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HomeMy WebLinkAbout0092 ACRE HILL ROAD - Health )2 Acre Hill Road `. Barristabie A_297 - 059 DATE 5/31 /06 PROPERTY ADDRESS 92 Acre Hill Road Barnstable MA 02630 �� On the above date, the septic system at the address above was Inspected: This system consists of the following: 1., 1-1000 gai eon zeRt.ic tank. 2., 1-/ izi-2-igut•ion Box., 3o 1-1000 gaiPorz eeach.ing 121tz Based on inspection, I certify the following conditions: 4., 7h.iz .i-6 a 7.it ee T ive zefit.ic zyztem (78C0A&) 5., Septic tank iz .in paope2 woak.ing oade2 a f'the paezent time., 73 c: SIGNATURE = W.a Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 CH P. MACOMBER & SON, INC.Tan ks-Cesspools-LeachfieldsPumped & Installed Town Sewer Connections x 66 Centerville, MA 02632-0066 77$-3338 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION a TITLE 5 OFFICIAL INSPECTION FORM—.NOT.FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM FORM PART.A CERTIFICATION Property Address: . 92 .Acre Hill Road Barnstable MA 02630 Owner's Name: John'Petrueciorie Owner's Address: Same Date of Inspection: 57 31 /0 6 Name of Inspectors(please print? Robert :A Pao-1 n�i Company Name:_2. P-Aacomgez S:o.n _rnC, Mailing Address: Cen eay.c e, a�sb. 02632 Telephone Number: 5 0 8-7 7 5=3 3 3 8 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 1040 of Title 5(310 CMR 15:000). The system: XXX passes — Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: Date: -CIO 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. Title 5 Inspection Form 6/15/2000 page 1 Page 2ofII OFFICIAL INSPECTIONYORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIFICATION(continued) Property Address: 92 Acre Hill Road Barnstable MA 02630 Owner: John Petruccione Date of Inspection: 5/31 /0 6 Inspection Summary: Check A,B,C,D'or.E/ALWAI'S�e-dmplete atl of Section:D A. System Passes: ytS NO I have not found any information which indicates'fhat,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: Septic zyztem .iz .in paopea woAk.ing oadea at the. /2aeze.tn time., B. System Conditionally Passes: NO One or more system components as described in the"Conditional Pass".:section need to be.replaced:or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. NO The septic tank is metal..and,over.20 years old*or the septic tank(whether metal or.not)is:structurally unsound,exhibits substantial inf ltration or exfiltration or tank failure:is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank,as approved by the.Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: NO Observation of sewage backup'or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled 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 br replaced ND explain: NO The system required pumping more than 4 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 ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR .VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 92 Acre Hill Road Barnstable MA 02630 Owner:. John Petruccione Date of Inspection: 5/31 /0 6 C. Further Evaluation is Required by the Board of Health: No Conditions exist which require further evaluation by the Board-of Health in.order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless!Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: No_ Cesspool or privy is within 50 feet of a surface wafer No__ 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 any)determines that the system is functioning in a manner that protects the public health,safety and environment: No The system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet.of surface water supply or tributary to a.surface water-supply. No The system has a septic tank and SAS and the:SAS is'within a Zone 1 of a public water supply. No The system has a septic tank and.SA&and the SAS is within 50 feet of a private water supply well. No The system has a septic tank and SAS and the SAS is less than 100 feet but 50-feet or more from a private water supply well**. Method used to determine distance visual **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. 3. Other: 3 r - Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 92 Acre Hill Road Barnstable MA -02630 Owner: John Petrucci one Date of Inspection: 5 1 /0 6 D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"to each of the following;for all inspections: Yes No _ X 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 thel 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 an overloaded or clogged SAS or cesspool _ X Liquid depth in•cesspool is less than 6"below invert or available volume is less than'/S.day flow X Required pumping more than 4 times in the last year.NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply.or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone l of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X 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 wateranalysis, 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 forlp.] No (Yes/No)The system fails.I.have determined that one or.morei'iof the above.failure_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 serve a,facility with a design flow of 1.0,000 gpd to 15,000. gpd• You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"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 under 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 92 Acre Hill Road Barnstable MA 02630 Owner: John Petruccione Date of Inspection: 5/31 /66 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No V Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in.the previous two weeks? X _ Has the system received normal flows in the previous,two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS,located on site? X _ 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? X _ Was the facility owner(and occupants if different from 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 X Existing information.For example,a plan at the Board of Health. X _ 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)) 5 Page 6 pf 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 92 Acre Hill Road Barnstable MA 02630 Owner: aahn Petrucci ane Date of Inspection: 5.13 1 /(Lti FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): . 3 Number of bedrooms.(actual): . 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3.3 0 Number of current residents: 2 - Does residence have a garbage grinder(yes or no):y ee s Is laundry on a separate sewage.system(yes or no):a_Q_ [if,yes separate inspection required] Laundry system inspected(yes or no):aa_ Seasonal use:(yes or no): no 200.4::=40,. 000 gai eonz G%D=109.i 5 9 Water meter readings,if available(last 2 years usage(gpd)):200 5=3 8,'000 ga iioaz G%D-e 104.E 11 Sump pump(yes or no): Last date of occupancy: 122e,3ent~" COMMERCIAL/I1bUSTRIAL Type of estabJ sbment:. N 1,4 Design flow(bas'ed on 310 CMR 15.203): gpd Basis of design"flow(seats/persons/sgft,etc.):, Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system-(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records - Source of information: N/a Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X 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): Approximate age of all components,date installed(if known)and source of information: 1978 Were sewage odors detected when arriving at the site(yes or no):a 0 6 Page 7 of l l OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 Acre Hill Road Barnstable MA 02630 Owner: John Petruccione Date of Inspection: 5 31 06 BUILDING SEWER(locate on site plan) Depth below grade: 3 6" Materials of construction:_cast iron _40 PVC X other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): ao.in.tz appeaa t.igh.t no eedkage., Vented .thltough house Vent., SEPTIC TANK:_(locate on site plan) Depth below grade: 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: Sludge depth:_ Distance.from 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): — GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: 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: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page$of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 Acre Hill Road Barnstable MA 02630 Owner: John Petruccione Date of Inspection: 5/31 /0 6 TIGHT or HOLDING TANK:NO (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: „ Material of construction: concrete metal fiberglass .polyethylene. -other(explain): , Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present-(yes or no): Alarm level: Alarm in working order(yes or no.): Date of last pumping: Comments(condition of alarm and float switches,etc.): 7.igh.t oa hoid.ing tanks ate not /2aezent DISTRIBUTION BOX: Ye (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert. Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): Box .is ieve o Ha-6 1 .Pate2ae,, N.o noiid caalttlovelt oa ieka e in. oa Out o� kox" PUMP CHAMBER: N.0 (locate on site plan) =-. Pumps in working order(yes or no): Alarms in working order(yes or no): Comments((note condition of pump chamber,condition o1;pumps and appurtenances,etc.): l um/2 chamgelt .is not .Rae,3ent 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS — . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 Acre Hill Road Barnstable. MA 02630 Owner: John Petruccione Date of Inspection: 5/31 /0 6 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located 16ee /gage 10., . T,y P a leaching pits,number: •C 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.): Loamy to medium zand., No z ignz o� �a.iiwze., :So i e,3 a2e day.i ege con 1 � no2ma CESSPOOLS: NO (cesspool must be pumped as part 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(yes w no):. Co�t�ments(note condition of so)'1,signs of hy4raulic failure,level of ponding,condition of vegetation,etc.): C.e4,312oo b a2e not /2aeben PRIVY: NO (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.): l IL ivy i,6 not /24eZent 9 11 �. 5x� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTA ' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPC 5. PART C " SYSTEM INFORMAT'I.ON(continued r .......... � 92 Acre Hill Road y Property Address: . Lh Barnstable MA 02630 �.... 'Owner: John Petruccione n Date of Inspection: 5/31 /0 6 `�, N xL'• ' SKETCH OF SEWAGE DISPOSAL SYSTEMx f Provide a sketch of the sewage disposal system including ties to at least two #* g P Y g benchmarks.Locate all wells within 100 feet.Locate where public water r � } K�L J j h t ' 391 3 0 SO, 10 I II Page 11 of 1 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART.0 SYSTEM INFORMATION(continued) Property Address: 92 Acre Hill .Road Barnstable MA 02630 Owner: John Petruccione Date of Inspection: 5/31 L0.6 SITE EXAM . Slope Surface water Check cellar Shallow wells Estimated depth to ground water� feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: u e.3 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board.of Health-explain:n g u Q_t _a2d no Checked:with local excavators,installers-(attach documentation) 1,[_e.3 Accessed USGS database=explainh t t12:t o wn.I g a a n s to g.2e,,ma..,u s You must describe how you established the high ground water elevation: 11.sed. : Cape Cod Comm.is.ion ldatea 7ag-ee Coritouas And Puktie Vatea Suppiy Veii head paoteet.io-n _azeas mal2o Sept 1995 Vatea aezouzeez ot,ice cage cod comm.i6.i0n.1 Top of Cround Leaching Pit sect ty Groundwaterf ofeet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frim ter Method . ._ P Therefore,the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table isk � feet. 11 •I111nT•Irn,71",17��7R+�J1/innR1�'7nfM WIN I flog r---` TOWN OP BARN,STABLE BOARD QP HEALTH r SUBSURFACR REWAOR DISPOSAL# SYSUM INSPECTION FORM - PART D•*• CERTIFICATION «•rn�r•tiK,+� ant'roe+runnw•wnnrs�a � •.•�.►•-r• -TYPE 01 PRINT CLEARLY- PROPERTY rNSPWTHIQ STREET ADDRESS 9re Hill Road Barnstabl,e63�,�_�,_^ A•SS•ESSORS MAP, DLQ,C3K AND 'PARCEL, OWNSR.'9 NAME John ccione PART'' D 08IiTIFS0ATX0N NAME 'OF INSPECTOR Robert A PaolInj COMPANY NAME J-6a nh.:P: Ma(-Q.mhar A:.•Son ` •• •� Tnc�32.._-0>`p�7�:�ox 66 C rville M 2 .0 i6COMPANY ADDRSSS � AW4Toim-or y. LISP COMPANY TELZPHONE ( 508. ) �7.5 3338 FAX 1' 508' :1190 f 578 . CERTTFICATION. STATEMENT I certify that I -have personally .inspected ..the sewage 'digpopij. system at this nddress and that. :t )Q information reported .is true$, ggoara•te•, and omplete al of the time .q.ftinspect,ion.s. The in;gevtiorn was performed and any recommendatlons regard.ini .upgrade•, .ma•intens.noe,' abd repair •are• congis'tent with my training and experience in thq proper function' acid maintenance of on- site sewage disposal systems. Cheo-k one: ystevl PASSED i S , The inspection whic.M • . have .•conducted has .,n-vt- found any information . which indicates that :the system' fails to ' adequately. protect .publi•c = health or the envlropment as defined in- .31'0 CMR. 1C30.3•s My failure cri•ter.ia *6t •evaluated* are as stated in the FAI'LURM' CRI'iMA .seeti"n o•f this form. System FAILED* The inspec•tioh which I have 960. lirtted 'has'-`found that the System fails to protect the public Health end tho enV,i.roninen•t • in aogo'rd•ance with Title 61 310 CMR 15 . 305, and as • specifically noted -on .PART' C �►. FAILURE CRITERIA of this i cti ,n Inspector Signature' Date ne• copy of this cacti,f icaU41i must -be Erovidad U .- the .QWN99•, t �9 wn— where appi l kca•ble) and t•h* BPARD OF HEA Tll. „ •• * if the inspection FAILZ-b., 'thb - 9 .owneV.Or " A 041 erator . 3, upg•r00''•the system. within one year of the date of the inspection, unleso. allowed Qr- req li,red . .•,t.harm{se. as urovided in 110 CMR 16 ,306 ,. LO CATION - SE E PE MIT N0. 0 T -P I /4-C = i L L r(l) VILLAGE biz/t/�-Tiq/3t�� 6 �7 INSTA LLER'S NAME i ADDRESS lV l=TTD/2/,o-o llgo5 T-L BTU K D E R OR OWNER { DA T E P ER MIT I S S U ED 22 DATE COMPLIANCE fSSUED 1 r � I t 3 • , 0.1 \J •too . ✓O t 07� Fimis 1-41 No.. :...... .. .... ...... THE COMMONWEALTH OF'M4ACHUSETTS BOAR® OF HEALTH �OGU-./.j................OF....... ...---------------------------------- � fir #ilan fur Dinpu.sa1 Works Tomarnrtiun Famit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at ,�{pQ r // T ACe._&-�Z-...... .Ca: _..�. .....`.. il�l2.�k:dd��� ..........5o.. .f......... _ ..-Lo N. '----•-----•----....---•-•---•---......-- • •-•-----.. Location-Address or --• o. ..................................................... --... _.P►cwsTq E...... ......................................... Owner Address Installer Address Type of Building Size Lot..5.Z.42/.....Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic (fVO) Garbage Grinder (IV4 p., Other—Type of Building ..Nl.^............. No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ................................... �'ORo W Design Flow........... /�P_......................gallons perg�erson.per day. Total daily flow---------_.7J_� ?.____.._.._____.._._gallons. WSeptic Tank—Liquid capacity/Ml O.gallons Length 6._.67 Width¢f.--/V...-- Diameter---------------- Dep th..$.!®e` x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......Z---------- Diameter... ............ Depth below inlet......la._. ._..... Total leaching area.R-03;;�....sq. ft. Z Other Distribution box (L< Dosing tank ( ) '-4 Percolation Test Results Performed by--7TAZ7V-4-C-1—) .__.A--..C—ld.g:��41?- .......... Date.. C1;......ll;,0.l��� 0.4a Test Pit No. L-e—'.--Z...minutes per inch Depth of Test Pit....f. ....... Depth to ground water.... Test Pit No. 2................minutes per inch Depth of Test.Pit.................... Depth to ground water........................ ----------------------------------------••-------•------•-------------------..........-•------_.............................................................. O Description of Soil............0-7:.-3••.....e,af -------4.1V-Z-......5(1__Aff-SZ.t°- .. V - ................................... " lt`'' / . ........ ••--------------------------•-------•--•--•---------------------------------•---------------.....-•--------.......-•------------•-----------------•-•-----•--------------•-••-.......................... 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-E- 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 health. Si ned..... . .. .....•--•---••----....... .-------•----...............-•-----•••---••--_ ------ ....�--.----- ---- �0(!14L— Date D'a'te�Application Approved BY �. •-- ----•--••--------•----•--- .� - Date Application Disapproved for the following reasons:.......-......................................................................................................_ ............................••-----•-•--------.......---------------•-----....---•--.....---------------------------------••--- •--•------•----- ------------•-••-••••---•--------•----•-----•-•--- Date PermitNo......................................................... Issued �......... ....... :. - Date C7P) THE COMMONWEALTH OF MASSACHUSETTS ;..:.., BOARD OF HEALTH OF......�«? RW.S.74.54.e.................................... Applicatiom is hereby,made for a Permit to Construct (1'') or Repair ( ) an Individual Sewage Disposal System at ACR.611_..._ : . . ......... ....... -- ....................................................... t Location-Address or Lot No. ...................................... .......... 1ST.�IS L........................................................ `1 T Owner Address a Y ..)..�e Q _10. .......................... p Installer Address ` Type of Building Size Lot_ _1._. ,f......Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic (+kA) Garbage Grinder (�+d) p.l Other—Type of Building JQ/..A.............. No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. meshw' -- ------------------------------------- -------------------•----- W Design Flow...... Z ......................gallons per^per n pier day. Total daily flow.........-3 3.0....................gallons. WSeptic Tank—Liquid capacityt!Q.gallons LengthA....46.0 Width'' �14.`... Diameter________________ Depth. ��... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..... ..... ...• Diameter..&.'......... Depth below inlet....�a............ Total leaching areaA.q....sq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by. ?Vt4K_4�.....1i1 A_.<5.�. OA.A.......... Date_.0.1C%...... �r.i9>$ 1.4 Test Pit No. Lee -7-_....minutes per inch Depth of Test Pit / _...... Depth to ground water.._ Gz, Test Pit No. 2................minutes per"inch Depth of Test Pit.................... Depth to ground water........................ �+ --------•------------------------------------------------------•-------------------------•---•--••--......................................................... 0 Description of Soil----....--0...... ._e..0.4, !......A.l1t.0..-----�v +a r!�----------------••------------------------........------. x .............................................3........ ...........t'C e._V.e..-----.SAzS SAN.Z>................................................................................. W .......................... •---------------•--•-•-•-----------...........--•---...---•--------•.--•-------------•------------------•-••---• ......•................................................... VNature of Repairs or Alterations—Answer when applicable............................................................................................... t Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT LE 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 health. Signed i Date Application Approved By.. ------ --- _7 *-- Date ................ Application Disapproved for the following reasons:--........................... ---------------------•--------.-------------•-----------------------------------------------------------------•----------------------------------------------------------------------------------------- I Date ' Permit No......................................................... Issued........................................................ Date ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............I.0.kOP...........OF.... ........................................... Tr tifirttte of Tome iaurr THIS IS TO CERTIFY; That the Individual Sewage Disposal System constructed ( �or Repaired ( ) Installer LILI at..... ----------------------------------•---------------- has been installed in accordance with the provisions of TI r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No�.C � dated � + ' ......... THE ISSUANCE OF THIS CERTIFICA' E SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ s.. --------•-•---- ,.Inspector__:._..-•--•--------------------------------.---------------------..................................... THE COMMONWEALTH OF MASSACHUSETTS Y' BOARD OF HEALTH :^.cam. Qw1a.............0F.....1�''IK.SST.. ,. _........................._............ ,raJ NV x.... FEE. ...3 ""'.... Permission is ereby granted......QE.Rnkl.LID:.f 2OS. ................... to Consfr ct: (i or Repair ( ) an Individual Sewage Disposal System k •. at No.......- &--. E------"k1 . ...... 1QA15T 1. ---------•------------------------------- -1:J Street as shown on-tlie application for Disposal Works Construction mit o.____. Dated_«._/4}-:a- 7,0_.•.... Board of lth�yr''3"'-....r-------••-•--___-•••� DATED �7 - � { -mow • . FORM 1255 HOBBS�-& WARREN, INC., PUBLISHERS r` THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A- 7 IL DATA TEST . HQl -01 7/ PrZo P0.sc,�' kill n LlAT�tZ (�J1ti1 k . SEPlYC zoo LEA C N A7 T tci '6sy L- _�--.��_ �.. 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CC�-.�:-� /� /4'` 4�/FONT L ¢ -lit!` M/!ll /4"�Faor - �00°, I'WAS NEc7 100 _ j GA L Doi IAJ VFe r G �` 4 /N✓�T CAi�4G / 7-Y _ II A n o v,vo ff Y -- - - P/7 / zr NO -- GA)e5A0;,E - - ----- ---- 20' /►i//✓/A4 u.A4 2-v a 7-� )ti SE,r->7 TAn/.0..__ :� t�! - 8 1�..-- 3!/ _ PAGE" ��----- - Y} 1 N. PL - �5 OUTLETS A,`/J �E�IC�//n1C� T � s ST2EAVaTiz/ 0000 S_ - ''--- �. c\ $ ;'. STEEL �OOUD r3>' Zo .Z CERTIFY TH r E EXISTING FOUNDATION 5 CbrzRECT AS SNOtON Ali! LOCATION / � DOES C(.)NFORM TO THE 1?01�-DIN6s C-� ;-, , _._--- - - - -- -_ -- - - SETBAICX 9E4v'IRCMEA175 OF. 'rP E 70 WN OF BP RN 5TA 13 LE, � �::�'�`;�rry,T��0, -- v G� l 22 N 1 ( STAKE — GS LANE SET BRAG - — NO2 47'10 b' ~yy —'n LOCUS el.i !145.00� � STAKE r : SET — MID-CAPE HIGHWAY I CERTIFY TO -THE BEST OF MY 1 I PROFESSIONAL KNOWLEDGE, INFORMATION LOCUS MAP I I AND BELIEF THAT THE LOT CORNERS., ! DIMENSIONS AND SETBACKS "TO THE NOT T❑ SCALE STRUCTURE AS DETERMINED BY I INSTRUMENT SURVEY AND AS SHOWN ON I THIS PLAN ARE CORRECT. _RECORD LOCUS INFORMATION I I I • wl C 1 CURRENT OWNER: PAUL W. & JANE C. SWANSON STAKE SET vl of I TITLE REFERENCE: BOOK 21465, PAGE 128 ml clq N N I PLAN REFERENCE: BOOK 311, PAGE 11 �l I STAKE a I I SET ASSESSORS MAP: 297 20' 1 PARCEL: 59 SrocKADE ZONING DISTRICT: RF-1 (O"ITT 2oI6) I PROFESSIONAL LAND SURVEYOR DATE SETBACKS: FRONT 30' SIDE 15' LOT:, 8 II REAR 15 STAKE I (05 7,171 s S:F. I �, MINIMUM LOT SIZE: 43,560 S.F. SET I z ! I NDWATER OVERLAY DISTRICT: GP w I I STAKE 1 64.3 I SET pK °5�0 THE STRUCTURE IS LOCATED IN ZONE C, � d AS SHOWN ON FIRM COMMUNITY PANEL 10) 55.8GARAGE 8� CERTIFIED �� k�tL�{�� ,4DD Ir�or.� PLOT P 250001 0005 C, EFFECTIVE DATE: 8/19/85 cv ' 1.5 STORY 33,1 �N coI�— — #s2E ° I LOT 9 GAS I AT EXISTING METER I LOT 7 DRIVEWAY / I / n #92 ACRE HILL ROAD CB/DH — / — — — ►� FND I I / — ^— —,'Jl 0 ZD, 40' IN ! / BARNSTABLE STAKE I i S SET I 02 4710^E AKE MAS SAC H U S ETTS 5 5.00 SET 12 ' STAKE (BARNSTABLE COUNTY) T I � / 0 r LITE - Aw I i 00 VFwx VE 5 o — 3o x45 fox 45 N MoVst LE ISLAJJD � � N Cl- ro bp ro cow. r SLOPE j SLOPE GerL ruE�y cnMPci*N�� I IVA t.L5 R Zv A.00F X 4 9 ,Fi.002 A3,0 f CAI.AZJNGf 4A4x u-32 cE/z rNCi S re-? JI, i �xcsr x C . . f FIRST rL,qv/Z PiAu i 9 L 46 k6- N ELL QD z � - 3-2xG �o5r BRRIv�r�}g��, .vt�F OZ`3o Ier W 4 4-O ' C A-<<p CbP C^j 1 NCB — — — — — — —— K/ - - - `- S ccIqAuSanl Sr�2uc TuRaL, /eve, -JroF-, ��Go JZ�i5/2olB BEAM 07 br. 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