HomeMy WebLinkAbout0306 CAP'N LIJAH'S ROAD - Health 306 Cap'n Lijah's Road
Centerville P
A = 193 110
— ------- — — —-- -- ----- -------
�` e
llll
UPC 12534
No.2` 1,_5o0R
MASTINOS.NN
i 43 RECEIVED
,
COMMONWG;AI.A.11-I of MASSACI-IUSC'f`i'S JUL 3 1 2003
EXI''C:U`I'IVI'. OI'I ICI: Ol' ENVIftONMI;;N'I'AI � I �RNsTABLE
r1 DEPT.
DEPARTMENT OF ENVIRONMENTAL PROTECTION
_ Map:_193_ Lot:
Par:_110_
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:_306 Captain Lijah's Rd.
_Centerville_
Owner's Name:_Albert Makkay_
Owner's Address: _same
Date of Inspection:_7/24/03
Name of Inspector: Dion C.Dugan
Company Name:_ 1543 Main St.
Mailing Address: Brewster,MA 02631
Telephone Number:_508-896-9390
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
_X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 7/24/03
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 die 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: *Recommend garbage grinder be removed.
*Recommend: Maintenance pumping 3—5 yrs.
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Page 2 of I l
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:_306 Captain Lijah's Rd.
_Centerville_
Owner's Name:_Albert Makkay_
Date of Inspection:_7/24/03_
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
N/A 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.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration 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:
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 or replaced
ND explain:
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)arc replaced
obstruction is removed
i
ND explain:
Page 3 of l 1
OFFICIAL INSPECTION FORM. - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:_306 Captain Lijah's Rd.
_Centerville_
Owner's Name: Albert Makkay_
Date of Inspection:_7/24/03_
C. Further Evaluation is Required by the Board of Health:
N/A 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:
_ 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 any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the.SAS is within 50 feet of a private water supply well.
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
**This system passes if the well water analysis,performed at a DEP certified laboratory,for colifonn
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:
1
I
• Page 4 of I l
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:_306 Captain Lijah's Rd.
_Centerville_
Owner's Name:_Albert Makkay_
Date of Inspection:_7/24/03_
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
_X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_X 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 1/2 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 1 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 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.)
_NO_(Yes/No)The system fails.I have determined that one or more of 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: N/A
To be considered a large system the system must serve a facility with a design flow of 10,000 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
_N/A_ the system is within 400 feet of a surface drinking water supply
_N/A_ the system is within 200 feet of a tributary to a surface drinking water supply
_N/A_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-1WPA)or a mapped
Zone 11 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 sliall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS
Pagc 5 of 1 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.
PART B
CHECKLIST
Property Address:_306 Captain Lijah's Rd.
_Centerville_
Owner's Name:_Albert Makkay_
Date of Inspection:_7/24/03_
Check if the following have been done. You roust indicate"yes"or"no"as to each of the following:
Yes ` No
_X_ _ 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 7
_X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the
condition of the bales 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
distancc is unacccptablc) [310 CMR 15.302(3)(b)]
Page G of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM. INFORMATION
Property Address: 306 Captain Lijah's Rd.
Centerville_
Owner's Name:_Albert Makkay_
Date of Inspection:_7/24/03_
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_R DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms):_854_
Number of current residents:_3
Does residence have a garbage grinder(yes or no):Lyes_
Is laundry on a separate sewage system(yes or no): no[if yes separate inspection required]
Laundry system inspected(yes or no):_no
Seasonal use: (yes or no):_no_
Water meter readings,if available(last 2 years usage(gpd)): 2001:_175,000: 2002:__151,000
COMMERCIAL/INDUSTRIAL: N/A
Type of establishment: N/A
Design flow(based 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:_pumped 4/5/99 owner
Was system pumped as part of the inspection(yes or no): 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
NO 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:
_Installed_7/9/91 (12 years old) B.O.H. Records _
Were sewage odors detected when arriving at the site(yes or no): NO_
I
huge 7 of l 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:_306 Captain Lijah's Rd.
_Centerville_
Owner's Name:_Albert Makkay_ ,
Date of Inspection:_7/24/03_
BUILDING SEWER(locate on site plan)
Depth below grade:_30"
Materials of construction:_cast iron X_40 PVC_other(explain):
Distance from private water supply well or suction line:_N/A
Comments(on condition of joints,venting,evidence of leakage,etc.):
_Joints are tight,venting is through the roof,no signs of leakage.
SEPTIC TANK:—YES—locate on site plan)
Depth below grade:_18"
Material of construction:—X_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: 1000 Gallon_
Sludge depth:_2"
Distance from top of sludge to bottom of outlet tee or baffle:_28"_
Scum thickness:_3"
Distance from top of scum to top of outlet tee or baffle:_6"
Distance from bottom of scum to bottom of outlet tee or baffle: 11"
How were dimensions determined:_by tape and rod
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Recommend tank be pumped next year.Tank and Tees in good condition,no signs of leakage.
*Recommend: Maintenance pumping every 3—5 yrs.
GREASE TRAP:_N/A_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:
Continents(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of I l
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 306 Captain Lijah's Rd.
Centerville_
Owner's Name:_Albert Makkay_
Date of Inspection:_7/24/03_
TIGHT or HOLDING TANK:_N/A_(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.):
DISTRIBUTION BOX: YES_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:_0"_
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.):
D-Boa is level and distribution is equal,with some signs of carry over and no signs of leakage
PUMP CHAMBER:_N/A (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 of pumps and appurtenances,etc.):
i
}
Page 9 of I i
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 306 Captain Lijah's Rd.
_Centerville Owner's Name:_Albert Makk_ay_
Date of Inspection:_7/24/03_
SOIL ABSORPTION SYSTEM(SAS):_YES locate on site plan,excavation not required)
If SAS not located explain why:
Type
_X_leaching pits,number._two 6'a 6'pits w/stone
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.): no signs of failure.
CESSPOOLS: N/A—(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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
*Recommend: Maintenance pumping every 3—5 yrs.
PRIVY:—N/A(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Continents(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
Page 10 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:_306 Captain Lijah's Rd.
_Centerville_
Owner's Name:_Albert Makkay_
Date of Inspection:_7/24/03_
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building.
A a
317
3q �
I� = 56
O \ � r - 27'
Id
O
F
W �{
70
r
Page I 1 of I I
OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 306 Captain Lijah's Rd.
_Centerville_
Owner's Name:_Albert Makka_y-
Date of Inspection:_7/24/03_
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 22 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
_X—Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
By U.S.G.S Atlas H—A 692.
YLLO_COT ION SEWAGE PERMIT NO.
i �✓. w s
TILLAGE
I N S T A LLER'S NAME i ADDRESS
_ Cftc. 3l .2ss Cd►,� lr�sA�4's
BUILDER OR OWNER
DATE PERMIT ISSUED 3lj /fir
DATE COMPLIANCE ISSUED �
r,
� s
363
ISoo c&L f4Nk LO*4 2V-
,hso o �• ��f !�•.
4 )-- '1� l� TOWN OF BARNSTABLE
q
:LOCATION SEWAGE # 491-
VILLAGE ASSESSOR'S MAP & LOT f
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIWATER
sh
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED:`,, Yes No
71
P �
�' `(7 �-,
No............y:_....._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF..........................................................................................
App iration for Elhipug al Works Tnnitrnrtion Permit
Application is hereby made four^ a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sys: .a f . ,, .'.` .. - ......
L!- _. - -•------•-------
V� 'tom .. .ocati n-Address :j!J /�'o, Lot�To.� /`�
/ _ F/
- - 3 l -= = - * =%V.... . . ..../--..........
Owner Adddress
Installer Address �e �/
Type of Building Size Lot...---../.......... ....S feet
UDwelling=No. of Bedrooms.._.......�..........................Expansion Attic ( ) Garbage Grinder_-..(-^ '
p� Other—Type of Building ............................ No. of persons..........._................ Showers ( ) — Cafeteria ( )
Q+ Other fixtures -- ---------- --------------- .
d �...... ..... --------------•----
W Design Flow..........................,.__ D gallons per person per day. Total daily flow....................................._gallons.
WSeptic Tank—Liquid cap�ci .._......gallons Length...//:...... Width................. Diameter---------------- Depth................
x Disposal Trench—®oG_.. G�_�r Width.................... Total Length....e............ Total leaching area....................sq. ft.
Seepage Pit N .�__4.___ diameter.................... Depth below inlet.................... Total leaching area__._..__._.___.___sq. ft.
o.
Z Other Distribution box (` ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date.........................................
aTest 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........................
R' ................................................................................*---------------•---------------
.------
-.-....
-----
----•---------------------
0 Description of Soil........................................................................................................................................................................
0 ..
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 TLME 5 of the State Sanitary Code— The undersigned tftvtl:er agrees not to place the system in
operation until a Certificate of Compliance has been ' by e-bo alth.-----
�,/ e
�Application Approved BY ------ ........................................
� Date
Application Disapproved for the following reasons:------•--------------------------------•----------------------•-------------•---•-------- ....................
--------------------------------------------------------------------------------•--••-•--------------------------------------------------------------------------------------------------•-
Date
PermitNo._-........ /o y--•---•----•-------------------- issued.......................................................
Date
s .
No..... 1..:.._...... FEs .��...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........."--."........"...................OF.............--.......................
Appliration for Dispntial Works Tonstrnrtiun unfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................_.....................-.......................................................... .........._....-•---••--...........••--••-----........---•--•••--••-------.....--•---.....---••---
Location-Address or Lot No.
--••------•-----------.........................................................................•• -•....-••-•.........._......•................••-_....'--•-.....••---•......................_.....
Owner Address
W
Installer Address
Type of Building Size Lot............................Sq. feet
DwellingNo. of Bedrooms............................................Ex anion Attic— p ( ) Garbage Grinder ( )
Pk
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ----------------•------------------.....--------------•-----•••••-•-•----•-•-------•--•••-••-•••-••••---.....-•-•••••••--••-••••-•-•-........_-•----
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.
Other Distribution box Dosing tank
Percolation Test Results Performed b ..................
( ) Y (•-•-)--••••-•--......-•-•••-•-••----••••••--•........._. Date........................................
W
Test Pit No. I................minutes per inch Depth of Test Pit..................... Depth to ground water........................
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •-•••••••----••-•-..................................................................................•-• - ---------------
•••............
_.....
-----------
0 Description of Soil.......................................................................................................................
..............................................
W
V .............................•••••-••••-•...••-•••••---•---•••-•••-•-•-••-•..........--•...-•-•--•-- .....-•-••••••---........---••---••-•-••-•••---•----••••••-••--•-•-•.....••••....-•--•--•-----•--•-.
W
---------------- --------------------------------------------------------------------------------------•-------------------------------...............................................................
U Nature of Repairs or Alterations—Answer when applicable..............................................................................I.._...............
--•------------------•--------------•--.....--------------------------...-----------.......------------•.....----------------------------------•---------------------...------•---••••-•--•--•-.....-••-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE
p S''of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued�y the board of health.
Signed...................................................................................... ................................
Date
ApplicationApproved By........ - ....-_.......................................................................
Date
Application Disapproved for the following reasons------------------------------------------------------------------------------------------------•-•......•.....
....-••.....................••••••.._...•••-••••--------••-••-•-..._.......-•---......-••...-•••••-••---.•••--•-•--•----•-_.._._..•-----•••-•---•-•••----------••••-••••--------••••-------••••••••_._..
Date
PermitNo.....�........_./r -•--••........................ Issued_.----•--------•------------------•-••-••-•--•..._•-----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Ou HEALTH
j........ .....OF.. .. /............................
%Tlrrfif iratr of Tlantpliatta
TT, TO E TIF , That the Individual Sewage Disposal System constructed (4")or Repaired ( )
- ---- -- -
by -----•---•--------------•---•-•----- -------------------------------------------------
at.... . •. /ye e{ y to er
has been installed,in accordance with tl�'provisions of T j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.��f.l�__ �.................. dated_-5. __:_,�7:__XZ..................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIO ATISFACTORY. ,
DATE Q� Inspector. '= 1 I
--••- �' l........................ Inspector
COMMONWEALTH OF-MASSACHUSETTS
'* BOARD OF HEALTH
71
............................................................ ..-w
No.._..._ °.Y........ FEE..........
.W71.....
Raposal Works Tonstrnrtion rrntit
Permission is hereby granted........e'._'�....._._`.f'�'"�'/ f C.f
to Construct (X ) or Repair ( ) an Individual Sewage Disp sal Sy to /
at No......... 11�/............. !(3 1".-..........................................L 1J��, ...r t"t r� >"G`l C/e- �� ......
Street
as shown on the application for Disposal Works Construction`N'r'mlt No..................... Dated.... . � .?,.- ...••....
i
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.;--PUBLISHERS` r ,tyr�,�;
3
. ......, ... <,: -..•� •_ i� rit' �'air Y
m
r
SNEET of
,�►
,SPIV �-I JA I-I S tZoAD ��
1 Sq
t
r.
l00%
Yak �^ E�PrY►t)S I DA) I
.4; Q\ O o ;
Y Y!
L \ 2 THOM.AS yG
`4 p
' KELIEY N
tlu.44260 Q
CIS
ss�ONAL
LOT#z3
I OF
Q6 a /
'� ? N. OF
kn
M �
'• Y, �csr� THOMAS G,
L
�FQ1ST����
�7k0 SURq�O
Lo T 24
47 '11io.-OAS E.;KELLEY C-0.
ENGINEERS—SURVEYORS
344 LONG POND DRIVE
SOU'I'H YARlvSOUTki,MASS-
01664
pi-
k �
\ 1
LOCATION . CCNTERv1 Ltd (`'JABS•
' SCALE . l��. 30.'. . . . . DATE .MY'O /M
PLAN REFERENCE . . .. . ... . .
PLAN linoK
3q cRaS�Y F�►�l EASr CNARlES . . .. . .
SAvrTRy - SuRVEYof? 60(GV5TV 073
Fop ,CHA?LL4,5. .F . STANCE`(,
I CERTIFY THAT THE
SHOWN ON THIS PLAN IS LOCATED ON THE aROUNO
AS SHOWN HEREON
;` GHARLES F STANLF-Y
y ���A PAN L I JA H'5 ROAD DATE . . . . . .. . . . . .. .
PETITIONER:-fCENTERV I LLE1 M ASS. 026322 REGISTERED u►No SURVEYOR
'\Al
SHe_e`.T 2 or 2
L.
TOP OF FOUND ION CONCRETE COVER
° CONCRETE COVERS
e 4"CAST IRON IZ MAX. OJT 12"MAX.
• PIPE (OR
" 4 ORANGEBURG(OR EQUIV.) `
EQUIV.)— MIN. PIPE- MIN. LEACH
PITCH 1/4"PER. PITCH 1/4*PER.FT PIT PRECAST
LEACHING
c N"rl INVERT � PIT OR
EL... t a.•• SEPTIC TANK �INVERL.O DIST. T w EQUIV.
o'- EL... . .�. . 6 BOX ELF...¢ _s 0
INVERT b 0 O GAL. 1NVER.T Q a.. Q ••: 3/4°TO I I&
�gla�v
EL... -71. INVER . w w WASHED
EL....�2.. ';� w� \ STONE
-
T
W DIA.
DIA.
i1/b
PROF1 LE OF GROUND WATER TABLE
SEWAGE DISPOSAL - SYSTEM �orro�y fir
NO SCALE
SOIL p LOG �WITNESSED
P.BY :
DATE �IfI�•j'J.? l TIME.9! /9. •4'• .IV BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 TF�prtiPrS t_� ,.l�ELCE�✓. ENGINEER
ELEV. . . . . . . ELEV. .. . . . . . . ..A V'W bCC,AL�9 02
(7oPs'o,C.� ToPSo1L DESIGN DATA
O� SUBSoIC, S(�gSo�l. NUMBER OF BEDROOMS
TOTAL ESTIMATED FLOW . . . . GALLONS/DAY
� n
O� 4
m BOTTOM LEACHING AREA 7o'.SD. SQ.FT. /PIT
SIDE LEACHING AREA . . . .I.8Q
. �.'s'aSQ.FT./ PIT
GARBAGE DISPOSAL (50% AREA INCREASE)
TOTAL LEACHING AREA ��'l50 SQ.FT
/ •i /AA �l PERCOLATION RATE 4C:s$ T7�P. .4? MIN/INCH
— LEACHING AREA PER PERCOLATION RATE .J�Q�. SQ.FT.
/IUD.WATER ENCOUNTERED NUMBER OF LEACHING PITS .O. 0Z7.P1T (.
r
APPROVED BOARD OF HEALTH TLA-).a•�T Q F
_ /sG4ToA3S. =. . . . . . . . . . . . . . . . . . . .
DATE . . . . . . I UIL
AGENT OR INSPECTOR
OF A%
f�T THO' A
o K h
THOMAS V•KELLEY CCU. 4260 �
1.• �� f►.�G�1� . . . (� ( ENGINEERS-SURVEYORS
C'/STE �
346 LONG POND DRIVE FFSS/ONAL E��\
PETITIONER / ,C/ �lh►� ///d SOUTH YARMOUTH,MASS. /
01664
3.