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HomeMy WebLinkAbout0094 WATER VIEW CIRCLE - Health 94 Water View Circle Centerville P A = 254 028X02 I lllt NPC 12543 o.53LOR WpCnN(jC YN COMMONWEALTH OF MASSACHUSETTS r f 0�=- !*F „xi ay" f1 EXECUTIVE OFFICE OF ENVIRONMENT FAIRS PARTMENT OF ENVIRONMENTAL PROTl 1 Ail 10: 38 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 4 CERTIFICATION Property Address: a-�e✓v�e �v Cl v- e C✓✓r o1�3aZ Owner's Name: Owner's Address: (.✓� yr @ G r r Date of Inspection: p r- Name of Inspector:Wease print) r /� Company Name: � 0 M MailingAddress: O � O ` Y-)— Telephone Nnmbe 08yV T CERTIFICATION STATEMENT I=y that I have personally inspected the sewage disposal System at this address and that the info below is true,accurate and complete as of the time of the inspection. training and experience in the proper function andmaintenanceofon site sewage dispos te inspection was rmation reported performed based on my approved system inspector pnrsnat to 'on 15 de S 310 CMR 15 00 .1*e .I am a DEP � � ). system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: /® pr' The system inspector shall submit a copy of this' re DEP)within 30 days of completing this inspection won rt to the App ving Authority Board of Health or gpd or greater,the inspector and the em is sharedsystem or has a design flow of 10,000 DEP. The original' s3' owner shall submit the r eport to the appropriate regional office of the ��y should be sent to the system owner and copies sent to the buyer,if applicable,and the approving Notes and Comments report only describes conditions at the time of ins pection time This inspection does not address how the system will Perform indthe under re�nnderrthe same or different conditions of use. i Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A n CERTII�'ICATION(continued) A operty Address: T Owner. �! Z ✓� G3dt Date of Inspection: r Inspection Summary: Check A,B,C,D or E/ALWAYS complete an of Section D A. �yjpasses: I have not found any Information which nuhaltes that any of the failure criteria described in 310 CM15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: B. SYrft Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired-The system,upon completion of the neplacemem or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. " explain g Cements If not please The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial i MhWon Or exfdwdhon or tank failure is imminent.System will pass Aexis�tank is replaced with a complying septic tank as approved by the Board of Health. inspection if the septic tank will pan inspection if it is structurally sound,not leaking indicating that the tank is less than 20 years old is available. and'if a Certificate of Compliance ND explain: Observation of sewage backup or break out or high static water level in the distribution obstructed pipes)or due to a broken,settled or uneven distribution box System will button box due w broken or approval of Board of Health): pass inspection if(with broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required Pumping more than 4 times a year due to broken or obstructed Ppe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(conc=4 Property Address: "4e vi- G 1 v, -, 63.E Owner: Q/' - z Date of Inspection: G C- Evaluation is Required by the Board of Health: 7Conditions exist which require fiuther evaluation by the Board of Health in order to determine if the system is hilmg to Proms public health,safely or the environment. 1- System will pass unless Board of Health determines in accordance with 310 CMR 1S.3030)(b)that the system is not�ctioning In a manner which wM 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 hn a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributwy to a surface water supply, — The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a Pete water supply well".Method used to determine distance "This system passes if the well water anal bacteria and volatile o �'performed at a DlR certified laboratory;for coliform c compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 plan,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 INSPECTION FORM PART A CERTIFICATION(cow Property Address: / �f (,./o,->'e,,c/i e�✓ C ✓` / ✓ O 31- Owner: oar Date of Inspection; �r D. System Faflure Criteria applicable to all systems: You mug indicate"yes"or"W to each of the following for aR inspections; Yes No� age into facility or system component due to overloaded or clogged SAS or cesspool ✓✓ of sew — �or ponding of sweat to the surface of the ground or surface waters due to an overloaded or /dogged SAS or cesspool ./ Static liquid level in the dishftition box above outlet invert due to an overloaded ar clogged SAS or ow Required�h in cesspool is less dm 6"below invert or available volume is less than N fl Pumping more than 4 times in the last year NOT d obs ue to clogged or Number _ any portion of the SAS,cesspool or privy is beloA. w high groundwater elevation. Any p°SUP cesspool or privy is within 100 feet of a surface water supply or tributary to a surface Any portion of a cesspool or is within a Zone 1 of a_ -7'� �' public well. .-_ Any portion of a 1�Portion of a cesspool or Ivy is within 50 feet of a private water supply well. supply well with �1 or privy is less than 100 feet but greater than 50 feet from a private water Performed at a D acceptable water quality • [This ry�Passes if the well water analysis, EP certified laboratory,for coliform bacteria and volatile or ganic anic cum that the well is free from pollution from that f '"g pounds nitrogen and nitrate nitrogen is equal to or less than 5 pm'provided and the presence of ammonia are triggered.A copy of the analysis must be attached to this form. that 00 other failure criteria (Yes/No)The system fad,I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To gpd.considered a large system the system most serve a facility with a design flow of 10,000 gpd to 15,000 You must' cat-either"yes"or"no"to each of the following. ('The follo criteria apply to large systems in addition to the criteria above) ye n — the system is within 400 feet of a surface drinking water supply — system is within 200 feet of a tributary to a surface drinking water supply — Zone of a— the stem is lecated publicwat Mter a nitrogensupplywe sellnsitive area(Interim Wellhead Protection Area-IWPA)Ora mapped if you have answered"yes"to any question in Section E the system is considered a significant "Yes"in Section D above the large system has failed, The owner or �� d answered signiscant threat under Section E or failedunder Section.D shall operator of any large system considered a 15.304.The system owner should contact the a the SY�inaccordanc�with 314 CMR mate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 6-"a^ vvt-eL,1 C 1 ✓,' Owner. � �` ✓vti 601 Date of Inspection: r Check if the following-have been done.You most indicate es"or"no"as to each of the following, Yes �o —✓ A-UnFmg infomuahm was provided by the owner,occupa�or Board of Health — _ Were any of the system components pumped out m the previous two weeks Has the system received normal flows in the previous two week period v Have large volumes of water been mtzoduced to the T system n:cently or as part of this inspection v Were as built plans of the system obtained and examined? T (If they were not available note as N/A) l� Was the facility or dwelling inspected for signs of l�sewage up Was the site inspected for signs of bmak out Were all system components,excluding the SAS,located an site Were of the ba$Ies or the�tank manholes uncovered,opened,and the mterw of the tank inspected for the condition teen material of oonstraction,diu�ams, of hqmd nth of Budgie and depth of scum Was the 6cility owner maintenaaoe of (andts if different�o�`�provided with information on the proper �- - The size and location of the Soil Absorption System(SAS)on the site has been determined based on Y�no — Existing information For example,a plan at the Board of Health Determined m the field(if any of the Wore criteria related to Part C is at issue approximation of distance is unacceptable)[310 ChM 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSES SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION'FORM PART C SYSTEM INFORMATION Property Address: If -41,q-e L Cf v+ Owner. l4rt 477 Q ©�G 32 - Date of mVertious; �.OW.CON)ffIONS RESfDFNTiA3, , Number of W oom(design): Num ber of bedrusoms(� A )r w DESIGN Blow based.an:310 CWR-15203(for.example: 110 .x o f. r 3?o Number of current residents: d Does residence have a garbage grinder(yes or no):j�0,5 Is laundry on a separate sewage system no). [if yes separate inspection reguireQLaun �t y System inspected(yes our ): Seasonal use:(yes or no). O Water meter rmdhV%if (last 2 years usage(g d)): Sump Pip(yes or no): *V Last date of occupancy: L4 i/'.�� COMMERCIALMDUSTRIAL Type of establishment: Design flow(based on 310 C101R 15.203): �. Basis of design Bow(seatstpersondsgft,etc.): Grease trap P (yes or no):— Industnal waste holding tang Present(yes or no):— Non-sanitary waste discharged to the Tifle 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records 1 Source of information: old 03 — D �-✓vie t/- Was system pumped as part of the inspection(yes or no): If yes,volume PmP&:_gallons—How was quantity Pumped delermined? Reason for TYPE STEM tank distnbutiion box,soil absorption system —Single Cesspool _Overflow cesspool —privy —Shared system(yes or no)(if yes,attach previous inspection records,if any) —lnn from c/Aftanativa technology.Attach a copy of the current operation and maintenance contract(to be obtame--Tim tank —Attach a Copy of the DEP approval —Other(describe): Approximate age of all components,date (if bum)and OTof information: Were sewage odors detected when arriving at the site(yes or no): Page 7 of l i OFFICIAL INSPECTION FORM NOT,FOR VOLUNTARY ASSESSMENTS SUBSURFACE SERFAGE DISPOSAL SYSTEM INSPECTION FORM PART C Q re SYSTEM INFORMATION(conSmiedy Property Address: 7 ✓fir-e(�/ C� ✓' Owner. Q�rz ✓vr /f Date of of dior. r BUILDING SEWER 00cate on siteplan) Depth below grade: oZ If // Materials of constmction _cross in 40 PV Distance�private water supply weft or h1k- Comments(on oos>xlition of joixds;Mmflm &mIdm=of Ieaka�,etc•); SEPTIC TANK;—0=49n site pin) Depth below grade:Matefial to (Ofconshutio c. —� _otber _polyethylene x&W If tank' metal W age:— Is age bya of coi ficate) Compliance(yes or no):_(attach a copy of Dimendew X g sbadge to bottom of outlet tee Mud or baffle:Scum thidmest a--- Distance from top of scum to tOP of Distance from bottom of scam to o tee or bade: bottom7 outlet tee or baffle:2 How were dimensions determ�; o Comments(anpuaipingAxommendati a 2v! G as to outlet invert, of usIo inlet and outlet tee or baffle condition,struchui l integtit3's liquid levels vl wi n leakage,e�C) GREASE TRAP:_(loq�on site Flan) Depth below grade: Material of construction;_concrete (explain): —metal —.P0IY�kne_otler Dimensions: Strom thiclmess: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet We or bs�e: — Date of last pumping ---. Cows(ou pumping recommendations,inlet and outlet.tee or baffle con&,0 as related to outlet invert,evidence of 1cturalgnh',liquid levels ealsage,etc.): I Page 8 of 11 OFFICIAL INSPECTION FORM-�NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL,SYSTEM INSPECTION FORA PART C C�C� SYSTEM INFORMA77ON( Property Address / / 61�-k✓w ee ,l Date of Inspection- TIGHT or HOLDING TANKe j!y (tom must be p=PW at time of in.spectiam)(Iocate on site plan) Depth below grade: Material of construction concrete metal fiberglass_.Polyethylene other(explain): Dimensions. Capacitr Rallons Dedgn Flow: mod, Alarm Present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DETRIBUTION BOX:Z(Jfsent mast be opened)(lopte�Wsite plan) Depth of liquid level above outlet mverL V7 0/'01 G Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evil of 1 into or out of box,etc.): o�C -Js L PUW CHAMBER;A (locate on site flan) Pumps in working order(yes or no): Alarms in working order(yes or no): Cimments(note condition of Pump chamber,condition of pumps and appOrtmax:es,etc.): I Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE OIS.POSAL SYSTEM INSPECTION FORM SYSTEM EWFOR AY14DN Property Addm A42vc--,-e owner: Date of Inspecti� Qom/` SOII.AMRP'MtSVSTEN(SAS}; trade as*g Plan,twawatioa jut.regaree If SAS no located why: leaching ganaiM mmbw. Id- s , dimms CmPook SYstem Typdname of tool noloW vl�J`�08 Of�signs of hydraulic faiharC,Ieve1 of pondmg d�np soil,condition of vegetation, L SSPOOI. �(Ce�must be ppmped as part of mspectionXioarte on site plan) Numberaad : Dcpth—topafto inlet invutf: Depth of solids k Depth of scm aft: Materials of oo : Indicatkm Comme>��� • --pottedwater�(Yes k Of hydt2Wic Wme.lewd(ifpottding conditim ofv ,etr� PRIVY: � an aft plao) Materials cmisuacdm Dimes Depth of soh COS(nI� ofmPs of hydrJWic failure,level of pow won of veg ems): Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION&o Property Address: / -4cv k/ C�� owner: 4 Z Date of Inv ww. p� SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system mdufmg ties to at least two benchmarks.Locate all wells withm 100 feet.Locate where public watm en�theof ��C2 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Q SYSTEM INFORMATION(confimmM Property Addnese: / (✓�-�er�, ,� Owner: �,-, 44 Date of�nspedion: o�' SITE EXAM Slope . Surface water Check cellar Shallow wells 10 0 I to g E �� As� stimated depth mmd water��� Please indicate(check)ail methods used to dit m w the b%hs m w wow (o" % r o �� des ign l racatd-if che�d,date of design plan reviewed C�eciced=(fig property/obsmm ion hole within 150 feet of SAS) hx t Board c'Health-explain: p"1 e v 2 1- Checked with local excavators,installers-(attach dme> ion) F Accessed USGS database-explain: You must descnbe how you hed Ile Pvmd water elev ww , �f�� �l s iJ a6 � ,i Jam✓ Oo o d ji 0 000 - ' — 1 t0 0 Do �I 0 op ��� - c,2 �_ 5r3 <o 74r , No.... _.... THE COMMONWEALTH OF MASSACHUSETTS /F.Rx P BOARD OF HEALTH TG i ... oF.....,/�fl�. .51 C ------------------------- ------- Appliration for Disposal Morks Tanstrnrtinn Vamit 0 � Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal System at: 3g / Loc ion Address or Lot '�� i ..._�0.----•-----16 G ... igf/✓ �T ... ow Address ,Wa ............ • /:7......:C--<n1e_�4e .e-..�2:s._,................:... Installer Address Q Type of Building Size Lot__� � ..Sq. feet U Dwelling—No. of Bedrooms......3.................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures .----•-------------------------•-•--•---------------....-•--•----------------------------------•--••----------------=-------•-•••......---.........--- W Design Flow...._�1��P _gallons per person per day. Total daily flow..............31-'....................gallons. WSeptic Tank—Liquid capacity_/.} Q.gallons Length._!_D..4.'.. Width.S. Diameter________________ Depth...__.7.`./.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....Q/_✓E...... Diameter-----/��___.._. Depth below inlet................ Total leaching area....�-lB�...sq. ft. Z Other Distribution box ( �) Dosing tank ( ) Date 3r� -------------------- Testo a Percolation Test Results Performed by.....LC-VYI-. L.111 ...................... a Pit No. I....<..Z-._minutes per inch Depth of Test Pit....1.3`........ Depth to ground water./__✓_._ � (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.__............_.... Depth to ground water____-_--__---__--_-____. P4 ................................---... -..................................................................................................... O Description of Soil............................ _-�'..__Tt�.s�4 ........................................................../-.... l--a___�..••.�..... 1/b%z wSTO/� ----•----- 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 TITLL 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 the board of health. Signed.......................................................... ..... .................. ................................ Date Application Approved By......... •� 1� �---------- ---- Daatt' 3 4:� e Application Disapproved for the following reasons:....................................... ........-................................. ............................ ....--------•----•-------------------•----•••••-•-----••---........ •-•••--••••••--•-- -•----••••••-------------•-•-•••----------..................-- ¢ Date Permit No.........�• ... .. .. '..... .. Issued Date Date No................---... 1 G FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS /00 BOARD OF HEALTH S b I.... OF..... fd�..,. .f Appliratiun for Dispoli al Works Ton .rurtiun Prrmit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at .•.. ......... .../.f....L ..................................... . "✓/i..t!.. ..........Gar.. ----- t Lo ion Address ......................... .......................................... ....... ................................... ...... ....... Owner Address a •-••---•........................•--••••-••••-----•------.........._............................... ---•--......---.......•---........------............................ Installer Address �1 !3 ,r Q Type of Building Size Lot___________ _______________Sq. feet V Dwelling —No. of Bedrooms ...................................Ex ansion Attic gp ( ) Garbage Grinder ( ) WOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures •---•-•••----••....-•--••-••••••••••........-•--••••--.-••••--•--•-••••••--•-••••••..................•----------•--•--•.......-----••--••---....------ W Design Flow..... ' ',�a, ��= '-:'s'.�'.gallons per person per day. Total daily flow--------------?a-.......................gallons. /f. '� r W Septic Tank—Liquid'capacity._-:`:�.�w°_gallons Length._.:°..`. .__ Wldth_�_.�'='_.._._ Diameter________________ Depth____._."�.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area-------- ....sq. ft. Seepage Pit No....f=Ev! :__._.. Diameter...../.. __........ Depth below inlet........ Total leaching area... ........sq. ft. Z Other Distribution box ( i ) Dosing tank ( ) Percolation Test Results Performed by.____Lr=?� _, ��r4- c- .. �' . --•--....-----•--------------------------- Date.------•-----...... ----------------- Test Pit No. 1._:�ti_.r=::..minutes per inch Depth of Test Pit.._ /. .......... Depth to ground water_.'_... fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------•-•- ---•------••------.......................................................... O Description of Soil............................. x --=............................................................ U -•• --- -------- -- -------%'......•..w/r�1, .A�t/. r ..../ /'t'=s���..5 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 TITIZ 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 the board of health. Signed...................................................................................... ................................ Date Application Approved By...................................................................................... -- --•--- ........................................ Application Disapproved for th4frms Qo'�l�'..... ......................... -•-••-•••••......•...... .�. `............................................................ .................................•-•---.....-•-------.........--•---.........---------•--•-•••-----•-••-•....._...--•---...--\---/.........._.----•---•-•--••-------_..._......•-••-•-•••-•......-- Date PermitNo......................................................... Issued....................................................... 93 ` / 7 V Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................�.................................... rr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............................................................................................................................................................. / Installer at --••-•-•----•--•----•--•-•--------- -- ---------•--• --•-- .................... has been2a�i�ed for an p� of TYTd.�' 5 of �� Code as described in the application for Disposal Works Construction Permit No......................................... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NV=E CbbA*ED AS A GUARANTEE THAT THE SYSTEM .W...I...�...•.FU a N ATISFACTORY. ` oiv ...•-•-•..DATE...... Inspector _ A . %%% THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ...............OF........................ No.__o3....�..__. FEE............. 7 i u �tl urk Tuntr ion rrmi !o Permissionis hereby granted.------••--••---•----------•---•--•-•----...----••-••--••••-•-•••••-•••••••---•••••-•-----•••••-••••--•--•-•-••.........................•----- to Construct ( ) or Repair ( ) an In�i4uaI� Disposal System atNo................... .............................................................. pl5i' ZI 1 a� r/,�,. q� Street as shown � &7a lca on f r s os AA ors onstruc Jon ermit No..._ _ Dated---------------------::................... .............................. �67P --- --•.................................- •-----•-•----•------••------------ �oard o ealth FORM1255 HOBB��A��N. I ,�,,�BLISHERS `'-Sew gyTOWN OF BARNSTABLE LOCATION LpT 3R c%vL SEWAGE # Ojj-b/?'l VILLAGE e.�►�1 tIIC ASSESSOR'S MAP & LOTZe —d � INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY Otro LEACHING FACILITY:(type) tT (size) i� NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: v g VARIANCE GRANTED: Yes No 1� z e SOIL L 0 G ��. �¢�� NO. 1 0 N0 7SITE PLAN I ! ==L, 7.�-S 3�aSniL I 3 I � �aAesE 4 I • r RA VEL 7P SO v�l/TH ., , TOP OF FOUNDATION El. : 6 1 I i 8 MIN. 2% FINISHED P R A D �-- 9 E E 7Z• G Z u ° - _ v.1 . IN l �bivc. eiSE,e caves-rz 1 � .• vXf -7170 MIN. COVER +iiTi/ini Z FG• /E�ic�f • • . 2 COVER 1/8 3/8 WASHED STONE ' v• IN IL7Z,.� L'� %�, 09 I r itl ! oao • • `- � IN El./DSO , _ , ° O/ B W / So SUMP ° . .•. • :. ; , • , ° 3/4 1 1/2 WASHED STONE 3 4 LIQUID tEVEL ' . � � ` O• 00 NO ° • . . q; 6' E F F ' °• ° ' Ei✓CcJ(/NrE,eEv , r •�t�T-; � °. ° '.• ° : DEPTH .,° °° • PERC T EST1 RESULTS ° ° • 0 • I PRECAST SEPTIC TANK WITH • . .• ° , ' °e° • ° PRECAST LEACHING PITS PERC RAZE' : -- z/y�� yz5e/n/CN CAST IN PLACE INLET AND EL• �sso . . • ° NO SIZE: � a''� � 6 E''� DE'`'�'`! WITNESSED BY 1 0Ul'LET T 'S PcR TITLE V � /saa G l L sroZvE � 'D I A 2 _ .-�'2"/sT'9B`.� BOARD OF HEALTH I SIZE . A 0 N S , I ST�^'� OF STONE DATE : 3- 7- 90 - 7s�-3 � s��•' ,r LONG x � �"" W I D E x D E E P l Pervious X0 'OIA ALL AROUND I zs PROFILE OE PROPOSED SEW -AGE SYSTEM SYSTEM DESIGNED BY THE TOWN OF _ tfAKivsTAQLE REGULATIONS AND �N STATE TITLE V FGR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4~- 1 ' 0 " i LN 1 . ALL PIPES SHALL BE SCHEDULE 40 P.V.C . SEWER PIPE 2 All PIPES SHALL BE SLOPED 1/4 PER FOOT EXCEPT FOR o T,INik �� /soo G• , ' I � ��� � �o•', ,SEpTic � 3 THE FIRST 2 FEET OUT OF THE 0 /B WHICH SHAII BE LEVEL �� _ _ - ��� - S� 07/U438 '. 3. DESIGN FLOW BEDROOMS AT 110 GALDAY PER BR 330 GAL/ DAY h - 14 aX 43, G3� s•F. I SEPTIC TANK SIZE 33o X /soyo GAL ZG USE is�o GAL . W/ o� GARBAGE DISPOSAL P c� 3" i L 1 � 3 i LEACHING SYSTEM : USE ' /��� �' r .�T,,� �eEcv T ��•4cyin� ���� ��� �5 "� o,T, ' EFFECTIVE AREA : SIDE Z BOTTOM ��e x /,o - 7rX0s,r/,o = 78 0 , I TOT -A7i �78= s¢9ZR��.s9 TOTAL REQ 'D FLOW Sao X /00% .336 GOD W/ewr OARBAGE DISPOSAL � �' ?RESEAVE FLOW s-�ti- 330 =-= 2/9 GAL/ DAY IN RESERVE 7'L 1 ��� �- - " - ,� I RIFE RENCC PLANS .moo 6f.16ril - x APPROVED BY : ���= �-`s sc.9cE:�'•=�o' BOARD F HEALTH 0 N l N ( I DATE : PROPERTY OWNER . SITE AND SEWAGE PLAN i'A OF F 0 R : 11//cKULA.S 341/1-1/N6 CO DEOROOM SINGLE FAMILY OWFLI. ING LgHm 101 : o• 38Ww C/QCLEDorU, ti' � I �ttlo. 71� 1 Na. sass r 0 A T E eBOYLE ENGINEERING "ASSOCIATES INCORPORATE U Box 595- 530 Thomas B. Landers Road W. Falmouth, MA 02574