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HomeMy WebLinkAbout0238 HUCKINS NECK ROAD - Health 1�238--'H-u--ckins Neck Road. Centerville A=252-024 . Yrf S M E A D No.53LOR UPC 12543 smead.com • Made In USA COMMOWE NT _ALTH OF ALASSACHUISETTS Paz EXECUTIVE OFFICE OF E�Z IROI\�TENT<AL��F F SIRS II�� T` DEPARTMENT OF EINTVIRONIZENTAL PROTECTIO'- e v TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION p 3 ?� /7� it r va s /I/ �Pro erty Address: G c Owner's Name: ero q✓ DO Owner's Address: q re,,/ s f '. co rm ti �, iG oa y 6/ Date of Inspection: d,? p� = U --�'1 Name of Inspector lease print) p / cn Company Name: &it'///'/ O % © r�ri Mailing Address: Telephone Number:( pg �{ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the inforrration re o ted below is true, accurate and complete as of the time of the inspection.The inspection",as performed based on rni training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP" approved system inspector pursuant to Secti n 15.340 of Title 5(310 C iTR 15.000). the system: pursuant passes Conditionally Passes Needs Further Evaluation by the"Local ApproVing Aathorin Fails Inspector's Signature:94Date: The system inspector shall submit a copy of this inspection report to the Approving Authont,. (Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a C.esign f'o. of p-).�jnr gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional ots ce of-t DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the aTmro -ing authority. .. - Notes and Comments _ /4c�ell-�rona� — 61115AeJ Room-r t✓l /-?11se01.r- Flee ****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/I5/2000 page 1 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR-Vr PART A ,p CERTIFICATION(continued) Property Address: o 1�oc, *e,/, Q�.1 lie, pa6 eL Owner: Ga✓� Date of Inspection: d� Inspection Summary: Check A,B,C,D or E/ALN8 AYS complete all of Section D A. Sys Passes: I have not found any information which indicates that any of the failure criteria described in 310 C\•1R 15.303 or in 310 CviR 15304 exist.Any fail-are criteria not evaluated are indicated below. Comments: B /Svstem Conditionally Passes: AOne 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,�-T,ND)in the for the following,statements. If"not determined"please explain. y The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structural!-,: unsound, exhibits substantial infiltration or exf`iltration 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. \TD explain: Observation of sewag,e 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«ill pass inspect on it'(ts.i-r approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced \,D explain: The system required pumping more than 4 times a year due to broken or obi n ucted�i e s J. T L st;s-e r i pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed \�D explain: y r Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE-7INSPFCTION FOR-NI PART A L/ CERTIFICATION(continued) Property Address: 122� At4C4✓ihf *Ca4G RCI / ne e,-vi Owner: �a✓ham✓ 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 ses?ern is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CNMR 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 v ithin 100 f et 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 _ The system has a septic tank and SAS'and the SAS is less than 100 feet but 50 feet or rnore from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laborator<-. for coliforna bacteria and volatile organic compounds indicates that the well is free from pollution from that facilit. and the presence of ammonia nitrogen and nitrate nitrogen is equal to of less than 5 parr, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3. Other: Page 4 of 11 OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM J SPTCTION FOR NI PART A CERTIFICATION(continued) Property Address: c2_3g J rti rv� 0-2C3.)— Owner: Cs✓ Date of Inspection: V22LY ce D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ _ ackup 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 logged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or, clogged S_S or esspool Liquid depth in cesspool is less than 6"below invert or available volume is less than ',,day f o%v _ 2equired pumping more than 4 times in the last year NOT due to clogged or obstructed piue(s). Number Hof times pumped t/ y portion of the SAS; cesspool or privy is below high ground water elevation. c/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. � iy portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or pries 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 annnonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.provided that no other failure criteria are triggered.A cops of the analysis must be attached to this form.] QYes/No The system fails.I have determined that one or more of the above ter. ex-I'S ( ) 3 failure cn��_ta �Z__,as described in 310 CMR 15303,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: To be considered a large system the system must serve a facility with a design flo,,--of 10.000 apd to 1-5.000 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) V,es 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—IZ??_z':• or a r__n-o=d Zone II of a public water supply well If you ha-,,e answered"yes"to any question in Section E the system is considered a significant th-,eat. o-a11:Z%Vz7=d "yes"in Section D above the large system has failed.The owner or operator of anv iar2e s,Stt';i e0:i=itiered significant threat under Section E or failed under Section D shall upgrade the system in accordance -6-;i j C\;? 15.304. The system owner should contact the appropriate regional office of the Depa=nnent. Page ; of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPIFCTTON F0R1r PART B CHECKLIST Property Address: p2�� / �l Glvi.Zj If,-ec% gd zee ,- — -da.6.� Owner: ( G✓5T f7 Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the follor.i-712: "es 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 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'? vl 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? v Were all system components,excluding the SAS, located on site? 4 Were the septic tank manholes uncovered;opened,and the interior of the tank inspected for the:onaition of the bafflesor 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)prwrided with information on the p_rop_er 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 ono 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 approxsmation of distance. is unacceptable) [310 CVIR 15.302(3)(b)j Page 6 of i l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSAfE\TS SUBSURFACE SE«'AGE DISPOSAL SYSTEM INSPF_.CTION FORI_i PART C UU SYSTEM INFORMATION Property Address: /�ye�in3 ,/,, ��✓ ems► �� � 6�.� ,�.. O-vvner: C4 Date of Inspection: a? a$ FLOW CONDITIONS RESIDEI\'TI.4L Number of bedrooms(design): .3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x 4—,-of bedrooms): Number of current residents: t,2-- Does residence have a garbage grinder(yes or no): Q5 Is laundry on a separate sewage system(yes or no): -0 [if yes separate inspection required; Laundry system inspected(yes or no):/1/0 Seasonal use: (yes or no): 2S Water meter readings. if available(last 2 years usage((gpd)): Sump pimp(yes or no):/fv Last date of occupancy: K -e- COILtiIERCI.4L/INDU STRIAL Type of establishment: Design flow(based on 3100MR 15.203): g-od Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Nlon-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: a Qo — 0 wry Was system pumped as part of the inspection(yes or no):�/t7 If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP OF SYSTEM _Septic 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 cor!acT 1,1e obtained from system owner) —Tight tank _Attach a copy of the DBP approval _Other(describe): Approximate age of all components ate installed 1� Zn wJn)and source of info aon: i ��- Were sewage odors detected when arriving at the site(yes or no): Lv T;+l. Page 7 of 11 OFFICIAL INSPECTION FOR-81—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC'TTON FOP—It PART C p SYSTEM INFORVL-,tTION(continued) Property Address: ��o T �tG�.rhs Iiec� Owner: 6 as Date of Inspection: 'flo t 716 BUILDING SEWER(locate on site plan) Depth below grade: // /� Materials of construction:_cast iron !/ 0 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) Depth below grade: AL Nateriai of construction:_/concrete_metal_fiberglass_polyeth3%lene —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: Sludge depth: 3 a9 Distance from topsludge to bottom of outlet tee or baffle: Scum thickness: n ,� Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto 10 outlet t e or bafflr--. How were dimensions determined: e d2v1CL Comments (on pumping recommendations,inlet an outlet tee or baffle condition.struniz l inteain licui s:d le eh asgated to outlet invert, evidence of leakage.etc.): �etc.)://ll / r n60 Cc-It, o APV t GREASE TRAP: (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.strucr•�ral i_teg . lic id as related to outlet invert, evidence of leakage, etc.): Page S of 11 OFFICI_AL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DTSPOSAL SYSTEA4I;\�S]PECTIO\ FORA PART C Q SYSTEM INFORMATION(continued) Property Address: O T7�tG/"A- /Yec� �l � / e� , 8163� Owner: (TG✓�✓-f/ Date of Inspection: '8 O TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site nlan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene o rer(elplain): Dimensions: Capacity: Qallons Design Flow: gallonslday Alarm presen,'(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: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 1401ol.4 1-- Comments (note if box is level and distribution to outlets equal; any ev-idence of solids carry-over. an e-idence of leakage intooyoutof box etc.): OJ( �2r/Pi 1, /P0 PI.11P CHAINIBER: (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.)_ s Page 9 of 11 OFFICI_AL INSPECTION FORM—NOT FOR VOLU\T LRY ASSESS'IEI TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPF__CTIO\ FORM PART C SYSTEM INFORIMATION(continued) Property Address: arc Lihs ke ::; ✓ Rd P� t�;"3O)- Owner: �✓ Date of Inspection: 0?3 f SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: ZType leaclung pits, number: O leaching chambers,number: h1d / / leaching galleries;number: w 02 S vc 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 poriding, damp soil; condition of vegetation. etc.): T// /�'' i -c CESSPOOLS: (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. condi-dion of vegetation. etc.): PRIVY:/V (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil,signs of hydraulic failure,level of pond' eia-i . � rio� Page 10 of 1 1 OFFICIAL, INSPECTION FORM, —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C T i i T S�STEI_!Z Il�FOR�IATIO� (continued) Property Address: �✓ /�`���'�nl /l/�c(/ Je� /' ''► r� BaLG 30�-- Owner: <T'a✓�j per. 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. A o ur P. r /rJ Q3 i T:Ho G T—..a..+: Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOKINIATION(continued) Property Address: cU? Nc�✓inf �PG�j Q� O«ner• C' Date of Inspection: d3 SITE EXAM Slope Surface water Check cellar Shallow wells /jio v.-e- Estimated depth to around water & feet Please indicate(check) all methods used to determine the high ground water elevation: �Checked from system design plans on record-If checked;date of design plan reviewed: site (abutting property/obsen ation hole wji�}in 150 feet of SAS) �E with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must des be ho you established the high g ound ter eleva i9n: S it dI-/ r oLleG v-C,4'f/_ Town of Barnstable of tHE Tp� Regulatory Services * BARNnABLE. * Thomas F. Geiler,Director 9 MASS. Q� 1639. A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Disclaimer Private Septic Inspections.DOC No..... .1........ (� Fns..... ..D................. THE COMMONWEALTH OF MASSACHUSETTS 0/0� 10 L BOAR® OF HEALTH .._..L.Ow.r�........................................OF......... ..�1 .f C ............................... Appliratiun for Dispas al Works Tonutrnrtiun Famit lication is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal PP Y CSC,) P ( ) g P (� System at: Location-,Address or Lot No. ... �"k w -------------------------------------------------------- /'� Addre s tp a •--.)1QTJ�A.._.)....--- _ .......... .... �{.�. Cr .... .�LL....._.. �.. 1�w�li.}-•--•-----....... Installer Address d Type of Building Size Lot_ r_ 4.0.._...Sq. feet U Dwelling—No. of Bedrooms -......................Expansion Attic ( ) Garbage Grinder ( )r aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeterias,,( Otherfixtures ------------------------------------------------------•--....------••-•...........----------•-...--------------------.......--------............---- W Design Flow......... _.............................gallons per person per day. Total daily flow..........3.3-0_......................gallons. WSeptic Tank—Liquid capacityllD.Q. tgallons Length."Ao."___ Width__f.'J0."_ Diameter................ Depth.5.'...4'. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......I------------ Diameter.._t©_41------- Depth below inlet.....(a........... Total leaching area_.?4k6.._...sq. ft. Z Other Distribution box (✓f Dosing tank (, ) Percolation Test Results Performed by____. i. ...... .............. Date__-.%-�,�.S.I�_I_......... .- W yy Test Pit No. 1-.A:?:..._._minutes per inch Depth of Test Pit----- z-._........ Depth to ground water..tl.Q___4ti2111�- (' Gr4 Test Pit No. 2__,.2.....minutes per inch Depth of Test Pit-----L4f....... Depth to ground water._M-0..U.jf +e___ 9 ---•---•-•••----------------------------------------------------------------------------------------......................................................... 0 Description of Soil....49._".. s1....t+El.(AXX _.....t:'1 n.gl....9 raj r 1 �or�t-S s�'n► V ( K14 ......�._f'A�l. �... aT�?n�.5...,...... �-----p-......--2-......SA.^—P........ L?5. W -----------------------------------------------•---------------------------------------------....••---------------------------------------------------------------•-----•-----•--••-------------------- U Nature of Repairs or Alterations—Answer when applicable.............................................................................................__. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••....... Bement: +eprpa dersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with I TITLE of the State Sanitary Code— The undersigned further agrees not to place the system in t' a ti a of Compliance has been issued by the board of health. SiT",.. .. .... ..................................... .4A.1 Date Approved By........ . . • ........................... ........................................ Date Disapproved for the following reasons:......--•------------------------•--------------------------------.....-•--•--------•-.._......------•......--- -•---•--••••--•-•--•••----•----------•••--------•--•-------------------•-•--•-•----------------•-------...--••-----•------------------------------------•-----------------------•---------------...------ Date PermitNo....................................................... Issued....................................................... Date 06 No....16. FEs... Q................... THE COMMONWEALTH OF MASSACHUSETTS BARD OF HEALTH _s%J.n+.....................OF.......6n.i7...�.�� �.��. ....................... ApplirFatiun for Disposal Works Tonutrn.rtiun rrrutit Application is hereby maZle for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System at: ,, ...._.1LQC.:Li _..._ . � ._.. .._.. �� ...1C.11 .................................................. Location-Address or Lot No. W -ner dr ss a .s r "... Q.�t r:-•--` °` ?r. .... .Q.is E_n ......... : 3 .. ................... Installer Address d Type of Building Size Lot�Br. '-o.......Sq. feet ai Dwelling—No. of Bedrooms.._V__C-.!-.......................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Buildng.....................,:;...... No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ........................... W Design Flow___.__. _" ..............................gallons per person per day. Total daily flow------- _3,0............. ...........gallons. WSeptic Tank—Liquid capacitylO.OQ.gallons Le�gth ..... Width`A.`- Q". Diameter................ Depth=.`_6..... xDisposal Trench—No..................... Width.::-........._f..... Total Length.................... Total,leaching area....................sq. ft. Seepage Pit No.--.-_4_____________ Diameter__1.0.._4.__..... Depth below inlet----(,v.�0...... Total leaching area.?��.._....sq. ft. Z Other Distribution box (✓j Dosing tank ( ) ll a Percolation Test Results Performed by.... __ ............... Date... ._. ... Test Pit No. 1.. .......minutes per inch Depth of Test Pit , --__-- Depth to ground water.r%�%__.� . _ f=, Test Pit No. 2_:S_2......minutes per inch Depth of Test Pit.... -'._...___. Depth to ground water_(:�.�__W) -----------------------------------------•-------------------------- ....... ------------------------------------------•-------------- ��„ _ Description of Soil .. <1 r�7 ... _ .c c _r - � 2— c n�-: s a ........ 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 TIT114 5`of<the$tate Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of 06nipliance has been issued by the board of health. Date Application Approved By---.. x..__ . _ . . ........................... -------•-•-------•--•------------•- Date Application Disapproved for the following reasons:............................................................................................................... ------------------------•----• ------•-------------•--------------------------•=--------••-•--- Date i" PermitNo.............................. ------------------------ Issued_....................................................... Date r 1, THE,-COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........`..........OF......... t��..��1.. ?. .' ............................. Trr#ifiratr of TuutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (�Q or Repaired ( ) byr..1 ' ...._ s kt CD..... ...................................................................................................................... I stallez at ._ ............................................................... has been installed in accordance with the provisions of TIT F j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. '. 'G'. ................ dated_-.._______-_.-_-_______--_.___--___-_•_-..----. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. `r DATE........................................... ....... Inspector......... 9r_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. f .W.�.......:.........OF........ .�1. ra..� ..-......................... No.. .7.....flf�,r�__ FEE..S.?............... Disposal Works %'Donstrudivit ramit Permission is hereby granted....4� �j-rt' ---..�-")........ ----- !.=....................................................... to Constructy('>C:;L or Repair ( ) an Individual Sewage Disposal ystem at No.----,..ss_t ........1'-.0-_ _._....�_. .C._ ._�:7`a...... _ l .. Street as shown on the application for Disposal Works Construction P 't No............ ... Dated.......................................... - - Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON r ,t SITE PLAN SHEET I of z SCAL E: I = ¢a' /voTE S,EW.4Y�E O/.3P0.3RG 5�✓TEM SI�B�/ECT Ta P&.4eC,04ATl4o4l r&.lr /.JiVO..�.elJ oF.v,�gL TN APP,�7G✓RL . �A 0,e,--4 T pp,c�DJ lI j� • 11/ATE,e EL. 34.d i I Ir +1 r V R LOT /o241 m [JPL.gNO /19 Q W WrTLANO /954od 3 � �I Z-07- /O/ �3sa64 Q N Z TRH HAY�/ls 4�. OGD ,R010D B�O� G�acc' EErYV�7GL .ZGCt -46E7' W41-1. �. 45 44D.-crc, _ 4 - m 4qqG 46 - p 48 Q W P4 3 f,C,0W4 t zz 49 ttl jn FL -7-,,c ra vk 0 � SOx2 /DO 90 ,cxp 1 - Cl,L� \ / /159* - 'fig w�— -' - -�.00' •ice _ 4ZKF- E EX EDGJ3Z�VNIT��--_ t2'sl._- - - WILLIAM M. a ` v ^� ---- A9 WARWICK con) s `. No: 19771 ��// � C¢D 9A�,/ S U R V L%�����G?/3•s.LJ FOR DDG/lnl.4� ,LE/3EL REGISTERED LAND SURVEYOR T /D2 ALZICAVAI /t lEC go c o ZONE ViL_i PLAN REF. 4C 2023a sh. 7 DATE 4fi-S¢ BENCH MARK DATUM WM. * `WARWI_CK'B ASSOC., INC. DOMESTIC WATER SOURCE Ta w" KLATE.Q BOX_,80I NORTH FA L MOUTH g r FLOOD ZONE N,qzg-o "a" MASS. 02556 - (6/7) 563 -2638 c_: �✓r ii/ /Iu C1�dJi/y JL L.,I L yiy NOT 20 S(,AL-- L2 _ 24 C.I.MH COVER EARTH FIL L � BRICK ANO MORTAR COURSES AS REO'O, TO BRING _ COVER TO GRADE 4 -L� B'FLOW LINE . INLET J__ _ -_ — 2'- l/B TO�' WASHED PEA STONE FREE OF IRONS, PIPE FINES AND DUST /N PLACE i Y " TO l k'WASHED CRUSHED STONE FREE OF I , ':•' g' OPENING WITH 4%B' IRONS, FINES AND DUST /N PLACE Ira OUTER 0/AMETER AND 13/4' INSIDE D/AMETER I.. CONCRETE TO BE 4000 PSI 28 DAYS 2. REINFORCED WITH 6%6" NO. 6 GA. W.W.M. 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR \x GREATER DEPTH REQUIREMENTS — z --}- s'o" 1 Z"-� 4. NUMBER OF PITS REQUIRED f MIN I /10" NOTE: EXCAVATE TO ELEVATION r OR EFFECTIVE DIAMETER 38.o l (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL 1 WATER TABL£ - NONE LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN TYPICAL PROFILE GRAVEL TO DESIGNED GRADE. FL•G`G.$O•S lB"STD. LT. WGT C.I.MH COVER 49 5 49•0 ¢9.5 50•0 4"B/T.FIBER PIPE 4'C/.PIPE T/GNT JOINT OUTLET LEVEL DWELLING FLOW_LINE TO FIRST ✓olNT 14" OO 0� 1 47.E ° C.I. TEE 47.zo 1 1 0 00 1 1 i i10oO� O0 11 I 42-o 47,0 .`STD. PRECAST CONC. 47.37 D/ST BOX TO Be 47,p 0 00 00 1 IG'ZAL.SEPTIC TAN if 9 0 O 00 0 1 i I INSTALLED ON LEVEL, i it 0 000 00 0 1 i STABLE BASE i iI 000 00 1 1 i \SEPT/C 7ANK TO BE 1 000 O 0.4 1 I 1NST LL D N LEVFC, it 1.001 00 1 1 STABLE BASE. 11 0 0 O O 0 1 1 1110 0011 , i LEACHING BASIN : i 1 0 p O 00 0 1 BASE TO BE LEVEL r 0 8 O O 1 1 FL ¢z,o SOIL AND PERC. DATA PERC. RATE 7- MIN. /IN. TEST PIT NO. I TEST PIT NO. 2 0 Lour» TEST BY c6,�-i5 Gos�Zr Z• Gi-a vc/ WITNESSED BY: Qon• G. ora� �3�N Cvar-sc and S�u.� TEST PIT GR. EL. DATE: i ZI Qi 3B /Z it/d Grnt� GHQ Cr DESIGN DATA GENERAL NOTES BEDROOMS -3 NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. DISPOSAL /l/vne SEPTIC TANK, DIST. BOX AN LEACHING BASINS. TO BE STANDARD EST. TOTAL DAILY EFFL. 3-0GPD. PRECAST REINFORCED CONCRETE UNITS. SEPTIC TANK /000 GAL. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE, SIDEWALL AREA 2•s GAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA LP GAL./SQ.FT. SANITARY. SEWAGE EFFECTIVE ON JULY It 1977. LEACHING REQUIRED 17f.o7SQ.FT. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL LEACHING AREA OF HEALTH. L35_�aSQ.FT AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES I/4, / FT. UNLESS INDICATED OTHERWISE. ESN of SE AW DISPOSAL SYS TEm o MARTIN E. ., v MORAN ,Lo� /02 yG/c.�cn5 .t/ec� ,ev4c/i "Q 1f<23417�Q 0/Sl•r�G����� _ Gcn�c/•y�/le " /.��r�ns><orb/e �1as� �P S��Ofi Rl E� • SCALE AS INDICATED GATE 0��4 • wm. M. WARWICK A ASSOC., INC. 80X 80I NORTH FAL MOUTH AMASS. 02556 - (6/7) 563 -2638 PROFESSIONAL ENGINEER g; OCATION SEWAGE PERMIT NO. to a u e,�• � r1�cr. 'y�D 6 VILLAGE INSTALLER'S NAME i ADDRESS t 0. i G S �ILCD E R OR OWNER DATE PERMIT ISSUED S�-l/ dig DAT E COMPLIANCE ISSUED 33 / yl