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HomeMy WebLinkAbout0352 NYE ROAD - Health -352 NYE RD. , CENTERVILLE MAP-148 PAR-012. 004 a V t r No. � Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Die;potal *p!tem Con5truction Vermit Application for a Permit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components Location Addressor Lot No._3�;:�_)�" - 1 C C�—kkN Name,Address and Tel.No. Assessor's Map/Parcel ,01 Installer's Name,Address,and Tei.No. 7_79— ( Designer's Name,Address and Tel.No. VN, ,� C6-f.e, S " C v IS Type of Building: Dwelling No.of Bedrooms � Lot Size sq.ft. Garbage Grinder( ) Other Type of Building IQcc�A ,� KIUNo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4(4 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank X' �`t `?►—`ate ` �'� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when ap licable) tfC�`�ct((I,S�- ( v �� U�l� 5 yoeS I Lok V �,r r•�fti-�-t l �'j�'Y� i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this 1 Signe Date Application Approved b Date 7 Application Disapproved for the following reasons Permit Nc..­. Date Issued No.- � ~ , Fee, k THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS F 01pplicatiou for Migogal *pgtem Construction Permit a Application for a Permit to Construct( )Repair( V5 Upgrade( )Abandon( ) Complete System EJ Individual Components Location Address or Lot No.Sj�-\, "r( Je4,4 to er_t kkk(Q Name,Address and Tel.No. Assessor's Map/Parcel C) Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. \'\_� *�-00-1.'p, si C- o �S Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �JNo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 41 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank f X'cft 2,-4 C7OV —)At U"&� Type of S.A.S. v t_o?—L< wt-C'bjs Description of Soil Nature of Repairs or Alterations(Answer when ap licable) _��CT W.�� G 5)� Date last inspected: •° l ; � Agreement: P i 41 F The undersigned agrees to ensure the construction and maintenance of the afore described on$s to sewage disposal system w in accordance with the provisions of Title 5 of the Environmental Code and not to place the system.in operation until a Certifi- cate of Compliance has been issued b this eal i Signe i" ' 1 c� Date Application Approved b 3` Date .4 Application Disapproved for the following reasons � t z Permit No. _, Date Issued ------------------------------------- --- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( 1�� Abandoned( )by . - 1 <�I. at 01iA Ce. kly,04 i`, s_ has been constructed in accordance with the provisions of Title and e for tspos 1 System Construction Permit No. dated_--- � --�1,T Installer a a��-�5— Ge.xl Designer The issuance of this perms,shall not be construed as a guarantee that the system w 11 function as designed. Date - 7 Inspector No. /~'�^�!� ----------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwizpozar *pgtem truction Permit Permission is hereby granted to Construct( )Repair( ✓)Upgrade( )Abandon( ) System located at � d and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi it. Date: `7 &-7 Approved b r NOTICE: ThisFormis to Inc Ilsed fur the Repair of Failed • • •�'� Septic Systems Only CER•I'1FICA'I'ION,_OF SKETCH AND APPLICATION FOR A DISPOSAL. 1V0106 CONSTRUCTION 1'1,10111 0VITHOUT ESIGNED I'LANS) hereby certify that the application for disposal works construction permit signed by me dated concerting the property located at meets all of the following criteria: `�. There are no wetlands within Soo feet of the proposed septic system There are no private wells within 1 So feet of the proposed septic system /Thc observed groundwater table Is 14 feet or greater below the bottom of the leaching facility &6 Thcrc is no increase in flow and/or change in use proposed "41/Thcre are no variances requested or needed. SIGNED: �i DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER IAttach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submillcdl. i ., �-- � . e �� .. f TOWN OF BARNSTABLE LOC 111ON•� -3 N 00— SEWAGE # VILLAGE Ci 11-Q ASSESSOR'S MAP &LOT 1YL0/2- 60V r INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY U LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIIDATE: 9 - ��..� ��- COMPLIANCE DATE: 3 d Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ Feet Furnished by i �� � � � , ��_ ��� � � . .. �� � ��i :� �' ---� o �. � . . � . � �� � _� No. _ -- - Flns.....`3........ ,. THE COMAONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF. r ale Apphration -for 43Wp foal Workii Tonstrnrtion Prrntit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: Roar. Centerville .........Lot---# 4-.............-..................................................... Location_Address or Lot 1�G.. Box 10 Hyannis a.�...02601................. Owner ress stru.Qt 9A --•------------- -Marstons__Mill................... a Installer Address Q Type of Building Size Lot....22_,836.______-Sq. feet Dwelling—No. of Bedrooms.-.----2..................................Expansion Attic (x) Garbage Grinder ( ) pa-, Other—Type of Building ---------------------------• No. of persons_..._------:._______--__-._- Showers ( ) — Cafeteria ( ) Q, Other fixtures -----------------------------------•• - •- Design Flow...._._..._.`�S........................gallons per person per day. Total daily flow-___-______--_---s..__,►.p. 1 gallons. W -- ----------- �tllons. WSeptic Tank—Liquid capacitylOCO..gallons Length Width.. ._ .-1_ _ Diameter________________ xDisposal Trench—No--------------------- Width.................... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No-------i............ tameter......���-C�2::. Depth below inlet---- __e__ _. Total leaching area--- ---sq. ft. z Other Distribution box ( Dosing tank Percolation Test Results Performed by--------C....__D___Spohr.................................... Date...... /$/_79...._......._._... ,_l Test Pit No. 1___ ?--_minutes per inch Depth of Test Pit.....(. ........ Depth to ground water.._RQ ....... fs, Test Pit No. 2__15kMr>__minu1t er inch Depth of Test Pit------------------- Depth to ground water-.--..---_-----.-----._. Is ----------------------------------------------------- O Description of Soil_� ..........!5�`)- '2.._.. V -----------------•-----•-••-----------......---•-•.._..............---•-•------•-•-•-•-----......_.._...................---•---•---------•...........................--•••-......------------------ 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 Article \I 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 the board of health. Sigd/,J- -------- ---------------•---•-----------•-•-••------------------------•-------- -Date Application Approved BY /'4 L.i.L. - - 7.-9- Date Application Disapproved for the following reasons: ••-------•-------------••-•---••---•---••---------------------------•-•-----•----------- --••-•........-•--••------•••.............................•----•••--•......------......----•-•--------------•-•-•-----------------•-••------•-•--•-----------•---•------------•------•---------------- / Date- Permit No.......................................................... Issued------... 1 7 -7. ---- Date No................... _.... F>�s.....:�.�....�... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH d'a lo ...........OF...........B.a=F3tapia e............................................. Appliratiun -fur Btspuuttl urkjl� Tunutrurtiun Vrrni t Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: C: Os __ ,dg+Y,::Nylr ?oad-q-Qq t rvjll.e ----Lod Location-Address or Lot o one.s--------------------------- ---- :.... Box.. 3Z0 � a.-�--- 26Q1. .............. Owner ;. dress w . towne Construction = Marstons Mills:-- a. ._.... a Installer Address UType,of Building Size Lot...22-,8.3b........Sq. feet -, DwellingNo. of Bedrooms--_--_2-----------------=----------__.---Expansion Attic Y Showers Garbage per, Other—Type-,of Building No. of persons----------------- ( ) ( ) g ( ) a' Other Q --------=--------------•-------•------•------------------•---------•---•••---•----------------------------••--•- --•-------------- g °-5s-------------- ---------gallons per person.per day. Total daily flow-----_......... ?--------_-------g gallons. W Design Flow_._..__.__._ WSeptic "Tank—Liquid capacitvf s ?__gallons Length�::_�a_.._._. Width 4_.-I c?_.. lliameter---------------- Depth._1S__7.?_- x Disposal Trench—No. .................... Width---_---------_-_-- Total Length.................... Total leaching area._`!.,t_::� 'sq. r. Seepage Pit No.......I............. tameter .1.Q_-(a'._ Depth below ml t_-_/7-0d, �A-Total leaching area. � � sq. ft. z Other Distribution box (4 Dosing tank ( ) ` `r�'1 aPercolation Test Results Performed by.___-:C_..._D.._._Bpnhr-------------......................... Date.....6/a`.7.9------------------- Test Pit No, i_.' _7—.__minutes per inch Depth of Test Pit....(_Z......... Depth to ground water...40. S........ f� Test Pit No. 2.��..!'tZ..mmu s per,inch Depth of Test Pit-------------------- Depth to ground water........................ ,4 O Description of Soil ` 1 1t3!n!�._, ti °2.G?u 1�?------•-- `� � ' r ---- --------------------:_::. �-- --- ---- -------------•- x 1 1P. UE '--------••--------•---••---•-------------•-_-.-•-------(--`-------••--•-•----•---••------•------•------...--.-•--------•-•--....---------•-------------.----•----•-------------------._-••--•---------- d ---------------------------------------------:--------`---•----------------------•-------•-----------------------_----------_--•----------------------------•------'--•-------••-•--•---------------- U Nature of Repairs or Alterations—Answ`rwhgq applicable.-..-------------------------------------------------------------------------------------------. ------------------------------------------------------------------------ --------•----•--•-•----------------------------------------------------------------------------------------------•4 Agreement: { The undersigned agrees to :install the aforedescribed`�.Individual Sewage Disposal System In accordance with ;r the provisions"of Article,XI of the State Sanitary Code_Ttie undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig d r Y ti. Da te Application Approved B ... Date7 ,--- Application Disapproved for the following reasons:_ ,. -------•-- :'::, :.. ..................... ...........................•--•--== ......--...._-----••--•...------. .......................................... ------------------------•--•------------•-•-------- ' I i' Date Permit No. --------•-- l Issued = Date -. _, .-•- - - - ., _ .. - .�.:, �- �_.,=.,�.�_. ..a.,<_._ . - it _ - x.<-�. _a.`.. _ . THE COMMONWEALTH OF MASSACHUSETTS BOA'RD� OF/HEALTH .� ..0 (v.tJ..............OF.... �. �2�J :1 ! t-f� ............................... �rrtif irate f Tompliatta THIS IS 0 CER Y, the I ividual'Sewage Disposal System constructed ( �) or Repaired ( ) by --------- P - Ins a r ---------- ..----• has been installed in accordance with the provisions of : XI f The State Sanitary Code as described in the application for Disposal Works Construction Permit No� � .,` 7 - dated .: . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT SE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY;, DATE........... � C 1 - ------------•-----.-------•-.-. Inspector--•�------------------ .. --•-----------................ THE COMMONWEALTH 'OF MASSACHUSETTS C/ BOARD OF HEALTH (.. .tiw'.i�t.:.: oF... `�. ............................ N 3d FEE---•............. 3 d_.. i� u�ttl �Vc CEu rnrt It r "Unt Permissioei eby granted---_--"" ,�....--- .- „c�----. ._... .....___- to Construc or epair ) an India al Sewag t osal Sy em ,� at No._.. . ._. '!' ------•1 �h Street _ �� as shown on the application for Disposal W,o,rks Construction Pe • No__ ____ _____ ___ Dated______._..__---.--.-.-___..........._... /e �J � `L 6 Board o alt FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LO CATION,' SEWAGE PERMIT NO.- ►- � .3 s z -b VILLAGES . Y � �/�12U Ul P I N S T A LLER'S NAME i ADDRESS B'U It D E R 0 OWNER t� DATE PERMIt #SSUED DATE COMPLIANCE ISSUED I. �/�� �'J- G� ,,�U,✓ ic'�a /�/ a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF NMENTAL/PROTECTION ONE WINTER STREET,BOSTON MA 02108 (&7)292-§AOO �e �i TRUDY COXI WMLIAM F.WELD `q �F,;, " Governor '° fq��y O� Secretar ARGEO PAUL CELLUCCI ®f AVID B.STRUM Lt. Governor Commission: B SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION n Property Address:3s,9_ A-,),Ie /c-cf. C"to ' "/(` Address of Owner:3woves A Date of Inspection: v 3 l& (If different) F6-1 6c^c-4 cu d S` Name of Inspector: t-(,C_ r Company Name, Address and Telephone Number: /uµ4-i'c. EN 2 3?4,• hPF4sN/�//. r(f9 02E 4-1 CERTIFICATION STATEMENT ( 56�� 4-7-7. /41 20 1 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails �w a Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 A %,j*Printed on Recycled Paper b \ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution bo is due to broken or obstructed �'■pipe or`dueto a broken, settled or uneven distribution box. The system will pas inspection if(with approval of the �Boa'O rd,of�Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of H alth in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMIN S THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAF AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface w ter Cesspool or privy is within 50 feet of a borderi vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEAL T (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER T AT PROTECTS THE PUBLIC HEALTH.AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil sorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and s I absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and oil absorption system and is within 50 feet of a private water supply well. Y _ The system has a septic tank an soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well wat analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that acility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 ' — SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:g ,,9 Owner: Date of Inspection: 3 ias jcJ� D] SYSTEM FAILS: have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will.be necessary to correct the failure. Backup of sewage into facility or system component due to an 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. — is -V-looAL&, ' 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 than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply: Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. APAs built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. AThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C _. SYSTEM INFORMATION Property Address: 3s� /� / e- Rol, CeK TomA �,`/Q Owner: P 91, 2 R Eit-s�,�/-? - I Date of Inspection: ©3 `o S / 9. 'FLOW CONDITIONS RESIDENTIAL: Design flow: -930 gallons Number of bedrooms: '5 Number of current residents:o Garbage grinder(yes or no): tzO Laundry connected to system (yes or no): G$ Seasonal use (yes or no): 00 Water meter readings, if available: Oj p,- Last date of occupancy: Pw VT ins Uas sr COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)N( If yes, volume pumped: gallons Reason for pumping: TYPE 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) Other (explain) fi APPROXIMATE AGE of all components, date installed (if known) and source of information: o Sewage odors detected when arriving at the site: (yes or no) � (revised 11/03/95) 5 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SEPTIC TANK: (locate on site plabj Depth below grade:-0L6-') - Material of construction: 1,Concrete _metal _FRP—other(explain) Dimensions: Sludge depth: 'F N Distance from top o a to bottom of outlet tee or baffle: o Scum thickness: CAN Distance from top of scum to top of outlet tee or baffle: (0 M �� Distance from bottom of scum to bottom of outlet tee or baffle: 1-6 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.), S NVWI GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 i OF SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION (continued) Property Address: —?S 2 A.A�/�. ,/col_ 62,/Zt v7 L(Q Owner: /�!'Lo/�• Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: eallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) S r� �I k 1� ✓ f -Z4 pb"k N PUMP CHAMBER:-E)J (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SY STEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: p Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):110_5 (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comm nts: (note condition of soil, signs of hydraulic failure, level of-5 rzm�saf ponding, conditi of ve t 'on,etc.) fa Fs _! 5 CESSPOOLS: Do (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �rj Z / Q ��- �lP� ` v'e ``- Owner: Date of Inspection: o3/ems/q� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Z `�" az 44 ` Pt 3-y3 83 y3 DEPTH TO GROUNDWATER Depth to groundwater: -r 20 feet method of determination or approximation: (revised 11/03/95) 9 F, F. t . 00� ' TYPICAL SYSTEM PROFILE -� A R E A PLAN FDN TOP FINISH GRADE= _ NOT TO SCALE I .. 3�' ' S0'00 FINISH GRADE OVER TANK= �}_ 9' OO FINISH SCALE : I "= GRA 0nt I DE OVER PIT=_�_ OT -# 4 NYE ROAD "C ROS 1 R I DG E q-1 C)U PVC OR • T" ,� i C. I . TEES '�6.33 • • . . o NO 1 I � THE V LOO D PLA' q �. �w 4 - • • , . . . . ° • . ° BSMT ' 1000 — _ FLR 43.00 GAL. 4'� Q(-� , J, _ • • o o • e • o o o 0 �^ , t ^ ,,�� "� i AV REINFORCED D I S T. B O X • o ° o • • e o 0 0 0 0 N GU�i.; _ �'�; `'✓ + ! ' .� I : �� ,.� !, �r' Y''� CONCRETE —8" --- TO BE INSTALLED ON ° ' ' ' ' ' ' ' ' ° ° ° =o :o A LEVEL STABLE BASE • ° • • o o • SEPTIC TANK ' 1 TO BE INSTALLED ON A • • o ' ' ' ° 7-L }` • 1'`� ' r LEVEL STABLE BASE s. V L.`" �+1,ST C, B. FWD -t 50.0�1 2"-1/8'� 1/2 "WASHED PEASTONE ALL ' ' ' ' • e ! • • • • • • 57'r E BRICK a MORTAR COURSES AS AROUND FREE OF IRONS, FINES � • • e I • • 0 0 0 --+• .w ,—�-� ••-••• . _ \ REQUIRED TO BRING COVER TO GRADE AND DUST IN PLACE ,� � �� 223, oq - , LEACHING PIT O 1-7 C�iDE) LOT # 4 2 j(� ", 24 "C.I. MANHOLE COVER a 3/4 TO 1 -1/2 WASHED CRUSHED FRAME - SEE DETAIL STONE ALL AROUND FREE OF BASE TO BE LEVEL OQ� 1 49,00 38C,S1pE� IRONS, FINES AND DUST IN !\/► T. H PRECAST. CONCR.�TE LEACHIk-, PLACE PE j0 -�-5EE DETAIL.5 � — FOR FIN. GRADE r�14,� �f�r '�•�� ACID t'f20>"IL.£ ry� SEE SYSTEM PROFILE SOIL, AND PERCOLATION � ---- 14 DATA -� f _ - - -- -- -- --- ,. r Pfl.,E�ST �:.0/.1C32CTE 8 , U I ' . �: PERC RATE : < � M N. I N. O �. '�.. Fc'Yt �Ss�� �o „ — � FOR INV. SEE °T ' - � q /4 °. C. D. SPOHR 9� Gj� INLET ° SYSTEM PROFILE TAKEN BY : {,� �)t_ MuimzR LINE 0 6 ° ' , •aAL1.I51"At3;._E gD. !�F EALTN _ WITNESSED BY' 0 OPENINGS W/4-1/8" OUTER OIA. 8i I -3/4"0 • DATE . J U NE t 9 't9 P ° ' •,• Q' 7' o INSIDE DIA . ° :-•, TEST PIT -GND ELEV. �` 4`� 12 ' 0 6 a D TOTAL ° o 0 0 o AREA p o 3 - ° o, - >�O A hit EG Wt� ice.U STD L [>G , 0 0 ° sum s � AREA O R o o D s r= op- PfT - _ o o o ° 0 0 0 0 0 - , ° M E C3 I L tit 0 0 ° ' O _ - • 000 '00 0 0 0 _ - - powI1 2 6 ' 6 " DIA . 2 � ' ALDEM HOKAP-15 INC 51'+ 10 ' EFFECTIVE DIA. BOT. PERC. HOLE f, P. O. BOX # f G Zo _LEACHING PIT - SECTION DOWN 62C07-LA U 02C3c � i i�? � Uj 12' NO SCALE DESIGN DATA . NOTE: DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM NO. OF BEDROOMS 2 PRUL. -- r NO DISPOSAL i LEACHING PIT NOTES: EST. TOTAL DAILY EFFLUENT -44 2 GALS.. I I . CONC. TO BE 4000 P.S.I a 28 DAYS . SEPTIC TANK is-17�0 GAL. AREA PLAN *• 2 . REINF W 6 " x 6 " �6 GA- W. W. M. AREA RLA W PREPA;�?-Et," "RCM SUBDi V I J I0W 3. 2 'AND 4 ' SECTIONS ARE AVAILABLE FOR GENERAL NOTES pL-AW1 OF LAND I N GREATER DEPTH REQUIREMENTS 1 . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ;70Q' ALDER HOW I NC •; " CQ>USS k1 DCXE'%I NOTE : ' ACCORDANCE WITH TITLE5 OF THE STATE SANITARY CODE EXCAVATE TO ELEV. 3 OR LOWER AS DATED JULY 11977 aANY LOCAL RULES APPLICABLE. ��,A� E � " 60 ' ;�] �ji1 Irj � 'Y .�, P, UOYLE R . �.- . REQUIRED TO REMOVE ALL LOAM AND CLAY CONTAINING ' 2. ANY CHANGE TO THIS PLAN MUST BE APPR D. BY THE MATERIAL BENEATH PIT. REPLACE EXCAVATED MATERIAL BD- OF HEALTH, AND CHARLES D. SPOHR. WITH CLEAN,CLAY FREE GRAVEL, MECHANICALLY 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, COMPACTED IN PLACE. �? S.F.�_S.F./GAL 49� GALS NOTIFY THE ENGINEER FOR INSPECTION. SIDE AREA = 19 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. BOTTOM AREA= (R-7 S. F.@0S. F./GALS-7 GALS 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN B, M. NOTE = TOTAL AREA = Z~� S. F. TOTAL GALS APPROVAL BY CHARLES D. SPOHR. - LEGEND 6. FOUNDATION INSPECTION READ. WHEN EXCAVATED. ALL ELEV5, SASEtD O ,l TOP OF SX 1ST'. C. 8 AS SHC),,Y% i @ ASSOMED ELEY, 50,Q0 4 + 50.0' EXIST. GROUND ELEV. 50.0' FINISH GROUND ELEV."UNDERLINED" 27Josm- KcvtsED IC^t; rrom oa= GAkaCwIF 4750' PIPE INVERT. ELEV. REV. DATE DESCRIPTION p TEST PIT LOCATION SEWAGE DISPOSAL SYSTEM FOR 0 0 SEPTIC TANK ALDEN HOMES I NC. ❑ DISTRIBUTION BOX - . LOT-*- 4 NYE ROAD, "CROSS R I DGE 4 " C. I . PIPE `I ,..z � 14 L ARNSTABLE CE N T ERV I L L S MA. -ttttHtt}- 4 BIT. FIBER PIPE -TIGHT JOINTS s DESIGNED. C.D SPOHR DATE: B JUtJE l D R A W I N G NO. — -- — PROPERTY LINE \ DRAWN: C 5 SCALE:AS SHOWN (� �F MIN. CODE DISTANCE �� y 6 -/ A MAP SEC PCL LOT CHECKED' C. D. S .