e Aa u(n, '-� •(size) Z?— CA 6 C--1( [�Siow V_- NO. OF BEDROOMS !`( OWNER PERMIT DATE: 'S��� COMPLIANCE DATE:/ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY R�iC O O Z •l - LfLi T? Y` JD 3 TOWN OF BARNSTABLE LOCATION L N 7`I M.S r C_ f DR, SEWAGE # e'_ 5— VILLAGE 0 0, ASSESSORS MAP& LOT D INSTALLER'S NAME&PHONE NO. C0 LI7-8 -and-5 SEPTIC TANK CAPACITYC- LEACHING FACU rrY: (type) L2AGh 21'r- (size) 2 )000 BL. NO.OF BEDROOMS C' BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Z- 1 9,'7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � 3.� � � � t . 3z ��� � F 3s z '� �' 3 � - 2 �g ��� �: •.. - y �z ys - 4 . a 4 ��. _ V - �J • .. '� - {/ ' , � ,.�Y.t� � , t� a n} P ..7 3/3 ., 7 �-7 3 rt No.._ .- 4 ? FEB THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Alip iratiou for Diti-poml Wurk,i Towitrurtiun ramit Application is hereby made for a Permit to Construct (1/) or Repair ( ) an Individual Sewage Disposal System y - / �� '� ------------------------------------�. ca on ss - or Lot No. --•-------- ------- `�---------------------•------- -----•-- . •............................... �. Address 4J1 la..l! W _ 14� Installer Address ��. f� UType of Building Size Lot-----...5�..............Sq. feet Dwelling—No. of Bedrooms.¢-------__ ___.Expansion Attic ( ) Garbage Grinder ( )(q% p`4 Other—Type of Building _____ .--_--r�...!—No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ........... n - Q ---------- W A 6----------------------- - -------- Design Flow...............�l-U------------------gallons Per Per day. Total daily flow......... .._...........-_-.-._._._gallons. WSeptic Tank—Liquid capacity. -JF gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft. Seepage Pit No..-----_-.-_---_... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing t ( _ -•`� ' ~' Percolation Test Results` Performed by..... {.... ...... ...�.........__ ----------_----------.------ Date--_-. ...------.....-_---_./.__•-------. a Test Pit No. 1---_____ ____minutes per inch Depth of Test Pit-------------------- Depth to ground water.. --;9-.� . (� Test Pit No. 2................minutes per inch Depth of Test Pit__._____....____._.. Depth to ground water -................_...... x -- -------- Description of Soil....... --- i(-- -- - -------•------------------------------------------------ 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli been issued by he board of health. Signed ----- < -/ ............ ----------------------------------- Application.Approved BY ----------- CR�s�- - oS - - ....:. . .Y.� Date Application Disapproved for the following rearons= ------------------------------- ----------------------------------------------------------------------------------------------- -------------------------------------------- ------------------------....-..---- ---------------------------- ........................................ Date - Permit No. .'... �! --------:. .. Q-.. . ------ lj. Issued ---------------- - Date TOWN OF BARNSTABLE LOCATION L UT 7-1 M 5 7'L Da, SEWAGE # CS ._ 3 4--�2 S VII,LAGE' �a�nS ��']�. ASSESSOR'S MAP & LOT - O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I S DO SSA LEACHING.FACILITY: (type) 11 0O `\ P E (size) 2 low, NO.OF BEDROOMS ` BUILDER:OR OWNER PERMTTDATE: �=�j .�%r�COMPLIANCE DATE: 7- I q "7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water,Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist withi4.300 feet of leaching facility) Feet Furnished by, A 38 �3 Ll LP ' /,1/ -73 THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Di-spasMl Workii Tott6trnrtivit rumit Application is hereby made for a Permit to Construct (I ) or Repair ( ) an Individual Sewage Disposal System at & UkLe—, Ay_-7�1 wx& / j�/L�cation-:1dpql 5/ or Lot No. ...... b' �...Address........................................... •wnei • --t---- W ........._.!.....•.. )-t� ,...( !.!��!.�✓1�1, ...... ............!-.`..!. ....................................................... Installer ` Address d Type of Building Size Lot-----LKs. _...Sq. feet U Dwelling— No. of Bedrooms...................._--------. - - ---_.--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building � i- -No of persons-_-----------------_._--. Showers ( ) — Cafeteria ( ) Other fixtures . ray W Design Flow...............//U---.----- -----gallons per person- per day. Total daily flow............YO--------------------------gallons. WSeptic Tank—Liquid capacity..7gallons Length---------------- Width...-.---.------- Diameter.---..-------.-- Depth................ x Disposal Trench—No. .................... Width....--....--...----. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.------- -_--.-.-- Diameter-------------------- Depth below inlet---................. Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results =..Performed by------� ..---" " 1 ----•---------------•-- Date-----f---f 7... -/-•----•--- Test Pit No. 1..:•Z.<........minutes per inch Depth of Test Pit.................... Depth to ground water--.. :-.. f= Test Pit No. 2................minutes per inch Depth of Test Pit--.------...--...... Depth to ground water-.U"'...... .. x Description of Soil..--... 1. -`'�1_. ��^ --- U --------------•-••-•----•-•.....•--•--•-•---••------------•---•-••-•-- --- W 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com lia ce h.a. been issued by the board of health. sys p p Signed ........f�l � / 'K f - ............. - .. �`r-...-- ----- • to Application.Approved By ...... ale� ---� -"'�+>-------------------------------------------------------------------------------- ---- Application Disapproved for the following reasons: ...... ..... . ............................................ . .. -- ......... ................. .................... . ... . .................................................... .. .. . . --......................... . ..... - .....----- ------------------- . � .. Dale p� Permit No. ...7 - � - .. Issued .- -- --..,�.-- �-n..--..�':�... - .. 13— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO��TTWN OF BARNSTABLE LLJ Irtifiratc of TDmplinure THIS. S TO CERTIFY, That the Individuual Sewage Disposal System constructed ( V/ ) or Repaired ( ) by ........ ....:... 1 C .Lr' -1) _.�.^-�. ---- - - ..l at ........ }1.....{......... .t — f�—" "t :......... . .........-- ..... . /'?? ........................... .. .. ............---... ...`.-- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. dated ......................_.__...._------...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN-TION SATISFACTORY. DATE - -- o -- ....---------------------------- Inspector ........... .. -- ... .....__......--------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...-•g =• S FEE.....���'?_f)........ Eiapmat uxkii Tonstrurtion rmit Permission is hereby granted....<_l..s 2:..._...�. .. ...:.---- �Q--��--- ..C7.! )Y, lJ---------•-----••--•............. to Constru��c��t���(,`pp/) or Repair ( ) an IndividualSewage Disposal System, at No.......C�:Ir"....................... 1'Y�itY'! !C'.-...l 1_ ....- 1 --------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No...��__�w� Dated........................................... 1 ----•-•-••--------------•••---------•-----------•----------------------•-••----•-•= Board of Health DATE...................-----•....... ...............-•..-----•-------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS raB I � b 3 � QED �CA r 3 ft. J -71. 1 00 o ( Z ® .�. TAT c�v c"S?b Tr) w, it t �►1 � ' �> ��►,�s►� 6 P1 1P : 70 1W •�+ + 4' Tn5T i 6AA.. CIF Z era�� 2 -Box �5 sepnc � f to 00 41 GAL... . ,z A PIT WvrW ' SGT. MO ge r�4AO 4,- SPro0 -l-'/ •J vOV Tz' r30- - WASTED L4- N! L. T� II STowE �� �� (PVC,.. SG�� ,. ? • 4• � i S� U c , N(P vu CCU. ytt► Ur RATS PtTER C 2N U511 k)CH A. Sul LIVAH { No. 2J733 Design Data Single Family - 4 bedroom No disposal, Daily Flow = SS�ONAI 4x110=440 GPD. Septic tank = d 440xl.5=660 gal. Use 1500 gallon septic ..tank. DisposaL _ Use 2-6x6 leach pits w/1' of stone. Bottoms. = 100 sf @ 1.0 G/s.f. = 100 G/D. Sides = 301 s.f. @ 2.5 G/s.f = 754`G/D. I certify the proposed dwelling OF ., conforms to the sideline and setback ,��- ••A�, ���-` � �� � f requirements of the Town of Barnstable o WtLLIaM '��,� (� A. and is• not located in the .floodplain. C. N Y E v E5 M ,d,rZ 5/ � ILL, 5 MA No. 19334a + Professional. Land Surveyor Date L o 77 7 /�L�9�J / � Z�3 hovIC 53 54x �z f/V YE, /Nc- CZeV14-17GvJ 5 ejA5a2 cVU %o 1,ox J c v' !=��.��✓b�u�?�. C. D s v L yU�.t O/A it 0 u k-7i G//U 6: ;