HomeMy WebLinkAbout0026 EVELYN CIRCLE - Health ��v
elyn Circle
trville P
A = 187 062004
12534
i
�lO 1,®531OR
HASTINGS.MN
-\ COMMONWEALTH OF MASSACHUSETTS
Ch EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS .
DEPARTMENT OF ENVIRONMENTAL-;PROTECTION. .
MAP
PARCEL ®(0 Z.O O_A_
TITLE 5 LOT '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 2 6 Evelyn Circle
CPntPrvi , , P, MA RECEIVED
Owner's Name: nnn Pa-re
Owner's Address:
�.
Date of Inspection: '' aFEg 7 2004
TOWN OF BARNSTABLE
Name of Inspector:(please print) William _ .Robinson Sr. - HEALTH DEPT.
Company Name: William E. Robinson Septic Service
Mailing Address: P O Box 1089
Centerville, MA Telephone Number: (508) 775-8776
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 S lion 15.340 of Title 5(310 CNIR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: ZU , i Date: 4fZ —1"
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 I
t
Page 2 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 26 Evelyn Circle
CenfiPryi 1 1 F MA
Owner: nnn P
Date of lnspectloni
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all orSection D s.
A. Sys inPasses:
y 1 have not found any information which Indicates that any of the failure criteria described in 310 CMR
15.303 or in 31O.CIAR:15.304 exist.Any failure criteria not evaluated are indicated below.
Yrw`s, , t?
Comments:
j
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
reps' ed.The system,upon completion of the replacement or repair,as approved by the Board of Health;will pass.
Answ yes,no or not determined(Y,N,ND)in the for the following state
explain. ments.If"not determined"please
Th septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally
unsound, xhibits.substantial infiltration or exfrltration or tank failure is imminent.System will pass inspection if the
existing is replaced with a complying septic tank as approved by the Board of Health.
•A metal s ptic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating at the tank is less than 20 years old.is available:
ND expla'
O servation of sewage backup or break out or high static water level in the distribution box due to.broken or
obstruct pipe(s)or due to a broken,settled or uneven distribution box..System will pass inspection if(with
approva ofBoard of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND ex lain:
e system required pumping more than 4 times a year due to broken or obsWucted p'rpe(s).The system will
pass ins ection if(with approval of the Board of Health):
broken pipe(s),are replaced .
obstruction.is wwred
ND cxplai
Page 3 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 26 Fva 1 yn C i re 1 e
.x3.tervillim MA
Owner; Dan. Ra
Date of Inspection: .
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is fail' g to protect public health,safety or the environment.
1. yytem will pass unless Board of Health determines in accordance with.310 CMR.15.303(1)(b)that the
stem 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. S stem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
syste 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
1ivpratc
ace 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 front a
water supply well** Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliforim
-bacteria and volatile organic compounds indicates that the well is Gee 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
ailure criteria are triggered.A copy of the analysis must be attached to this form.
3. O her:
3
Page 4 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A `.
CERTIFICATION(continued) . .
Property Address.
26 Ev
elyn e
Cen PrviIIP. MA
Owner: Don Parp
Date of Inspection:. ;1--/
D. System Failure Criteria applicable to all systems:
Yo must indicate',yes"or"no"to each of the following for all inspections:
Yes No
�. Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surfaceof 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 thin%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 SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within I00,feet of a surface water supply or tributary to a surface
water supply.
Any portion of.a cesspool orprivy 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 fect from a private Kato
supply well with no acceptable water quality analysis.]This system passes if the well water analysis,
performed at a DEl 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.]
(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. L rge Systems: .
To be onsidered a large system the system must sen'e a facility with a design now of 10,000 gpd to 15,000
gpd•
You m t indicate either"yes"or"no"to each of the following:
(The fo owing criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
— the system is within 200 feet of a tributary to a surface drinking water supply
_ he system is located in.a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
one 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,ar answered
"yes"in Sc tion D above the large system has failed.The owner or operator of any large system considered a
significant hreat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.T 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: 26 F e 1 yn cirrie
rent�rvi�le., M�1
Owner: D1@14 _F
Date of Inspection:
Check if the following have been done.You must indicate`yes"or"no"as to each of the following:
Yes —o
Pumping information was provided by the owner,occupant,or Board of Health.
_ _✓/Were any of the system components pumped out in the previous two weeks?.
t/ Has the system received normal flows in-the previous two week period?
(/ Have large volumes of water been introduced to the system recently or as part of this inspection T.
Were as built plans of the system obtained and examined?(If they were not-available note as N/A)
V _ Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out.?
r/ Were all system components,excluding the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffle;or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?.
_ _/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 S the site d p y (SAS)on s has been determrned base on: .
Yes .no
Existing information.For example,a plan at the Board of Health.
I/_/— 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)j
5
Page 6 of I
OFFICIAL INSPECTION FORM-,NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM
PART C`
SYSTEM INFORMATION
Property Address: 26 Evelyn c i r c 1_e
Ct-ni-t rvi 1 1 e MA
Owner.
Date of Inspection: 3—
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):. Number of bedrooms(actual):_
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms):3 6
Number of current residents: �--
Does residence have a garbage grinder(yes or.no):;
Is laundry on a separate sewage system(yes or no): [if yes separate inspection required]
Laundry system inspected(yes or no)?
Seasonal use:(yes or no): U
Water meter readings,if available(last 2 years usage(gpd)) 2003 21 9;-0 0 0
Sump pump(yes or no):k 0 2002 — 2 2 4 ,0 0 0
Last date of occupancy. `s '
COb ERC LJINDUSTRIAL
Type of establi eat:
Design flow(b ed on 310 CMR 15.203): t pd
Basis of design ow(seats/persons/sgft,etc.):
Grease trap pre ent(yes or no):_
Industrial wast holding tank present(yes or no):_
Non-sanitary ste discharged to the Title 5 system(yes or no):
Water meter re dings,.if available:
Last date of o upancy/user
OTHER(de ribe):
GENERAL INFORMATION
Pumping Records ,✓
Source of information:
Was system pumped as part of the inspection(yes or no):,&Co
If yes,volume pumped:_gallons How was quantity pumped determined?
Reason for pumping:
TYP OF SYSTEM
_ eptic 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,ate jnstalled(if known)andso��of information:
Were sewage odors detected when arriving at the site(yes or no):/i' �
6
]'age 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART:C
SYSTEM INFORMATION(continued)
Property Address: 26 Evelyn Ci role
S Pntar �i 1 1 a� MA
Owner'
Date of Inspection: -0
BUILDING WER(locate on site plan)
Depth below de: -
Materials of c struction:_cast iron 40 PVC other(explain):
Distance fro private water supply well or suction line:
Comments( condition of jouUs,venting,evidence of leakage,etc.):
SEPTIC TANK: Y(locate on site plan)
)
Depth below grade: _
fiberglass
Material of construction: oncrete metal
_ _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: / a LIT' Ga
Sludge depth: ._
Distance from top of sludge to bottom of outlet tee or baffle: O'L';2— _
Scum thickness: .7z `/ �J ,
Distance from lop of scum to top of outlet tee or baffle: ?f
Distance from bottom of scum to bottom
'�°f outlet tee or baffle: /. '
How were dimensions determined: O 1"iY'- - C-o i JR.S 4 n- td
Comments(on pumping recommendations,inlet and outlet tee or battle conditi ,structural integrity,liquid levels
as related to outlet invert evidence o akage tc.):
6 a cJ d.� 1 T � „� !�
GREASE T P: (locate on site plan)
Depth below gra e:_
Material of cons ction:_concrete metal Fiberglass__polyethylene_other
(explain):
Dimensions:
Scum thickness-
0
Distance from t p of Scum
top of outlet tee or baffle:
Distance from ottom of scum to bottom of outlet tee or baffle:
Date of last p ping:
Comments(o pumping recommendations,inlet and outlet ice or baffle condition,structural integrity,liquid levels
as related to utlet invert,evidence of leakage,etc.):
7
Page 8 of 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAR. TC
SYSTEM INFORMATION(continued)
Property Address: 26 Evelyn Circle
nterville, MA
Owner: Dnn Pare
Date or luspectioo: 9--Z 3 p v)
TIGHT or OLDING TANK: (tank must be pumped at time of inspection)(locate on site.plan)
Depth belo grade:
Material of c nstruction: concrete metal fiberglass Aolyethylene other(explain):
Dimensions:
Capacity: I gallons
Design Flowrndition gallons/day
Alarm prese :.
Alarm level: arm in working order(yes or no):
Date of last p
Comments( larm and float switches,.etc.):
DISTRIBUTION BOX: `4 (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,cte.):
PUMP CHA5 ER: (locate on site plan)
Pumps in wor• g order(yes or no):
Alarms in wor•ing order(yes or no):
Comments(n to condition of pump chamber,condition of pumps and appurtenances,etc.):
8 �
r
Page 9 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: . 26 Evelyn Circle
Centerville, MA
Owner: Don Pare
Date of Inspection: D '
SOIL ABSORPTION SYSTEM(SAS): t/{locate on site plan,excavation'not required)
If SAS not located explain why:
Typ _.
leaching pits,number:
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.): /7 _
CESSP (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top f liquid to inlet invert:
Depth otsoli slayer:
Depth of scu layer:
Dimensions f cesspool:
Materials of onstruction:
Indication o groundwater inflow.(yes or no):
Comments ote condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locat on site plan)
Materials of cons ction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
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: 26 Evelyn Circle
Cen ryi11 r -M-A
Owner: Damn Pare
Date of Inspection:
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.
!7
G
3
� l 5
3i
10
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 26 Evelyn Circle
CenfPrvi11P., MA
Owner.
Date:of Inspection: 4.17
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:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 eel of SAS)
/�hg�ked with local Board of Health-explain: �Y S 7' 7yo%.s 0�— G�e s
Recked with local excavators,installers-(attach documentation)
/Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
A.,LaL / o
v
Il
LESSOR'S MAP NO. Infif PARCEL
OCATION SEWAGE PERMIT NO.
V'd`LLAGE
I N S T A LLER'S NAME A ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED 30
DAT E ' COMPLIANCE ISSUED 72 /JlI
L,o
I
ASSESSORS MAP NO: _ �� -7 `¢ '
PARCEL NO.: 6 FIC$........... ..THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
------�..------------OF....... `/LS.:.. ...............................
Appliration for Bigputitt1 Workii Tanotrurtixtit ramit
Application is hereby made for a Permit to Construct (L4 or Repair ( ) an Individual Sewage Disposal
S...y..s.c — � c ax......... : _......._.._ .........._.
.. :.... A)ocas // ....
.. - ( ......c ... :..............
Owner Address
............................ S .....
Installer Address
d Type of Building Size Lot��._:6��Q.0 t....Sq. feet
Dwelling—No. of Bedrooms___..._ ..........:....................Expansion Attic t7C) Garfiage Grinder
Other—T e of Building No. of persons............................ Showers ( ) — Cafeteria ( ) ~
a Other fixtures --__•------•-------------------- -
W
Design Flow........... ..................gallons per person per day. Total daily flow.........1-_3-Q------_---___-----gallons.
Septic Tank—Liquid capacitA C?0.cxgallons 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 to )
_ r
Z Percolation Test Results Performed by.. �.�1 --�--- --1%f�PIC!�_.j Date• _•�- Ar�--...-.
0-� Test Pit No. 1 4°S .____minutes per inch Depth of est Pit.- -. Dept11/to ground water......
Test Pit No. ..minutes per inch Depth of Test Pit.�`��:_....__. Depth to ground water.__.!_
----•-----------•------•----•-••••-•Description of Soil--- - -- .--- -•--••-------•--•-•-•••--•---•••-.........................................................
O ' `���-' `
--- ._.._�'.�.�1 l
W . -------•------•--•------•---•----------•---•--•--•-•-••---•--•--------•••--------•-•---•-------•-------•-- --------- -------------
•--•-----------
VNature 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 iITL LE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance�l}as been issued by oarA�ofth.
Signed = r
--•..
Date
Application Approved BY ..........
Application Disapproved for the following reasons:_ _____
----••-•--••-•••---•-------•-••••--•............................•_,Date----•-....---
.............................................•---------_.._........-------•-•---......---------------•---- Date
PermitNo......................................................... Issued........................................................
Date
No................-....... Fss............._..... ....._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE� TH
I�1Lx.j. ................OF..... ell_5...... .f._................................
Appliration for Diopoual Works Tontrnr#ion rrmi#
Application is hereby made for a Permit to Construct »') or Repair ( ) an Individual Sewage Disposal
Sys
st
! -_ - .... ._.. ... - ........... 0 tom'
9 Location-A ess �^ r^ ......................._...bL.. _�.... ...P. .St"......--+ - ..a'..................... .. S :.......................................' =-^�
- Owner ! Address
--
W �"a e..: __...` %.�.. C• `•...... .....-••••--•--•....._ . .......:.~ � �' �w ' .............
Installer Address
UType of Building Size Lot____. .................Sq. feet
Dwelling—No. of Bedrooms____..................................Expansion Attic A7q Garbage Grinder#er)
�'4 Other—Type e of Building ______________ No. of ersons.___.____._.___.____.__..___ Showers
YP g --•-----•----• P ( ) — Cafeteria
Otherfixtures ..............................•- ...._.._._._..-----------.._.__....---•
W Design Flow.......... :... ........................gallons per person per day. Total daily flow......... ....................gallons.
WSeptic Tank—Liquid capacitj tSO.Q.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___17.............sq. ft.
Z Other Distribution box .( ) Dosin to ( ) c{
Percolation Test Results Performed by. : '__.._k y� ,'!i'�t" !! '` r
Date........................ ..............
minutes per inch Depth o est Pit.__ __. .__ Dept t
Test Pit No. 2 ______ o ground water,.. r_ .
a
fr Test Pit No. '..__.. .,minutes per .inch Depth of Test pit/_______________ Depth to ground water........................
RS ---- ....... / ...................•-•••---.........................................................
0 Description of Soil 1 :s ✓ . _61 /�.. ..-•----------------•-------......----••-•----...
ael
U c
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 TITIE 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 oard of Apdlth.
Signed__ ................................ .......Z. ...........
Date
Application Approved By................................... .........
Date
Application Disapproved for the following reasons:_ __.._____•-_•...........................................................................................
-----------------•---•---.._...._------------........--•---............•.... .........Date--•--....-•---
PermitNo...............•-----••--------•------------------_.... Issued..----:......__...-------------•-••---......Dat-.......
Date
THE COMMONWEALTH OF MASSACHUSETTS
„- BOARD OF HEA T�
...............OF... /4r ....:.........._........_.._....
Tntifutt#r of Tompliatnrr
TH�S�I. TQ CI�FY�rT�•t ��vi�lual S` �gee D�s�po�t��,s constructed ( or Repaired
� M� r Installer
has been installed in accordance with the provisions of.TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.-_._ -.....V?-........... dated__._/__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WIL NATION SATISFACTORY.
DATE............ -- Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
. BOARD OA HEALTty
1� ..�.� `4.........OF......:. _.. Cr-�"/ `' ' .......................
No.__.�1.......-•-•- . _,, .., FEE........................
Ri o work n #r�tr#' rrrAft
Permission is herebyranted-- ± " ..f..
g .................................••---..............
to Construct or Repair ( ) an divid�}ai SeWAA Disposal ystem
-• -•-
a.
Street
as shown ori"the application for Disposal Works Construction Permit No..... .......�� Dated.______.._"C .__ .. �.•.•.....
---
Board of Health
DATE = "" . -----
FORM 1255 A. M, SULKIIV, INC ,,60STON f ....a
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WELtNBERG
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/ONAL E
LEGEND �C.
EXISTINS .•SPOT ELEVATION 0,t0 CERTIFIED PLOT PLAN
EXISTIN® 'CONTOUR --- 0 --�
FINISNED. SPOT ELEVATION /
,h0?"4fYEL tJ GiGG
FINISHED CONTOUR O
�NOTE'c `The location of any, exis'ting 'unde�ound sewerage, . � �L z"�
wells, or other utilities shown on this plan is approx-t -
imate. only as determined from records and/or verbal
a A ��a � �� , ��{' +
information. The contractor is responsible for the •+'�'' .
verification of the existing locations in• the field. SCA LEI � h�v ' DATE 3-11,060
.DREDGE ENGINEERING CC�IN ChIENT. I CERTIFY THAT THE PROPOSED
EOISTERE REGISTERED IOBNo. jej/2 BUILDING SHOWN ON THIS PLAN
°� ,
CLVIL LAND CONFORMS TO THE ZONING LAWS
E
DR,9Y 0 F„EA RV . OF ` BARNSTAQLE , MASS. r NvTE)
:71.2 •MAI N STREET
HYANN I S MASS. 3 8�
9HEET.L OF DATE REG. LAND SURVEYOR
20 FT. M/N• J � NOTE .. /F EITHER .THE SEPT/G TANK DR.
^Ef+cH/ivG 'P/T ARE /✓TORE THAN /2"BE4ON/
�O � /y/N. �"-- , :.rkAOE, fa 24 O/AMETEK COiyCRETE CODER
SWALL BE BROuGyT To G/gAole �itiN EXTRA r
99•� RCTE" .0, O/Pf le,4VY CAST /RON CODER S/�.4LL !3E USEO
CCNC
co AERS I8 PE,QT� j /F DR/YENi.4 Y !!f
' - 21 MAN. CDNCRE TE
o _ 4�tAOE CC) VER
CLEAN SANS i
BAC.k'/�ILL
�4- ' StHEDut64a0 o 0 2*LAYER/�r
p.V.C. PipE G.�IL9 o a o P v
tr 'MIN.P/TCN D/ST, , o ►• ,• . . •. c o 04. yYASHED 57 IVC : >.
V4 PER/T 8 •. • • • • f 0 a
SEPTIC TANK Bp}l ' ° i i • • +
/
o ► • • p � • • • � OX
O - T f ♦ •�s i •• f o o e
.. WASHED ST E
j p Q 4 0 jo
-
tj. 7`&: S_x /U 7 s a f • • • • • • • s !� • v PREC•ASTSE.EPAGE
!N RT L A DNS �o° �'*� • .. . . •.r f s •o P/T OR EQU/V
VG E EY 7Y �„ S cJa Cr.'P.D x • a a EL�1/_= 8� 9
� h a - '—
lNYERT AT:41U/LP,/Nf q7 D/AM.'
JO/�4M. t C(SEE 7WuLA7JO/1!>
/NL ET .SEPT/C •TANK 9 G 7 fT _ i�[
xN.
Ot�TLET SEPT/C 7,AN/f "'9G "S.F�' z :t ,
INLET D)5TR/6l/j/0N BOX 6 3 FT GRDUNv ItIATEioir TABLE F '
00TLETD/STR/BUTION
"` SEN/.4GE !S'P4SA L .SYST'
EM
l/YLE7 ZEACN/Atli'' /�I T 4S 5 F�' TABULATIG/V r ;
.OIMEN.SlON R Z.' frT ,
DES/6X. CRI,TERlR P4Fr a
,...,
Y
:o
' 4
NUMBER OF BEOR OMS 3 --
GAROAGEGI5,PO5A4'(fiVtr 0 NE SOl : L.OG
•. E
TaT.a c Esri/H.aTEv F'Low 3 3 G G.►t./D. y,. SGtt L TEST. !.'✓. 3o�t TE, T#2 -%
SOIL TEST
NUMBER Cow 4.eACMIVa P/TS__1_` - .EGEti ELY, pA.TE OF Sall TEST'
S/OE LEACH �Q•� Z TDO . LLGk ELD/tED — l
RESt/LTS,h//TNESSED BY_ � S�J ,a
BOTTo/ti LEs4Ct//NG.PER P/,T 7B•S �' f .S PE/�COLAT/ON`RATE / , . 2 1y! 1IVGK
��'7 S4 Fr.' s a., �, , /vi�
TOTAL LEACHING AREA 2�7 SQ. iT AEJtCotnT/Onr iPA1TE2 MIN.�lNCH
(RESER►�E LEACNJNG AR'fA 7 SQ FT 2/ /2-
� K of1-IA i►F k� C Ct ,4 LOT 4 ,Ev LYE! G II2c L�
/t4CD.. GENT�2YiL�E.,� 6�atj0EFd'f. �,
VVMJMBERG 3 -
'A 9t0. 3fi6 a j 99 .
367
-�
EL DREDCAff A7 IV INC
MA I ni YA s, MA s s.
NO.GROU/KD kV,4Tt•R rNCOU/VT1&REO CL/.ENV CTPFEI�B(PGt�iQD.tTE