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Home My WebLink About0002 PASTURE LANE - Health 2 Pasture Lane A= 248—255 Hyannis < Commonwealth of Massachusetts tag Title 5 Official Inspection F p Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2 Pasture Lane Property Address — ---- _____ Anna & Robert Flemin Owner g is informationOwner's Name -----_. required for Hyannis every page. City/Town MA 026__01 3/20/2012 State Zip Code Date of Inspection_— — Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms on the computer, use 1. Inspector: only the tab key to move your Wayne Archambeault cursor-do not use the return Name of Inspector -- key. Company Name Box 914 Company Address --------- — Hyannis MA City/Town ------- ---------- 02601 State Zip—Code _ 508-775-1362 355 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 ❑ Fads t " i r a ❑ Needs Further Evaluation by the Local Approving Authority e C> `- tom ,. 3/20/2012 -ra s ector's Signature ------ — ' Date The system inspector shall submit a copy of this inspection report to the Approvi g Authors Bo1 of Health or DEP) within 30 days of completing this inspection. If the system is a shared sem or ystb 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. Lq ( t5ins•11/10 3 V� Title 5 Official Inspection Form:Subsurface wage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form i i_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a a% 2 Pasture Lane Property Address -- _ Anna & Robert Fleming Owner Owner's Name R--- information is -- required for Hyannis __ 02601 every page. City/Town � State Zip Code^ 3/20/2012 D ate 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 in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are described 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts __ Title 5 Official Inspection Form m' I" Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2 Pasture Lane Property Address — ----- _ _ Anna & Robert Fleming ` Owner Owner's Name ----- ---- information is --- required for Hyannis every page. City/Town -----_-- MA 02601 3/20/2012 State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water 9 e 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts 53 Title 5 Official Inspection Form i=1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c / 2 Pasture Lane _ Property Address — ----- -- Anna & Robert Flemin Owner Owner's Name information is required for Hyannis every page. Cityrrown — -- -- MA 02601 3/20/2012__ State Zip Code Date of Inspection B. Certification (cont.) 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. ❑ 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 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 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 Clue to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts rr Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ........... ^ a / 2 Pasture Lan Property Address — — ---- _ _ Anna & Robert Fleming Owner Owner's Name — information is required for Hyannis every page. Cdy/Town ----- -- MA 02601 3/20/2012 State Zip Code Date of Inspection B. Certification (Cont.) Yes No ❑ ® 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. ❑ ® 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �- 2 Pasture L"✓ ane Property Address — ---- — Anna & Robert Fleming Owner Owner's Name ------ - information is -- --— required for Hyannis MA 02601 3/20/2012 every page. CltyFrown — _ 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? ❑ FI 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)] D. System Information Residential Flow Conditions: Number of bedrooms 3 (design): Number of bedrooms (actual): 3 ----- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments P, 2 Pasture Lane Property Address — _ Anna & Robert Fleming — Owner Owner's Name -- information is required for Hyannis MA 02601 every page. City/Town ---- 3/20/2012 State Zip Code Date opection D. System Information Description: Number of current residents: 2 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 years usage (gpd)): na Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 3/20/2012 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: — t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 ..,. Commonwealth of Massachusetts _ Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form - Y Not for Voluntary Assessments 2 Pasture Lane Property Address — — --- _ Anna & Robert Fleminq Owner Owner's --- information is required for Hyannis every page. CitylTown — MA _02601 3/20/2012 State Zip Code Date of Inspection , _ D. System Information (cont.) Last date of occupancy/use: ---�-- Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? site gauge on truck Reason for pumping: maintaince 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts I WE Title 5 Official Inspection Form _i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments / 2 Pasture Lane Property Address Anna & Robert Fleming - Owner Owner's Name — — information is — required for Hyannis every page. City/Town -- ------ MA 02601 3/20/2012 State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed 5/24/1984 permit#83-774 Were sewage odors detected when arriving at the,site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.2' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 2' feet Material of construction: ® concrete ❑ metal ❑fiberglass 9 El 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: 8.5'x5'x5' Sludge depth: 3" t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 commonwealth of Massachusetts Title 5 Official Inspection Form 7 — �! Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2 Pasture Lan Property Address Anna & Robert Fleming — Owner Owner's Name ' —----- -- information is -- -- required for Hyannis MA 02601 every page. City/Town ----- _ 3/20/2012 State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4 _ Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? measuring rod Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: _ feet _------------------ Material of construction: ❑ concrete ❑ metal ❑ fiberglass ' 9 ❑ 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I=' i t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a � 2 Pasture Lane Property Address Anna & Robert Fleming Owner Owner's Name ___— ---" --— ----- — information is required for Hyannis — _MA 02601 3/20/2012 _ 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.): 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 El other(explain): 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments p y 2 Pasture Lane _ P roperty Address Anna & Robert Fleming__ — Owner —----- -----...-----——Owner's Name — — information is — — ---- required for Hyannis MA 02601 every page. City/Town ---- 3/20/2012 State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): box level and water tight Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 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: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Oisposal System•Page 12 of 17 Commonwealth of Massachusetts -(� Title 5 Official Inspection Form I. . _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments tea / 2 Pasture Lane Property Address — Anna_&_Robert Fleming i— Owner Owner's Name -----"---—-- ----- information is --- required for Hyannis MA 02601 every page. City/Town 3/20/2012 State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: T ❑ leaching galleries number: ❑ leaching trenches number, length.- El 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.): no liquid in pit although a stain line is at 4.5 from inlet pipe 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 ElYes ElNo t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts w� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �A4 2 Pasture Lane Property Address ------ Anna & Robert Fleming Owner Owner's Name -- -- information is — required for Hyan nis _ MA 02601 3/20/2012 every page. City/Town State ZipCode Date of Inspection D. System Information (cont.) 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.): t5ins•11/10 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `A 2 Pasture Lane Property Address Anna & Robert Fleming _ Owner Owner's Name --- — - -- information is ��---- required for Hyannis MA 02601 every page. City/Town - 3/20/2012 State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately — / = s t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts -0; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2 Pasture Lane Property Address ---- _ Anna & Robert Fleming e Owner Owner's Nam ---.-- — information is required.for .Hyannis___ _ MA 02601 3/20/2012 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12' 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: well#ma-aiw 254 You must describe how you established the high ground water elevation: usgs well shows 11.85'to water bottom of leach pit 7" seperation 4.85' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t51ns•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage p ge Disposal System Form Not for Voluntary Assessments 2 Pasture Lane Property Address _ Anna & Robert Fleming___ Owner Owner's Name ---- information is required for Hyannis MA 02601 3/20/2012 every page. City/Town -- - State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I I I LOCATION SEWAGE PERMIT NO. Lp'� L. Q Qay Jk-e La viz, VILLAGE ` IA 1A.1 INSTALLER'S NAME 0 ADDRESS -a -� - sC6T VA at 2t. eia i uj c V .S 0 U I L D E R OR OWNER DAT-E PERMIT ISSUED q /�l � O DATE COMPLIANCE ISSUED L,-/Iff k I F No.... l:2 / .......'/D_" THE COMMONWEALTH OF MASSACHUSETTS BOARD � OF- HEALTH V---------OF........./ . Appliration for Diopoaul Workii Tomilrnr#ion Prrmit Application i her9by made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: N, ................ ............ _. .........-----• ............................ . Location- res ��r Lot No - - r Address... .. ........................... - .... Ins .•. .-•...-•••••••••.••................. ...........t� �. .......--•-•••-----------•••.. taller Address �� UType of Building Size Lot_._,,................:....Sq. feet Dwelling—No. of Bedrooms............... Expansion Attic�/C�) Garbage Grinder1w aOther—Type of Building 6- 0 �� ._.._ No. of persons._.... .................. Showers (�) — Cafeteria ( ) dOther fixtures --------• •................-••--•-•-----------••••••-----•------••--...---...--•-••......--• ............................ W Design Flow............��......:........gallons per person per Oay. Total daily flow---_---------- 3_................gallons. 0: Septic Tank—Liquid capacity allons Length..-/d(....... Width............ Diameter................ Depth• .:-._:. Disposal Trench—No. . Width.................... Total Length.................... Total leaching ..W P area.. `_ isq. ft. x . ? Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. tank Other Dos '-' Percolation Distribution Results . ) Performed by.... ).... --- _... /�4< ........ Date.___._.. �f 3 �.l �th o i a Test Pit No. 1. ..minutes per inch Depth of Test Pit._..../ ....... Depth to ground water.._._.__?7 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ PG . O Description of Soil------.0.• •-•-•-- .�..... . ----------- p V •-------------•-----•--------•--------••--......--••-•-•....._-•--•- ---------------•-•---------- W -----------------------------•-----------•-•----••-•----••-----------•-••--••----...•-••--•-•-••--••-•-••---•-••----------------------------•--••----•-•----•--•---•-•---•--••-••-••--••................ VNature 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 TITLE 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 ,Qboard ,of health. �. -- --- l Signed-•-- :..Cll -_.. ....... --- - - Date ApplicationApproved By............................................:............ ..................... ............... Date j Application Disapproved for the following reasons:........................................•---•-------•--•------•-------------•----------------.............------ ...............................•-•-•_...............--•-•••-•--•---•--•--•----••...................•--•-•-.........:_..-••-•-.............•----•---•-•••--•-•••-••---•••-----•-----•-••-•---••--•••--- Date Permit No..-•----•-•...................................•---•----- Issued................. ...................................... ....._ Date J No........................ Film.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH • "'' � Appliratiun for Diipu,ial Workii Tomitrurtion Prrmit Application is reb made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at ............ ................'.....:_._...:_. ..:: . .......•---•-•-•-•••••. ---•- Location- dares � , 11 ...........-• h .�..1. ---••.1. .. __..... �l% -•--•.......... � i s N� ............................ - r Lot r w r Addres a -- -- -- � ----.................................... ....._...._.. 7 a..__.......----------••---•-- Installer Address d Type of Building Size Lot__d _=L__/. '____Sq. feet Dwelling—No. of Bedrooms................................__Expansion Attic4/(J) Garbage Grinder, tm aOther—Type of Building ,_ _.__ No. of persons______ _________________ Showers ) — Cafeteria ( ) Otherfixtures ------ ---------•-•--•--......-•------•--•-------................................... -------------------•........ W Design Flow............ ____________gallons per person.per Jay. Total daily!flow_.___.._______.,.' _d_._..____._____gallo�ns. WSeptic Tank—Liquid ca acity__�(Wallons Length___/_!f....... Width___.__._.... Diameter________________ Depth___ __.__.._-. x Disposal Trench—No_ __:'. Width.................... Total Length.................... Total leaching area_.4? _ 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..... .fc,...-•-•- Date.........a .__ r '3 Test Pit No. L _minutes per inch Depth of Test Pit__...... _ ......... Depth to ground water-. l?_a:? 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ri --•••••-•••----•--•...-•--••-••--------------•-..................._...---- 46 O Description of Soil......... � 4 xrf t --•-------•----•-----------------•---------•-•••-•----••--- Un_c _ ._ ........•-.............................................................. VNature 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 TITL i, 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. *t*4.. ��f! C-•• -_----_. Date ApplicationApproved By----•-----------•-------------------- ........................................ Date Application Disapproved for the following reasons-------------•-----------------------------------------....-----------------••--•----------=-----.......--•-••_.. ....................................................... --------••- -••------•---....._..--------...-•----•----------••--•_...-----••-----------••--•-••--•---------:.--•-_...------------••--•-••-- Date PermitNo......................................................... Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH may. ......... 1/-•"!'•-• ••T.:.:....OF............:.e 2 ( ......................... Trrt" iratr of Tontlilianrr THIS IS TO CE F That th dividual Sewage Disposal System constructed ( or Repaired ( ) b .................................J. �:',F....... .._... ................... ----................................................. - hns�allgr� T 4 -----•.............•-------•---...----------------- at !_. j o (v I has been installed in acc rd e wit i ie provisions of TIT of T e State Sanitary Code as d 0i a in the .�application for Disposal Works Construction Permit No...._ ..................................� � dated_____________ _________ THE ISSUANCE THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WIL �F/U /TION SATISFACTORY. DATEs ••• --••-------------------------••--••------._..._... Inspector.--•'..... --...:..-----------•----...._..........._....••••••--••-••....-•••-•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .�r r— No.. _- L .........f••• ......OF........rJ ........................� A,40 �.,..� FEE._._.... ... �iu�ro,s�l or �onutr iun rrmit Permission is reby granted............. --=• .. --........... ---•--------...----------•-------•--••---....-----•---••-....._.........._.... to Construct ( r Re air ( an I 1 ual ewage Qisposal System at No.._, _0-••--- d -•••-....... Street _r83 as shown on the ap licatio or I al Works Construction Permit No..' .. _..*............ ted........ ..................... .................................. -•- Board ealth DATE.....�`_�_-`'�.�.._.-- .................................................. FORM 1255 A. M. SULKIN, INC., BOSTON - rip Zc�N "_ _ Al: 10oc)o IOa ' W I b r d Poo `. p T �KN ST U"i�.F-_ p. S �� "�. p fix^ •.\ 1 BERG N No. 366 6 4�/11P N IC A t_ 'b A-7 A S FFS /ST E "Gad p MNAIEN Icy L: jn&ELIM WNiT'tti�� LEGEND EXISTING SPOT ELEVATION 0;0 IN OF M CERTIFIED PLOT PLAN -EXISTING CONTOUR --- 0 FINISHED SPOT ELEVATION ( o'� ROBERT y� LET 2CD FINISHED CONTOUR 0 BRUCE $ ELDRE y ` IN APPROVED , BOARD OF HEALTHA �f - c �� GNU ST��yo DATE AGENT su SCALE 1 I — `Iv DATE: [ LDI?EDGE ENGINEERING CO. IN CLIENT. � -��--C 1 CERTIFY THAT THE PROPOSED EGISTERE RLRE ERED JOB NO. .L3Q � � BUILDING SHOWN ON THIS PLAN CIVIL D CONFORMS TO THE ZONING LAWS DR.BY= �.,.. ENGINEER R OF BARNSTABLE , MASS. 11 712 MAIN STREET CH. By � ^ , 1� .� � �" ^�,�. HYANN I S MASS. -� /A' I ..0 ' SHEETS OFF— ATE REG. LAND SURVEYOR ?O FT f4/N NOTF /F E�TNER Ts/E Si PT/C TAN/C OR --AcAViivG ?/T ARE ,MORE TNA:"/ /2"BELOiV': /D IaT. M/N• JRAOE� fi 24'O/.4M ETER CoiyCR E7'Z= COVER `� SHALL eE BROUGHT TO 6RAOE.�i4N EXTRA 9"PYC P/PL . /DLO GONCRBTB t/ERYy CAST /RON COVER S/�.4LL•IjE USED. 1 ",IV. A/TCA, e . COVERS M//B'A&M FT /F/N DR/VEyt/A y 2'G M/N. CO/VCRL�TE 1 O D7tAID& C ✓ER — CLEA%V SA NO _ BACA'F/LL Llowo Level- 4 P/PE I C7 O O ° • e /8• 3vB M/N.P/Tc/II G.4L. • • • • ..•• s �o WA 5f/FD S7nNE SEPT/C TANK O/sT. • • • • • • • • • • • • v sa + BOX w of B • • er• + �•• • 0 1VA5,YAFp S7- v • 1 • • • O•I1 �eo � • • o ` DRECA57'SEEPAGE t I •S ua r=. l7( Gib' • a. • • • e e • +° • o ••a t e. . • • • a •. ► • e o O/7 OR AWL//V.. fAlVrRT L'LENAT/o/bs '1k.S X I:o 7k • /NYERT:AT Bl%/LD/N6 92,0 ��: SA15 Gp 6 fT. D/AM. IIC T.4/VK l•u T l] FT. A -PA4. C E.TABUL.4TION, OUTLET SEPT/C 7ANKF7.' iA/LET 0/57RADIM0M BOX :GROVNO:WA 7-ER TitDLE -, O/JTLETD/STR/®t/T/ON BAJO� /,2 FT SECT/ON OF. /,VLEr LCACHIM4 Io/T � •SEWAGE ®/S/�4�5'A L SY.S'T�M /VG P T 7AQ/ILAT LEACHI ,I Al A/9 FT E JCAL.E �4 =. / D, •. DESf6/V CR/TER/A - OrfEws/oN-. 8 G D FT. AIUMDER OF SEDRGOhJS . 3 D/MENS/ON ',C►„_a __FT �'1'1l�J SO/G LOG TOTAL EST/MW'TEO FLAK/ 33y GAL.1DAY SO/L TEST J / SO/L M 7-40 J1!lJMBER QF LfACNlNG P/T,S 1 'r fCtEY. Z� 1 „-!■YJ�Y, pATE OF SOIL TEST �3 S/OE _ `AC H I N PER P/T �_/�-.LAM REStJtTS iv/TNESSEO dY J ✓�Co�i 907TOM L64CN//VG PER P/T k. so. RATE,*/ TOTAL LEACH/NG AREA .267 sQ. FT. �� AERCOL,AT/ON RATE RESERI�EGEACNIN6 AREA 26 7 59P. FT. T&s,r S 7 ' M slikz s G vP �� Of As��ti N OF/yA L�T O9 0 � �a Z ROBERT X BRUCE /f PHILi. v cm ELOR v WEIN G - r ' ENG/NEER/XG CO,/NG. 80.7 7/2 l►!/9/N ST. ,` HY.gNN[S,:MASJ. s ND su AL ENG� ( 'VO GROONO YVi4TER AwNCOU/VTFR—L-G GL/ENT: DATE: / 3: [� GROUA/O WATER AT ELEV _ JOB NO: k3D 4 2 , SHEET—OF �_