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Home My WebLink About0115 HARBOR POINT ROAD - Health 115 HARBORPOINT RD, BARNSTABLE u . = 352 030 o r • - a c :. , -. � :, �it ,, a • -.,.':. ._, .- •.. � ` c 7, • :'.-.. � -nG{"a., Y. .., ` „t.. �. .. , .. ', ! 1 :: ... .: w` , ,r , L • a i Z , a , �r n o r , , v [ 7 a r _ , ,� a �.�' f� - ,�. ..,, o ,. - ", �;• �, .•.": q- Y Kati 4 o• r S do Date: g_ 0 -R q TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: T-HE 5Ttx1>10 BUSINESS LOCATION: 115 fjj12(3ok P-1 P-b CArAMj46kW+C) M4 02,&, 7 MAILINGADDRESS: P000X 8j2 Mail To: TELEPHONE NUMBER: 570 -3&2-)2-44 Board of HealthTown of Barnstable CONTACTPERSON: SUSrt®v DNTaR! P.O. Box 534 EMERGENCY CONTACTTE TELE PHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: 1-ko-i0_A-Pukt 7c_ Prr_rS S8-9yiGE Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) _ Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes N® PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M A�C(, I Z:� / ' ' L DATA Commonwealth of Massachusetts Executive Office of Environmental Affairs8 1997 Department of Environmental Protection Wllllam F.Weld xe c;ov«n« Argso Paul Celluccl �- -- vid 8.Struhs U.Gorsmor f ComrnW@kWW SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION P®1N o Property Address: 115 Harborpoint Rd, Barnstable Address of owner. Blair Date of Inspection: 3 (If different) Name of Inspector. W.E. Robinson. SR Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA 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: /Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: 4�u Date:-3 —;-/-r7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 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] SYS PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 'sr• Any failure criteria not evaluated are indicated below. c B] STEM CONDITIONALLY PASSES: '' I m,One or more system components need to be replaced or repaired. The syste upon completion of the replacement or repair,pr' Indicate ,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain W The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,.or tank imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic by the Board of Health. (revised 1 /03/95) 1 •}?r. i A One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Teler?, . �Ait Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) PropertyAddresec 115 Harborpoint Rd, Barnstable Owner. Blair Date of Inspection: 3 B]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled 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 pestBoard of Health): broken pipe(s)are replaced .obstruction is removed Cl FUR ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: nditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the blic 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) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) ETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply 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 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. , S) OTH IM (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 1 5 Harborpoint Rd, Barnstable Owner. Blair Date of Inspection: 3 D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. 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. _ Backup of sewage into facility or system component due to an 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 an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number 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 I 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 YSTEM FAILS: e following criteria apply to large systems in addition to the criteria above: 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 and safety and the environment because one or more of the following conditions exist: 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 H of a public water supply well) The owner or ope for of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 3 4 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST propertyAddeem 115 Harborpoint Rd, Barnstable Owner. Blair Date of Inspection: ]^� Check if the foing have been done: the information was requested of the owner,occupant, and Board of Health. ZNone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. i/m built plans have been obtained and examined. Note if they are not available with N/A. facility or dwelling was inspected for signs of sewage back-up. _f e system does not receive non-sanitary or industrial waste flow ,2The site was inspected for signs of breakout. 1 system components, excluding the Soil Absorption System, have been located on the site. 'he septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or gees,material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. i/The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. i (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION property Address; 115 Harborpoint' Rd, Barnstable Owner. Blair Date of Inspection: FLOW CONDITIONS RESIDENTIAL. Design flow: j LL'gallons Number of bedrooms:4 _ Number of current residents:�1. Garbage grinder(yes or no): R=0 Laundry connected to system(yes or no) Seasonal use(yes or no):_ Water meter readings,if available: 1994' — 1995 172 , 000 gals. , 000 gals. Last date of occupancy: 3 9I PoJ 7 COMMERCIAL/INDUSTRIAL:- Type of establishment: Design flow:_gallons/day 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: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: ZA System pumped as part of inspection: (yes or no)_ If yes,volume pumped: gallons Reason for pumping: ✓ TYPE QF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow owspool Privy Shared system(yea or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: !D Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Addnmm 115 Harborpoint Rd, Barnstable Owner. Blair Date of Inspection: SEPTIC TANK: (locate on site laa P ) Depth below grade:� Material of construction: +iooncrete—metal—FRP—other(ezplain) — e Dimensions: 't 6 Sludge depth: / 0 " Distance from top of sludge to bottom of outlet tee or baffle: �l' scum thickness:` Distance from top of scum to top of outlet tee or baffle:_�� Distance from bottom of scum to bottom of outlet tee or baffle:- Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,-structural integrity, evidence of leakage,etc.) ems- X A- U 3 7- VIC 1'0 'C O E TRAP:_ (locate n site plan) Depth ow grade: Material f construction:—concrete—metal FRP other(explain) Dimens' no: SCAM en: from top of scum to top of outlet tee or baffle: Distan m bottom of scum to bottom of outlet tee or baffle: Comments: Oecomman ticn for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence o leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART C SYSTEM INFORMATION(continued) property Address: 1-15 Harborpoint Rd, Barnstable owner. Blair Date of Inspections 3®�I-q TIG , OR HOLDING TANK:_ (lxate site plan) Depth be grade: Material f construction:_concrete_metal FR.P_other(explain) ions: Capaci gallons Design w: gallons/day Alarm 1 1: Comore (couudi ' n of inlet tee,condition of alarm and float switches,etc.) . �DISTRIBUTION BOX._ i (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal,evidence,of solids carryover,evidence of leakage into or out of boa,etc.) PUMP C BER:_ (locate on si plan) Pumps in wor ' order:(yes or no) . Comments: (note ooadi n of pump chamber,condition of pumps and appurtenances,etc.). (revised 11/03/95) r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA RT C SYSTEM INFORMATION(continued) property Address: 115 Harborpoint. Rd, Barnstable Owner. Blair Date of Inspection: 3 ro2 / 7 SOIL ABSORPTION SYSTEM(SAS):v (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching Pits,number: leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool; number: Comnents:.(note condition of soil,signs of hydraulic tati failure, level of ponding condition of ve ,o 4- S 1 a +� i 3 ' T , y ge on, J /6 e 0 �L- 6 ►— W � bL� O CESS LS:_ (locate on s plan) Number and nfigurstion: Depth-top of to inlet invert: Depth of soli layer. Depth of scum layer: Dimensions of pool: Materials of nstnution: Indication of water: (cesspool must be pumped as part of inspection) Comments: (note ndition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY:_ (locate on site p ) Materials of oo n Dimensions: Depth of solids Comments:(note edition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrese: 115 Harborpoint Rd, Barnstable Owner. Blair Date of Inspection: 3 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' zo A � II al I J` ^ Y.1 a DEPTH TO GROUNDWATER Depth to groundwater. 'b°l feet . 2 method of determination or approximation: (revised 11/03/95) 9 LOCATION! // SEWAGE PERMIT NO. 40 7- VILLAGE INSTA LLER'S NAME ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED , - DATE COMPLIANCE ISSUED FRONT q7 r �� / .. ......g FEs.... d............... � h� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ✓. .........OF.....I �/STi l'��................................. Appliration fur Diipn,sal Workii Tnnitrnrtion 1hrmit Application is hereby made for a- Permit to Construct (L-1 or Repair ( ) an Individual Sewage Disposal System at: ¢ 11 .... .---•............... -----•--........----------........_......... ........................................... Location-Address or Lot No. .............................. --•-Sr�� / �zo��-? `Zia s s . ...........-•--•.....-- Owner Address W Installer Address Type of Building Size Lot.Z h?a........Sq. feet Dwelling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ . W Design Flow...........6-5.........................gallons per person per day. Total daily flow...........94e.....................gallons. WSeptic Tank—Liquid capacityZaiPt,5�..gallons Length._.: ........ Width. /6 Diameter................ Depth.-5-�8 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 ( ) 9 y Percolation Test Results Performed by...�;_ ?? ._ 1.. .......................... Date..// , 7 ,.-1 Test Pit No. 1._L..Z.._.minutes per inch Depth of Test Depth to ground water...... (i Test Pit No. 2. ..Z...minutes per inch Depth of Test Pit... Depth to ground water-------............. �+ ----------------------------------------------------------------------- ................ ------........................................................ 0 Description of Soil......a.�.'.-�6.g.".... �'y_Sa13:5—e- � G •-•-------- ---- - •--••--------•----- - - ---- --------------------•-----------------------------------•------------ U -----------------------------------/G 8"-_zzz". i ..._!'�<`f%T .....S.9?L- -----------•--•----•-----........--------....-------•----•-----............ W -- - -------------------- -------------------------------------------------------------------•---------------------------....-------------------------------------------•--------------------------------.-- 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 iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is ed b e alth. igned-- . -•....../...... ....... ................--------• ....... T------ ApplicationApproved By---- ----------------------- ------------------------------------------•---......•••--•.----•- .._ ......... Date Application Disapproved or t following reasons:.............................................................................................................. ..................................•-•----...........---------...---•--------------...........-----------•-----------------•-----...•------------------------------------------------- ------.....--••-- Date C PermitNo.......................................................- Issued_........................................................ Date ----- ------- ....... No '- - FEs.............................. S THE COMMONWEALTH OF MASSACHUSETTS .BOARD OF HEALTH ............ .........OF e f.ST Applira#ion for Dhipaii al Workii Tonotrnrtion umit Application is hereby made for a Permit to Construct (,,,� or Repair ( ) an Individual Sewage Disposal System at: .............../3 ,..............2 _i_�_o__&.!T_:-__Z�__'�-'a1Cr� ,,r is►: +c.i .... ----•------------------------------2 ..'_'.�.�1........................................... Location_Addres or Lot No. s .- - .............................. •- __ Z �r j ...r!`r�. s----••-•--•---•--- W Owner Address a .............••••...-•--._...•-•-...••••-•-..._...._..••`•-•--•----•••--••-•._...-•-............._ Installer Address UType of Building Size Lot_2-1- 7.4?______._Sq. feet 2- Dwelling—No. of Bedrooms..............9.........................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow__.....__..�_,�__________________________gallons per person per day. Total daily flow............ .....................gallons. WSeptic Tank—Liquid capacitv.lop4_gallons Length_.. Width. Diameter________________ Depth__S._'I;�".. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area..._.__.____._..._..sq. ft. Seepage Pit No---------/---------- Diameter._.__.q_�__.__ Depth below inlet......_4.......... Total leaching area..Z.C.7__.._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) //�-/e aPercolation Test Results Performed by--_ : ':3 !?T...._. c ___________________________ Date..W—/If$ z-.............. Test Pit No. i__A:_._Z_...minutesperinch Depth of Test Pit._ZZZ_'..... Depth to ground water........................ fs, Test Pit No. 2.4•:_.?-.__minutes per inch Depth of Test Pit... Z. Depth to ground water......................... ----_--•-•-•-----••••........................•--•._...•---•-......_. D Description of Soil....... 14.8'` 4o,!".j•-5c.! -••-f ••---• g �--•-----------•---••-•---------------••-----...._.__........__---•-- 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 Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued b t e board o lth. ned •-----....-•-•••.._...•-- z/ !`..._ D./ 5 Application Approved By-==- l�;E .............. -..._........-----------•-_---... - t Date Application Disapproved fp th f ollowing reasons:----•-----------------------•-------------------------••------•-----......................................... ............................................... --•--•--•--•---•-••-•••-••-•--••--•-_. -----•••--•--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD�OF HEALTH 'T.u(• /...........OF......... .. ?4�'��ST 3LG'........... (9rdif iratr of Tontpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (6..�''or Repaired ( ) .i by.. .� ------------------------------------------------------------------------------------------•-•-- ,,/ /r , nsta.ier at__.. t�� /G' ' 'C `--�' -----•-------------•-------- _- _- ------------ tary Co e a de cribed in the application for Disposal Works Construction Permit No.__ rf .................. dated_., _. �___..______._._.________. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. /� DATE .- 1.' ................... Inspector •l u - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.. �j T li0/�'.......0F.......i-//i^J?�t�. �`_T/a [,C ....... { b r� FEE; Lf................. Disposal Vorks Taono#rnrtion Vprrmit Permission is.hereby granted.................... ----- ----•--•-----••------- ---- -- '' -----•- ......... to Construct (raj'or' parr ( �ldua) Se) e a posalf stem 5 i at No.- ' ! ----- -... tr -- aStreet as shown on the application for Disposal Works Construction Permit .Nor........._......... Dated.......................................... c._• 1/� Board of Health DATE............................--/�--/-�---((-//-�.......................... FORM 1255 A. M. SULKIN, INC., BOSTON A�PRO 1�1 L>O 17 I ig i Ze b-Z.-V 1p= Tw 'rH N p-8-4z N, 5z I A, Alort-- /01.0 elA."D, 72> 13 -17 k 0 /2�L,P. P-1313 774"3 p*RVPC.Se-P 31-oo 7A,04 p ZoT S-7- Mo 7-6- -5-17-6- ZOe-9 r/OAJ -6--- SC,,9 t.,r D-17a 9W4 SIVo vlAl eA.1 -7-T53Oov L ARD G .27-C&7Z77,rX 77/4-7— 77-l-&- KELLEY 7;L-Ae-- KL 25100 9�''1ST- 7viv^/ 0/:r 1` •SN6Z`7— Z o/= Z .5HeCZ1s TOP OF FOUNDATION e CONCRETE COVER CONCRETE COVERS n o 4' CAST IRON 12"MAX. ` 12"MAX. ' • PIPE OR 4"ORANGEBURG(OR EOUIV.) o EQUIV.)— MIN. PIPE- MIN. LEACH �i o PITCH I/4'�PER. PITCH 1/4"PER.FT. PIT ono PRECAST NVERT a a LEACHING `•o EL..Zz• ... INVERT INVERT o . e•; PIT OR SEPTIC TANK DIST. EL..ZZ.,lZ EL?./.87 • ' >_ EQUIV. o INVERT "" BOX — . . . . . . .. GAL. INVERT •, q� c~ia 0: .•� 3/4 TO 1I/2 INVERT w w o. •:•• � EL Z/.7o, �U. : WASHED w � .;'• STONE ' 8 -- —6 1 DIA. —�-� o• o , ., /o, DIA- PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM HeQ/f�L //V TN 4= NO SCALE Aw'n �o'Beyo•�0 rp �t SOIL LOG WITNESSED BY : DATE Bq///P.L 100A/, �!�i a20,/,e.S BOARD OF HEALTH .ism-icy C�'e,wc TEST HOLE I TEST HOLE 2 , • . �•-•/2, .S/N.•e�.��/ ivC. . . ENGINEER ELEV. .28r . . . ELEV. .Ze,.�. . . DESIGN DATA : S�l3-So/c. NUMBER OF BEDROOMS . . . . . '? . . . .2 Z O . . . �,L� TOTAL ESTIMATED FLOW . . . . . . . GALLONS/DAY eGAy BOTTOM LEACHING AREA SO.FT. /PIT SIDE LEACHING AREA . . �88,Sv SO.FT./ PIT GARBAGE DISPOSAL (50% AREA INCREASE) WNiT� SAGA TOTAL LEACHING AREA . ZG? �. SOFT " •� PERCOLATION RATE 955. ??�!1� ?Ik!Q MIN/INCH 222 c2 . 9.yo ZZz ez, I.70 /Vo .WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .. SO.FT. NUMBER OF LEACHING PITS BOARD OF HEALTH 77^/v •JcEZ7� G� .STD!n/� Gam/ .A2G APPROVED . . . . . . • - • • • . . • • . S/aE3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE . AGENT OR INSPECTOR OF M`� CRAIG �y ?� D E.RD SG ' �� RAYMOND SHORT GN �� Cj• �' ✓ H0.26100 ti �No. 274830 ti /STF-� PETITIONER : ��.� . �+� 81�9j� ��•�( � (r�