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HomeMy WebLinkAbout0134 ZENO CROCKER ROAD - Health 134 ZENO CROCKER RD., CENTERVILLE A = IN 1Y Ti yy��,,UPC 1253t/4 IV 1�p o. 2..,...-1�.C 3L0R •�$AOS7.COti�V��� HASTINGS.MIy 'JA p1 2 6 1999 �-V COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEG PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 134 Zeno Crocker Rd. Centerville Lot 642 Name of Owner n/a Address of Owner: John Chronis Date of Inspection: 1/20/99 Name of Inspector:(Please Print)John Graci /am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: John Graci Title V Septic Inspection Mailing Address: P.O.Box 2119 TeaTicket,Ma.02536 Telephone Number: (608)664-6813 CERTIFICATION STATEMENT 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes Conditionally Pass Needs Further Ev uati By the Local Approving Authority _ Fails Inspector's Signature: �� Date:1123/99 The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS Septic system passes Title V Inspection.All components are structurally sound and functioning properly.Recommend pumping system now and then maintained every two years to prolong the system's usefull life.The leach pit was 1/2 full at the time of the inspection. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: nla Date of Inspection:1/20/99 INSPECTION SUMMARY: Check A, B, C, or D: A. . SYSTEM PASSES: _ 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. NO The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. NO Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed _ distribution box is levelled or replaced AID The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: n/a Date of Inspection:1/20/99 C. FURHTER 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool.or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance nLa_(approximation not valid). 3) OTHER n(a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: n/a Date of Inspection:1120/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Wa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: n/a Date of Inspection:1/20/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: n/a Date of Inspection:1/20/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-=g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):nLa Total DESIGN flow: nLa Number of current residents:2 Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NQ If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NQ Last date of occupancy: D& COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: n&gpd(Based on 15.203) Basis of design flow: nLa Grease trap present:(yes or no):�LQ Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:nLa Last date of occupancy: D& OTHER: (Describe) nLa Last date of occupancy: nLa GENERAL INFORMATION PUMPING RECORDS and source of information: nLa System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nLa_ gallons Reason for pumping: Wit TYPE OF SYSTEM XSeptic tankidistribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: Wa APPROXIMATE AGE of all components,date installed(if known)and source of information: System is 13 years old. Sewage odors detected when arriving at the site:(yes or no) NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: n/a Date of Inspection:1/20/99 BUILDING SEWER: (Locate on site plan) Depth below grade: l Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: nta Comments: (condition of joints,venting,evidence of leakage,etc.) nta SEPTIC TANK: X (locate on site plan) Depth below grade: C Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) n[a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No Wa Dimensions: L 8'6"H 6'7"W 4'10" Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: M Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 1L" How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING NOW AND THEN MAINTAINED EVERY TWO YEARS, GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Wa Dimensions: n[a Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:-/a Distance from bottom of scum to bottom of outlet tee or baffle Wa Date of last pumping: n& Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nta. revised 9/2/98 Page 7 of 11 C + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: n/a Date of Inspection:1/20199 TIGHT OR HOLDING TANK: h[Q (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: Wa Capacity: Wa gallons Design flow: nta gallons/day Alarm present: NQ Alarm level:jiLa- Alarm in working order:Yes_No_: MQ Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nLa DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:n& Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) Wa PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n& revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: n/a Date of Inspection:1/20/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nLa Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: _nLa leaching galleries,number: _nLa leaching trenches,number,length: nta leaching fields,number,dimensions: nLa overflow cesspool,number: Wa Alternative system: Wa Name of Technology: -nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY,THE PIT HAD X OF WATER IN IT AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) Number and configuration: Wa Depth-top of liquid to inlet invert: nLa Depth of solids layer: Wa Depth of scum layer. Wa Dimensions of cesspool: nta Materials of construction: Wa Indication of groundwater: Wa inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa PRIVY: _ (locate on site plan) Materials of construction:nLa Dimensions:Wa Depth of solids: nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: n/a Date of Inspection:1/20/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a t wC� � I JCC�C FED. O RA �3 Do a� revised 9/2198 Page 10 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 134 Zeno Crocker Rd.Centerville Lot 642 Owner: n/a Date of Inspection:1/20/99 NRCSReportname: nLa Soil Type: nLa Typical depth to groundwater: nLa USGS Date website visited: nLa Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers XUsed USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revis5 d 9/2/98 Page 11 of 11 bI i>5 EC iiE VILLAGE I H S T A LLER'S NAME A D D R SS - Z/l� s DATT-FIR MIT ISSUED DAT E C0MPLIANGE ISSUES} ���Aa • zi 5 �- _ � Q` © ��I V / _ 's d .» ----ter �. _- _r. __._ .--.'-_=.ice. _.--�__ "p++..`_-_, r -33 No.... .J...........� . ....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF� 1HEALTH ..... ..........................OF.......��rt' Appliration for Uiipnaal Vurkg Tontitrnrtion Orrmit N Application is hereby made for a Permit to Construct (ti/) or Repair ( ) an Individual Sewage Disposal System at: r .a o �.. � ..... . :�o..G: :�� .C% 13' ..... ......................................... 1 '� Location-Address or Lot No. �' ............... .. ..._..__.. ........................................ O L' dd Ter Are C ...... --•-------- 1-- .---•----------------•-- JIGY.�`� • -- -nst Address Type of Building Size Lot.... f�t. ..._Sq. feet Dwelling—No. of Bedrooms____. ...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Othe ures -----------------------------------------------------•------•-----------------------------------------------•----••---------...-----•...........---- Design Flow.._._....�?�...........................gallons per person per day. Total daily flow---------- .�✓......................gallons. W , WSeptic Tank—Liquid*capacity10M.gallons Length.... Width---------------- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No__________J______. Diameter.............. Depth below inlet_... 7Z. ... Total leaching area._ sq. ft. Z Other Distribution boX Dosing tank { ) Percolation Test Results Performed byWAVW1G�.. �5Ct�....11+ :................ Date.....�.�._--L '. :... Test Pit No. 1_.� � m t-est � .m utes per inch Depth of Pit......1 ......... Depth to ground water- __--_-___. ;4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................... .. ... .............................................................. caj O Description of Soil... W '- /s.--•.- --------- ------------------- -----------------•----------------------------•-------------------------•--------•------------ W U Nature of Repairs or Alterations—Answer when applicable.________________________________________________________________............................... -----------------------------------------------------------•---•--•-------------------------.....-•-----•-----------------------•----------------------•-------------------•---......---•••---......---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordanck�!.ith the provisions iITLb 5 of the State Sanitary Code—The un ersigned further agrees not to place the system in opera u il. Certificate of Compliance has bee ssu d b of health. - S' ned -------- . --��-w}---•- . --. ....--- Application Approved By.. .... .......................................................... ........ ...."..................•... Date Application Disapproved for the following reasons-................................:............................................................................... ..........................................--- ----- ---•--...-----------------•--•---•--•------------... Date < Permit No......................................................... Issued....................................................... �/ M..+ 1 Date J No. ..�-�.... .".......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------------------------------- Appliratinn for Dispas al Works Tonti ruction rrmit Application is hereby made for a Permit to Construct (I/) or Repair ( } an Individual Sewage Disposal System at: % ..�Q,2r.....:� .:'-�� r..`..L_.:k.��, ..................-si.......... _.._....... ................ Location-Address r or Lot No. 4 / Owner.•- f E ' Sddres ` Installer Address J � Type of Building Size Lot....` fl�t.... V............Sq. feet �-, Dwelling—No. of Bedrooms........1...................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otheyf res •. Design Flow- ?... ______________ gallons per person per day. Total daily flow.......... ....................gallons. WSeptic Tank—Liquid capacity_1IL!�l/.gallons Length_!--_M... Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.__.....•._.........sq. ft. _Seepage Pit No.___--_- I.-__-_. - Diameter..__..__1.2-..... Depth below inlet....d'��__....Total leaching area..Z_"_ _ --_sq. ft. Other Distribution box ( ) Dosing tank ( ), ,i a Percolation Test Results Performed bytUAA't2aJ1�.'!. __-A S(7�___.j.r�`L_-••.__._-••-__-- Date..... Test Pit No. L.��f. ._minutes per inch Depth of Test Pit...... ...... Depth to ground water_____________________ rr�X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ....._..iV-.c ----------- --•----------------------- D Description of Soil... —; ._ ? ' S _`a e l(., ;-= pia\•h.? Cs 1 U c 1 P.�ANlJ7 i V ••-•-•---•-------•-•-----•-••--•------•-----------•---•----• --------•-------------------------------------------•--•••-•-••-•....... W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------------------------------------------------------•-••-----------------••----••••.........•----•--•---••-•---------•-------••--•---------•-.......--•-=----•----•---..--...._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions ; ,LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ope�rat'o kun iI Cerlificate of Compliance has bee 1ssu d ` tl 'rb Z of health. g t Qom_ - ' 4 � -- �_ N ned � ...................................... � - � - Application Approved BY _ ....................................................................... -• wzi.'y•-•:-.............. Date e Application Disapproved for the following reasons----------------------------- ------------------------------------------------------------------------------•---- ....••--••••-•---•-••-......---••----------------• •--- --------------- ----------------•-----------•------------------------------................................................ Date Permit No. . ---- k ' ==. Issued..... ar. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH , { _=.— .. J r � - i oF........ , .f..�......;........ .. ... . .:.......... wrfifiratr of ToutpliFanrr THWjj Tn _ERTIFY, Tb,4t the Individual Sewage Disposal System constructed (L).,or'Repaired ( ) �7 . . ,.- i by ! �4'�? --- / •a :� / e,P�---•----•-- ." / c a 1h'staller has been installed in accordance with the provisions of rti *'-= 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------------------------------------- dated------------...--_-_________-___----.----.__---. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE ' SYSTEM W Lf FUNCTION SATISFACTORY. !. DATE.............. ......................................................... Inspector................................................................................... THE COMMONWEALTH OFF' MASSACHUSETTS r i BOARD ,OF HEALTH `, ... ......... - ..:......... ° ................. I� No..............................."S� �' FEE..`-::��i^ ........... w DisposF,!ai �orksZomitruction famit . - .erebY gra l 15 -"j Permission" is h nted__ � --•-••• ..r-- ' ..°.'................... to ----•--- to Construct ( "o R air ( ' ) an Individuat,1sewage Disposal System at No. �-- Street ^ as shown on the application for Disposal `'Forks Construction Permit.No .' Dated..__h�ff`�t' : ................. . ._._..*.... Board of Health DATE------------ ----�------� .................................... ` FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - _ P SITE PLAN SHEET I OF 2 SCALE: I . Zv' t • 1 (000 Gtk>r. t..scA4.N pt"fi" I Uo1g q y p o O ' d 4. ,4 I so • � �I y` ( � ��4-3 4 I ! S OF Ass9 o o :WILLIAM : Qn U WARWICK H No.,19771 orF /ST ER�� ���a�AL LA'�a�'�� • REGISTERED LAND SURVEYOR FOR Lei T L.��•E-'�-- 'Z�t�J o �.�zy�`� R, ZONE t L L " PLAN REF. DATE A � BENCH MARK DATUM WM. M. WARWICK 8 ASSOC., INC. DOMESTIC WATER SOURCE To�� �'- r--iz BOX 80I — NORTH FA L MOUTH i FLOOD ZONE I1 v I-4— MASS. 02556 — (617) 563—26 38 - f LEAGHING BASIN SECTION NOT TO SCALE She•el 2 .7 _ 24C.I.MN COVER EARTH F/L L BRICK AND MORTAR COURSES AS RE0'0• TO BRING _ COVER TO GRADE INLET �B FLOW LINE j y,i 2 �8'"TO "WASHED PEA 5TONE FREE OF IRONS, P/PE l : FINES AND DUST/N PLACE ,� ':v �' • OPENING W/TN 4%B" . � �4" TO I%p"WASHED CRUSHED STONE FREE OF OUTER DIAMETER IRONS, FINES AND DUST /N PLACE AND 1414„INS/OE , DIAMETER • ' : •• I. CONCRETE TO BE 4000 PSI 28 DAYS I 2. REINFORCED WITH 6%6" NO. 6 GA. W.W.M. • 3. 2�AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH- REQUIREMENTS 40 3' —�----6 0" I 4. NUMBER OF PITS REQUIRED MIN. I 62 NOTE: EXCAVATE TO ELEVATION 3-7 mil' OR EFFECTIVE DIAMETER T.__ (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL -WAFER UftE- LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL.WITH CLEAN TYPICAL PROF/LE GRAVEL TO DESIGNED GRADE. /8"STD. LT. WGT. C.I.NH COVER ;.: 4"C./.P/PE 4"B/T.FIBER PIPE OUTLET LEVEL DWELL/N, T LOW L/NE T/GNT JOINT _ Z TO f/RST JOINT s-+ r._ ,v ' /4" OO 110 pQ01 � 'Z C.I. TEE 1 l a I V O 1 1 ' 00 of STD. PRECAST CONC. 4T,S 4 i 1 100 00 0/ST. Box ro BE y. IO •;LGAL.SEPTIC TAN INS AEON LEVEL, • I I 1 100 00 Of I I • STABLE BASE I Igloo 00 13 I i \SEPTIC TANK TO BE i 1 $0 0 00 1 Ill ; /NST LLD 0 LEVEL 11 100100 1 ".1 STABLE BASE. i I 1 100 0 0 1 1 1 , � 11100 G011i � � LEACH/NG BASIN BASE TO BE L EVE4 ; ;l l 8 0 O00 0 1 ; i ; �' e v SOIL AND PERC. DATA A-II.y TEST PIT NO. P37o% TEST PIT NO. 2 � PERC. RATE � � MIN. /IN. 0 0 TaR /h v�So�L TEST BYiw�� ��-D 2 WITNESSED. BY: Z-0 0 to L r_1r_o . D I TEST PIT OR. EL._... 17, MEDIuM sA0L> DATE: N1 D Cep(RAJ D.\.,)A 94?- 37-,,, 4 , DESIGN DATA GENERAL NOTES BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. rev �� r DISPOSAL SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD EST. TOTAL DAILY EFFL:!3-' GPD. PRECAST REINFORCED CONCRETE UNITS. SEPTIC TANK I vo0 GAL ALL ,.SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE .. TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE,, SIDEtiYALL AREA 2'yGAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA.1:�?GAL./SQ,FT. SANITARY. SEWAGE EFFECTIVE ON JULY 11 1977. LEACHING REQUIRED Zak .SQYT... ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL LEACHING AREA OF HEALTH. � 9.�Q;F1 �; AT -COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. %po-t-r�vr>�.; I ' ��� PITCH ALL SEWER LINES / FT, UNLESS INDICATED OTHERWISE. `"OF SIEWAG'IE DISPOSAL. SYSTEN o�• MARTIN E. FOR' LI✓l , - ��L1�DW y �I n MORAN h �23417�Q �.d"� C��Z Z ilJ4 G�Oe_ �y y SSlo NAl ' sae SCA4f AS`INDICATED DATE WM. .X WARWICK. 8 ASSOC., INC. 8OX 801 - -NORTH fA4MO41TH MASS. 04556 -;(¢I,) 36.E-2658 PROFESSIONAL ENGINEER