The URL can be used to link to this page

Home My WebLink About0110 QUAIL LANE - Health 110 Quail .Lane Hyannis P A = 288 215 I� re O�'✓N OF BARNSTABLE LOCATION SEWAGE # V&LAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Aet�o 1E K LEACHING FACILITY: (type) f �l�'y 6 x�� (size) l D NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet I# - 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 Leac 'ng Facility(If any wetlands exist within 300 fe lea f i ) Feet Furnished b j �l i // � �j��' � ` U � �� ei� � i � � � c� � � w, ,tea J �,q' �,; ® ., -�� .�7� _� ,€� ,J r I 3 DATE: 4/ 19/02 PROPERTY ADDRESS:110 Quail Lane ------------------ ------ ---- ---- --I----- ED On the above date, I Inspected the septic system at the above qress. This system consists of the following: MAY 0 3 2002 1 . 1- 1000 gallon septic tank . 2 . 1 -Distribution box . TOWN OFBAP.NSTABLE 3 . 1- 1000 gallon precast leaching pit . 6 ' X10 ' HEALTH DEPT. Based on my Inspection,. I certify the following condltion4AP 4 . This is a title five septic system . ( 78 Code ) PARCEL ' 5 . The septic system is in proper working order LOT ' at the presc-n=t time . 6 . Pump�t" septic tank at time of inspection . Heavy scum ar..d solids layers were present . . The septic tank should be pumped annually . Garbage disposal is present . Ze, SIGNATURE: Na me :_J _�_ Macomber Jr,______ Company: Josei)h_P__Macomber-& Son , Inc . Address : Box 66 Centerville , Ma . 02632-0066 -------------------- Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-LeachfIelds. Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 • i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 110 Quail Lane Ijyanni s o _t ,MnsR _ Owner's Name:R; 1 1 crn j e7 Owner's Address: Same Date of Inspectlon: Name of Inspector: (please print) Joseph P .Macomber Jr . Company Name: J . P. Macomber R Son Inc . Mailing Address: Box 06 . 02632 Telephone Number. — — CERTIFICATION STATEMENT I certify that I have personally irispected the sewage disposal system at this address and that the information reposed below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my rraining and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Zi✓ Passes Conditionally Passes - Needs Further Evaluation by the Local Approving Authority _ Fails Inspector's Signature: Date: Z `11 The system inspector shall mit 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 now 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. Notes and Comments j,—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, Title 5 Inspection Form 6/15/2000 page I Page 2 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 110 Quail Lane yannisport , ass . Owner: Bill Crowley Date of Inspection: 4 19 0 2 Inspection Summary: Check A,B,C,I)or E/ALWAYS complete all of Section D A.=SystemPasses 4�6 I have not found any informati p which indicates that any of the failure criteria described in 310 CMR 15.303 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working -order at the present time . 1 t B. System Conditionally Passes: . U 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. A)-� 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 e obstruction is removed 1 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: r .Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 110 Quail Lane Hyannisport , ass . Owner: Bill Crowley Date of Inspection: 4 19 0 2 C. Further Evaluation is Required by the Board of Health: ,J)Q 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(l)(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 ej)2 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: rV� 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. N� The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ti10 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 b 50 feet or more from a private water supple well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic 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 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i I 3 Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 110 Quail Lane Hyannisport ,Mass . Owoer: Bill Crowley Date of Inspection: 4/10/02 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 pond-ing 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 ¢ox above outlet invert due to an overloaded or clogged SAS or / cesspool !-•j-1d9d 61AAD squid depth inA"&peel•is less than 6" below invert or available volume is less than '/h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number — �of times pumped �y 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. jZ Any portion of a cesspool or privy is within a Zone I of a public well. . _ y portion of a cesspool or privy is within 50 feet of a private water supply well. �y 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. (Tbis system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic 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 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) _ (YesfNo)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. 1 ' 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria'above) yes no/ V 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 _ t �/e system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone Il of a public water supply well a ' 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. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 110 Quail Lane yannisport , ass . owner: Bill Crowley Date of Inspection:4 19 7Y2 " t following: ow' have been done. You must indicate s or no as o each of the fol Check if 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? _ — s 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!r luding 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 ? t1 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: Yes no / � , ./ 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(3)(b)] f 5 Page 6 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 110 Quail Lane Hyannisport ,Mass . Owner: Bill Crowley Date of Inspection: 47/19/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms),, Number of cur-rent ents: )-ent resid y� Does residence have a garbage grinder(yes or no): Yam. Is laundry on a separate sewage system (yes or no):,VZ [if yes separate inspection required] Laundry system inspected (yes or no):Xi� Seasonal use: (yes or no): A,�C - Water meter readings, if available (last 2 years usage(gpd)): 2 0 01—C o 1n p u t e r s d o w n Sump pump(yes or no): V-0 4 19 02 Last date of occupancy: COMMERCIAL/1NDUSTRIAL Type of establishment. 44 Design flow(based on 310 CMR 15.203): ell gpd Basis of design flow(seats/persons/sgft,etc.): AM Grease trap present(yes or no): (Zj Industrial waste holding tank present (yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: ' OTHER(describe): GENERAL INFORMATION ' Pumping Records Source of information: 1 it lt /9�j� 4y A-4-7 Was system pumped as pan o the inspection (yes of no): If yes, volume pumped: /490 gallons -- How `vias du ntiry,pumped determined? Reason for pumping:4E,✓tt�j 24A011 I • T.t/ O SYSTEM c Septic tank, distribution box, soil absorption system Single cesspool ,At 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 fiom system owner) Tight tank ��Attach a copy of the DEP approval 4�) Other(describe): Ap ro)9 to ao_e of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site (yes or no): 6 Page 7 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 110 Quail Lane Hyannisport , Mass . Owner: Bill Crowley Date of Inspection: 4/19/0 2 BUILDING SEWER(locate on site plan) Depth below grade: .?6-d / Materials of construction: cast iron v 40 PVC 44other(explain): .fJIQ Distance from private water supply well or suction line:/Y r Cornments(on condition ofjoints, venting, evidence of leakage, etc.): Joints appear tight . No evidence .of leaka�ge . The system is vented through the house vents . SEPTIC TANK: b' (locate on site plan) Depth below grade: Jt Material of construction: concrete�metal.r�fiberglass,c�polyethylene 4�Lother(explain) A)A If tank is metal list age:&45 Is age confirmed by a Certificate of Compliance(yes or no):, (attach a copy of certificate) Dimensions: V 41i j Sludge depth: _ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: _0 Distance from top of scum to top of outlet tee or baffle: (2 Distance from bottom of scum to bottom of outlet tee or baffle: (9 How were dimensions determined:N.9 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels ras related to outlet invert, evidence of leakage, etc.): )Pump the septic tank qpnua1_LX-- . ._ — Inlet & outlet tees `are in place .The tank is structurally sound and shows no evidence of leakage . Pump the tank at time of inspection . Garbage dis osal is present . GREASE TRAPa/e(locate on site plan) Depth below grade: )_14 Material of construction: Vlconcrete�metal4i fiberglass4, ,+polyethylene 4Aother (explain): A/4 Dimensions: Scum thickness: ill 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: 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 is not present . 7 Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 Quail Lane Hyannisport . ass . Owner: Bill Crowley Date of lospection: 4/1 9/0 2 TIGHT or HOLDING TANKt�we., (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: 1_ Material of construction: concrete 11L9 metal dLfiberglass dJ�olyethyleneW other(explain): AA Dimensions: 424 Capacity: _____gallons Design Flow: gallons/day Alarm present(yes or no): n1 Alarm level: AM Alarm in working order(yes or no): AIA Date of last pumping: _,O Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present . DISTRIBUTION BOX: Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: WO 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.): Distribution box has one lateral . No evidence of solids carry over . No evidence of leakage into or out of the box , PUMP CHAMBERA/4,(locate on site plan) Pumps in working order(yes or no): AM Alarms in working order(yes or no): dl' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present . 8 Page 9 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:110 Quail Lane annispor ass . Owner:Bill Crowley Date of Inspection: 4/19/0 2 SOIL ABSORPTION SYSTEM (SAS): Zlocate on site excavation not required) 1-1000 precast leaching pit . 61X_101 .,. _ If SAS not located explain why: Located ; See page 10 Type 0leaching pits. number: 0 leaching chambers, number: O .)6 leaching galleries,number:_Q NO leaching trenches,number, length: O _Q leaching fields, number, dimensions: 0 ,00 overflow cesspool, number: 0 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.): Loamy sand to sandy loam to fine sand . No signs of hydraulic failure or ponding . Soils are dry Vegetation is normal CESSPOOLS,t.40e(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: O Depth—top of liquid to inlet invert: Depth of solids layer: > _ Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools are not n SPnt _ PRIVYA&/4 (locate on site plan) Materials of construction: Dimensions: Depth of solids: AX Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy is not present . 9 page 10 of I I OFFICLAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properry Address; 110 Quail Lane yannisp r . Owocr. Bill Crow ey Date or Inspecti0o; 2 SKETCH OF SEWAGE DISPOSAL SYSTEM �1 Provide a sketch of the sewage disposal system including ties to dtm .fcrcncemdmar I ocnchuks. Locatc all wells within 100 (cct. Locate where public water supply enters the building. P I� \ I� v 10 f page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 110 Quail Lane yannisport ,Mass . Owner: Bill Crowley Date of Inspection: 4 19 0 2 SITE EXAM Slope Surface water Check cellar Shallow wells q � Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: 1,"d QWained from system design plans on record - If checked,date of design plan reviewed: bserved site a uttmg prope bservation hole within 150 feet of SAS) �L0 Checked with local Boar o Health-explain: A✓ Necked with local excavators, instaljZrs- ( j ach documentation) ccessed USGS database-explain: lid. C7, You must describe how you established the high ground water elevation: Used ; Gaghrety & Miller M Ground water elevations sea ievel . Used ; USGS Observation well data June 1992 Used ; Technical Bul et ' 92-00 —1 levels . Janualrof U11019TI, Leaching �� Pit .eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom Of the leaching pit and the adjusted groundwater table is 6�40f feet. 11 •R*1rn.—n'rt+—•rr +n.—mr•nmrrnn rerr.rTrr.:•.T+:T7rr:mr'�rnm mT.t1u 1�1'�Rr:RT .rn•RT-'n:'n•-..-. TOWN OFBarnstable IlOARU OF HEALTH r j 0 SUBSURFACE SFWACF DISPOSAL ,SYSTEM INSPECTION FORM - PART D CERTIFICATION •••T!9^T••••.: —T. /.^.�Tn.Tf:'nt•R.'T.IIT'TlrRT1/1T'TI'r"1 r11ItR:71TlIr TITRR711r RT10RRflA'I� lltrtn -TYPO OR PRINT CI.EARL1•- PROPERTY INSPECTED STREET ADDRES$ 110 Quail Lane Hyannisport , Mass . ASSESSORS MAP , BLOCK ANU PARCEL # OWNER NAME Bill Crowley PART D - CEI?TIFICATION NAME OF INSPECTOR Joseph P . Macomber Jr . COMPANY NAMEJ . P.Macomber & Son Incre - COMPANY ADDRESS Box 66 Centerville , Mass . 02632 Street" Town or City state iIP COMPANY TELEPHONE (508 ) 775 3338 FAX ( 508 ) 790 - 1578 t'f , CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at 10 his address and that the inrorination reported is true, accurate , and omplete as of the. time ofeinspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one ; n _&/System PASSED The inspection which I have conducted has not found any information. which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* \ The inspection . which I have con ticted has found that the system fails to Protect the hublic health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Dat, Dn6 ..�n,.---�. __ _ --- copy of this rt.ification must be provided to the OWNER, the BUYER where applicable ) and the 130ARD OF HEAL7'1t, * If the inspection FAILED, the owner or"'op unless allowed or orator shall upgrade ' within one year of the date of the ore system i<'rapection , r required otherwise as provided in 3.10 CmR 15 , 305 . partd . doc LO. CA�I�N �� , SEWAGE PERMIT NO. . VILLAGE �12 I N S T A LLER'S NAME & ADDRESS . 57, 141, D U I L D E R OR OWNER DATE PERMIT ISSUED S-/7=SS- DATE C0IRPLIANCE ISSUED ;r C-j �O \II, 'L6 r 1 1 j - No...... -1 Jr ................... Fus.:.....t�.... �IN , THE COMMONWEALTH OF MASSACHUSETTSOGE �� y BOAR® OF HEALTH RPAUL o MICHNIEWICZ ...-...Town......................oF......B.aznai<.able........................... No.304,20 Go CIVIL �O Appliration for Disposal Work.6 Tunutrnrtiun Famit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage isposa System at: 5.g�- ...............Quail...Lane1 •Fiyann s ort........._......• ..........Lot...#. 2-------------•-•----•-----------------........_......--•--•---...--- Location-Address or Lot No. .... ..__.: ....... .-•----------------•---------..........._----------•--•-----------........---......--•----- Owner Address W Installer Address U Type of Building Size Lot..4 0 ►4 5 5 Sq. feet 0-4 Dwelling—No. of Bedrooms.......... ................................Expansion Attic ( ) Garbage Grinder (to) P., Other—Type of Building ............................ No. of persons..........................-- Showers ( ) — Cafeteria ( ) a Other fixtures ------------------- ........................ W Design Flow..........._55..........................gallons per person per day. Total daily flow.........3 3 0_.....-_.__._________.____-P'allons. x Septic LiqudcapacitylQ Qgalns Length0 Width Diameter D .. W Disposal Trench �o . Width Total LengthTotal leaching area --......Sq. ft. Seepage Pit No.......1........... Diameter...1.0........... Depth below inlet.....5 t.U.... Total leaching area...2.5..........sq. ft. Z Other Distribution box (X) Dosing tank ( ) '-' Percolatiore;Test Results Performed by.Cape Cod Survev_Consultantf5ate...10/10/80 a Test Pit No. 1......2.......minutes per inch Depth of Test Pit...,12........... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit------.............. Depth to ground water.---.................... --•---------------------------- .---..........-------•------._......_.--.-- 0 Description of Soil.•M 3_--Q°-8__"....WQ.Qd...laam;....B.--3 0."...auhsQ.i.l-;....3.0"-9 6.......caar se---S-and.. W &...gmameI;....9.6.: -144_......fine...vhite---aancL................................................................................................ W x -------•------------------------•--------------••-•-----------------------------------••---•----•-----------------------------------....---------------------•••---•-------......--•••------------------ 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 TIITL I 4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in oper tion until a Cer to Co li as issued by the board of health. ._ l o cation Appro Appli Date Application Disapprove a r t e following reasons---------------•---------------------....----•---------------------------------------------------------••-•--•--- ................................... ......... .-----........------------------........------.._...•--------------------------------------------------------•-............------... -----...._..-- Date a PermitNo......................................................... Issued-....................................................... Date a t N ..................... Fxs............. THE COMMONWEALTH OF MASSACHUSETTS � ,tN OF BOARD OF HEALTH or ROGE yG PAUL Town- -----------------OF.......Rar.nS.t.ab.je.------------------------.......................... v MINo I I Z 3 Appiiratiun for Disposal, Works Tomitruriion ram, o $`L Application is hereby made for a Permit to Construct ( x) or Repair ( ) an Individual Se System at: ...............Qua L-Zanp......Lyax nispc zt..........-----.. ----------Lot...#.2.3.................................................................... Location- ddress or Lot Nb. ....... ............. .._.... ...... Ownez Address W Installer Address d Type of Building Size Lot-AD 4A55 .....Sq. feet U Dwelling—No. of Bedrooms----------3................................Expansion Attic ( ) Garbage Gnnder0) Other—Type e of Building No. of persons............................ Showers Pa YP g ---------------------------- P ( ) — Cafeteria ( ) a -- Other fixtures .----•--•-------------------------- --- --- W Design Flow.............55..........................gallons per person per day. Total daily flow---------33.0...........................gallons. WSeptic Tank—Liquid capacity.Ja(Logallons Length&_6.t..... Width...,+ 1.1.011 Diameter________________ Depth...V.4"... x Disposal Trench—No._._.t............... Width.................... Total Length..._;............... Total leaching area....................sq. ft. Seepage Pit No.......I........... Diameter.... a!._--___- Depth below inlet...... ..47... Total leaching area...2.57.......sq. ft. Z Other Distribution box (g) Dosing tank ( ) aPercolation Test Results Performed by..CaL?e.._CQd...S=Vay. ...CnAz sUltaritDate....1.0/ID/--H............. a Test Pit No. I......2........minutes per inch Depth of Test Pit...J2!......... Depth to ground water........................ Test P.it'No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•--------------------------------••---......-•-------------------•-•-•---•----------...---.....--......................................................... 0 Description of Soil..T.P.43-•.a-"----8......Wc0-...loam-?....g!!_39"----s-ubso l-i----3-0-!t-94!!--coarse---send--. v . .......&-•-gr_aue14..36`•.114.4`•'- flne--white...sand..•. •--•----•---------------- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until 'a Cer ' to o as-been issued by the board of health. ...... Application Approv � i ........................................ Date Application Disapprove or a following reasons----------------------•----------------------------------------••------------....--------------------............ Date Permit No............ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................OF..................................................................................... Trdifiratr of TompiiFanrr T I CERTIFY, That e Individua Sewage Disposal System constructed ( ) or Repaired ( ) Installer �- ;= has been install%ed,in accordance with the provisions of TIId.- f The State Sanitary scribed in the application for Disposal Works Construction Permit T�o......................................... dated................................................ THE ISSUANC OF HIS CERTIFICATE SHALL NOT BE CONS E® S A RANT E THAT THE SYSTEM WILL U .CTI N SATISFACTORY. DATE. L� .. Inspector.............. ---•-•...... THE COMMONWEALTH OF MASSACH S TTS BOARD OF HEALTH --1st s No......................... FEE......................... • �io� I w •;�� o �unu�raiun rrnti� Permission i -eby grant • •--•-•------• .................------------------------------------- --------------------------- ..._.............. ................-------- to Construct or I$F air an 'I dividual Sewage Disposal. System at No........................................................ -•---.....................--•-.... ------ ----------------- Street f .... �� as shown on the application for Disposal Works Construction Permit . .._ ........_-..._. Dated.._.....................................:.. • --------------- -- .......................................................................... ` Board of Health DATE....:. .. .... . ......:..:.. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - y ,_ .. ,_ ., .-: ..:_. v �I�� a .• . ]� .. .. ,_gyp L� .. .. .�'... $. ,'i:. .. is ..r. .�,.*Si,_ a. � 41� �s!°-.. . vd�. - yr� ., ..-. -. .. - ,. .,.. • � t ,. _ ., :_.Y R _ ••v --pper� x. ,r � "` REVISIONS: TEST PIT :9ATA DATE a� rEsroNG:�_ a �, -tom <-� PERC. TEST DATA : SEPT/C TANK DETAIL = sr ° � r�_ _ DIST. BOX DETAIL : LEACHING F� C�IL /TY DETAIL "° DATE ^ /O//C��r�__-�___ TANK TO CONFORM TO T/TLF_ 5 REQUIREMENTS �:: CONFORM TO TITLE 5 REOU,'/?EMENrS T �' "' TEST BY TEsr! T_____ NO OF OUTLET • W/TNESSED BY: —__ _ DATE OF N � r Cir/ -., , _ „i°�• , ,I� ,rl it .d 4 N�1�.' r.,. 't°` "' ' Lnll�► r �1#"�`wD W/TNESSED BY -- -'-- + �i�T 3//�'1/!t%i' / !%!` /`1� _ �`� An '., ��'!h:�C\ � ''��: r REMO6FA8LE COVER ��.. 41 bf,,NHOL E BROUv H, rO T 'b h}T °•., . — e.•: o F/N,SH GRADE. w t . � f'L�ASTONE�. LL14M�FJr L-� /2"MAX. �M:.sD �t'9►�J�$taG'1'gYJ A �/ �.�- - yr t �--------- - 3 GLfAR 3 CLEA YI ) ( I OUTLET PIPEST�a 1 r " —1'-- 4O1R "t�l�}R'11� �±R.tCatl.i01L3�" IC�11J - - ----- 6 M1N. 2'MIN „M/,1I , 1 AS REOU/REO �J 2 -_ 4 5�" 4., DEPTH OF TEST 3 � .� r^ ,� E r - - - - 5 P 'tS a - -- � f Bpi sar t4 S.s 71r�J/1./ /si:+w r i I j i'` �. ��G '�► T�kT� � �,r�wbi i�J RATE' -.------------ - -- •v `,� — INLE. TEE - }�� O MpN - t (/ -� Sp T i I R�.�115 _ i T / G/ OUTLET TEE X / $ /000- GAL, + y INLET Ah"0 Oc/TLET 4'0" MIN/MUM i ,; OUTLET TEE DEPTH � I j yr>�+`dJ ( Es/G• ��'', ' I TEES TO BE CAST I,; L/0Uf0 DEPTH 14 AT L!OUID DEPTH OF 4' j c E„ 6„ �.� / SEPTIC TANK ` �. PI?ECAST OR BL01^A' ,. c.ONCRF_TE ' '' i SEEPAGE P/T i IRON, SCHED.40 �, 4 5 " I— _ J CONSTRUCTION DEPTH OF TEST �__ 24 " s' / • � ____-.__ ____ PVC. OR CAST/ti , ' G?g ,. ., � o b .� d a IO Pra "r I PLACE CONCRETE •` 34 8' BOTTOM L.EVEI_ STABLE2ASf RATE' �' ONCR�TE ij � y� j } C 4 + CONS UCTION (WATERTIGHT) -- I:✓LET TEf_ PRO VIDEO WHERE SLOPE , i .. .. • 6 %• ► a, FOUNDATION I, T �• OF INLET PIPE EXCEEDS 0.08 % OR TANK .0 HE ABLE TO W, TH TA ND - -- BOTTOM OF TANK ON LEVEL STABLE BASE H-IO LOADING UNLESS IN A PUMPED SYSTEM. I _ - _ _- — -- QQ�M/N / i ^� --- j I/ WASHED STONE' PAVEMEN7' OR IN ORI VE, H-70 LOADING UNDER PAVEMENT OR I DRIVE ' RECOMMENDED MANUFACTURER RECOMMENDED MANUFACTURER �� ° ( (OR APPROVED EQUAL -- j � ( OR APPROVED EOL/AL l �� , 4e, �... .-0Ir .-w:.r, a, .. w Fy.;1, -. ,:/*. 4. ,-. .�:. :: •�;+ .S •'S 'f r iG7 Xrr.?,. � .,.if4. �,. .,,..� '�5 S.e.a AkSy,,• ��.. -.,,.-:' a: � Y _�.,.. : ,. •a'«;' pit..... ., , ,, ^,•.,.'. - '�' 9 •',3s NOT �, _ . ., . .,• �. �w - _ �f }, N VE'R T EL E A Tl D PLAN V/E !N_._ � - ._ -.�. w , .r : . . �, a: ••' .,., . ., a A.. ,rtn � .X a y.,� .- • � !J�y'}A��... _,..� :�+ • 'S•`i: � _ c �' ... � : � ro .. - _. .< ,s4.., :.:;.y •1.".,'- r,. :A }�:. :a < .Y3 ��y .-r : ,•f. - :e.. -.. :: ,^ „•k-...,:. y. > '. 1r'+-. /. THIS PLAN IS FOR THE DESIGN AND CONSTRUCT/ON OF THE SEWAGE �.�.. .,� .>.. .. .a: � � ` s ,,�. ..� ..{1r�:'y•�:':-s ,, . .,-� .„�, •,, �.��,� � ., ��.,.. z .. .. : , � :w � . .:. . ._. .:, ,. � � .�. :�:� DISPOSAL FAC/L I T Y ONL Y. SCALE - .-. .. .. k( ,: -�, '.� 'F:.'r-.'E•:,:T 3x.. - -6,.N ,,:.• Rf4 �..-•-.; � f�:r..j�l�: .. Y'�y - ,..3.: of '.�'�-. `-.b. i.� 'A,. 4•. ,��<�.. .A � _. .�> '�• _..., ,,�. ., • .. �;=� � INV. AT BUILDING �5.40 _ y. •-� e A rt s ii .{ VV M1M1 2'. ALL CONSTRUCTION METHO(?S AND MA TER/ALS SHALL CONFORM TO � ,r ,� E .• _ .: .� ,. _ _ r � . _�.,.. .:-, ,4. . _ f •. ? ,, 0 n,•:. > ",.. ;�'_rim. . tr :-, �n4 ;FS'•,,,. u�-"_: Ar: ,.�.. ct. 1v.... -, , r<_, :�r. ,..... x,, .,�+�.-•r .:,� .. ..,, . .:� ., ,� .�; INV AT SEPTIC TANK(/N) � 'S .2.d�•_`. .. _ :ksrlp - ;.Y- ,•s.. s ;,.+ ,. . ...... ;: '":�l' .°. e-:, t _ �v` �.-� _.��, s' �., .:<:.� G ..,.�.:•�*'>..�•;vK-�'y'!'�; ^, c � 'S".'_ ��s .Ism,• a. ...r+,:� s` e,... ��. .,.o'"''�" „"a MASS. D.E.0.E- TI rLE 5 AND THE .,� �,� BOARD OF _ ..- ��// ;, _ �__ st�_.1LS.G'__.----- � > f /� ,N.a. e..- ,�� ,�,^. - ` '. ...:,,v . ,,n, :q,.,r ,:- . .C'P' �./�{/ n/�y •"1T�. L -. K`.:^- *..>. ._ ��y r .a .. a:-. �,.• , r.;Cis,..,' •9-':•. ti >_ ,:. :.n.Arr-. ...'91"•.. - ' , , . ,_ .5� T/C TANK(GYJTI °�4. , � . 4 � �x . . �"� as °.r;.. ,,.�-, HEALTH REGULATIONS. _ �� ,�� •,,t-; �.,� �z. ��. ., v. Y. ,,.�.. ,._ - • / Z , . , ._ �; ..•:,.. :` i ;, 1. „.,...; . �: ,.. ti. �. Ers�c mac • e �. r a> � .5 ..•.fqm.. � - p .. �a73-.,. �n y,. �t'. _,>. -Y Ft .0 ;a'.. :�' ,.., .t. _��Y'.•r .� .i: o •:?1. -P r.•c- l' +4• sal .h ^;'.Lam`: .T�., �F f• A. � .`4 ''„\. :'psi .,f.'•ia as' ;..,ypY. +•xY v .N9! - n E�4.',. +th ?Y..e FR. Yf s . � ', .�.�, ._.Y. .r,`£e .h'4 lr• r a-✓. e�. h:Jl,: �< r.._ r .J r , ! •�i "». S �...° .� ,yei...h %f .,. ..n,. it fir. ,._ -tr: ,. YR 4.i.�,,'4 .',i:'S.,4:y• pla4.. .l .I".. ..r... ..._ .. �.r"..:� ..�. .:..o.��•jW�F �., >.'^ ,1• f.. ).,. S.U(tl A,•.� .. J....5 �i(l�� .efEl 4� Y e w:}i.-: M /NV AT D J , h��?a y,.., '��r�� ... ,,:- _..;tr. �,d, , rh.,,,,.,. ,i:,.a �• � '�, :x c�.',�4, NV AT DIST BOX(CUT) T •�� ']c,7s+.^-• �..: .�r� ,. . �� " � � .�... -. .,� �. _ ( ) rs ��' 4.. ...•R•�CrE?'tr:. S _ jfikk_ .. - �� ! .'. - �- AT LEACHING FACILITY- 94.5 _ A% RCJ T TO,'�? C'iF�'/T �9 O. $S Bt3STON, MASS. WORCESTER, MASS. 4 HALIFAX, MASS. NORWELL, MASS. _ BEDFORD, MASS. LEXINGTON, MASS. HYANNIS, MASS. MANSFIELD, MASS. CRANSTON, R.I. DERRY, N.H. ZOT Z Z % O. B C Al a -- - -- = OESIGN FLOW, • . 2h , J ! )) ;�i � � '=n.m. :.xaf^"'•'!, � „` .�Crr.. `."" �• „_ � .`.w..� w-.,�"'+e.y x .._.. i. .. .. ,lit:, ?'z_it.Q 2f"_� 'r±:L 1�A^..�...:"r. z .a.LS.E-.T�1, / /r r / _�II � _�_ \ �y 11.: �"� _.+ ,.,_....,1.�_' _.\ `` `�:` \� � +r,. � \' ` � ,, -...- !J[.� ...'rt��l1�Jii.-_-•1l•T'.�.:!'1C SJlS. e]C..- .._...._ __ ._—_._ �� ' ��i �° / / "•^ .,.,. ,•.' •.- _ � Syron.,- ..,. `�., �"� ''�, ` \ �,,,« 'x.. \ .� - _ - -_ --..--.. -�_-.-_._..._.._...__—.. ._.__._.___.._. __ ..._. - _ -__-_ f / � y� ';"'gam,-.,�„ �;h. ..x.F�i. -.`:•,.,.®...; �� "q`w,. \ � � � 'EOU/RED SEPTIC TANK _ — ! \ Q. .y',r •✓`,., ! - .r•- iyr. ,..,..,_ w.<.,.::r e,...:w, ^y„�aR �� \ 'i \- � Q 7C 4ll-! GAL...� SEPTIC TANK PROVIDED = t �_c, CAPE COD SURVEY ,«�. .�- �•,. �,,..�""".. •— - y:�b'+e•,ua*Nr.:.� su.. .,,•, ,.y, �\ �',�. � .� � _ ---l-" GAL. CONSULTANTS -•"' �.�. .r �. _ ,, b , ,� \ \ �'EOUIRED SIZE LEACHING FACIL I T Y - �- - P O. BOX 56 COD DIVISION OF DOSTON SURVEY ONSSULTANTS INC. °;./ZE OF LEACHING .'ACILITYPROVIDED ENGINEERING SURVEYING PLAivNING e 'LL ' L Of; SYSTEM TITLE: 4Z tee - Al ' OIL .L1J' -r .- •.•- /S.4_/ ~•��x 'sY ,,4 .:`� a. � .s�. ' .F*y �r,,,_..�� ' � � .-.f1`1 i..i- C w�.D-. 7.c�r2�`s'.�.u.__- r'�T.� .,i T3 ai 1; , p SEWAGE DISPOSAL SYSTEM xcas..acM ••�,., :��`'f � �, it "°�.,.�,-. �"':;� � � _ _ - � DESIGN y'i�r J I V".., `� k - - x, r w , r L C PLAN J '4 { . 1 _ � � I , .• �,, l r7 t'�:� Lr �-�''..,J�E''r ,+ �*".r'm+ I"1'�fr�,� y ,/.�%✓f../ !„r s. ;', ,.+,.•'' .. t'w ,7 A:< -.�^^'..w• � � �,r ,y� A�` \ k; A�ir�.Iid'� �.`4..a��,e++^�T~.f`' .�..`' //'4•� ?.«f�"' �=�-e:R r,:v+� ..:',+�.,✓ p ' ' �l f 4e NY 1 .E`i .- �.�a•c�o .. r -, '_�. ....:_K-=---�' tt f�: v'�' tit `l s•� ,r •s j ��,i... ry I� v s� CO�,..,� _� r �� Y w�-...._.=-..'��Y <» ;, .. 4 •.0 t'L� �� ..,�P" ::i l..r� x�,^i`Y.�..s��''�- r SZ. G 94 SCALE' AS SHOWN i /� ' : r - / Y '�y `'✓� w` DATE _.._ r 4 P =T_ COMP./DESIGN- CHECK: -'r - • �' � DRAWN • M %�..G r_^.. RAJ r /pit �. f�.E't FIELD: FILE NO: i DWG. NO: 0 7 JOB NO: SHEET: I QF: I .N _ -t .. � -.. . -.,. j�r r- l"• �• �y +':t�.S � _ tur. '! ., - �. -...cam- "•FYe. e. :, ....__ - _ _ —, _ - .. - � - .- A' - - .. .." .- N:+ , - ,...4_ ,..�. '-' ... yF.:...r�'Yr _ - ., '. _a- .., e. _. _.... - iy . ._.ems:='�s`�I^•' .,. `:V..w- � �v �!• _ _.. _ - � - - .. .. .. - I7L""''�:��>.:id3'.,!'4`".-0�:..:....�•srk;rc.�..,;s',•d:✓:.._�--.'_. .,_„«. �•..,,z.,ar'i.3yJ•vw'•- �ad.i�sY"yr`✓,3a'•-..'-- - - _ - .. ._- «P ��... s _ - _ -_ - _. _