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HomeMy WebLinkAbout0011 FAIR OAKS ROAD - Health 11 Fair Oaks Road Centerville A= 168-092-005 SMEAD No.2-153LOR UPC 12534 atl,COM • glade In USA tISH "mumfI%4 'FIRM mwm Gfummomm COMMONWEALTH OF MASSACHUSETTS EXECUTIVE.OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 11 Fair Oaks Drive Centerville,MA`02632_ Owner's Name: Estate of Osborne Marney Owner's Address: Date of.Inspection: March 23, 201J Name of Inspector: (Please Print) James M.Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Centerville,MA 02655-6049 Telephone Number: (508)862-9400: 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: ✓ )'asses Conditionally.Passes N ds Further Evaluation by the Local Approving Authority � i Inspector's Signature: Date: April l7. 2013 The system inspector`shall sub t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of compl g 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 Forin 6/15/2000 page 1 P Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 11 Fair Oaks,Drive Centerville.M4 Owner: Estate of Osborne Marnev Date of Inspection: March 23, 2013 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ 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: 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 yearsy 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,settle`u 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: i The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken:pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 11 Fair Oaks Drive Centerville,MA Owner: Estate of Osborne Marnev Date of Inspection: March 23, 201 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 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: F 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen'and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: t 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 11 Fair Oaks Drive Centerville,AM Owner: Estate of Osborne Marney Date of Inspection: March 23,2013 D. System Failure Criteria applicable to all systems: You must indicate either"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 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 isi less than 6"below invert or available volume is less than%z 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 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 1 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. [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.] i . 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 whatiwill be necessary to correct the failure. E. Large System: ; 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 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 II of a public water.supply well If you have answered"yes"to any question;in,Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the',appropriate regional office of the Department. 4 ,i Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: I Fair Oaks Drive Centerville,MA Owner: Estate ofOsbo'rne Marnev Date of Inspection: March 23, 2013 ii Check if the following have been done: Youimust indicate"yes"or"no"as to each of the following: Yes No ✓ 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? 4' . ✓ _ Has the system received normal flows in the previous two week period? w ✓ Have large volumes of water,been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for�signs of break out? ✓ _ 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 baffles 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? 7 The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ` ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 1 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: I Fair Oaks Drive Centerville,AM Owner: Estate of OsborneMarnev Date of Inspection: March 23, 2013 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): N/a Is laundry on a separate sewage system(yes or no): N/a [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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: .Unknown ; COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): . epd Basis of design flow(seats/persons/sq/ft etc,'): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/a Was system pumped as part of the inspection.(yes or no): Yes If yes,volume pumped: eallons=-i.How was quantity pumped determined? Reason for pumping: Maintenance TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool 5: Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology.'Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Date of installation - 1986 Were sewage odors detected when arriving at the site(yes or no): No 6 l� Page 7 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SlgSTEM INFORMATION (continued) Property Address: 11 Fair Oaks Drive Centerville,MA Owner: Estate of Osborne Marney Date of Inspection: March 23, 2013 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) a Depth below grade: 18" Material of construction: ✓ concrete metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" t Distance from top of sludge to bottom of outlet:tee or baffle: 30" Scum thickness: 5" 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: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.). The Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet.tee or baffle: Distance from bottom of scum to bottom of'outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage;etc.): 7 4 , � 1 j Page 8 of 11 ,f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 11 Fair Oaks Drive Centerville,MA Owner: Estate of Osborne Marnev Date of Inspection: March 23. 2013 TIGHT or HOLDING TANK: None (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: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: = Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): None found PUMP CHAMBER: None (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.): 8 f Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 11 Fair Oaks Drive Centerville,MA Owner: _ Estate of Osborne Marnev Date of Inspection: March 23, 2013 SOIL ABSORPTION SYSTEM(SAS): e ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 6x61000 gal. with 2 `ofstone ver design 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.): The pit had 6"of water on the bottom. There did not appear to be any signs of failure The cover was 10"below Trade CESSPOOLS: None (cesspool must 1$e.,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): n Comments (note condition of soil,signs ofhydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: 9 Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): y1 9 7 1 .� Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 11 Fair Oaks Drive Centerville.MA` Owner: Estate of Osborne Marnev Date of Inspection: March 23, 2013 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. sk,6,r hack � Q i O O 3 as yy a as 301 3 0 a� u . 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: 11 Fair Oaks Drive Centerville,MA Owner: Estate of Osborne Marnev Date of Inspection: March 23, 2013. SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+1 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: Topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain:! You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 20+/-to ground water at this site. r e This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 i; is TO OF BARNSTABLE LOC ON I �Ax(, AAr,� SEWAG E# VILLAGE ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ,�IT �X(o (size) C—� S� NO.OF BEDROOMS 3 OWNER MA r/1t PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist orr site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) J Feet FURNISHED BY �S Wrl OrCa �� �3 iDe�k i I a 3 � Q O 3 -�o ;n `O No ..f THE COMMONWEALTH OF MASSACHUSETTS _ BOARD O�F�; 1HEALTF-L� � I .�.�".dV...............OF.... C IC�U�2 ..& b.................._..._... Appliration for Kh"viial Works Tontrnrtion Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at ................_. ` on. eS .L � !! {�.JIR l._ ►;l..... or Lot No.. .�.bk.:. .. .Address ........................................ Installer Address Type of Building Size Lot....•... �5..L_-......Sq. feet ..� Dwelling—No. of Bedrooms..............�.�_._........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building p., yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aa' Other fixtures ................................... ...... ......................... Design Flow...........L.1 .....................gallons per �r y. Total dajly�ow...........-a?�d.D.. .......-.-.. 110> . Septic Tank—Liquid capacity. .gallons Length... .NCO..... Width:.`a.�... Diameter................ Depth.4:..0.... x Disposal Trench—No.............:....... Width..........._...... Total Length........... Total leaching area.........�.7 .sq. ft. Seepage Pit No.__....._..�....... Diameter...... 1 . 3 epag _. _..... Depth below In1et.....�P_......_.... Total leaching area.�..`.�.�sq. ft. z Other Distribution box �) Dosing tank ( ) ''" Percolation Test Resultssr-- Performed b 1.4 Test Pit No. 1..�....._._.minutes per inch Depth of Test Pit...... Depth to ground Ca: .... D th ound water........I�l P P j...... .- fi, Test Pit No. 2................minutes per inch epth of Test Pit.................... Depth to ground water........................ O Description of Soil.....Q.. -� k( �4r•.. U ..------•- �0_.'..1.�z�!lF ............. _.........._.. ........ .................. ............ ........................•--------- - -..................------ ... . .............. 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 LITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in op on ntil a Cert''sate of ompliance has been issued by h of health. Signed... .. .. ................. .?. �. ._.... . .. ............. . ..... 1 do A roved � ... �.i..`. .------• Date Application Disapproved for the following reasons:......................................•----••-•-•--•-•-..................................................._.._ ......................................................................................................^�� .....................................--••--••---..........--•-•-........-•--...................... Date Permit No...---- _ �.. �.:.[�•-•-•............._ Issued.......................----..-...................... Date _ THE COMMONWEALTH OF MASSA HUSETTS BOARD OF HEALT ....... .7.. ...................................... - a� No.��..��.....C.). —. ...�I .....................OF............� .. 1F .«."_ Maps Workil (91111 #r ri �erutit Permissionhereby granted......... ... .1.._._1....----•---....... _........_....._.........-..._.......................................... to Construct ( or Repair ,(_ ) an Individual Sewage Disposal System ........... .. 5_. r .� i�nF��S Street as shown on the application f r Disposal Works Construction Per t o Dated..' ...�� ..... ......_.... ....._... o d of Health DATE.............. ... ----6-------------------------- THE COMMONWEALTH OF MASSACHUSETTS w BOARD OF HEALTH G,.1 !v O F...........��....�—. .�.......'..`..�.la..��,.. ............ (Intififit#r of Tompititurr THIS IS IFY, That(the� T?jaSewage Disposal System constructed ( or Repaired ( ) by.....*,*,*....--1 .. at........ ......... 1`� -G . Mir .. )��.... �4C t6 has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal;�Vorks Construction Permit I�'o..... ���`?..'. r?` ...... dated......... .-�....r� ^........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. h� 6i? ��� Inspector.....l I. ...............................---........................ y ..... ....: ..... I1 , THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.. . .... ........... - ......---..---- .��ftrtt#ion for Disposal Works Tonstrudion Frrmi# Application is hereby made for a Permit to Construct �( j or Repair ( ) an Individual Sewage Disposal System at• r. ................_ Location.Address ....................................................or Lot No. ............ ................_: ( Lpct� �afT.- -lk-�*;,1���.-- �ai�f��A... .._......---•--...... ............_..... .......Owne Address •\ M Installer Address ? 11 Type of Building Size Lot.-.......�.................Sq. feet V Dwelling—No. of Bedrooms.............. ........Expansion Attic ( ) Garbage Grinder ( ) e G4 yp of Building .................... No.. of persons............................ Showers ( ) — Cafeteria Other—T ( ) p' Other fixtures -------------•-------•-•----......d.......A.-•---..._..._..............---............._............................................................. Design Flow....... # _. _....... gallons per pie onpe r day. Total daily(flow.......... `� ................gallons Septic Tank—Li ,capacity :gallons.a Length._.............. Width '�� Diameter:............... Depth� ..... .. x Disposal Trench—No. .. : ... W>dth' Total Length .. ` ....... Total leaching area...f` sq. ft. . 3 Seepage Pit No............. Diameter 4 r7� _-Depth below,inlet...�.!:!.......... Total leaching area..:�?.�_:1q. ft. Other Distribution box Dosing f Dosing tank`( ) �-- aZ -,�' �k JE J� � 1 1' f � S. Percolation Test,Re"salts, Performed by.. _, �r f �. #;,.... Da e:...._._....�.....I a Test Pit No. 1:L::.....:._minutes per,inch Depth of Test Pit.... : .._. Depth to ground water.......C)�&. Test Pit No. 2................minutes per inch Depth of Test Pit. ..... ... .Depth to ground.water........................ ar h [ l O Description of Soil.. �%� ...7 .-_ - •.5EaU .....:Z _-':'_..L !�....... C:L. r IL 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 LITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in op on 'ntil a Cert'ficate oompliancc has been issued b�yth(ef`board'of health. �tr Signed... �� 1. ..................................( '.�`�.. ! ...�:........ pl .0 A P ed,r y... �. ..... i/... .........................•--•--...... ........................l �.�C....... �� Date Application Disapproved for the following reasons:.....:.......:.........:...................................................................................._.. r Date Permit No........ t•� ................. Issued........---•----. ...................... at....... Date TOWN OF�BARNSTABLE . e LOCATION SEWAGE # ��' `"�op VILLAGE ASSESSOR'S MAP. & LOT INSTALLER'S NAME & PHONE NO. Ltqg L ) L, d v SEPTIC TANK CAPACITY ldbo O 5' LEACHING FACILITY:(type) 16 G 0" (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER A i J A !.Y F DATE PERMIT ISSUED: z�, DATE .COMPLIANCE ISSUED- VARIANCE VARIANCE GRANTED: Yes No n r / >"f r 0..4 .. i 4 • SECTION - SEWAGE -TolI W QC \ f� 1 r7rza t 20 \ \ Lr�{ b (y -SEPTIC TANK - ��pl - "D"BOX - I LEACH TOP OF Z�G�Qa. MSL)= 3 ( ..2..OF{IeTO Me" �(U G��. 2 O wk" WASHED STONE � � �� � OO/ 12 ko. 0 IN- OUT- OUT• IN IN 1,7.3I oo G __ _ ELEV. TANK 1- e-2, ](P,- bun Q,t LE ELEV. Q- ELEV. ODtIR ELEV. ELEV. 6 Ib If`jv{ •... / - ,/� N E Ley. ...� OF*'Z I4h" /fey-/ LI 79. r WASHED STONE r�� MOLE LOG p$k 5 3 rac�rrOM c>"r TAT r(Or TEST - _ y TEST BY T{ 911MAJ u L©�L.O�I TEST DATE Z 3 WITNESS BEDR M DESIGN oo HOUSE T.H.- �► 1 T.H. • 2 I v�� I I - �• �, �-_ __ I \�-- __ ELEV.I5.I ELEV. NO PERC RATE G 2 MIN/IN. DISPOSER DISPO ER �- Z� ZI FLOW RATE 330 (GALJDAY) SEPTIC TANK REQ'DSEPTIC TANK SIZE Ov0 18 i i, \ �V„ LEACH FACILITY SIDE WALL ie�f� _ (Z,S) - �J � G/D. 80TTOM � TT=�1� `� ; .o} _ �•`� G/D. 1 TOTAL ZG�7.OS.F °�, � 2.( USE: LEACHINGT o I E �q x WATER ENCOUNTERED �D F I� (1�OTE5. (UNLESS OTHERWISE NOTED) 1.DATUM(MSL):TAKEN FROM;L*4 F l�� QUADRANGLE MAP 2.MUNICIPAL WATER is AVAILABLE 3..PIPE PITCH:1G"PER FOOT 4.DESIGN LOADING-FOR ALL PRE-CAST UNITS:AASHO-�_�I1,G--44 S.MIN.GROUND COVER OVERALL SEWAGE FACILITIES:(1)FT. 9 }}}\\\ 6:PIPE JOINTS SHALL BE MADE WATERTIGHT E�• ��-__� 7.CONSTRUCTION DETAILS TO BE ACCORDANCE.WITH COMM.OF MASS. .. �% `y0 / STATE ENVIRONMENTAL CODE.TITLE 3 - CI. �71 1 G �L,/1 _. Vim'/C p M. T�it� Piers. FoL o-r�ka ►—mac IC-a :�x A._�P 'S J� {.... LOCUS. I,OT- r-io-e= �E t•.15t=D Pam '.�tZG'•c—.L„f l „tC: ���.c�vv �s O. E F-EIJ. EL J✓V. IC0.00 At c>" REG.P �F�5;tio L`ENGINEER I H \J ITA �J-EA�I ... 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