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HomeMy WebLinkAbout0241 PINE STREET (HY - Health =�24 et 3 I ���� pECvclfp AY UPC 12543 No.53LOR Ft �'�n•coN�� HASTINGS,MN Commonwealth of Massachusetts -ry _ _-W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 241 PINE STREET _ Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for _CENTERVILLE MA 02632 4/10/07 _ - — --.—..-- every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. �a�5 'mp°na"t When filling out A. General Information forms on the © 3! computer,use 1. Inspector: only the tab key ~s'f to move your MICHAEL DEDECKO cursor-do not Name of Inspector ` use the return - >~ key. COMPASS REALTY DEV CORP Company Name { P.O. BOX 2384 Company Address MASHPEE MA 02649 return City/Town State Zip Code 508-221-5003 _ Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority r 4/10/07 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts --- Title 5 Official Inspection Form sl Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 241 PINE STREET Property Address C/O DAVID H_OLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name -- -_- --- ---- -----'- information is required for CENTERVILLE--- MA 02632 4/10/07 -------...--- — --------- - — ------- --------- - every page. City/Town state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 241 pine•00/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 241 PINE STREET Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is C_ENTERVILLE MA 02632 4/10/07 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form - -- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments —; 241 PINE STREET Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 4/10/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 241 PINE STREET y Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 4/10/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ay. 241 PINE STREET Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 4/10/07 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts --p Title 5 Official Inspection Form —- — " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 241 PINE STREET Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 4/10/07 _ ._ ___-- every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): -3------- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 ----- Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage (gpd)): n/a __ — 9 ( Y 9 (gp )) Sump pump? ❑ Yes ® No Last date of occupancy: N/A Date Commercial/Industrial Flow Conditions: Type of Establishment: ------ — Design flow(based on 310 CMR 15.203): ---------- - Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): - -------- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: --- -- — -- Last date of occupancy/use: Date Other(describe): 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �J 241 PINE STREET _ Property Address C/O DAVID HOLT 15_3_3_ FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 4/10/07 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: n/a Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? - --- -- ---- ----- ---- ----- 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No 241 pine•08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form -- - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -. Y 241 PINE STREET -- -----------_----.----_—_-- Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is CENTERVILLE MA 02632 4/10/07 required for - every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): ---------- ------ Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints tight, yes vented, no sign of leakage. Septic Tank (locate on site plan): Depth below grade: 1 --------- ---- feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years —� Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------------------------------------------ ----------------------- Dimensions: 1000 gallons _� 6" Sludge depth: -- Distance from top of sludge to bottom of outlet tee or baffle 28„---- 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 10" — Distance from bottom of scum to bottom of outlet tee or baffle 14" - -- ---- How were dimensions determined? measured — _ .- 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 241 PINE STREET Property Address -- --------------- ---------- _C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name ----- -- --- ------ information is required for CENTERVILLE MA 02632 4/10/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): no need to pump, tee's intact, structurally sound, liquid level equal with outlet invert, no leakage. _ Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — - Scum thickness Distance from top of scum to top of outlet tee or baffle --- --- Distance from bottom of scum to bottom of outlet tee or baffle ---------------- ------- ---- Date of last pumping: Date— - - Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: ---- ----- - Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 241 pine-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 241 PINE STREET Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name — --- --- ----— - -- --- - - information is CENTERVILLE MA 02632 4/10/07 requiredd for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: _.------------------_. - Capacity: gallons Design Flow: ---- ---- — gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date ----------___._.______-- Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert equal with outlet inverts Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is level and distribution is equal, yes solid carryover, no signs of leaks e Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 241 pine•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 I Commonwealth of Massachusetts -_ --- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments nr .4i.a 241 PINE STREET Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner — - ----Owner's Name Name information is required for CEN_TERVILLE MA 02632 4/10/07 _ __— —_._--_._____.__—_ every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ---- - ❑ leaching chambers number. -- ------- ---- ❑ leaching galleries number: ® leaching trenches number, length: 2/28'x4'x2' ❑ leaching fields number, dimensions: -- - ❑ overflow cesspool number: ----- ------ ❑ innovative/alternative system Type/name of technology: -- -� Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): soilgravel, no sign of hydraulic failure, ponding dry, no damp soil, vegetation-normal: 241 pine•08/06 Title 5 official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 241 PINE STREET Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 _ Owner Owner's Name information is required for CENTERVILLE MA 02632 4/10/07 ------ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration -- ---- -- Depth -top of liquid to inlet invert — --- --- -- ---- Depth of solids layer —--------- --- --- Depth of scum layer — --- Dimensions of cesspool -- Materials of construction -------------- -- Indication of groundwater inflow ❑ Yes ❑ No 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.): 241 pine•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 y , Commonwealth of Massachusetts --- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 241 PINE STREET Property Address C/O D_AVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name ---- -------------�—- information is CENTERVILLE MA 02632 4/10/07 required for ------------ —..— ------ - ._-------- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. ,t cj Dr�-3t{ iV'l 30, 241 pine•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 241 PINE STREET Property Address C/O DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name --------.._._..------------......_ -------- information is required for —__CENTERVILLE MA 02632 4/10/07 _.____ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 55' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: ----------- Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ® Accessed USGS database-explain: town of barnstable gis You must describe how you established the high ground water elevation: town of barnstable gis topo shows ground elevation at 55' 241 pine-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE CA- LOCATION 7r 9 � : GE 6)"_� �� �� SEWAGE # VILLAGE C6� V `d-,6 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C—X' LEACHING FACILITY: (typed 14e fire rs (size) � NO.OF BEDROOMS :BUILDER OR OWNER Ci 2 ,+ PERMITDATE: COMPLIANCE DATE: / -7-6Y Separation Distance Between the: ti Maximum Adjusted Groundwater Table to the 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 306 feet of leaching facility) _. Feet `Furnished by ` �Z= 3cl pq 1 qo l O Y ` No. 2=ad q FEE OmmO'NWEALTH Of MASSAC14USETTS Board of Health, 0'1S r�`� MA. APPLICATION FOR DISPOSAL SYSHM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair(ol<pgrIde( ) Abandon( ) - 0 Complete System ❑Individual Components Location t/tl Owner's Name Map/Parcel# ,aq8 — Ova Address L Lot# 3 Telephone# Installer's Name Designer's Name Address 50 Main Street Address Telephone# W. Yarmouth, MA 02673 Telephone# G Type of Building Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 33 V gpd Calculated design flow Design flow provided 33 gpd Plan: Date T y Number of sheets Revision Date 4/ZA Title Description of Soil(s) /A Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS (� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not t` lac a Aystem.in operation until a Certificate of Compli nce has been issued by the Board of Health. Sig ed Date t' 3 Inspections f r � `.-„ .. .r.'•t_.may,.-... .�:�.-•�.,Y._....,, '� ) -._ ^r r � r'vi.,., �•.--r: .•w'''r4-q"''��r. .T� +, ' 4.',, ; `..� - -..T.. „ `E _Yti_'`.ti.F„y 4.'i.:`f�"r'4""�'�.,r, •,^ti"'e,,� t� �_+' .-4; .n+�. r 1 LNo. U!1 FEE ' Board of Health, _ ll S `� MA. t APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT k.! Application for a Permit to Construct( ) Repair(01'pgrade( ) Abandon( ) - ❑Complete System ❑Individual Components Location �LI ( jJ;,�� �'� Q� 12f t,�� Owner's Name /Q£ ;-, w t Map/Parcel# �y&-� �- �(�� Address Lot# ?� �� Telephone# Installer's Name Designer's Name ? leq;l e Address Address Telephone# Telephone# Type of Building ��C`' Lot Size sq.ft. Dwelling-No.of Bedrooms _ Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria.(. ) Other Fixtures Design Flow (min.required) -3 3 U gpd Calculated design flow Design flow provided 33/ gpd Plan: Date��� L� Number of sheets Revision Date Title �/'TP — '5 - -t Description of Soil(s) ,(� D 14 b 1 Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to lac a system in operation until a Certificate of C/ompli ce has been issued by the Board of Health. Signed `� ✓ Date / / 3 Inspections No. JigL -o FEE COMMONWEALTH OF MASSAC14USETTS Board of Health, &/ems 1-14�r- , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired (I-)-LTp'jraded ( ),Abandoned ( ) by: at �� /�i/1Cz Sf P� fPrvi��e has been installed in accordance with the provisio s of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. 00�I-o/ff ; dated l)V . Approved Design Flow (gpd) Installer y�/ 1 /1( (f r} Designer: Inspector: 1-, rnY t''V �_i( � Date: ) ! 1 I 11Nq v 1 � The issuance of this permit shall not be construed as a guarantee the systemrwill function as designed. r�l No. 90()y-01K FEE CJ COMMONWEALTH Of MASSAC14USETTS Board of Health, ( irr .�+ 4 MA DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at --�C// ,�/. 1 P ,��. ( �- 17-le- u i//-e as described in the application for Disposal System Construction Permit No. 06 L/--01 , dated t�_t u l� Provided: Construction shall be completed within'three years of the date oftfhis permit. Alit ocal conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 1 13 l J Board of Health `/ r TOWN OF BARNSTABLE LOCATION �l'T� SEWAGE # WII,LAGE f�� � ' ASSESSOR'S MAP & LOT IL D°3,r�3 INSTALLER'S NAME&PHONE NO. � -7W-—,�E66 SEPTIC TANK CAPACITY ' LEACHING FACILITY: (type)( QMK.� �►2 �5 (size) �L1C rolC��v NO.OF BEDROOMS -MALDER,OR OWNER -- PERMTTDATE: COMPLIANCE DATE: Separation Distance Between�the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and leaching Facility (If any wells exit Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet p within 300 feet of leaching facility) ; Furnished by i' i �t 03 . — _=_ __•__ — ..r— `.ems 4 r� c � ' � I i ��;,� Qss;��e � �,5„� f�� �l -- _.. .:, ...,:, l .. r..�..r' n ,--,_-. y-. yro^..,n .,..,.+hra^,'+7''v::i.. r.+..;7 �q-.:.. s"*.�r ar�.3,. r+.�-r �.�;.✓^a!'e... r.r:a; tr TOWN OF BARNSTABLE BAR-Wp 67 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ( .�. Address of Offender ''/:/r ,t.( 0 MV/MB Reg.# Village/State/Zip (.. ejf14rV1, ! ` 1` t; Business Name ZO am/ m; 0 42 '7 200� Business Address t 7 S gnaturd-of Erifo cing Officer Village/State/Zip Location of Offense 2` ! Peru . 01114e.v►,��P �' �' /6°.., t e , Enforcing Dept/D�+ivwision Of f e n s e /�.r". 6vle 41119. ( / E�f '� , C? -I c r f y,r+l+f.' t C Facts y'.c e�r e<Lc,�,d c.r - 0-k- 70e"if le r. 10"ZA.' �, 0, 4o( •. This will serve only as a "warning`. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W1�d Ordinance or Regulation w WARNING NOTICE i Name of;:_Offender/Manager .. ' -Address of Offender J,,'Aj " MV/MB Reg.# Village/State/Zip L p v , +r ty` T Business Name "'"�"�'" """ � 'W am/pm; on 121 200«�° Business Address `"" Si*gnature`Rof Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense , i_' '� ll,( `. .:.. ✓� . "° . '� , 4 fr ff r Facts fE• . � '"des This will serve only as a `warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG.,-""PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. .... :....a. ..,.. .. ....-:. .s ..:....... .r-.._.:.... ...-....:..-.. _..... ...................W. .,... i LYy,-.o-+ .'.✓3...... - .:...f_.... ... .....:,,. .0 ._. ..-.,.... .-.. ....- ... ro of 110USIRG RSSISTRIICE CORP. Tel, (508) 771-5400 877-852-9317 Fax: (508) 775-7434 TTY on all lines T 460 West Main Street, Hyannis, MA 02601-3698 www.haconcapecod.org 460 West Main St. Hyannis, MA 02601 September 3, 2003 To Whom It May Concern: I am writing this letter to inform you that Mr. Thomas and Regina Ewing of 241 Pine Street in Centerville,Massachusetts are working with my office to secure a Housing and Urban Development HOME Rehabilitation Loan to replace their septic tank. They are currently going through the application phase of the process: The process will take about a month to complete. This is a zero interest, differed payment loan This loan is good for work rehabilitation up to $10000. If you have any questions regarding this loan feel free to call me at (508)771-5400 ext. 390. i- S Sincerely,. p<�&_-�-2,� ichael Berry Director of Energy and Home Repair Loan Programs . Housing Assistance Corporation f r 2 14001� A housing partnership and community development corporation F Oos W L1 i OpTMETpN, Town of Barnstable Regulatory Services • snxivsTnsLE, r MASS. g Thomas F. Geiler,Director �A 1639. TEDMA.�A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 3, 2003 Thomas and Regina Ewing 241 Pine Street Centerville, MA 02632 NOTICE OF VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REOUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE The property owned by you located at 241 Pine St., Centerville, was inspected on March 31, 2003 by Sam White and Donald Desmarais, Health Inspectors for the Town of Barnstable Public Health Division, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code Il - Minimum Standards of Fitness for Human Habitation: 105 CMR 410.300 AND 310 CMR 15.02 (207): Septic system is in hydraulic failure. Raw sewage has been observed just below ground level and evidence observed of overflowing sewage running downhill, along with strong sewage odors. 1) You are directed to keep the on-site sewage disposal system pumped as many times as necessary (daily if need be) to keep it from overflowing onto the ground._ 2) You are further directed to contact and hire a professional engineer to design a septic system which meets local and state regulation requirements within fourteen (14) days of receipt of this letter in order to repair this system or connect to town sewer. 3) The newly installed septic system shall be completed on or before May 15, 2003. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Iv ([Q p0� i Health Complaints 03-Apr-03 Time: 2:50:00 PM Date: 3/26/2003 Complaint Number: 3968 Referred To: SAM WHITE Taken By: DENISE PERRY Complaint Type: TITLE V SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: Number: 241 Street: PINE ST Village: CENTERVILLE Assessors Map_Parcel: i Complaint Description: COMPAINANT STATES STRONG SMELL OF SEPTIC OVERFLOW. Actions Taken/Results: SW and DD investigated complaint. Spoke with owner,Thomas Ewing, who stated that the system was pumped roughly 45 days earlier because it was overflowing. Observed soft soil and extremely strong sewage smell coming from area of concern. Order letter sent 4/3/2003 to repair system by May 15, 2003, and to pump the system daily if needed to prevent from future overflows. Investigation Date: 3/31/2003 Investigation Time: 2:45:00 PM 1 COMPLETESENDER: COMPLETE THIS SECTION / ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si nature n `.item 4 if Restricted Delivery is desired. X ■ Print your name and address on the reverse c� Addressee so that we can return the card to you. B. Received by(Printed Name) C..D t o/Dvery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 3 D. Is delivery address different from item ❑Yes 1. Article Addressed to: _ If YES,enter delivery address below: ❑ No —1 ur1c4-r v4 2q1 P, st 3. Service Type Certified Mail ❑ Express Mail ❑ Registered Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7001 1940 .0005 13769 6671 -^ (transfer,. . service l t j 3.R.,.; t, ,.i,z, ,; ., ,, f,f t t t t i 13 t.1, r �1! PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERU6fiE First-Clas Ot`NCE es, P'VINo. p 5 APR � • Sender: Please prin 7og5b�m , address, and ZIP+-T'ih-this-•box'6'-" Public Health Division Town Of'Barustab'l'e 200 Main Street nyan:nis;Massachusetts O2601„. Jf 1 .1 1 1 iii=t:,t •j9'Vaia+iil s�jt, :tisii�as .U',S.Postal Service rl niestic Mail Only; No Insurance Coverage Provided) ..0 Postage $ u j Certified Fee 2• �� / �`` m 'wryw�q� Postmark Retun6�Receipt Fee "7 t� (Endorsen Here ent Required) 2� OO ResMcte�Delivery Fee a (Endorsement Required) r3 Total Postage&Fees •y Fr Sent To .nu x . ................ . Apt O I I or PO PO Box No.o. Z � or _I C3 ------------------ —------i - Q City,State,ZIP+4 /�_ ,1_ v l MA f)Z(.3 2 N lL Fir 1 PS Form :00 ?001 See Reverse for Instructions Certified Mail Provides: '■A mailing receipt 11 A unique identifier for your mailpiece ■A signature upon delivery 0 A record of delivery kept by the Postal Service for two years Important Reminders: -,■Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. ■Certified Mail is not available for any class of international mail. ,n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,-please consider Insured or Registered Mail Ili For an additional fee,a Return Receipt may be requested to provide proof of delivery.Tcobtain Return Receipt service,please complete and attach a Return Receipt(P�btorm 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified'Maii receipt is required. , ■For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail ratueipt is not needed,detach and affix label with postage and mail. IMP69TANT:,Save this receipt and present it when making an inquiry. PS Form 3800,January 2001 (Reverse) 102595-M-01-2425 n A w �7; fo = ' e 2ql R� v� lie A • ZN S- 0o3- Qo 3 °Ft ti,,ti Town of Barnstable Regulatory Services • snxivsrnBLE, • nines. g Thomas F. Geiler, Director i639• �� 9. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 J ' April 3, 2003 Thomas and Regina Ewing 241 Pine Street Centerville, MA 02632 NOTICE OF VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REOUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE The property owned by you located at 241 Pine St., Centerville, was inspected on March 31, 2003 by Sam White Donald Desmarais, Health Inspectors for the Town of Barnstable Public Health Division, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation: 105 CMR 410.300 AND 310 CMR 15.02 Septic system is in hydraulic failure. Raw sewage has been observed just below ground level and evidence observed of overflowing sewage running downhill, along with strong sewage odors. 1) You are directed to keep the on-site sewage disposal system pumped as many times as necessary (daily if need be) to keep it from overflowing onto the ground. 2) You are further directed to contact and hire a professional engineer to design a septic system which meets local and state regulation requirements within fourteen (14) days of receipt of this letter in order to repair this system or connect to town sewer. 3) The newly installed septic system shall be completed on or before May 15, 2003. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF' HE BOARD OF HEALTH Thomas A. McKean Director of Public Health .. 1 TOWN OF BARNSTABLE LOCATION L`® � �� !��e ST SEWAGE #��i "� r VILLAGE r(f J 1K O dl f- ASSESSOR'S MAP & LOT2.Vg' 3 INSTALLER'S NAME & PHONE NO.%� Co SEPTIC TANK CAPACITY LEACHING FACILITY:(type i % / (size) ,N NO. OF BEDROOMS-,2— _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ` - a N fS DATE PERMIT ISSUED: ! ( T l DATE ,COMPLIANCE ISSUED: 9 - 3D 2-f 7 VARIANCE GRANTED: Yes No �_�- �-� ;q ,y No.._F.Z=...19L Fimic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 01 .............OF..... Appliratiou for UWVviial Works Toustrurtion famit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at ......................... ..............................................a.,4........................................... Location-Address or 1�,ot No. ......................7 .... .. .......45 ........ ... ........ .......�1...... ....... ...Owner Address.....................EE ............. ....... ..........11� ­-------­,­"',--",........ Installer Address Type of Building Size Lot...IZZ��...Sq. feet U ....Z..............................Expansion Attic ( ) Dwelling—No. of Bedrooms.._..._. Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ........................................................................................ ............................................................. Design Flow.........................._.2� --__gallons per personk day. Total daily flow----------e-;?_--e0....................gallons. Septic Tank—Liquid'capacity.Z,!o�_.gallons Length--------- Width..14.,�';� - Diameter__.___"..... Depth_,f'V. Disposal Trench—No. .................... Width........ ......... Total Length.._.........._..... Total leaching area....................sq. f t. Seepage Pit No........../...... Diameter.__..._.. Depth below inlet........._.._.. Total leaching area`�ie�.......sq. f t. Other Distribution box Dosing tank ( .10 �F4 Percolation Test Results Performed by.....4.-,y ................................ Date....4� ./......... .................. Test Pit No. 1 SS. minutes per inch Depth of Test Pit.._.._` ....... Depth to ground water---------............ GTq Test Pit No. 2................minutes per inch Depth of Test Pit..__..........__.... Depth to ground water.._....____..___........ 9 ...................................... .......*------------------------------------"--------------"............ ------------------------­-- 0 Description of Soil.... ............ ............................................................. ---------------------------*-------------------------------------*----------------- ---------------------­-----------------------------------------*--------------------------- ............................................................................... ...................................................................................................................... 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 TL I'L U 5 of the State Sanitary Code— The un ersigned further agrees not to place the system in operation until a Ce_qi:d'&Vtof Compliance has been issue 0 Ith. . ... . .................................. Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo......a.. nxaa----------------------- IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .. ...........................OF...........................-_.......... Appliration for Disposal Works Tonstrtirtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys" ......1... I...._.�:.. 5 L nvw ..' .... °'... -- Lgcation Address por �.�. .-•--•--•-•- .. 1AC��' ° 1 �'� ............ 1�._... /`---1c),"�. ........S�i.-.....- r� ------------------------- ' Y:.1'' (' C �-�� L. ' l�J C� ` dress �p d 1� _ Installer Address Type of Building Size Lot...... ...t._-..Sq. feet aDwelling—No. of Bedrooms........... ..............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . ... --------••--------------------- w Design Flow.................................6 -_gallons per person per day. Total daily flow_.__........._:-p................. .5ps, WSeptic Tank—Liquid capacity.../,_,3-ogallons Length___--__....�."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--------mil.. ............................. Date......._................. -...... `� 01 �, Minutes per inch Depth of Test Pit.................... Depth to ground water•-_----______-_--------. 14 Test Pit No. 1_._. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .......................................... ----..-----...... ...... Description of Soil........ ? S -✓� x �., ---------------------------------•----•••---••-------••--•-•---•-•-------•.....---•-•.......--••-••-•----••--•--•--•--------•------••---•--•---•---•------•--•---------•--......---.......--------••--•. w U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -•------------------------------•-----------------------------------------------•----....-•--•-----•--------•-•----------------------------------------------......................................... . Agreement: The undersigned agrees tQ install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The unde signed further agrees not to place the system in operatiot} until aj/ f Compliance has been issued o0a alth. •--•--•Signed------. ? =lr1..•..... Date ApplicationApproved By...................................................................... ------ ........................................ Date Application Disapproved for the following reasons--------------------------------------------------------•----------------------------------------...----...-•---- ----•---.......-•------•-------•--------•....-•----------------•------•--------•--•...------•--------...........----------•-----------------•---•-----------•-•--•----•--............................... Date PermitNo. ..... �' ........................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS �} BOARDh OF HEALTH ..........................................OF......1 ,: ......................................... Tntifiratr of Tuntplianrr TJ6�k'lS 06E�FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..-_�o-•----•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- M P 7 Installer at............................................................................................................... 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..� :-.;L.7k'/................ dated---------------------------------------_........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. l_ ...... n..:. ........................ Inspector............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �a -,rok' No......................... FE ...... DispoTarks Tonsirnriion rrntit ©'tr' 4 Permisss'o is hereby granted......... -------------------•--...-•------•--•......----•---•-••--------------•----•----•-•-•-•-----......---•--.........................--- to Cons2ruct �ork Re o an �IInd�'vidual wa Disp sal System P ( ) t-�-p Y atNo.............................................................................. -� ........................................................ Street r, �^� as shown on the application for Disposal Works Construction Pierrm�i-t�-)�o.......... ........ Datedt !_�i.-....� ?........ ....... ........... Board of Health. DATE-----------•--- ----- ----•---------------------•------------------------- FORM 12551 A. M. SULKIN, INC., BOSTON t pine. ,t Courtly 1Zoad) fitt Cape f emu 49 1da�o2 t�ad 14 yanxj, , (f a. 02601 Scate- 1"-30 t l-6 '�G �! bate 3-18-87 pit v ';'Cow !"q// 14 No. bed-&,00m6 2 I Ga�tbar§e dii no 7o-tat eat. J.Cow 220 d I J�each bw, a4.& .150 i v' 34 o w I Capac i,#f 301 gpd N a $6 J'o,t 1 A NO fite 7 � I i No SccLLe i �0.73 2�' 37d 1000 o di �.s. i N \ 39.0 2 �. 38 I-6 i� 4 �pi" v 4.tone \ <" PROPOSED =l S0 'd 2-a.R. z�`301 �.pd 3G.& Xot 2,q 1000 .('off 3A �W S. 2 17, 150 r38• 3-l? 37•' C.13. n,�.1 100 40.0 37.4 317.0 ,Sketch Pt an o i J'and •bi Cert t e/w�.e, pia. ;'opt 3acey ldonw4 i3e ih� Cot, Aad. shown on a plan �teco tde i in 6=te aeji," bk. 380 pq�. 67. Cteuationw, d own ate on an adder ed dattwt. Ne 86-aZd-o7'Rec tr;h--- ''east pit #P-5841 Made 6-10-86 'V t. 9. McKe'Aw No wa tez encounteAed -'e&a. &, te, " than 2 r,.tA pet I'� -top&dub Med a& dand IL jo,qn rrrI NE ,rN-r ,�OMN 9p� o No. 2400 IST I LA KO Z7./ I' - ASSESSORS MAP : �1�� NOTES: TEST HOLE LOGS PARCEL :At t} THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH G, SOIL EVALUATOR :��. �� �� THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF J rr ,�. I FLOOD ZONE: �IrJI� « - t__► w WITNESS : NyT (Z. I P 6 E7 BOARD OF HEALTH REGULATIONS. s µ REFERENCE : DATE: . t-V•6�tL 7U�3 G, t, � -- -+--- 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, nns PERCOLATION RATE: � wj►rt I1Il�$` {r''✓) �1.`��^- 'Z. lwC.. SEWER. INVERTS AND SEPTIC COMPONENTS PRIOR TO ;a Ita Kul MRl R6 nd 1 lus . INSTALLATION.)) y , t l TH- I l✓L .�I_ TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION .. ONLY AND SHALL NO"r BE USED FOR PROPERTY LINE DETERMINATION. `` 4) ALL PIPING TO BE 4" SCHEDULE 40 t@ 1/8 "/ FOOT. (UNLESS r• STL&&E_r' U)AMQ, SPECIFIED OTHERWISE) L OCA T I ON MAP (W T.S) 2b b3 ,i� S")p i���`-1 N �A 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A 2- 0 GARBAGE DISPOSAL. � fl 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) j 1`t J o MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON �7r�t A BASE OF 6"OF CRUSHED STONE. r-- I t ' � �XlSTIN�___��C�-f.f����-ZU.._]3G__I�vMY�?=►�, C,�I�SI�� _�_._.:__ AR� ti o m No t boo eSr- ®—t�_._Q°`�.�..7.e.. 0�"t V YT f G_l/\/rrl/� W 6 t� j�U C]�'.I,.. /"�� .-._l.rf•.LI,. ' .. SEPT I SYSTEM DESIGN q� No FLOW cT, MAT TE �0�1 E_�. �. �°����R�N��S.��'UM 7l`C�,��._._ai�_.��?�►�__d�_���ST�"�3�.�.._ BED'OOMS AT I l0 GAL/DAY/BEDROOM GAL/DAY SEPTIC TANK 1 j310 GAL/DAY x 2 DAYS - GAL I I USE 1 �00 GALLON SEPTIC TANK-A,tI~tJ 9 i SOIL MISORPTION SYSTEM W vj tc N I SIDE AREA: 22, x 'z x 7- x 0 7V x N I BOTTOM AREA: x q xLOT 73 r --- SEPTIC; SYSTEM SECTION 4 10 0 -Mm =To- EL: .A coves -� -......... 1JI _r I 4 t t�l/yy p 2I/cal 2 ''i)a�/ Ivasl�e 3 B �/ ��, " ems * I 1 I GAL D-BOx 3g,0t rr GF 3v 4 // 1 1 SEPTIC TANK �'",,level#less) 37.15 ,vv . Z12�tL_x 4 UJA �ll f U I U L " (. : 3{ C5�atr , {� lSs� S I TE AND SEWAGE PLAN zAtl — -- 4\ �, LOCATION :110, o, t Lr rcx a rn �� PREPARED FOR : o I --- M. 0 o SCALE :�tl� a DARRE M. MEYER, R.S. zsuUN . - I 3 � INE STREW T DATA : tl P(, (. o, SUN (abz �1 U R`l, A 02332 , �AT HEALTH AGENT��p C. WNU-INIAM {73 } 53 -093 • u