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HomeMy WebLinkAbout0116 OLD POST ROAD (CENT.) - Health (2) 116 OLD POST ROAD, CENTERVILLE A= 209 087.002 f/if REtrCtEn UPC 12543 No. 53LOR .-Cco" HASTINGS,MM 6-7 -009, TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385-13�0 19 Hummel Drive South Dennis, MA 02660 COMMONWEAI.ThI OI'' MASSACHUSE17S I XI.CUTIVE OFFICE, OF ENVIRONMENTAL, AFFAIRS DEI'AI1'I'MEN'I' OF ENVIRONMEN'I'AI., PI1O'I'EC'I`I0N "TITLE 5 OFFICIAL, INSPECTION FORM — NO)T F(>R VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM FORM PART A 1'rnpert�. Adchcss: 116 Old Post Road Centerville, MA 0 iter's Na tit c: Robert Lynch Owner's Addresit c/o Steve Bobola, Mass Building Systems 24 St_ Francis Circle, Hyannis, MA 02601 Dale of Inspection: November28,2006 O\V� Name of Inspector: Troy M. Williams Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive SOLltll.Dennis, MA 02660 Telephone Number: (508)385-1300 C'EIZTIFICATI0N STATE MENT I certify that I have personally inspected the sewage disposal system at this address and that the infpnnalion reported below is true, accurate and complete as of the time of the inspection. The inspection was performed.based 011' ty training and experience in the proper function and maintenance of on site sewage disposal systems. )I ant a UEI appros ed ststem inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The systena Passes t N Conditionally Passes ;y ::V Needs I rrrther Fvaluation b) tile Local Approving AuthoiN) T; _ Fails .. z Inspector's Signature: '? � ��,, _ _ Date: if /2(3 /p ry cn . The system inspector sliall submit a copy of this inspection report to the Approving Authority(Hoar(l o I lealth or DEP) within 30 days of completing this inspection. If the system is 4 shared system or has a design flow of,10,000 gpd or greater, fire inspector and the system owner shall submit the weport 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 authorily.. Notes and Continents Although systern meets the minimum requirernents set forth by the Massachusetts Departrnenl of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. «'•'This report only describes conditions at the time of inspection and under the conditions of use at that time. 7 his inspection does not addresshow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 tiaee 1 of II Page 2 of Ol�hl(/kI.. INSI'1?CI'jON. VOI2M — NO')I' Mi'Oli VOLUNTARY ASSESSMENTS SUIISLJIWACI? SI VA(li? OISPOSAW SYSTEM INSPECTION 1+0110d !'AMYII' A . CK�12`I'l)<��CA7'1(ON (continilial) Properly Address: 1 16 01d Post Road Centerville, MA Owner: Robert Lynch Date of Inspection: November 28,2006 Inspection Snn►nlary: Check A,1t,C,1) or 1 / AI.WA YS cllmplclt all of Secliou 1) A. System Passes: ji _✓ 1 have ool lound any inf lrination which indicates that any of file failure criteria described in 310 CMR 15.303 or in 310 CK4R 15361 exlsl. Any failnie criteria not evaluated are indicated below.. Conuuenls: It. Sysicul Coudilionally Passes: _ One or Inore sysleio Components as described in file "Cowlitinnal fuss"section need to he placed or repaired.The system, upwi colnpletion of (Ile Mplifeclocol or repair, as approved by the Board licallll, will pass. Answei yes, no of not determined(Y,N,ND) in the__._ for the following statements f 'not tielernlined"please explain. I the septic lank is inelal.anti over 20 years old* or the septic tank (w file[ metal or not) is structurally unsound, WNW substantial infiltration or exliltrulioiror lank failure A Iiniueul. System will pass inspection if The existing lank is replaced with a complying septic tank a appr�wed U le 13oanl of 1lcuhh. *A racial septic lank will puss inspectioo dins structurally souot 1 Icakiog autl ifa ,'ertificale of Compliance indicating that the tank is less Ihan20 years gild is available. ND explain: 0bserv41i0n o f sewllgc backnp or break r or high static water level In like dish iblitlon box Lille to broken or obstructed pipe(s)or tlue to a broken, settled mieven distribution box. System will pass inspection if(with approval of Bo4rd ol•llealth): — li `en pipe(s)ate replaced Of1SIrlIC(lnll IS lLI7UlVell - distribution box is lovVIed or replaced ND explain: file syste required pumping more than 4 times a year tlue In broken tit*obsirucled pipe(s),'file system will pass insect At if(with approval of the 13oartl of lCeulth): --Uroken pipe(s)int replaced obsliuctitin is reliuwed ND explain: 2 •I loge 3 of 0111ACIA!, INSPECTION Ieou yl - NOT I+Olt VOLUNTARY ASSII,'SSMI!:N'I'S SUBSURFACE S1?WACh DISPOSAI, SYSTEM INSPECTION PORIVl PA RT A CI'RTIj?ICATIt)N (conlinued) Properly Address: 116 Old Post Road Centerville,MA Owt►er: Robert Lynch Dale of luspection: November 28,2006 _. C_ I iu-dker Evaluation is Required by the hoard of licall1i; Conditions exist which require further evaluation by lice 13mard of llealllt iA ortler In ticlermtine if the system is failing 10 protect public leallh, safely or the cgvironntcul. 1. System will pass uniess hoard of Ikillll►tletcrudues ill accordance with 310 CWllt 15.303(1)(b) that lilt! sysicu►is not functior►iug fu a rr►;uu►er wl►ici► will 14o00 public 1►t:allh,safety and ti►e enviro uenL• Cesspool or privy is within 50 !eel of a sal lace water Cesspool or privy is within 50 Ed of a bordering vegetated wetland or a salt marsh 2. System►will fail uulcss ll►c hoard of Ilealll► (anti Public Water Su ►lice, if auy) desneiues Vial the syslcuk is funcli0nin6 ilk it nlauncr Ibal prolecls ibc public health, fcty and cuvirtiuuteot: The system bas it septic lack and soil absorption systci (SAS) and the SAS is within 100 leer ofa surface water supply or hAnlimy in a surface water sup The systein has it septic lank and SAS curl 0 SAS is within a Zane 1 of a public water supply. I'bc system bas a septic lank and SAS and do SAS is wilbin 50 Icej of a private water supply well. `l w system►has a septic lank a SAS [Intl the SAS is Ims Ihan 100 to but 50 legit or more hum a private water supply well". M ►nd used to deterntioe distance *""Phis system passes if t well walcr analysis, perlirrined at it UfiP certified laboratory, lot colifolln bacteria and VAX game compounds indicates Ibal the well is flee flout pollulion from that facilily and the pl*esetice oral fonia nitrogen and nitrate nilrogen is equal to of less Ihan 5 ppmt, provided that no other failure ether!' re lrlggered. A copy of the analysis nulsl he anached in Ibis tuna. -, 3. Mhcr: 3 . Page el tit,I I Oli'I''ICIA1, INS11CCTION 100104 — NOT FOR VOIJJNTARY ASSESSMENTS SUBSURFACE SII.WAC E PISPOSAi, SYS CM INSPECTION I101ZIVI 1'Ek RT A C1 Ii`L1 ICA'I'ION (cotllinucd) 116 Old Post Road Properly Address: Centerville, MA Robert Lynch Owner: November 28,2006 Dale of inspection, D. Syslelu hailure Criteria applicable It) IIII Systems; You mils( indicalc "yes" fir"no" it)each of the following fur all inspeclions: it Yes No __ _✓ Backup til'srwage into facilily or sysitnl component due to overloaded of clogged SAS or cesspool flischilige tit polldlllg of 01111t:111 to the Stlil:fce Of file ground or sill Bice Wipers title(o all overloaded ill- clogged SAS of ccsspoal Slatic liquid level in Ilse(list]ibulion box above outlet invert (file to an overloaded or clogged SAS of c.csspool _.__ ✓ l.itluid depill in cesspool is less than 6" below invert tit-available volunle is less Iban 'V�day flow __-- Retluiicd pliliiping lnorc lhau'I fillies Ili the lasl year NOT clue to clogged or ubstiucled pipc(s). Number of'times pumped __------- A ny portion ot'lhc SAS, cesspool or privy is Below high ground water elevation. Any poilioo ol'cesspool of privy is wilhifl IO0 feet (If it suffice water supply of 11lbi lacy to it surface walci supply. ____ ✓ Any poilion of a cesspool of privy is within it Lone 1 of a public well Any portion of a cessptitil iii privy is wllllill 50 feel of it private walef supply well --- - Any portion ofa cesspool of privy is less than 100 feet bill greater Than 50 leel lion)a private water supply well Willi oo acceptable Water quality analysis. ITIlis system passes if like well tvult! analysis; perfilrined a( a D p certified laboralury, for colilitril► bacleria mill volatile orgal►ic conipotiuds indicaleS (hat file well Is free fro►n pollution l'ra►►► tllal facility and the presence of arlunonia nitrogen and nilrale nilrogcn Is tiII141 lu 1►1-Iess.Illilli 5 phut, provided II►at dill Other lalJll►'l'l't'llel'la are triggered. A copy Of the analysis buts( he altached to ll►is forlu.l (Yes/No)"I'he sysleul fails. 1 have tiricifuilletl that nut nY 111olc of lili:above failure erileria exist as described in 310 CN1R 15.303, lhciefiire the system fails. The sysicol owoei should Contact the Board of Ileallh to delernlilic Whirl will be necessary to correct the failure. 1s'. Large Syslcrlts: I'll lie con.sidcretj 4 114-ge System (lie sysleltl 11111S1 serve ;I facilely with a esign flow of 10,000 gpil lu 15,000 gprl. You Insist inclicale either"yes"or"no" 10 each tit tile. following: (`I'11t: following criteria apply to laige systems in atltlitioll to (he ciit .is above) yes lit) the systerl►is wilhifl q00 feel ofasurface tirinkit water supply the systelll is within 200 feel of a llibilla.4 a surfat e di inking water supply 'CA( lilt systelll is located in a nilio8cli se ilive illlllttrtll) Wellhtild IiitllCcllon Area—1WPA)ur a uulpped `Lone ll of a public water stipply l If y(nl have; answered"yes" 11)any(lilt- too in Section r the system is colisidel-rd it sig►iifica►ll Illreat, pr answered "yes"ill Seclioll D ttUove file.lilrge shill has failett'l'lle owner of operator of tiny largt syslelil considered a si nilicaiit 44 te rr d ► ltt Si tl f)sllll 4pge lilt yste odance Willi 31p CMItutaf till 15.3Q4.The systelll gwIler sit .(l cogiilct lilt tippl'opllale fegtrinal office of I lie.Departlllenl'. �l t , • 1'agc 5 0l I l OUTICIAL INSPI+CTION FORM — NOT WIZ V0 1-.I:WFARY ASSESSMENTS SLJBSIJJZ 'ACIs S1 WAGE 0ISPOSA>I, SYS J� IY! INSP114.: .10N 0 it M PART 0 C�Ir?cr:1.r5'� III-operly Address: 1 16 Old Post Road Centerville,MA Owner; Robert Lynch Dale of luspecliuki; November 28,2006 Check if lilt lulhiwiug have [)tell done. YOti must indicate"yes"or"rki," as to each of the following: l� Yes No I'unkping iulurivalion was pri,vided [)y like owner,occupant, or 13i,:ud of I lean[) — -,� Were ally of the syslcnk Coll y,pnenls ptimpcd out in the pitvious Iwo weeks '? Has the syslenk 1CCeiVed nurknal flows irk the prcviorts Iwo week period '? (lave large volurncS of water bet IIIII61111Ctd I(I tilt systtIII rtccn(1y Of uS part of'IItis inspeelioII Were as boils I)laos of the sysleku oblikiklctl and exanlioctl? (If they welt not available note as N/A) Was the facility i,r dwelling inspected for signs ofsewabe back up ? Was lilt site inspected Iol signs of break out ? Wert all syslcnk conipooenls, excluiliug Ibc SAS, located oil Silt '! Wcre !hc septic tank n-kanholes uncoveicd, opencd, and the interior of Ibc lank inspected for like condkiou of the baffles or ices, material of construction, dinkcusiou5; depth ol•liquid, depth ol'sludge and depth of scorn? -;/ --- Was the facility owner(and kiccoparUs if.dilji;rtnl lii,ru owoet) provided will, lit lorlr kill iOn ou lilt proper maintenance ill:subsurface scwagt disposal systems '.' The size anal location of the Sail Absnrl►lion System(SAS) oil the site has been dettriniped based on: Yes nu Existing information. For example, it plan at like 130anl of I leallh. _ Oeterrninal in the licld(if any of flic lailtire clileria relatul to Pall C is al isskie approximation ofdishknee is unacctplable) (310 CMR 15.302(3)(b)) 5 Page 6 of I Oli'VICIAL INSI'I C`I'ION DORM - NOT FOR YUI,IJNTARY ASSESSMENTS SUIISURPA(,I? SE'WA(yl*,e I)rSI'OSAI., SYS'I'I?IVI INSPECTION VouM SYSIT-M INVOItkIATION l'l-operly Address: 116 Old Post Road Centerville, MA Owner: Robert Lynch Dale of lnspecliuu: November 28,2006 IiLOW �:ONI�I'I'IONs ItI�S11)FN'I'IA1, Number of bedrooms(ticsigo): Numbei of bedrooms(uclilal): 3 DESIGN flow basal o0 310IfAvlk 15.203 (foi example- 1 10 gpd x 1/ofbuhoorns): 3 3 o Nuniber ofcimcul icsidcnls: n _ - Does ICsidencc have it gaibage giindei(yes or no): Nu Is laundry on it separate sewage system(yes or no): zuo (il yes separate inspection I ell uiiedJ L_aundiy syslcro,iosllecictl(yes or no):N(,q Seasonal use: (yes or iio): ES Walei nlctei lVadings, if available(last 2 years usage (gpd)): _o(.-=-- 5 �a1pA)_4.a ll�h S D S Sumppiioip(Yes of'oo): /JD. p 0007ti(la.,S Last date of occupancy. (J r.1 o.L. v S<_ C f 11,.; s fi r. CONINIh:1tCI:1L/INI)I1S't'ItIAI. Type ol'cstablishutcnf: _ Design flow(basal all 310 CM It I S 203) Basis of design flow(seals/poisons/stlli,elc.) - - - Giease lisp picscnl (yes of no): - Indusnial waste holding Fink picscnl(yes of nu): Non-sanitiiry wasle discharged to the"Mlle S syst- (yes ur no): Watci rnetei loadings, if available: - — Last date ol,occupancy/usc: - - --- --- -- OTI11 It (desciibc): GI?NIl:ItAI. INFORMATION 1'uuylio6 Itecords Sonice of infornialioo: P�- ,1__Q.�.--- '` 5S �is.�_:..;__rs�o-U� :•, �. Was system pumped as pail o the inspcction(yes qt nip): A/o Il'yes, volun-it;punoprul: --- -..-_gallons Iluw was(luitnlily liumi)ed dcleio1inedY — — Reason Loi pulnpiog:Th, OF SYSTEM Septic lank, distribulioo box,soil absorptionsysleni --Single cesspool - Overflow Cesspool _ 1'iivy _Sh:ued system(yes of 11o)(tf ycs, i flach previous iospocligo ieconis, if ally) _._Innovative/Alternative lechnology. Allach it copy of the current opeiation alid maintenance coul►act (to be obtained lion syslciy uwoer) _"fight tank _Attach it copy of'file DFT approval —Other(ilescribc).--------- ------- ------- -- -- Appioxinrtic age of all components, Male iltslaileil(if known)and source of'ill lornlaluin: Were sewage gthirs detected when arriving at lhe.sile(yes of np): A(D 6' Page 7 of I 1 OFFICIAL INSPECTION DORM — NOT I+Oti VOLUNTARY ASSI?SS1Vll?N"I'S SUBS1J1tFjk(__% Sf 'WA(y�: I)ISI'OSt�L. SYS'I'1�M1 1NS1'1?C7'1ON yi'OIZM 1'ART C SYSTEM INFORMATION (coutiluled) Properly Adilt-ess: 1 16 Old Post Road Centerville, MA Oavuei: Robert Lynch I)atc of luspcctiort: November 28,2006 MALIAN(. S1 W1 1t(locate on rile plait) Depth below grade: --� /1--- Mateiials of construcliou: cast lion Z 1l0 I've_i/otlaei(explain): Dislance liotn priville water supply well or suction line: -- Coluntenls(on coodiliou of joins,veuling, evidence of leakage, Cie.): _ h c_�_ ----� -b.e.—L2.1n—i ti S�,L�--✓L_ie.t�.�----------------------- --- Sl,'J"I'IC"MANIC: v/ (locate on site plan) Depth bdow grade: 6�' Muleiialofcriuslrnclion: ✓ci,ncicte____metal__fibeiglass_._polyiilhylene If lank is metal list age: _ Is age confiirtred by it Celtilicatt;of Compli aocc(yes of no): — (attach a copy of ccrtilicate) Dimensions: Sludge dcplb .._. - --' ��- - -------- -- — Distance fruru lop ofslodgc to bolloin of oullct Ice or baffle: 7 Scorn thickness: ----- Distance froru lop ol'scutn to lot)ol'outlet lee or bal'llc:_ b 't Distance m fiom botlorn:ol�scuni to botto of uulli l The ix lrtfllc: I low wcie,liiucnsious detcrntined: Continents(tin paonpiug reconuocudalious, inlcl aitcl oullcl lee or ballle condition sit uctuial iulegrily, liquid levels as iclaled to(1utict invert, evidence o f leakage, etc.): -�._L.t_L.��_32.v...Tl.*!:YL'._�sc s__lN c��._J-4--._(�_�GL.1�_G_—Q—rc�.c-✓� rx�_.r14bA�---Se✓w G12 ASIC It AP; __0ocate on site plan) Dcpth below grade: _ Material of cpustiuclion: concrete-- melal —libciglass_-polyelliyl to other Dimensions: --- Seorn thickness ---_-----_--- Distance Iri�nt top of scuua to loll of oullcl ice or batflle: _-__ ------ Distance f1-out bottom of'scuni to bollom of oullcl lee of bit e: Date of lest IMMIJiug: _ —_--- ----- Comments(oilpruiapiug iccol►rnrcudalious, inlet and tllct tee of.baffle condition, slruclural integrity, liquid levels as relalul to outlet invert, evidence 61 leakage, etc 7 Page 8 of (.)F FICIAL INS1'I C'I'ION I"0Ii1Vl - NO'I' FOU VOI.UN'I'ARY ASSE$SIVII N`I'S SUIISIJIt1�ACI's SP �yf>�(yI I)ISP(aSA SYS'I CM INSPECTION FORM PA RT C SYSTEM INI�OII /!A'I'ION (continued) Properly Address: 116 Old Post Road Centerville, MA Owner: Robert Lynch I)alt of tospeclion: November 28,2006 TIGHT or IIOLDING TANK (tank,rulsl l)e punipect at line of ins clion)(locale on site plan) Dcpilt below gradc: Maleiial ofconstruction: —__concidt;__nielal---liberglas ___--polyclllyleuts__otlter(t xplain): - ------------------------------------------- ----------- --- --- -- --- - Dimcusions. Capacity: ------------ - -gallons Design Flow: ------ gallons/day A lit,ut Prescol (yes or no): _ Alarut lcvcl: -- Alarm in working a or(yes or no): - Datc of last puiupiug:-- — Conuncnis(condition of alarm"Ind at switches, etc.): VIS'1'011iUTION BOX: ✓ (ifpreseot owsl be opcned)(locale ort site plan) Depth of liquid.lcvcl above oullel invert: Conuneols(note if box is level and ilislribitliall to oullets equal, any evidence cif solids carryover, any evidence of leakage into or out of box, etc.): PUNIr' CIIAMIII R. -(locate(lit silo plan) Ptlinps in wolfing order(yes or uo): - Alarms in woikiug ostler(yes or lit)):—_ Cotnntcnls(note condilion of pump clianibei, condilion punq,s and appur lot lit ices, etc.): „ 8 r ' Page 9 ill I 01 FICIAL. INSP1 CTION I,Oltryl — NOT 1"012 'V01AWFARY ASSGSSMI?N'I'S SUBSURFACE SEWAcyl? hIS>��c�SAI SYSTEM INSV CrION FORM PART C SYSTEM INIIOIZMA`I'ION (continued) Properly Address: 116 Old Post Road Centerville,MA Owner: Robert Lynch Date of LcslWctioo: November 28,2006 SOIL, ABSORPTION SYSTIi-AI (SAS): (Iiicale otl Nile plan, e)(cayatjou not t-equired) IISAS not Ideated explain whty: l'yI►c leaching pits, nnnlher: _I_ G ,k r'cu L, �': f L,%i, rl., a.' 5 h,e _-- leaching chanibcrs, number. _ -- leaching galleries, number: -- ----- leaching lienchcs, uuucbcr, lengllc:__-- ---------- -- -- leaching fields, number, dimensions: --ovcrllow cessioul, uunibci: —. - --------- — innovative/alternative systcut 'hype/uaciii of lechituli�gy; _-------------...-..-........ _..--------.----_...__ Conuualls(nole condition of soil, signs of lcydniiclic failure,level cif poucling, damp sled, condilion of vcgclatioo, etc.): 7f. U/` �� �r.� ✓1.� i!'✓+"e per/ �Dw(�/c..r� , � /+�� �06L wcV� T�'v•�.L�✓ c J�-n � G`t CLSSI'OOI.S: --(cesspool musl lie jxuuped as pall of insheclion)(loc; on site plan) ' S f'`'9"� Nundwi-and conligureliOlk: Ucplh-- ►op of liquid to iulc( invert: 1)e01 of solids layer: -------_ -_ 1)cplli of scum layer. _—..-------- — -- I)iincnsious of cesspool: — _-- -- — Materials ofconslrucliun: —_ inelicaliou ofgionw.lwater inflow(yes or po): ------- ----- ----- Couiineuls(Hole eonilitiun of loll,sighs c ry(jnlullc I"ilurc, level of pondiug, condition of vegetation, etc.): I'LiIVY: (locale on silo Plan) Mateiials of cousliuclion: Uincensioos: Depllc o('solids:----- _ _ Caiuments(Hole condition of snit,signs of Irydrgc e failuri:, Ievcl ul'ponding, ciiudiliun of vegetation, etc.): 9 f Ul�'I�l( IAI., INSI'1�'C"I'1C)N l"OHM — NOT VOR VOLUNTARY ASSLSSNII N7'S S lilts tj1 1ACIi, SEWA(yL DISI'ASAI, SVS'K'j-eM yNSPIiTTION �eoiz Vl Pik I2'1' C SYSTEM INF0ftfYiA'1'I0N (continue(l) 116 Old Post Road Properly Address: Centerville,MA Robert Lynch Owiic�: November 28,2006 Date o!Inspectiiuk: SKET(.Al O SEWAC'E DISPOSAL Piovidc a sketch of the sewi�;c disposiil system inchiding tics Io tit Icast two perivanciii rcfeicnco Iandntaiks or benclunaiks. Locate all wells within 100 feet. Locale wbeie public walci supply enters the building. � - 37 Sy' C �- O f • Page 1 I o1' OFFICIAL. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SU It's IJIZ FACE ShWAC1(� )t)�SPOS/�1I, SYS'I-CM 1INSPMI�� PION Ii'URM PA 1(1<' C SYSTEM INVO)IZMATION (colitinnecl) Properly Address: 116 Old Post Road Centerville,MA Oweer: Robert Lynch Dale of Inspection: November 28,2006 SI7'I: i!:XAM i Slope Surface water Check cellar Shallow wells Estimated dcplh to ground water �$ }'lccl Ail.juslctl bigll ground wider cievalion — feet Please indicate(check) all methods used to detclnuue (lie high grorlud water elevalion: -�/- Oblaieed lion"system design plans on record - Ifchccke(l, dale ofdesign plan reviewed: Observed silt,(abutting properly/obscrvalion hill(, willlill ISII feet ol'SM Cbecked with local Uoar(l ul l Ic illh explain: (:pecked will) local excavators, inslallcrs- (;Vlach Itoclul tell L•II o I i Accessed 11SGS database-explaie: M-!- 1.2.5.__..:.Z_���i�..--y?---$.:7 ' S.u ' you nulsl describe how you established Ili(, high ground walel elevation: 1-1 I -.:.......Sr .U--..-. 9ar..C.J W __O a -t♦'T=r..S V�`..- J.t- ��'h.] .cam .._1....�J_w f:. .._ �" �v✓ L�t✓t.4ia, O ✓ J J` 5.0 .3 i� �► 5.0� u:G S 1 his report has Deer)prepared and the syslerrI Irlspecled as p(the dale of inspection. This report is not a. warranty or guarantee thatj file system w111 IuncllUfl pfopefly In the future. There have been no warrattlies or guarantees, either expressed, written of jl7tpllecl, felpling to the system, the Inspectlorl and/or ff►is report. Il v ` a li aooGv/ At J (T a47 C ,I��ih� r 41 1 _ /3 �•. El3 S'C '- 3 PC s t 4 f LEGEND EXISTING SPOT ELEVATION OxO "' 'u !: CERTIFIED PLOT . PLAN EXISTING CONTOUR --- FINISHED SPOT ELEVATION FINISHED CONTOUR 0 APPROVED BOARD OF HEALTH \ N DATE- wAL , � AGENT ► - = y T �r � SCALE� / ; DATE ?/,l 14/ CLOREDGE ENGINEERING CO. IN-d) CLI y" I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB NO. / G � �' BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR. BY OF BARNST BLE , ASS 712 MAIN ST. CH. BY HYANNIS, MASS. -' - -- - - - -- --- - SHEET-1- OF DATE REG. LAND SURVEYOR-- 20 FT. M/N. N(o /F E/TNfR TyE SEPTIC TA/t/,< OR - `� GEACN/ivG P/T A Are /`JORE 7-A4 AN /Z"DFtO Jet/ y /,C owr, M/N BRA OE, A 24 'D/I1 M ET.ER CONG'R ETA COYE.P' S),IALL B.F 900U(SNT To G,TAOE.(�f /V EXT,eA C°NCRCTE i g PYC P/PE tlE,4VY CA ST /�PO/Y GO V e T Sh�AL 4- 13E USED F/ M/N. A/TGN /F/N DR/VE11/A Y i0�' O CD YEJZS' �g"GFiP fT. _ 2 M/N. CDNG'R�TE i A , ::;: d,�,gptr CO ✓ER GL Ef�N S'ANO BACXF/LL I.a 2 LAYFR • • o P/rcN G�1 L.. + , • • • • • r , > . yyA S h'FO .572�NE.._ Pew fr. SFPT/C TANK D/ST. , , . . , , ,•• . , 1�... _ ,� t • i r •fir-ECr7YL ' • . • 3�4•- � �2� ' r • DL`PTN ' • r ' . y WAS)�FO 57 E �..:;:1,� � •`•• r , • • • • . , r o p p PREG4S T SE1.P1�G�... v y . � , • . • . . r r e a PI7 0R 547U/1/. I Nf�PTT rL EY.IT/GN S `� /NYERT AT GUILDJNG `'0 FT. FT. O/f7 M. I C CSgg TAdUL.4T10N> INLET SEPT/G' T.o-NIC 95'•r FT ` r. OUTLET SEPTIC TAN)< 9S' S f77 T /NLET D/STRJf3L/T/ON SOX qs`O FT 5- �7-/�N aF GROUND xt�TER T.4dLE OUfLETD/STR/B1lT/ON BOX ' /NL67- LEACN/NG Y7- SIFT. ITEWACE- O/Sf=OS'AL, SY.S'TEM Ti�Q1JL.4TlDN LF�4Cf"�/NG P/T y Fr. DESIGN CR/TERIA D/ •f�xs/°'`/ 8-FT. IVUMCER OF BEOROOJyS D/HENS/ON G y FT. � CA RCA GZ'P15PO.Se4J—4/,V/7" SD/L LOG SOIL TFST TOTAL EJT//►fsTED F'LOHW 30 G4L.�DAY $4/L TESTS/ S01L TEST2 / i NUMBER aF LfACXl,vG P/TS_ /� f`FLG`Y, 9 S G ELEY. 96' G IOATE OF SO/L TEST S/DE LXACHING PER P/T' 1709 SQ, fT. G ? / / RFSULTS *WITNESSED dY BOTTOM LF,�CfI/NG PER P/T $q. FT ear t S�4 ' Poe-ACOLAT/ON AAror #1 'j s M/N�INCN ,9E1tCC1r4TION R:4TF2 TOT.�►L LgAG'N//YG AREA _�s�SQ, FT. � , � a RESERVELEr4C'NJNG AREA S47 FT. CL SI Y 'Y- GV DRT, EL OR'EDGE AF - NF-R/J s CQ,/NC. ^. '=i 1�•:° 7j�uNct -. NY.QNN/J M.I SS. NC GTOUNO YY,4TrrT fNCOIJNTLreEO ❑ GRO UNO WATER AT AGL1rl! _ G Of JOB NO. SIA4 EL T" /w ` �pT l � I o� ' sue ► V� 07' Z OS - r t ► Gl C4 �id, L01 r 3t y-7 /Srn.�Y GAS � P I A_PP,1770N ocFD Po.sr tz��}z> CERTIFIED PLOT PLAN /�Or�: Ewsr/NF gvic.viNG 7-6 Be pErrioe.isNE11 f}ND IOCATM 4. 4 O�&-?-7.iW.Covmnwu&,4 ���[//G7'D/�,EXK�,T/n1G� EYTLG/VO�P �Ot1�D�j7'sA�1. SCALE . / �.���. DATE .11,l2-97IPC NO 7-,` � P/LO/F/ZTY DO ES A �1*Z' 4al> mil., P zoA�5. eZ.oN6 "G'>fl-s 50,' IA-J Cr IV PLAN REFME14CE L4tll: i�-? GOin�T:cJr✓ NEz NO. Z.SoOp/- OPT OSG a7,l p Ali/sEAsT��r� i�8s 8Y )c"E 017,f/'_.2 017 PcL I CERTIFY THAT THE �571.v�.�us a. SHOWN ON THIS PLAN IS T THE GROUND . . . . . . . . . g � E G� AS SHOWN HEREON */ A NEWTON N • ,A 17030 Q 9 Q /STslk DATE PETITIONER: SURVFy WE'3�yf1J� i �, . REGISTERED LAND SURVEYOR . 3 7 /L 16 -��� Los 4+•'4.� 4J ` � of iD' o� N. .,^k..e�a.•.:x�.ao.w„wa.�.txxw.,.vmv w .m.r,.w..,�.e Hh i 10 Em i d x S z. �� ♦ ..�"� ,. av,w:;•"'� ,iY:.,, i'.fBS.'f, "t "'",,s .:..:�.�'"� .�,e::. 9,w:✓TM NL`.„,'.teary 3A1rC p� � .f /;l u a e 1 �c e"c,c 7�e ZI/I r � r r f 5° / �a �� � I, �^lO�P q„Jwtl1 v „ ��/oa✓ v'7C 39 /�� � r' � ��,/�~ � ✓ /may._/.r/../7�^//�,.:f.� �, f� � ' •i , -_',....+._.�• J �!/ Of �' % +' .__..4��,.___. �� f rr f✓,J I ! N d•r l.! .i� l - a � � ��. �f �' !i , !�• '� .'I �cnT U�2t,J / d is -� .__...... ........_______. ._... o �_ �.Yh G 6°� ��5 �Yf a S S �to i 'd` 1•�$ _._.._..��=d-��-rN-$_.-_-�___....�_�0,._.g 9 -7 1...........,_.__..._._._.....,......_..- __ LJ- ,''� /•fir /' f ^... .�r / f� / IL ' . JO Aa o,d t rs F/0'a r Ra L'A 5 ,le rr c 0 0r1 leof ®, C n. v it �y 'A/ a f �.. 7 I � � 1 s ,. .. .. ... ... ...... .... .... .. f 110 . • B IEOt9C� — ecA r A) i 1 Phu C,/C ., rj I', / A 1 tL.� B ft r .�aP'� t �_�•_-._./ x nn QQ � 1. /L zIg YE'S,..t,�'ll.�.._._._,.,. I %e; Af up 9 _ J _ , } ,/r4LD s I A11' /e W.S 2 3 x w , C13) CB C13 Z gx 3 y �C '� �as�� AZ�►��� / �'�,. � � �� L R B d ! o� � x �� IgAP3 �.JX 83 , `- ,1 � R C*3 �.v_ / co Zn P r / 09 Y j � b I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK Address of property 6 d i d f a S 4- Owner's name " �G''v' � �C-4- Date of Inspection Z 22 22 H c_ �l��L� 0 PART A CHECKLIST J U N 1 9 1995 ; Check if the following have been done: NMTHM". =m OF B�NSTM E _-Z Pumping information was requested of the owner, Health. occupant, and Board of None of the system components have been Pumped .fortwo and the system has been receiving normal flow ratesaduringtthat weeks period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. No available with N/A. to if they are not The facility or dwelling was inspected signs for si g of sewage back-up. The site was inspected for signs of breakout. Al'l system components, excluding the SAS, have been located site. on the --.5e—/ The septic tank manholes were uncovere the septic tank was inspected for orinteri of material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ✓ The size and location of the SAS on the site has been determined on existing information or approximated by non-intrusive method&.based The facility owner ('and occupants, if different from owner Provided with information on the proper maintenance of' SSDS,�ere I { , .. C SUBSURFACE SEWAGE DISPOSAL SYSTEM 'INSPECTION FORM PART B SYSTEM INFORMATION / FLOW CONDITIONS If residential . number of bedrooms number of current residents Na garbage grinder, yes or no' No laundry connected to system, yes or no seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: 9 Y = o a �3 = aa�. 00a �u , Last date of occupancy GENERAL INFORMATION Pumping record and source of inf ormation: l H cr O 1� G� 7 YE S System pumped as part of inspection, es or no if yes, volume pumped /o y 6 4 Reason for pumping: v �rv5 t a t Type of system Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (it yes, attach previous inspection records, if any) * Other (explain) Approximate age of all components. Date installed, if known. Source of information: a. c- C-t N° Sewage odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continuad SEPTIC TANK: (locate on site plan) depth below grade: • material of construction: concrete metal FRP _other(explain) dimensions:_ .5 X / /� /oo o C-1 J �a sludge depth a" distance from top of sludge to bottom of outlet tee or baffle scum thickness distance from top of scum to top of outlet tee or baffle r� 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, recommendations for repairs, etc. ) 1 �-. - y r � � K o✓.�c✓. NJ S .., C� cam. I ,, ,r ; DISTRIBUTION (locate on ,site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, ev' ence of leakage into or out of box, recommendation for repairs, etc:) PUMP CHAMBER: N /� (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs , etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEX INSPECTION pORH PART B SYSTEH INFOR2{ATION continued SOIL ABSORPTION SYSTEM (SAS) :_ (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 and number ��u w leaching chambers and number /sz N leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) C 3L^ CESSPOOLS (locate on site plan) : f1/,y 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, recommendations for maintenance or repairs,etc. ) PRIVY : A/�/� (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, recommendations for maintenance or repairs,etc. ) 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION Continued SKETCH OF SEWAGE L=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Fro it 1' ibdo -r&41 ti 3L $6 w 3 5�, � � DEPTH TO GROUNDWATER N _ depth to groundwater method of determination or approximation: D CA\ C a l: 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / FAILURE CRITERIA t Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Backup of sewage into facility? .� Discharge or ponding of effluent to the surface o of the round surface waters? g r Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below .invert or available volume< 1/2 dad flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? within 50 feet of a surface water? within 100 feet of a surface water supply or tributaryto water supply? a surface within a Zone* I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? 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 analy,. for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 13 SUBSURFACE SEWAGE DISPOSAL SYSTE2i INSPECTION FORK PART D CERTIFICATION Name of Inspector Company Name Vt, S Company Address 1_1 0 d c.( a c 6 0 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maiitenance of on-site sewage disposal systems. Che one: V I have not found any information which indicates that the s st em to adequately protect public health or the environment as definedfinls 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303.. . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector' s Signature Date Original to system owner Copies to: Buyer ( if applicable) Approving authority 4 , 1 .?�� � a = f �poa(r•i/ '14 � �r r-t 13 .. 6-3 3%1'- 3 1 - S' 4. Rr3��JI clot s LEGEND EXISTING SPOT ELEVATION Ox0 A'`'"... CERTIFIED PLOT, PLAN EXISTING CONTOUR --- -- - '" FINISHED SPOT ELEVATION FINISHED CONTOUR 0 ';' rt�F'cr`r` L� IN TEp ��j flil�VlKl`i cn APPROVED BOARD OF HEALTH �,\ \ r+o.zzl�,z�0�� SA�,�� S��AS 1 L�J�ASS* DATE- AGENT '� ; .�N�, SCALE, / 0� yG DATE Ml-y ?/i LDREDGE ENGINEERING CO INO C. LI 1 CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB NO. BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR BY, OF BARNST BLE , ASS ?I2 MAIN ST. CH. By' s��)��� - - HYANNIS, MASS. SHEET-L OF � DATE REG. LAND SURVEYOR NO THE SEPT/C TANK OR L,Ef1Cs•I/ivG cl/T ARE MORE TNA/V I2"BEL0-$V f /D f7 M/�/ 6;RAGE, ,A 24",01A l ETER CONCR.ET� CPPemo SNALL BE BROUGHT TO GMAGE.�A/✓ EXTRA , q"PVC P/PL CONCRCTE � M/N. PITCH l'dEAVy C/�ST IRON Co��R Sh�ALL !3E U � �I /QG. O COVERS �9"PFiQ FT /FIN OR/✓EyVAY I P ' 2 MiN. CO/VCRETE �y ,�pE COVER GLEAN .SANS A BACJe,= LL L/gV/D LEVEL .r.• . 2•LAYER ..' Tva IRON J�/PE CIO O G,4 L ° �� 1 • • • • • •• • A •.� WA SHFO 57V)Ve o- M/J1/.P/rC// :`i %v•PcN/T SEPTIC TANK BOX • ~ i i 8 • • • • • ' •° ur: � � � 1 • IEF/rECT/✓L • � . ,+ 3 4~- � �2" ° • • • 1 • DPp7-N • • 1 • o AS//ED STONE • v• • P/7ORE 411V.. o � . • • • . • • . • • ' e o lNiiG�S"7' ALE✓.4T/oNS ' ° L JrT D/AM. /NYE/RT AT Ol//LD/NG G'O FT. fT SEP T.4 O/AM. C SEE 7r1DUL.f1TJO/V> INLET T/C NK QS•5- FT, OUTLET SEPT/C TANK 9S's fT GRpUNO NO<1TEX TADLE INLET OISTRl6L/T/DN BOX qs' FT SECT/ON aF Ot/TLETD/STR/Bl/T/ON BOX F7 INLET LEACH/NG /a/T y FT. S'EwAGE. OISPOSA L SYSTEM 7A8411-AT/40H LEACH//VG PIT DJMEN.S/ON A FT DES/GN CR/TER/A ,SCALE 01M.-A,510 4 $ C FT. NUMBER OF BEDROOMS SO/L LOG (,A RCA 6E D/SPOSAL UN/T �— SD/L TEST TOTAL EST/M.�TE FL D ON/ 3 3 o G.4L. DB' A SOIL TEST AkI SOIL TESTl 2 / NUMBER OF LfACH/NG P/TS-. / / f`ELC`Y. EL1�Y• q�'• G .DATE OF SO/L TEST RESULTS I•V17-,00VESSED BOTTOM 4A;4CN/NCi PER P/T f SQ. Ar. C 51, P--,V C0ZA-r1ON RATIF At/ -4 M/N,I/NCH f7 PW)tCOLAT'/O/V RATE lkZ a" MJN.�lNCN TOTAL LEACH/NG AREA Sip. Z � � RESERVE LEAC'N/NG AREA► _SQ. FT. p•t r C ' o . ,s.►.a, C Sd �,,,e s/�.?�+ Mfrs S= • `,a/� Z0 TcP. BUNIKIS S .a��No.izibz�o ? Sir✓ ELOREDGEEAUrhVAVg1hV CQ,/NC. y\F o �G/ T gP G i.. \ • �i _ , � / tI .G 712 MA N SrHYAA"Vli3lp MASS. � . yVi4T&R arVCOU/VTEREO Q GM UNO kVATc p 4T' EL-eV. - ✓Od ND. G SHEET O/: LO C # T; : N �' lSEW A G. E PERMIT NO. ga IN :. A:tLER'S NAME D ADDRESS aUILDE: R /OWNER DATE: PERMIT ISSUED DATE COMPLIANCE ISSUED 0 ,�k E No �IU Z_G ,7 r Fzcs..ao .../..... _P THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ��.�.u��e.vx............OF.............. -.�/ .IA.. d �.1.e.-------------............... Appliration for Dhiposal Works Toustrurtiun ramit Application is hereby made for a Permit to Construct (l`) or Repair ( ) an Individual Sewage Disposal System at: .....1.�.. _.._�.(. � .......................................ef ....`..............•----- .................-----...-----------------?.................................................. ......................Y� N C a ion-Add�ess� d/J `. 4` ...or Lot No... ^.^.... ............. ......... .......... .............^ .......�._..... Owner /�—� ! Address �(f .......•••-------•... •------..... ......................................... ....•----............................... � Installer Address e'2 )> Type of Building Size Lot............................Sq. feet �.� Dwelling—No. of Bedrooms.......... .......... .... .. .....Expansion Attic ( ) Garbage Grinder ( ) - PL4 Other—Type of Building w. �p._.� �. No. of persons........ Showers v Cafeteria Other fixtures � w�v ,---------------------------- ------------------•----------------------------------------------- W Design Flow.........................../'C.c!......gallons per rs per day. Total daily flow..................._. ._ ........gallons. WSeptic Tank—Liquid capacitylo .gallons Length....... Width........... Diameter................ Depth....e?....... x Disposal Trench—No.......... ......... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No........./......... Diameter...... ...O_. ... Depth below inlet........ Total leaching area.._ ..sq. ft. Z Other Distribution box (kj" Dosing tangy Percolation Test Results s, Performed by...........`..._. *. ?.1 !..�........................... Date. �'Y.�. .. Test Pit No. 11.072. .......minutes per inch Depth of Test Pit.................... Depth to ground water..................... LT4 Test Pit No. 2 _..minutes per inch Depth of Test Pit.................... Depth to ground water........................ x �_ O Description of Soil ..... - -----4--._... Co " 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 TITIS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a.Certificate of Compliance has been issued by th oard of health. ----•••-_.... "� Date 1 n Approved B Y. _Z = Date pplieation Disapproved for the following reasons: --......•-•--••••••----••------••----••....•-•••--•-•••-•-•••-••-••-•••-•-••--••--•--........-••••--------•••--••-•••••••••------•••------•-•--••••-•••-••-----•---•-•••-••---••-......--•••-----•••---- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH S .. 8i Trrtifirate of Tomplianrr THIS IS �O C RTIF by hat the I dividual Sewage Disposal System constructed ( 1/ or Repaired ( ) ---....._.. Installer i has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._ ....... _ ............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... 4 No..s'�1.=� -- f • FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................... ..................OF................................................................................... Appfiraation for Disposal Works Tuns rur#ivit Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ................-........_...................................................................... ----------•------------------------•---------------------•-------------------•---------------_.._. Location-Address or Lot No. ......................__...................................................... ....... ..........--...................................................................................... Owner_ Address W � ?s e�}rrA 'i are •.:"i: —i ................... .. ...... .:_--••.---•.--.....__..............•.----•..__.........-•.--..._......................1 M Installer Address I1Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria QI Other fixtures ----------------•--••--••••---•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length..........i..... Width................ Diameter________________ Depth................ x Disposal Trench—No_____________________ Width................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ................................. - -------•............... ...•---- ---__-------•-•-----•-----------------•------- --------- 0 Description of Soil----._....-•..........................•--------------------------•-------------•----------------•----------------------•------•-----------------•-•--•----.....-•--••... x U -•••••••---•-------••••---•••-----••-•-------•-•---•••--•-••••-----•-•--•--•-----•-••----------•-•••.....--•••-•••---•------••••-----••••.................•-----•-•-.._.......---.........-------------- W •---••----••-------------------------------•---------------------------------------------------------------------------------------•---------------------•....--•-------•-......-----•-••••••---...•... UNature of Repairs or Alterations—Answer when applicable................................................................................................ ...•--••-----•••••••--•••-•........................•-••-•-•-•-•--•-••••-••-••-••-•••--•...._........-•-•--...-••••••••---•--•-••-•-•--•-•-••--•-••---•-•-•-----•-•-----•--•••--•------•-•--.....--•-•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT LZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by th oard of health. Signed----•--�" p > on Approved BY /V- r.�' r✓� -..... L8- .! 1 .. . 4 ;47 Date Application Disapproved for the following reasons: --------------------•----.....------------•--._...--••--.......------......-•--------------•---••--•-•----••---••---•-•-••-------•••------•-•---------•---............................................. Date PermitNo.......... ................................------------- Issued....................................................... Date s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... t'N...........OF..... :' 'e' "F'Sa .......................... w Trr#ifiratr of Toutpliattrr THIS IS O IF , That the div>dual Sewage Disposal System constructed ( q/or Repaired ( ) b Installer . at........... 4. �' . . .t vs ......I......................................................................... has been installed in accordance with the provisions of TIT 1Z"_ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit _ ___________. dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Y DATE.....................................................•-----------...._--_..._.. Inspector.................................................................................... THE COMMONWEALTH OF'MASSACHUSETTS BOARD OF HEAL LOU No... �...r ..C?..,� FEE... J............. Disposal ots, Tomitnulintl rr 't Permission is h-reby granted •• .. ✓ ......................................................... to Construct ( )�or r ( ) a I vi al Sewag -`asposystem� atNo...__...,��.1l� © /_.. .. .(___�°: :�.... ......... .......................................•......................... 7 Street as shown on the application for Disposal Works Construction Permit No... ... �Boar�d 2 sated.......................................... ......... ' _ �_v f Health DATE........................................................ ---•••-••--•••-- ......-•.----- •-- ... FORkA 1255 HOBBS & WARREN, INC., PUBLISHERS 1 ~ t is�3 Gi 'It!ot. L' 451 IVG : I 3 u �'o' fit, ' �.� �Q� f'►Y�. 6, .� � i 13 c LEGEND = EXISTING SPOT ELEVATION Ox0 „�. .,.,- � �:. CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 - -- Y;$' . ;, �� 7141 s77 FINISHED SPOT. ELEVATION2, FINISHED CONTOUR p . ;,L.,: �, `'Y •�°`* �•1 v,� ;/e� APPROVED - BOARD OF HEALTH � �,.}•i+v.2'1'2 SAJlkl S�,,AS L9,A ASS* DATE AGENT � . .=..��F,�. SCALE= / y� DATE��.;ti.:. . . LDREDGE ENGINEERING CO. IN � 4yA r �' CLI T I CERTIFY THAT THE PROPOSED liqEGISTER REGISTERED JOB NO. �' BUILDING SHOWN ON THIS PLAN CIVIL LAND r� CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY= OF BARNST BLE, MASS 7I2 MAIN ST. CH. BY: HYANNIS, MASS. SHEETS OF —L DATE REG. LAND SURVEYOR IV /F E/TNER ?NESEP7/C TAN/C OR � 20 FT. M/N. 4wo �iEf}CNING P/T ARE MORE T//A/V I2"OELOW E /D FT: M/�/• GRAOF� Ai 24"O/AM ETER COlyG'RE'TE C'OYER S,"ALL BF BROUGHT TO 4RAZ I✓ ,EXTRA 4 PVC P/PE CONCRETE ti+EAvy CAST IRON CG{�FR Sh+.4LL L3E USE.0 /- AGO M/N. P/TCN ND C I ` O COMERS !F/ , R/VEWA Y_ CONCRETE P M/N. _'d G AOE co 1iER CLEAN SANG • . . . BACX,=/LL - - L/QU/D LEVEL -�'• �;: I • �:. - - �' '•.•I• Z LAYER CA � M 4 S T i� e 3 ( IRON P/PE c OG G o 0 0 • P D o OF /a - /B 69 MI/V.o/TC// // G K . D/sT. 0• O • • • • • I • r r e d4q WA SHIED S72�NE /4 PEA P-r SEPT C TA • 4 0 e BOX p ? O • 1 8 • I f • • r ► ; Ir N / p r 1 •EFFECTI VC � • ° /4 - _ e ° • • D • • 1 ' o WASHED STONE Gt•. 1 • • • ► 1 o e O O O a 1 1 • • • 1 • • r p o 3t'•::�e e 0 o O r a r • • • • . • , , p • a PRECAS T SEEPAGE d • P 7 R �U V r D • f • r r ' e p GN S a /NE/BRT ELE✓.4T/ e INVERT AT OVILD/NG O FT. 6 FT /AM. INLET SEPT/C. TANK 9S,5- FT• FT O/A!►'J• C�SFE TABUL.4T/oN� l OUTLET 9 r, $SEPTIC TANK Fr I/VL.Lr D/STR/4.UT/ON BOX 45'0 FT. SECT/O OF GROUN/7 I ITEK TA9LE /V OlITLETD/STR/BUT/ON BOXY g FT. INLET LEACHING PIT FT. SEWAGE O/SPOSAL SYSTEM � LEACH//VG P/T TABULATION StA %4"' _ /= D' DIMENSION A I/ FT. DES/GN CRITERIAG/M,ENS/aN a FT. /VU/NQER OF BEDROOMS D/MENS/ON G—�_FT. ! � GAReAGED/SPOSAL�//ti/Ir SO/Z- LOG TOTAL ESTIMATED FLOv✓.3 GAL.1DAY SOIL TEST #/ SO/1- 7EST.*'2 SOIL`TEST r G G / 0 /4lUMBER QF L,EtAGN/NG I f P/TS_• "'EL EY. 9 Q' Al—ELFY.—qG_ ,DA TF OF SO/L TEST /ti// S/OE LEACH/NG PER P/T / 7� SQ, FT. G ? RESULTS AVITA1ESSRD BY " k A 1 C I { ®OTTOM L.64CI•!//vCr PER PIT $Q. A'r oar.f 560 PER COLAWON RATE�/ �� � MI/V,//NCH { TOTAL LEACHING AREA 2 C Or SQ. r7 , PLINCo4A77ONRATE M/N.1/Ncv S RESBRVELEACNING AREAIAA� SQ. FT. `AZ., C $ r, h -'Z'' ROBERT !A- U/ ! e _ <t� r � v,.':;t<;�•.:�.:i_ ."r `-� BUNIKIS vi No.22162 0 EL DREDGE ENCr/NEERING CO,INC. J. ^� ,w� �/ �3•� 7/2 MA//y Sr UNA '�, ND G/40lJNc7 Li�i4TER ENCOUNTE.�EO HYANN/3, MASS. Q GROUA'Z> Y1/ATER AT EL.E V _ JQB /VO, �j G SHE,ET OF TOWN OF BARNSTABLE LaCATION I (a O SEWAGE # c n VILLAGE C e,n Lcam v`, 11- ASSESSOR'S MAP & LOT zo q_8-D--DO z INSTALLER'S NAME&PHONE NO. 146 L-JA—> C.4� s�✓V c_ o SEPTIC TANK CAPACITY 1 6 O(' S,c..t(o" LEACHING FACILITY: (type) L P: (size) NO.OF BEDROOMS 3 BUILDER OR OWNER 1�a ifl��L PERMITDATE: /3 COMPLIANCE DATE: y/ 8 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S '4- 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) /Vh Feet Furnished by Wr I 5 11 AS / 0 4, O G w �I - TOWN OF BARNSTABLE �i LOCATION SEWAGE # b I VILLAGE ASSESSOR'S MAP Cz LOT INSTALLER'S NAME & PHONE NO. /7b v.J C-S C S SEPTIC TANK CAPACITY o > LEACHING FACILITY:(type) (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER c DATE PERMIT ISSUED: I'- DATE COMPLIANCE ISSUED: Gf/ ,/-/ VARIANCE GR NTED: Yes No /r ���`�� a3�b �� t� � ���� -16 3K� �`"� �6,��� � �6' II � i/J�7Jbl` r. l� L. d �+/ � _.y LO.CAT N �' � SEWAGE PERMIT NO. �� /�/ VILLAGE v IM TA LLER'S NAME i ADDRESS ®w4--5 BUILDER A91 OWNER DATE PERMIT ISSUED "' kl DAT E COMPLIANCE ISSUED �t�� � �; ��'' � � �� d 6 0� t„ �1 � � �� �t