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Home My WebLink About0076 MARBLE ROAD - Health 76 MARBLE ROAD, BARNSTABLE A= 316 036 a TOWN OF BARNSTABLE (�} LOCA:T'IUN % �!�il. SEWAGE # P VILLAGE ASSESSOR'S MAP &LOT �S NAME&PHONE NO. /: Y4 4�,Yi!k`- r4- �.ON SEPTIC TANK CAPACITY Z�"O`er :X S `. LEACHING FACILITY: (type) (size) �� NO. OF BEDROOMS BUILDER OR OWNERI(1,7� i�J�' r cfWafffDATE: 40 �a ,7 COMPLIANCE DATE: 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 within 300 feet f leachin fa ' * Feet Furnished by f 1? ,y J Handles laundry kitchen and one bath. Handles Bathroom s - DATE: 3/1 /97 PROPERTY ADDRESS: 76 Marble Road Barnstable , Mass . 0263.0 On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 2-1000 gallon septic tanks . 2. 1.- Distribution box. 3 . 3-1000 gallon precast leaching pits . Based on my Ins.-*action, I certify the following conditions: 1 . This is a title five septic system. ' ( 78 Code' ) 2. -The septi system is in proper� _ • working order at .the� present time . ` 3 . Covers on th�'septic tank &__leaching pit that handles the kitchen, Laundry and one bathroom should be raised. Tank covers 31 " below grade . Pit cover 38" below grade. 4. No other repairs needed at the present time . SIGNATURE: Name:-J. P .Macomber Jn. i Company:_J. P_Macomber & Son- 7-- Address:_-Be�c-bg-----= ---,-- o --Cent S -- -- -- REcE�vEO _Phone:-- ----®- -- MAR 1 1 TOWNHEWH DEPT.BLE iD THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRA 0 � j 6 a • JOSEPH P. MACOMBER & SON, INC. Tanks-Ceupoois-Laathflelds . Pumpad & InsUiled Town Sewer Connection: P.O. Box 66' Centerville, MA 02632-0066 775-3338 7754412 Commonwealth of Massachusetts . Executive Office of Environmental Affairs Department of Environmental Protection WUllam F.Weld Trudy Cox* oo..rtwr 8wetary A W Paul Celluccl David B. Struha c e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION property Addre,. 76 Marble Road Barnstable Mass Address of owner. Date of Inspection:2/2 8/9 7 (If different) Name of Inspector.Joseph P.Macomber Jr. Com Nam Address and Tole hone Number. J.I�I acom%er & Son inc. Box 66 Centerville ,Mass . 02632 508-775-3338 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 u of the time of inspection. The inspection was performed based on my training and experience is the proper function and maiatsnaaw of onAuto so disposal systems. The system: :_ na11y Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: loam Dater The System Inspector 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 seat to the system owner And copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Cheek A. B, C, or D: A) SYS ASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicate below. B) SYSTEM CONDITIONALLY PASSES: 4� One or more system components need to be replaced or repaired. The system,upon oompl*tion of the replacement or repair, paaaes inspection. Indicate yes. no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not dstarminad",explain whey not) The optic tank is metal, cra:ked,, structurally unsound, shows substantial infiltration or extiltratio r4.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 ��Primed on Recycled Paper 71 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontlnued) Prop.rtymdre.,% 76 Marble Road Barnstable ,Mass . Owner. Elizabeth Wagner Date of IwP"tloa: 2/28/97 B)SYSTEM CONDMONALLY PASSES (continued) AQ Sewage backup or b:wkout or h0h static water leval observed in the distrbAlou boa is due to broken or obstructed pipes) or due to a broken, settled or unevan distribution box. The system will pass inspection if(with approval of the Board of Health: broken pipe(&)ars 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 systam will pan& inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is ramoved Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH; , d Conditions esLt which require Author 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. JS Cesspool or privy is within 60 feet of a surface water &Q Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh 7) 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: AlD The system has a septic teak and&oil absorption system and Is within 100 feat to a surface water supply or tributary to a surface water supply. R/0 The system has a septic tank and&oil absorption system and is within a Zone I of a public water supply well A2 The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well Qf� The system has a septic tank and soil absorption system and is leas than 100 feet but 50 feet or more from a private water supply wall,unless a well water analysis for coliform bacteria and volatile orpz&compounds indicates that the wail is &w from pollution from that facility and the presence of ammonia nitrogan and nitrate nitrogen is equal to or lass than 6 ppm. 3) �OTHER �1L1� (revised il/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 76 Marble Road Barnstable ,Mass . Owner. Elizabeth Wagner Date of Inspection: 2/2 8/9 7 D) SYSTEM FAILS: • V0 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. �(Q Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. d11 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 is the Ptribution boat above outlet invert due to an overloaded or clogged SAS or cesspool. 40 Liquid depth in oe p leis leas than 6"below invert or available volume is Is"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. 19 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 60 feet of a private water supply well. Any portion of a cesspool or privy is Is"than 100 feet but greater than 60 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: The following criteria apply to large systems in addition to the criteria above: 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: 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 /l the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 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.. (revised.11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM:INSPECTION FORM PART B CHECKLIST Property Address:76 Marble Road Barnstable ,Mass . owner. Elizabeth Wagner Date of Inspeotlon.2/2 g/9 7 ' Check if the following have been done: ,Pumping information was requested of the owner,occupant,and Board o:Health. �ons of the system componants have been pumped for at least two weeks.and the system has been receiving normal now 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 NIA- 0The facility or dwelling was inspected for signs of sewage back-up. system does not receive non4anitary or industrial waste flow The site was inspected for signs of breakout. system oomponsnts ii ng the Soil Absorption System, have been located on the site. Zile septic tank manholes were uncovered, opened,and the interior of the;septic tank was inspected for condition of baMes or tees,material of construction, dimensions,depth of liquid,depth of sludge; depth of scum. ,1._4hs wise and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. 'he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 J 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SY97EM INFORMATION Property Addresa:76 Marble Road Barnstable .Mass . / Owner. Elizabeth Wagner Date of Inspectiou2/2$/9 7 FLOW CONDITIONS RESIDENTIAL Design II ,�ow: llons,"A'l s Number of bedrooms: Number of current rwidaats: Garbage grinder(yes or no):_ _ Laundry connected to system(yes or no): � Seasonal use(yes or no):—&V _ Water meter readings,if available: S Last date of occupancy:____ COMMERCIAL/IND USTRIAL- Type of establishment:_ AM Design 1low:_.42j4_Xal1ons/day Grease trap present: (yes or no)A14 Industrial Waste Holding Tank present: (yea or no)—&Z.4 Non-sanitary waste discharged to the Title 5 system: (yes or no)A/Q Water meter readings, if available:_4)A Last date of occupancy: OTHER (Describe) le'4 Last date of occupancy:�l� GENERAL INFORMATION PUMPIN ORD9 and source of informatiQAL r -v�2 r 6' L 96i411�3 System pumped A part of inspection: (yes or no) If yes,volume pumped: /g^ ons Reason for pumping: iIJ/y' TYPE OF�fiYSTEM Septic tank/distrtbution box/soil absorption syWm Susie cesspool . Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APP ROJQMATE AG�E�r all components, date installed(if known)and source of information: Dom, Sewage odors detected when arriving at the site: (yes or no)/f,�Q (revised 11/03/95) 6 i. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C• • • SYSTEM INFORMATION (continued) Property Address: 76 Marble Road Barnstable ,Mass . Owner: Elizabeth Wagner Date of lmpection:2/28/97 SEPTIC TANK:-1�d� �� l' XS (locate on site plan) Depth below grade;,41N + 17 Cys,& o material of construction: Zconcrete _metal _FRP _other(explain) Dimensions: IF Sludge depth: f Distance from top of sludge to bonom of outlet tee or baffle.1/ne_*_ Scum thickness:—7_1:l9 t— Distance from top of scum to top of outlet tee or baffle:�/�►L� Distance from bonom of scum to bottom of outlet tee or baffle._ 71—wGe— Comments: (recommendation for pumping condition of inlet and outlet tees or bafflee. de th of liquid IPvel in relation to outlet invert, structural riry, evidence of leakage. etc.) Pump 'tanks every 2- years : Inlet & outlet tees are i'n la e : Liquid levels at t tt • taKjXp GREASE TRAP. 104,� (locate on site plan) Depth below grade:�A material of constrraiion;N?•oncrete _metal _FRP _other(explain) _ .., .),- Dimensions. Scum thickness. �- Distance from top car scum to top of outlet tee or batfle:_V d Distance from bonom nt rro- in bonom or outlet tee or baftte:- � i Comments: (recommendation for pumping, conds—n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity., evidence of leakage, etc.i_�, (lrpn sP trap i not, =rPSPn% s (revised 1/15/951 6 , y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddres.: 76 Marble Road Barnstable ,Mass . Owner. Elizabeth Wagner Date of Inspection: 2/2 8/9 7 TIGHT OR HOLDING TANI{:Aide (locate on site plan) • Depth below gra&:.AZ Material of oon",ationv( ooaerets_metal_W_other(e:plain) A Dimon.30ns: Capacity ns Design flow: n4day Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) or holing tank: Not present DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Ccmmsnts: (note if level and distrsbution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) Distribution box has equal flow in system # 1 . System 2 does no have rli et.ri hiit.i nn hnx;Nn avi r3ance of soli cis carry over: No signs of PUMP CHAMBER:4 (locate on site plan) Pumps in working orden(yes or no) NA Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addre" Owner. Date of IaspevUca SOIL ABSORPTION SYSTEM (SASI Oocau on site Plan,if posa ;auavatioa act required,but may be approximated b7 aon•intrusive mathods) If not dat=dnad to be present,explain Type: Lachiai pits,numbar�fo'�� l—J •rI Y L.ehin chambers,number. 1whia p1laries,a:rmb.r. lsaehia�trwrbes.aumbar,kD�ch iaaehia fields,number, as:_ overgow ossspool,number. M�edium sand: Nf84 sins "ot' h drauliof d"oj1 vegetation is normai. I system pits are dry. #2 sy em Has o uract.a water_ /,fin hPlow in .r CESSPOOLS:.Ala/,e, (locate oa site plan) . Number Lad ooa�urztioa Depth-top of liquid to inlet invert: Depth of solids lysr: Depth of scum lgar. Dimensions of oeaspool M.tarials of constructioa Iadmuon of vauadwater hOow(cesspool must be pumped as part of inspsct{on) ('.acennol c era nnt, present_ x COmmaat.:(note condition of 04 sips of kv&aulio f ahav,level of pandin& condition of vegetation,etc.) ('oeenr�nl c era nnt. nraSant; z PRIVY: 4�ve_ Goc"a as site plea) M.tarlal.od construction. DimansioDs 41"A Depth of solids:�jf� eommaat. (Dote oomdition of sue,�of hydmulie failurs,level of ponding,condition of vepstation,ite) I'livy is net s elq;6 �V (revised 11/03/95)• g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM PART B _ SYSTEM INFORMATION continued SKETCH OF SEWAGE L_SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Barnstable Water Company 362_6498 . s moo.zugBg satpuvH 'uqBq auo pup uauogtx sapunvT saZpuPH Z DEPTH TO GROUNDWATER 161 + depth to groundwat%r r Athod of determination or approximation: Installed new lead"hin i; ]Z 2 4; Permit 95-146 No water _ encountered �1 .nen�--n+�s•-.,�-s.wrarrr•nrrnn.-n.rrRrr�*+rnr•►+.nrr+r�*�.•nn+ne*wy s�-�n�rtw�+ .err�--rn—...-.r... I1' TOWN OF Barnstable BOARD OF HEALTH - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION I+ --.,,-.••.-: .—r.i,.-.-,-....,..+n,rn.,r„r,.s+.a+r�•r,,.--,.,vrn-�t...,.r--r.........n.r.,.,.....,..,, ...n •,..,rr.-.,.._,,,_..A , -TYPE OR PRINT CLEARLY- P11OPERTY INSPECTED STREET ADDRESS 76 Marble Road Barnstable ,Mass . ' ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME Elizabeth 'Wap�ner PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. , COMPANY NAME J. P.Macomber & Sb'h' Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 _ 3338 FAX ( 790 1 1578- 508 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent With my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : (XXXXXX4��X sys tedi-PASSED The inspection ;+hick I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con -Octed has found. that the system fails to protect the public health and the environment in, accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature pate 3/3/97 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALZ'lt. e If the inspection r FAILED, the owner or��opeator shall u rade 'p8 the system within one year ear of the date of the inspection , unless allowed or required otherwise as Q ed provided in 3.10 CFfR 16 . 306 . partd .doc �G w V THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. Junc 8, 1995 Acting Director of the W"ton of Water Pollution Control r TOWN OF BARNSTABLE LOCATION '7L M atz.bie R� SEWAGE # � VILLAGE-i�wizn4oIS(e ASSESSOR'S MAP & LOTV/9,10 jc INSTALLER'S NAME & PHONE NO. ,i, v' Son rtiC- SEPTIC TANK CAPACITY 000 LEACHING FACILITY:(type) (size) 1000 NO. OF BEDROOMS „ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: ` DATE' COMPLIANCE ISSUED: if VARIANCE GRANTED: Yes No z • r 7 A 5 r 1 3.3 r 'lJL i7 No.. �.1 .. . Fs$.....30......�..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABL.E Appliratinn for DiuVutittl Wor1w Towitrur#inn rainit Application is hereby made for a Permit to Construct ( ) or Repair XXX an Individual Sewage Disposal System at: 76...Marble...�Qad...B.axiasts ble.--•-------•--------- ------ ------------------------------------------------------------------------------------------------- Location-Address or Lot No. Wagner---------- Owner Address a J.P.Macomber Jr.................. Installer Address UType of Building Size Lot............................Sq. feet Dwellin No. of Bedrooms-----------3------------------------- ----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures -------------------------------- d W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------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 by-------- -----•-------•--•------•--...------------------------............ Date........................................ aa Test Pit No. 1.-.---_-.---_.-minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•----•••-------------------------------•---••-.....--•---------------•-•------•---•......-----•--......-----------......------------.......----•-...-•-- 0 Description of Soil...................................................................................... -----------------------------•------------------------------------....----------- x Sand & Gravel v •-•-----......-•--••----•-•--------------•-•-•--•------••--------------------------•------------------------------••---•---•-----•-••...-----------------------•--------------------•---•----------•--•- W --- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- VNature of Repairs or Alterations—Answer when applicable..----Adding-__an_-_additignal....], GJ7, - g---pit ....................................... . nk---&---pit..---•--•-•-•--•--t 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 Complia e has be sued by the b rd f health. Signed .V Da[e ApplicationApproved By ----- .... .......... ... .. .... - ------- -- ------- ........ -- --/ -- ------------------ ..:. .. . Dace Application Disapproved for the following reasons: ... . . -------------------- ------- ------------- -----------------------_----- Permit No. -- - .... Issued ..................... ...� ...�... ....... a........ Dace � +� $ 30.00 No..!-�6_._./.r. FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for DiuVu!3M1 Worim Tunutrnrtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair :((X�). an Individual Sewage Disposal System at: '76 l-arble Road Barnstable ----------------------•-•-------......-•------.....-----•-•-•-----------•--•-•-•-•-•-••••--•-_.... .-•--•-------------------•----•-•••---•-•----•-•---------•---•---...•--•-------•--.....---•••----- Location-Address or Lot No. Wactner ......................--.......................................................................... •-•-•----------••••-•-----------------••----------------•.....----..............._....---...------ Owner Address W J.P.Macomber. Jr. Installer Address UType of Building Size Lot............................Sq. feet Dwelling'y No. of Bedrooms-___-__-_-_3_______________________-_.__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ------------------------------------------------------ -----------------•----------------------•---------------•--•- W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............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 by------------------------ ................................................. Date........................................ aTest Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water....................... Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•--•••----•-------------------•--........-----------------••-----• ...................................................................................... ODescription of Soil........................................................................................................................................................................ x Sand & Gravel U ---------•------------------------------------------------------------------------------------------------- ----------------------------•-----------....-----------------------------••----------•------ W -----...---"--'-'-------'--•'-_.....•-•-----------'-••---------'--•----------'•--•--•--••-----'--•-'--•--------------'--------'....--------------------•-•----------•---•--•-•--•-•••••.........------ UNature of Repairs or Alterations—Answer when applicable.-___-Adding an addii:iona.l leaching pit tOanxlstingtank .. �a.�. ' _._ . _ ...•--------------------------•--••---------•-------•--•--••-•--••--•-----------------•-•-•--..._...._.._..........._....._. 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 Compliance has be•n issued by the board ,f health. Signed ------- �- � _... .........2./1�--7---9--------- Date �� Application.Approved By ............�. ' . ...,. y c - lis1_ --. ------... ..........A- - ' ,-..? Date Application Disapproved for the following reasons- --- -------------- -----------------------------------------------------------£................................................ ........---................_--------------( ---,;; --- `............-------------------------------"'—_------------------ ------ ------- .........-... .� .. -----------Date- ............ Permit No. ------------------ Issued I ......�.�..------------..... - ...........:........ .Date.,..r...r...�..................... C.I,X- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE QlErtifirate of Contlatianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by ..-----------J..P.tx_a.co...,,iber----J:r...-------_----------------------- -------_-----------------......_....------.---------------------------------------------.....---------------------------------- It„t:diet 7 b Alarble Road....Barn-s Barnstable ------------------_------------------------.......---------------------------------------------------- at .. ---------------------- -------------- has been installed in accordance with the provisions of TITLE 5 f The Sty nvironmental Code as described in the application for Disposal Works Construction Permit No. .._.... ..�-..-1..... _. ....._.. dated ......_...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTR E AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- ..'- �.�..--... -�" - Inspect~- :./ f...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. TOWN OF BARNSTABLE FEE $ 30.00 � .. !. O .............. I r �iu�uu�t1 ur�u �unu�r�.r#iun �rrmi# T.P.t1acomber Jr. Permission is hereby granted ------------ --•----.... to Construct ( ) or . epa'r (`X) an Individua Sewage Disposal System r 5 iaro.�e 'foal' '4arnstab .e atNo------------------------------------------------------------- ----- ------------- ----------- /-----------------------------------------------.-------- Street C / as shown on the application for Disposal Works ConstructionnPermit N,o.�__-/. Dated............................. . ------------- no - / / (r Bo of Health ti. DATE--------- l (J�:( , ------------•--•---- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS