HomeMy WebLinkAbout0035 MOSS PLACE - Health 35 MOSS PLACE, MARSTONS MILLS
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Commonwealth of Massachusetts
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Executive Office of Enviroranental Affairs
Dept. of Environmental Protection
One winter Street,Boston,Ma. 02108 John Septic
D.E.P.D. .P. Title V Septic Inspector
b D P.O. Box 2119
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Q- Teaticket, MA 02536
WILLIAM F.WELD (508)564-6813
Governor .
ARGEO PAUL CELLUCCI
Lt.Governor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t)
PART A CERTIFICATION `CElVC&
APR 2
Property Address: 35 Moss Place Marston Mills Address of Owner: F 3 1998
Date of Inspection: 3/30/98 (If different) �An pSTAB(F
Name of Inspector: John Graci Mr.Dietrick
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000)
Company Name,Address and Telephone Number:
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 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
Conditional) Passes code 310 CMR 16.303.My findings are of how the system is
y performing at the time of the inspection.My Inspection does
_ NeedjFth Evaluation By the Local Approving Authority not I-py any warranty or guarantee ofthe longevity ofthe
Fails septic system and any of its components useful life.
Inspector's Signature: Date: 3130198
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.
COMMENTS:
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, unless the owner or operator has provided the system inspector with a copy of a Certificate of
— Colhpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfillration, or lank
r 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.
(revised 04127)97j
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 35 Moss Place Marstons Mills
Owner: Mr.Dietrick
Date of Inspection:313019rt
_ Sewage backup or.hreakout.or hiah.static water level observed.in.the distribution box is due to a broken.
or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if
(with approval of the Board of Health). Describe observations:
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 watersupply 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 the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
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.
Yes No
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Digeharge or ponding of 011011110 to the aurtrice of the ground or`jurfacP watPra(1tle to an ovarloarled nr clnQgPrt
'- cesspool.
SAS is in hydraulic failure.
(reyleed 04127)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 35 Moss Place Marstons Mills
Owner: Mr.Dletrick
Date of Inspection:3130198
D)SYSTEM FAILS(continued)
Yes No
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 112 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:
You must indicate either"Yes"or"No"as to each of the following:
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:
Yes No
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 li 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.
[
1 revlaed0412D97
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 35 Moss Place Marstons Mills
Owner: Mr.Dietrick
Date of inspection:3130199
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
,c_ — 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.
x 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
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal Systens.
x _ Existing Information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is
unacceptable)[15.302(3)(b)]
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(revised 04127)971
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 35 Moss Place Marstons Mills
Owner: Mr.Dletrick
Date of Inspectlon:3130199
FLOW CONDITIONS
RESIDENTIAL:Design flow: 330 g.pd./bedroom for S.A.S.
Number of bedrooms: 3
Number of current residents: 2
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:(last two(2)year usage(gpd):.
rda
Sump Pump(yes or no): No
Last date of occupancy: We
COMMERCIAL/INDUSTRIAL:
Type of establishment: rda
Design flow:8 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: rve
Last date of occupancy: nfa
OTHER:(Describe) rda
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
pumped 1 and ahallyearo ago
System pumped as part of inspection:(yes or no)Ne
If yes,volume pumped:8 gallons
Reason for pumping: We
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)
I/A Technology etc.Copy of up to date contract?
Other:
APPROXIMATE AGE of all components,date Installed(if known)and source Information:
1989
Sewage odors detected when arriving at the site: (yes or no) No
(revised 04127)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 35 Moss Place Marstons Mills
Owner: Mr.Dietrick
Date of Inspection:3130199
SEPTIC TANK: x
(locate on site plan)
Depth below grade:3'
Material of construction:x concreate_m eta l_FRP_Polyethylene—other(explain)
If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions: LOW-115.7••w4•10••
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle: 24"
Scum thickness:8"
Distance from top of scum to top of outlet tee or baffle:6"
Distance form bottom of scum to bottom of outlet tee or baffle: tg••
How dimensions were determined: measured
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 components are structurally sound and tUnctioning property.Recommend pumping every two years.
GREASE TRAP:
(locate on site plan)
Depth below grade: n(a
Material of construction: _concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: nia
Scum thickness:nla
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:Na
Date of last pumping;,(-
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.)
Ma
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 3w
Material of construction:_cast iron x 40 PVC_other(explain)
Distance from private water supply well or suction Iin0o—
Diameter: 4•
Qomments: (conditions of joints,venting,evidence of leakage, etc.)
(revised 04(27)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 35 Moss Place Marstons Mills
Owner: Mr.Dietrick
Date of Inspection:3130199
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: ria
Material of construction:_concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: Na
Capacity: rda gallons
Design flow: rda gallonslday
Alarm level:_nfa Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
rve
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: nla
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.)
rife
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)tdo
Alarms in working order(yes or no)Yes
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
We
(revised 0412V97)
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 35 Moss Place Marstons Mills
Owner: Mr.Dletrick
Date of Inspection:3130198
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:
rva
Type:
leaching pits,number: one 10W gallon leach pit
leaching chambers,number:nra
leaching galleries,number: nla
leaching trenches,number,length: nra
leaching fields,number,dimensions:nla
overflow cesspool,number:nla
Alternate system: rda Name of Technology:_rda
Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The leach pit Is structurally sound and functioning properly.It had 3'of water In It atthe time of the Inspection.
CESSPOOLS:
(locate on site plan)
Number and configuration: nla
Depth-top of liquid to inlet invert: nla
Depth of solids layer: nla
Depth of scum layer: nla
Dimensions of cesspool: rda
Materials of construction: rda
Indication of groundwater: nta
inflow(cesspool must be pumped as part of inspection)
wa
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
nla
PRIVY:
(locate on site plan)
o,
Materials of construction: We Dimensions: nla
Depth of solids: nia
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
nla
(revlaed t14f27197)
• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
35 Moss Place Marstons Mills
Mr.Dietrick
3130198
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
(pan
y; P
Page ! of 30
.-(revised WNW) '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
35 Moss Place Marstons Mills
Mr.Dletrick
3130199
Depth of groundwater 12,
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators, installers'
X Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS maps and charts
(revised04)27197) page 10 of 10
TOWN OF BARNSTABLE
LOCATION 4aT J3' _ llqns� SEWAGE #
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p.-VILLAGIE �yi+�'r _ ASSESSOR'S MAP & LOT IUD-Q17-062
INSTALLER'S NAME & PHONE NO.
a
J\SEPTIC TANK CAPACITY c)
LEACHING FACILITYArype) 00 (size) Lcx-ck
NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER ���'l �r l�r e✓�� coli ,
DATE PERMIT ISSUED: I"-
DATE COMPLIANCE ISSUED;
VARIANCE GRANTED: Yes No �--'`
`�� -3D
No-----(V•.... YEE�7Y.........._
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
............ G"q........ .......O F.......914 Q��:f/I-- -6G C�
-------------------------------------------------
ApplarFatiun for Dispas al Murk Cnunitrurtiun rranit
Application is hereby made for a Permit to Construct �or Repair an Individual Sewage pp y ( ) p ( ) Disposal
System at: ��n
,.- 6T l3~lJO5SL�c.......... — ........ .............. ... .4.... ............ ..... ........................•-•...----------••.........---•--........................••....
Locatiyn-A dress r Lot N..
----------•------. .........�...Q� --•--------------------------------- /
/ / O ner Address
�' ' JZZSC�tL
PQ Installer Address
U Type of Building 3 Size Lot----
�d�°7 _.....Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic (y) Garbage Grinder (/k/)
a'k Other—T e of Building No. of persons............................ Showers
YP g ----•-•-•---------•-•------- P ( ) — Cafeteria ( )
.< Other fixtures -----------•--- --•-----•-----•-----------•-------•--•--------------------------------------------------------------------•- -----..
Design Flow.....................-_---__--...... gallons per person per day. Total daily flow------------? Q......................gallons.
* Septic Tank—Liquid capacity. gallons Length................ Width................ Diameter................ Depth................
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 ( )
Percolation Test Results Performed by.Llty ,_��°) E *?..(d!�UNVt Date-------��_� ________________.
a Test Pit No. L__ e�......minutes per inch I5epth of Test Pit----`�:..r... Depth to ground water_1►��^!�--__-____
Lr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------...............
P4 -----••--•-------------------•-- .. ....--
0 Description of Soil---77!s nr(` SP-� ...f'° 4--�h(�`- - - - - -- ---...- -
VW ---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------
Nature of Repairs or Alterations—Answer when applicable...._...........................................................................................
•--•----•-••...•--••••----------------------------•--•-•-•--------•---. ...........................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
'TILE
/plc•-�
the provisions of T LE 5 of the State Sanity Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complianc".-
is-supDA
e�bo4ardlf health. /
Si °/®o'� `�
------ -----••...---•••...----••......-•---•. ---• ........ .................
Application Approved By.b..?..__ :. at
-------------------------------
Date
Application Disapproved for the following reasons----------------------------•-----------------------------------------..------------------..........--•..........
--------------------••----....-------•--------------------------••---------------•-----------••----------•-•--•-•--••--••••---------------•-----•••---•--------•---•••--••-----•------•-------•••.......
// � Date
Permit No. ......&I-----------------•---•------------ Issued.----/•..°��...
oa�i
LOT 138 I
0.
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O.F.=76.
LOT 136 `o
LOT 137
10,784 SF
LOT 140
LOT 141
2 1-23-89 EVISE BLDG. & SEPTIC LOCATION - 1371 PAL
1 12-8-88 INITIAL ISSUE 1338-10 MCT
NO. DATE MCRIPMN I BY
BUILDING LOCATION PLAN — LOT 137
MARSTONS MILLS WOODLANDS
RI
BARNSTABLE, MASSACHUSETTS
FOR
of WOODLANDS ASSOCIATES REALTY TRUST
Sy�� SCALE 1' a 50' JOB NO. 1338
�o P AAU L rn 0' 50 100
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o A N'%10050�0 MON
LEFT, EL WGE do TAGM ASSOCIATES INC.
889 WnT MAIN SIRKXT CZNTICRVZU MA 026M
No.---- ...�.... Fim$ 5........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD. OF HEALTH
ai.G"." .............OF... ..rinl�"'4et f
---------------------.........................
Appliralion for UiipooFal Worka Tonotratrtion Frintit
Application is hereby made for a Permit to Construct y or Repair an Individual
pp y ( ) p ( } al Sewage Disposal
System at: Au
5. ( ?C� $/Ttx.S v v t t 5
p '••• .............................. ............d... r.........................:......................................................................
Loca i n A dress or Lot '\o
go ;Ifj
.... ... ......••• •......................••-........... .....................
x Address
g' y......t(.... ......G N................................ ......••...---------•--._.....--•--....---. ._.....----•-..._..............._..........
Installer Address
UType of Building 3 Size Lot----Ids_ __....Sq. feet
1-, Dwelling—No. of Bedrooms............................................Expansion Attic (�/) Garbage Grinder (A/)
Other—Type of Building __.. No. of persons............................ Showers
a YP g --------------•----••--- P ( ) — Cafeteria ( )
Otherfixtures -•--•-••••-----•••••----•-----•---••----------•-••••--•----••-•------------------•••••--•-••-•------------••--•-----•--•-----•.......----•---•----•--
W Design Flow..•.................� ...._...._.._ gallons per person per day. Total daily flow_-__-._-•_---�..M.....................gallons.
WSeptic Tank—Liquid*capacity_&b.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 tank ( )
'-' Percolation Test Results Performed Date..tJ��./i'f
W ----------
,_l Test Pit No. 1...5. ......minutes per`'inch epth of Test Pit °.._..�.... Depth to ground water.A-----`----.__----
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W ..............................................F_•.____-_--.-----------------------------------------
-----
------------------
•-_----_•__•••---------•-•--•-•--.
1-5
D Description of Soil.. <n i--••••_....Sn................; ........f'. 1�, a....
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 ': t E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b en issued btyftjhe board of health.
Signed.._.C- --------•--------------------------••- d X�
:,
J � /"/ ate
Application Approved By.4_1(._- ,•' : � s 1r_:.. `.. J�---------------------•--....._..... L.--C..L.-
Date
Application Disapproved for the following reasons---------------••----------------------------------------------...---------------------------------...-----•...
---------•-•---•---•••--•--...-----•--•-----••-••-•••---•------•••-•-------•••-•---•----••-••-----........--••-----------•----••-----••••-•----•-•-•-•--•----------••-•---••-•..........................
pp Date
Permit No---5/--—" ----------------------------------- Issued----f...y�� -8 --------•---•-----------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...............r........ ................OF.......... .R.�'"Ls T l V y...t
...............................
Trrtifirtttr of TompliFana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (') or Repaired ( )
by-----4 __J.........t��.r�t'or c...... q, 5�r�
-•--------•--••----•-•----------------------•------.....-----•------....------•---•-•-•---------............--------••••-•--••......--•---...
nstaller ;(�
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 No..Sl.... ................... dated-...-____.- ?�L,__._S"/}_-_--•------
EE .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANT T4T THE
SYSTEM WILL FUNCTION SATISFACTORY. 4
DATE....................... .^. 1...-. . ........................... Inspector-----------.......---`� t)...............................................
THE COMMONWEALTH OF MASSACHUSETTS
.1
BOARD---OF HEALTH
�.......................0F........6/l .i.v...a.p.�.+
.. .. ............................................
Now......... FE/
Rapos al Works Taono#rt ion rrntit
Permission i hereby granted...... _..._ � _.. of ur. ( �.. ..6.
---------------------------------------•----..._••.•----
to Construct or Repair ( ) an Individual Sewage Disposal System
r d
at No.. ° 77 1 cs t/�t'[r � x . ,..../T �Id iLc 5.,
-----• ••-------... f.......,.
Street
as shown on the application for Disposal Works Construction Pe ' Z /' d_.. r
Tr . 1-.--
..
Board o alth
DATE................. •----- .�j.---•••. = =
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS -
An J SHEET 7A OF 7
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® 1. ALL M11w!Alw W1wMl!HILL OOMIaI le 11&"
1000 GALLON SEPTIC TANK .3,AM rat vases e tr psr ors�AM
1 L r I r 1 r 1 � a w�•e100ia:a w�11�ew�cw swa ee e�alNar 1°
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SEPTIC SYSTEM PR F I- K i ` A BILL eN 110ef/0 a 01AQ
IL ALL eae BM 0►1e su"Mt$VIM NULL K cwwm
Nor is own BOTTOM a HEST NOTE Or w/wtLwer M-10 Lftaom Umm my AR unto at
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ELEVATIONS LEGEND:
Paola.sot eutl" m 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 f138 139 140 141 142 143 144 145 146 147 148 149 o11PICuw�a.eolcCo
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LN. �/ 770 74.5 1f,6 71.e 7N.e 7R,e 71/,f{ 7t.• 77 a 7B.e 7i.3 yi.s 7+i.o 'AV 11.5 74. A wo �1
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9 70.e 61.0 NA, 64J «•1 00.0 e1•f 71,9 -t.o 73•• 730 74•f 74.0 -n.f 77:5 71,3 7)►d 7rd 164 X.S - 70,o
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C 7b.1 o 69.7 ri.B ef.1 311 !,1 i Its IL7 7t.7 7s.7 74•i 7f.7 7••i 71 77•s 7*, '"A It* 7t.t - 77.7 77.1 7f.1 11 'tt3 7t(. 71.3 710.11• }.! 71.7
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APPROVED: BOARD OF HEALTH
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#NO2INInAL ISSUEDATE I DESCRIPTION BY
PERC TEST 1 PM TEST 2 PERC TEST 3 FM TEST 4 PM TEST S SEPTIC SYSTEM DESIGN
LOT 116 LOT 125 LOT 131 LOT 149 LOT!sa MARSTONS MILLS WOODLANDS
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1 10 2 INITIAL 1 ELK
\ ,r No. DATE DESCRIP n BY
BUILDING LOCATION PLAN
`\ 1.1 "Q` 1�1 MARSTONS MILLS WOODLANDS
`" LOT 110 N
\\ LOT toa
t,.am.R ; , BARNSTABLE, MASS CHUSETTS
WOODLANDS ASSOCIATES USTI
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