HomeMy WebLinkAbout0099 CAP'N SAMADRUS ROAD - Health _99 Cq f' §amadrus Rd. , Cotuit
A=- 08-054
COMMONWEALTH OF MASSACHUSETTS
� -- EXECUTIVE OFFICE OF FNVJRONMENTAI_ A SIRS
DEPARTMENT OF ENVIRONMENTAL P �E 'TIO'I;�+
ONE WINTER STREET, BOSTON, NIA 02108 617-292-
63
�l'ILLI.4NI F.11"ELD TRUDY CORE
Governor fl 1. Secretan
ARGEO PAUL CELLUCCI 8 DAY' VID B.STRUHS
Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - Commissioner
PART A
CERTIFICATION
Property Address: 6 99 Co _(�,MCCkd,S l j6fvi f,/0 Address of Owner: E:
Date of Inspection: Z 2$/Q (if different)
Name of Inspector. fifer c63 1'95r•
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: n V ee,,' Alo,4La
Mailing Address: Z3 P",- ITO/juj 2 , :;;yes+zla 0 Z&I/V
Telephone Number: y-77-5'E�S
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:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fail
Inspector's Signature: c Date' 0 7i 8. O j
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The System Inspector shall submit a-copy of this inspection report to the Approving Authority 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.
INSPECTION SUMMARY: Check A, B, C, or D:
AI SYSTEM PASSES:
_X I have not found any information which indicates that the system violates any of the failure critev'as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
B) SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The syste 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.
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 conforming septic tank
as approved by the Board of Health.
(revised 04/25/97) Page I of 10
DEP on the World Wide Web: http:/Avww.magnet.state.ma.us/dep
Cj Printed on Recycled Paper
SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 99 �o�'o se,,r,d,, &j, it IVA
Owner: Thom is 4-o�,
Date of Inspection: Z/Zp I F
BJ SYSTEM CONDITIONALLY PASSES (continued)
_ 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). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
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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
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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 the
public health, safety and the environment.
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1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
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The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to 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 (approximation not valid).
3) OTHER
(revised 04/25/97) Page 2 of 10
SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
/ CERTIFICATION (continued)
Property Address: 99 6""n Sgv�pY✓ f �� �"L"' M
Owner: �ioin k� x to^
Date of Inspection:
a/28�Y F
D] SYSTEM FAILS:
You must indicate ei;i:er "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined 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.
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Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool_
— Discharge or ponding of effluent to the surface of the ground or surface waters'due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded .or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow.
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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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
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Any portion of a cesspool or privy is within a Zone I of a public well. j
— 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, j
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as 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
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 11 of a
public water supply well) .
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5:00 and 6.00. Please consult the local regional office of the Department for further information.
(raviaed 04/21111) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: y9 Cap n
Owner: �/wr�at �eac 4.,,.,
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No' as to each of the following:
Yes No
_ 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.
_ As built plans have been obtained and examined. Note if they are not available with N/A.
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The facility or dwelling was inspected for signs of sewage back-up.
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The system does not receive non-sanitary or industrial waste flow.
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_ The site was inspected for signs of breakout.
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All system components, excluding the Soil Absorption System, have been located on the site.
_ 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.
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The size and location of the Soil Absorption System on the site has been determined based on:
_ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
_ Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b))
(revised.04/35/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 99 (��% �qr,�c/ivr 6A,,f NA-
Owner:
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL: 3
Design flow: 3 3o g.p.d./bedroom for S.A.S.
Number of bedrooms:
Number of current residents: 6
Garbage grinder (yes or no): Wo
Laundry connected to system (yes or no): YE5
Seasonal use (yes or no): Yio
Water meter readings, if available (last two (2) year usage (gpd): 4 de. a10Py o 1C//Y�a �G�1r 3Z�9ipdl
Sump Pump (yes or no): 1'1d 1
Last date of occupancy:
COMMERCIAL/INDUSTRIAL: _
Type of establishment:
Design flow: gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title S system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
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OTHER: (Describe) i
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
�, /99� � 2qye w�ien Leac�i�r4 X2 � r��L:rceol
System pumped s part of inspection: (yes or no) 770
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
f� 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)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: 1�� S��tT lah
Sewage odors detected when arriving at the site: (yes or no)
(revised 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 99 Cairn cyr�-a�/t�rj G AV-'
r
Owner: -7-7w m.'f-S 1L-�
Date of Inspection: Z/Z7/9
BUILDING SEWER: Al/A
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 PVC_other (explain) !
Distance from private water supply well or suction line
Diameter
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Comments: (condition of joints, venting, evidence of leakage, etc.) - I
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SEPTIC TANK:_
(locate on site plan)
rf Depth below grade:
Material of construction: —concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
x,/Dimensions:
yx
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: o
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: LS ••
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined: 9&4f TAPE
Comments:
(recommendation for pumping, condition of inlet and outlet tees or:baffles, depth of liquid level in rela ion to outlet invert, structural .
integrity, ev Bence of leaks e, etc.) " . P a dzo- tie.*- 11 n Ou t
A 7 l - arl Uid c I m q 1!7 eC elon-
GREASE TRAP:-4/Q
(locate on site plan) '
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
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.)
(revised 04/25/97) Page 6 of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 99 Ca/11/1 X-4 1.4
Owner: M�� 4�
Date of Inspection:
TIGHT OR HOLDING TANK: PAL (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
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Dimensions:
Capacity: gallons
Design flow: gallons/day j
Alarm level: Alarm in working order_ Yes; _ No
Date of previous pumping: I
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
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DISTRIBUTION BOX:
(locate on site,plan)
Depth of liquid level above outlet invert: O
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or put of box, etc.)
TU,o1 c�la/7/�/4 rJo-f-Irla//U at E/•y!P O t� //73/> EC /arI
PUMP CHAMBER: Yl/CL
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 99 M
J
/
Owner: F '' 9M�: ✓v-J ��,' r� L- AADate of Inspection: �G'.`Qj sc.co�
SOIL ABSORPTION SYSTEM (SAS):_✓
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number: Z
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
I
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) � j
2 -8 �� id /eve/ a66ve 6o t
�rZ
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CESSPOOLS: ct
(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 (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: a
(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.)
(reviaad 04/25/97) Page 8 of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 9q 60-n
Owner: /o n+-4 r
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
a t-t c he d yi 6e Plan,
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4
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(revised 04/25/97) Page 9 of 10
SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)nn
Property Address: `19 Lo'n �grn.ciGlry r /cJ:
Date of Inspection: �GMG-s S4!5ch4 �
Depth to Groundwater 40 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
✓Observation of Site (Abutting property; observation hole, basement sump etc.)
Determine it from local conditions
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Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers .
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✓Use USGS Data
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Describe in your own words how you established the High Groundwater Elevation. Must be completed)
'AVi!/e�- �5e7-veal ),0a6eA- Z"6/e �(unre, 1992
J�ou c1wat c/eVr,Jo.7 ZO �i�.v,d ats•{x.
c'ee eGeva fioh
Cti.-o�h�wq.te� elevaRio`! co4 ed 6� P0nC/
eocsr Qt e 7. tc, ble ,G/S j-oaf>>, .
(revised 04/25/97) Page 10 of 10
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a c 36'-2'
b c 30 a_8„
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b d 26'-5"
a e 53'— 10" 99 CAPT. SAMADRUS ROAD
b e 253-5" C®TUIT, MASSACHUSETTS
1 ° f 68 SEPTIC SYSTEM
b f 38
a 9 78,—4 INSPECTION
' a g 2 8'—511
" DATE: 2/24/9$ SCALE: In = 32'
Peter S. McEntee, P.E.
S"DWICII, MASSACHUSETTS
_ . T .. -
`SOWN OF BARNSTABLE
LOCATION 99' Cee'r tJ�c�ma d�-tv9 SEWAGE # 96- /96
VILLAGE Ca ruir / rASSESSOR'S MAP &LOT
INSTALLER'S NAME'&PHONE NO. ;r73 97710
SEPTIC TANK CAPACITY /000
LEACHING FA Act(type) Z 4 el-J i7 t (size) �o ��X C9
NO,OF BEDROOMS .. 3 - (/o o O qal
MBUILDER OR OWNER Tf?anra5 Je:xzh
PERMTTDATE: 5- 'COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility -(/U Feet
Private Water Supply Well and Leaching Facility (If any wells exist /
on site or within 200 feet of leaching facility) n`� Feet
Edge of Wetland and Leaching Facility(If any wetlands exist //
within 300 feet of leaching facility) n Gam. Feet
Furnished by �ng/wee?-ir�g o�-k5, e�ey / ` ohtee,
n �
n
^ r W `V
O -
.
A b b 0.
� - I
%,w
I�s .4,
mm �
kh
`, ,` .r '
y
TOWN OF BARNSTABLE
LOCATION TA/'o7- ;57R Y_Q/JA �S- /P4 SEWAGE# Flo G
VILLA ASSESSOR'S MAP & LOT q- 4
INSTALLER'S NAME&PHONE NO. �. /�o��iC/S d�✓-�'t 775�' �77�
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) ® T' (size)
NO.OF BEDROOMS
BUILDER OR OWNERS
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of le chin facility) Feet
Furnished by 7rOi �Q�
Q
En
NQ
ASSSESSORS MAP N0: 40 . 00
No. FApf��t Fee
E�THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
application for Mig ool *rae tt Con5truction Permit I
Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
99 Capt Samadrus RD �., Tom Sexton
Cotuit f
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
W.E. robinson Septic
P.O. Box 1089
Centerville :775-8776
Type of Building'
Dwelling No.of Bedrooms 3 Garbage Grinder(no)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil sand
Na o A er t' ns erwhen.a licable) install additional 1 , 000 gal
SP� � e� ea'�` ' o exiling plans
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Bo d o ealth. /
Signed + Date
Application Approved by
Application Disapproved for the following reasons t
Permit No. '�! � Date Issued Lg
40.00
Fee
No.
i
THE COMMONWEALTH OF MASSACHUS&TS '
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE,, MASSACHUSETTS
2pplication for ]DW& ar *pmem Cow5truction permit
Application is hereby made fora Permit to Construct(, )or Repair(X )an On-site Sewage Disposal System at:
g _
Location Address oi•Lot No. Owner's Name,Address and Tel.No.
99 Capt Samadrus RD Tom Sexton
Cotuit /-0
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
W.E. robinson Septic
P.O. Box 1089
Type of Building:
Dwelling No. of Bedrooms 3 Garbage Grinder(no)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
sand
Description of Soil
yinstall additional 1 ,000 gal
according W Uft1jilLCII PtttX15
4,
Date last inspected:
i
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Bo d o ealth. l
Signed Date
Application Approved by C G
Application Disapproved for the following reasons
der
Permit No. ``/ � Date Issued
e ens,
y;
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS Tc�-C TIFy h t the On-site Sew a D's osal System installed( )or re aired/replaced(x )on
�1. R6 inson sept Sisry for Tom Sexton .
s ty Samadrus O ul as been constructed in accordance
as
with the provisions of Title 5 and the for Disposal System Construction Permit dated�- wit "
Use of this system is conditioned on compliance with the provisions set forth below:
.,e--
91�(_ J 40.ao
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
1i!9po!6a1 *pttem Con!5tructiott Permit
h Permission is hereby granted to W.E. Robinson Septic Service
to construct( )repair(x )an On-site Sewage System located at 99 Capt Samadrus Rd
CeXuit
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
All construction must be completteed'within two years of the date below.
Date: ` �,7 �''% Approved
00
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per:. i
LOCATION SEW GE PERMIT NO.
ct> >VILL INE
INSTALLER'S NAME i ADDRESS
U
t UILDE R OR OVVNFR
•�a lib w 9't %f s
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
00
• �o X
6x8 Pf
16'
.,Fx�OQy s�o N
i
r � .��
t
1
,'
' 1
A�
�"
r "`��`
- � �p
f `W,'
\W
7
1
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y� 4
i
Faic............. f
THE COMMONWEALTH OF MASSACHUSETTS
g1 ��
o� BOARD OF HEALTH
70.1, AJ ._ ...__...........OF...... A.ltV..51rA.H�(- ...:.........................................
�1
pfiration for lhgoiitti Works Tonotrnrtimn Vrrntit
Application is hereby made for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal
System at: ul` Clio I-
ROMA- ....................... . ............ L----I........t...........................................................
)CS
--•---LgFatiqn: Address--•--'..........................•-- - l �Cl.�i_---h1 _.mdf1Y t'LV`.--�X '.__ 5�---
l�j�`x2� Ow/�l�.� Address
t. l
Installer Address
Q Type of But ding Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.........off-_------------------------Expansion Attic (N a) Garbage Grinder (4 O
)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ......................
Q •--•--------- --------- --------
Design ----- ------------- ------- ----- ----- ---- -------------------------------
W Design Flow._......../1..0..........................gallons per i per day. Total daily flow......._.......�-;2 _Q.._.........gallons.
L4; Septic Tank—Liquid capacitvlv9Sl__gallons Lengthd_ _6_..... Width.9..1.0.._.. Diameter......--------.. Depth-------------
Disposal Trench—No. .................... Width-------------------- Total Length...................- Total leaching area-__.....___.._._-__-sq. ft.
Seepage Pit No------/.......... Diameter-----/�1___-_--.- Depth below inlet__. s_5........ Total leaching area__/29____--sq. ft.
Z Other Distribution box (&,-T Dosin tank ( )
a
Percolation Test Results Performed by.—)VO- @f-a(._._../.Q--_6!-)/.:_Ol b.....K Kt.�....... Date--:. _.___._--
Test Pit No. L.A*_'.2-_--minutes per inch Depth of "lest Pit---/o�........._. Depth to ground water........................
LT. Test Pit No. 2__C _P_ _.minutes per inch Depth of Test Pit.Z.2-1........ Depth to ground water------------------------
a' ------------• --------- ------------------------------------------•........._..........-•---..••-----••••------------'---•--..-------•----------•------------
O Description of Soil----_Q.-.._�9-- _C�11t.M----/ / -1?-----.S.u8SstlL.............30--"=--- � 01�1�5-C------5:,WD.-.
(xj � .®AV_D_C.?!Qr!_S...-----1J307-ty 104 4-S)-----------------------
f�iiiz �a ;X&r6v..... -h !t _----------------
U Nature of Repairs or Alterations—Answer when applicable. ..... .......... /.—.___-.-__--_-_.....
�,.��� S L t j---- -l�C /�i--rc�sr-sue l�T/--cc-
-----rv....--��/_�c� • —- -------------- -
Agreement: LUT- -� l9w� df �CCS ,/<�/: 7-a- Ci r
The undersigned agrees to install the aforedescribed Individual Selvage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ' ed by the oar d o healt
Signed
Date
ApplicationApproved By----------- 1A--•------------------------------------------------------------------------ ----------------------- ---------------
Date
Application Disapproved for the following reasons:.........................................................................................................-......
••................•----•--------•-----•--•--••-----------------•--•------•••-------••--•-•-•-----••••--•.............-----•-----••....-•--••----••-•-----------•--------...-•-----------•---------•-----
_
Date
/. ]Sr
Permit No. ..--3---•-----------•----•---------------- Issued..----... .. `(..................................
Date
No.� ` ,', .,_..... Fnic............................
ti
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.__... --- .OF......TofJZN.ST-�9,&C_..........................................
Applirtttion -for Riipo.itti Works Tonotrurtion Vrrmit
Application is hereby made for a Permit to Construct (t/) or Repair ( ) an Individual Sewage Disposal
System4
•---------••-------------------------------•-- --..._...•-----•••-•---•-----••••---•- --•-•-•-----------•••••••=••-•--••••--•---•-•••--•--•-••-•-••••--•-••---------•-•-•-•-•---••----
Location-Address or Lot No.
Owner---- Address
W
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms--------�.............................Expansion Attic j&#.p) Garbage Grinder 6 o)
per, Other—Type of Building -_-_---------------------- No. of persons_........_................. Showers ( ) — Cafeteria ( )
Q' Other fixtures -------------------- -------- --- --------- ------------------------------------------------------------------------------- -------
eenW Design Flow.........//D..........................gallons per p per day. Total daily flow..............`�.�A.0..............gallons.
WSeptic Tank—Liquid capacity/000--gallons LengtlB_''_16_f�_-- Width_-j_.`/O..'''.. Diameter................ Depth----------
x Disposal Trench—No- -------------------- Width-------------------- Total Length...___....._.____... Total leaching area.__ _.-.__-__sq. ft.
r Seepage Pit No_____ ___________ Diameter..../O____-._-- Depth below inlet_'3:_S.r.._... Total leaching area_490-------sq. ft.
Other Distribution box (6.-I Dosinz tank ( )
`Percolation Test Results Performed by *,ftj f_d_.__. .:?.._. t_ ........ Date_-_.0��/- �_-?-----. ..
5'
:•.. Test Pit No. _..._minutes per inch Depth of "Pest Pit./;Z____.------- Depth to ground water-..____---_._.---_-----
r4 Test Pit No. 2.4A------minutes per inch Depth of Test Pit-/2.....:...... Depth to ground water--------------- --------
------------------------ --------------------------- ........................................................................................................
O WDescr tion of Soil---Q-"---3p._.____..COAs ..�tL-D------$- D_�V_�Ss'0>/4------,-i-t--r-�--3 a----_
x - •5 ��'�� axf c RG��" ►S
C --------'----t>--
-
-- - --------- ------ - -- ----------
-
V Nature of Repair o erat' rI� ,Anvey whe ,ya'pplicabl `
T�' v% ,
�- --------------
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I 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
fined u
Date
Application APproyed, By e K`'t �°'� �','k �`* - `xz
T *a, �y -�•aai'w-r ah 'W �>i..!^� _ ar �T`i'r � �
Application Disapproved for the foldoang reasons: 4`..:..... ................... ......... ......... ...........
•-•-•----•-•-•--•---••----------------------------------•------------------....:------•••••......•••-•••......---
t Date
Permit No.- -----------------•..._.. Issued................. ----------
Date
THE,COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....... lts 4....................OF.... 9` .`.....'
'; nrrtifirtttr of Iomphaurr
THIS IS R IFY hat e Individual Sewage Disposal System constructed ( ) or Repaired ( )
by................... ." ----- :----------•
........ ..................................................... •-------••--------------•----••---••-•--•---•-•••----
Ins Tiler d C+� 4
at•....4. 1 K----.----- ----------. 1 a'`` `
has been installed in accordance with the provisions of Art le I of The State Sanitary od ribed in the
application for Disposal Works:Construction PerM t,No... ----------------------_- dated .........................__.._..........._....
THE ISSUANCE OF THIS 'CERTIFICATE SHALfL'NtOT::BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. e?
DATE-------------------------------------------- ................................... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF r-'1HtALTH
'jj .. // r 1
�A ......•..... FEE..L.-- .
No._. __....
i> oottl k Ton nrtion rrmit
n ,
Permissionis hereby granted----------------------------•--------•••-• ---------------------------------•----------.._.._------------------•--............
to Construct o Re air an I. i al e Dis o em
�e ,
. •-•• ... .------ ---------------------------- ..................................
v Street Q +
.t . ,(( 4/Iy fit(
as shown on the application for Disposal Works Const>uction.Permit No .................. Dated......__.__..__._
DATE ._..._--7•• ........................................... Board of Health
-----.
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS.
We;..DOUGLAS' .H. BELLaand MARSHA -L. BELL, "in cons ideration ,of '
obtaining `approval from die Board of Health of the Town-of Barns
i vtable for. use of a4 we1:1* on Lot rl", Lumbert'sr Mill Road, ' Centerville;
rt.. 'Massachusetts,, hereby' agree :Rthat` we ',wi1-1 not' +sell- Lot w2 on plan a t
'recorded yin Plari Book {287, ;Page 26,• nor' build on said 'lot`.until'.
town water is (available "foz 'said:Lot 2,. .or until Ythe -Board;;of
- of
-Health other`wise' agreei-',that -the Lots shown on .the above 'plan are
not required` to. have town"water. 41
, r ' .. - .•a '', I -+ „ } 9 ` -- (Y .f nr'r •� .• .� k,="" !'r ,b. `r y, 1 .. P 4.' '
.p-
Douglas•' H�. -Bell
i..
r Marsha L. -Bell. , ,
i.-7• 't ir...µ' e' ` 1 7.
t .'4 ' a k.{. a 5 , . . t♦ 4 • ,
COMMONWEALTH OF MASSACHUSETT&.
}`,• Barnstable, >ss. ; . w f Y; '` 15ecember,'9, •1'977,"
,Then-personally; appeared the +'abov amen ouglas H.(Bell-and
a"cknowledged the .foregoing instrument o a is ee� act';a'nd deed,
before-„me.:' ,• r v „
N ory P l c S r iv c.
t: r fssi n 4 pires . i P,
•�.. , .. f. :mot •. r � , ;+ �- r . r -
r 4+# F N4 ;, F
CAPE WATER TESTING LABORATORY '``; `
Wellfleet, Massachusetts 02667,
Telephone: 617-349-3900
D`ce6be ' 21� 19 77 .
DATE ...... ................... .............
Gape We41F Drillers, Inc.
...............................TO .......................... .....................................................................................................
On the basis of a sanitary survey and a laboratory
examination of the sample of water taken from a ........wall...........................................................................
located on the premises of......................Douglats..Bell
................................................................................
• t
Umber- Hill hoed, Haratons mills
located at............................. ......... ......... ......... ......... ............................................:........................I.............
(place)
on, ...... :ram..... . :s 7 0 .this supply is approved for domestic purposes at
(date)
the time the examination was made.
Signed :......:.......:.
r
Richard Sturtevant `
Registered Sanitarian
t Ciolif1rrm 0 o= STURTEVANT H
U
tN, 463
EMT-R1�'�
' l
9 Lo7L J�4
LOCATION SEW } E PE`RMIT NO.
BILL JfGE
I N S T A LLER'S NAME a ADDRESS f
C3 cf,ye
�,,-� ,.�L
B U I L 0 E R OR OViNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED L— Z"=(
� � O
� n �
fro
s
ti
s e
r
4:
' LN
C
N
V
e
J
THE COMMONWEALTH OF MASSACHUSETTS
l" BOAR® OF HEALTH
CAP c
Appliration for Bid ati al ork�i Tomitrurtinnt Prratit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
..........................«..........'. ...ir._�._W __.._.... ...........-.. .}.. .........._____..... ... .........
cation- e Q/// � o
.......... .----•- --------. ..... ................. 2-•--.. �.... ..
Own Address
......
Installer A ress
GQ GAG.
U Type of Building ( Size Lot_______ p_______________Sq. feet
Dwelling—No. of Bedrooms........ _._./........................Expansion Attic (�—) Garbage GrinderPL4
Other= t e of Building .......... No. of ersons...... .............. Showers — Cafeteria
d0116 fixtures ---..................................................................................................- ...................................
W
Design Flow______...4W YL4 ..........gallons per person er day. Total daily flow.._..._�'��.......................gallons.
WSeptic Tank—Liquid capacity/ Length...___...__ Width----- ------ Diameter................ Depth... .___........
x Disposal Trench—No. Width.................... Total Length......._._____---- Total leaching area....................sq. ft.
P �,
Seepage Pit No._:�---�----- Diameter__ ___________••__- Depth below •nlet.._.�___________ Total 1 n ................sq. ft.
Z Other Distribution box (j ) Dosing tank ( ) ��� "�'L' � ' lP7, -,� r;�_��r
/!�S /¢SSA iA T �- Date %�2
W Percolation Test Re Its Performed by ............................................. -----------------------------------•---
/oA/e / T/A
Test Pit Nb. .........minutes per inch Depth of Test Pit____________________ Depth to ground water.A ...............
(� Test Pit No. 2................minutes per inch 'Depth of Test Pit.................... Depth to ground water........................
0 Description of Soil.... _ _._ �' -.------------
... ---° �
-------------
--------•---.--•-- �'
------------------------------------ - -----------
U - �� L -----------
�G q& - GGr 0 Ka 0 T �.�eew f
W ' --------------------------------------- -------------------------------- - -� 3�•-•----•--••......•..:.... ..v--_•-----
U Nature of Repairs or Alterations—Answer when applicable_____:.__. ,y�.Ar,........ .... .. . ......
- ....------. •--------•
-----------------------------------------------------------•------------------------------•----•---•----•--••-----........-------••-----••-•----•••••-•---- ...........................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI•", 5 of the State Sanitary Cod —The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been' ed by h` rd fiealth.
igned._ f...
--------------------------•••-. _._....
Date
Application Approved B _
Date
Application Disapproved for the following reasons:........................... ..................................................................................
......................................................-------------------------------•----•-----....-•---•------------•-•••-•-•------------------------------------------- -••••-----•--•--•-....-•---
Date
PermitNo......................................................... Issued_------- _. �� .................
Date
No......... l.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............................OF.........................................................................................
Applira#iou for Ilhgpoiia1 VorkgC�� t �xttr inn eruti
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
................°'' l ........ .. .... •...... --- •-•-•---•-••......•• ..............
cation-
4 '� I± Address
Installer A dress
Type of Building Size Lot..... �...Sq. feet
Dwell>ng—No. of Bedrooms......... ....... ...... Expansio ttic (.• ) Garbage Grinder
•.
Other—Type T e of Building ............. No. of ersons......l.. ...._...__.______. Showers — Cafeteria
Pa YP g --------•------ P ( ) ( )
Q' Oth fix r
--..----- -----------------------------------
.. - Ions.Design Flow......... .: : .:.........: ?..........gallons per person er day. Total daily flow__._.. '......_..._....__._._..
W Septic Tank—Liquid uid'ca acit / allons Len th_. Width_______..... Diameter________________ De th_. ._..__..
P q P Y-----------g g ------- P
x Disposal Trench o -__ Wih.�----------------- Total Length----- �;._.._.__ Total leaching area--------------------sq. ft.
Fd►
Seepage Pit No :.. Diameter ................ Depth belowjnlet ...... _._.__ Tot 1 i area..................sq. ft.
Z Other Distribution box (� ) Dosing tank ) � t
Percolation Test Re uIts Performed by ._ ._ ".'�"'�`� ... ................. Date. '
Test Pit No. ........minutes er inch De th of Test Pit.................... De th to ound water
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O .. /
Description of Soil--• + .._ ^--_ _
x ..,'.
U
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 1, 5 of the State Sanitary Cod — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ued by rdpyftealth.
kt
igned•. 26111 �+ �
...... ...............•----•--•---•--- --� ---------•---•--
Date f
Application Approved BY-�" ...... . ---- . -- ---- `' .................... . . --�-
Date
Application Disapproved for the following reasons:........................... --------------------•---------------------------------------......-----------------
. ••-----------•..................•••---------•--------•••----------•---•----------•--------------•---..... ............................. --•-----••-------•-----•-••-•••-••--••-•----------••--•--------•
Date
ti Permit No.......................................................-- IssuedL........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
( nVual
tr of Toutpila trr - -
THIS S eCE , T tl�e Sewage Disposal System constructed ( ) or Repairedby...... . ... ... !r
St
•....
has een installed in accordance with the provisions of T 5'f he State Sanitary Code descrii ed in the
.. 7
application for Disposal Works Construction Permit N ..__ __.__. _._..' '~___.___. da.ted._...__ -------- .�_:.._ .............
THE ISSUANCE OF THIS CERTIFICATE SHA OT BE.CONSTRUED AS A GUARANTEE:THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................................................•----......-•••-.....---••••-- Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
r ........1 ...6!...'r�!`.L........OF................ a;".. _-
FEE.. 9_ ..�...
Disposal 15 (Ion'llrwl� prrutit
Eermrs ion 's reb ranted-------------------- --Cif^ J:
to Constrru ( Re ) an Individu Se �, posaj S in
......................................
at N
Street
as shown on the application for Disposal Works Construction r it N -- _.-- -•_ - ...........
r � r oard of.Heath
'."''t
DATE.............. ....................................
FORM 1255 HOBBS & WARREN., INC., PUBLISHERS
a -
F
•r
P �.'d��r•ur�owl�tYr�'+`.Av�^wY►nrrYVfrrrw .
rK
\ ) r t
x ./ ' ,
if
\ .gam ? N
44.
y�
1
Fov.vv,47-/4r.>,.J � r'lam•`� O� �tA//.S NEOC-�.•2A0� B '
. 1^ft..' '•O // �i tt /i�i . / I . i •L"/�.//.SNU�'0 �S�KJd`G
'o•o' o'p�vc ScN yo ��� ,scf/ � � �
D' /�Tffh��/f!/C7' i . , , ,✓ �_ p 6. _ �B"_ //z"L!/iQs,tiJE o
{ �.vaF.eY' °`p: �J4+��C�i � � '��P'�...+'� �• � ST r/'k'..,y/. � ��'D;• s�--��`'i E
c6AGL o�/S /N461Zr /i►/!/F7tr
1 p•,., i�v�,rr s,EPT/c-TA�v� ,Bow � Q ; g - - 3 '-/� a��
; ,a ,
GA�BA� °;` LEY doYT �1 ,Di T
SS/9 ti//TA,e
SCAG�� ,Q�0�40/Til.S
/o4 y �
TO L,6�7 ACt`al .PA S"
c. 67-
SITE PLAN SHOWING PROPOSED - CONSTRUCTION
L O C A T 1 O N: 'c
F O R : ', '.%td` .� , �.� ; ;, `: .� A P P R O V E D 19:7
SCALE , "" DATE: — QUO"A2D Of= HEALTH
.,
REFERENCE : trO .4. : "
� �/y'C� c`�.`a`t't,✓' �',r✓' .G ��'`-� .�;..-7 ;� ��'°;"%„`�*""' ,;-^�•C;..-., �-r` DATE A G E N T
i
Volk OF SAS
livimrr
g H. �a JL'ic�r11 iN �+•
ci � Lr C M S ASSOCIATES, INC .i ,QNout j ,
,•p 13230 Q - 1266ri
�oFFp/gT£ �4�Q REGISTERED ENGIl�kEE.RS' $ I.'AND SURVEYORS ,�
sSrorvai �NG� MID-CAPE OFFICE BU'ILD.ING I2G5 ROUTE 28
SOUTH Y A R M O U T.t , M' A.S S. 026604
I
O Z 4z
src
k
�Plvl .
Foundation
Cem. Conc. Cover to Grade
- c
Cem. Conc. Cover to Grade
INV. EL I ' m i n. INV. EL. INV. EL. INV. EL. rt 2" - li " t /
57,5 - 57, 17 �7.0 7 56�0 I ' min. 8 o 12
_S= 1/8 "/ I 'min. 4 "0 PVC Washed Crushed Stone TEST HOLE
2 INV.. `E L.
INV. ELF7 ,5
12 I �� S = 1/8 "/ 1' min
6 Sump I u I L(-:)Ain
PVC Schedule 40 i 5 - Outlet
24"
Pipe aTees Dist. Box I `Ia p o - � p � R -- -- - ---- -- -- __ - _ -------
° Co Eff .. Depth ° n
- -------- T 3/4" to 1 1/2 " I o o D I L
Washed Crushed I o 0
o v _ o
Stone -' 1- _ . � a
I'
Bot. EL. o.
O'min. 8 ' 12" 6 '- 6" 1 2
20 ' min
1000 ga I Precast Septic Tank Precast Conc. Leaching Pit Imo` rl a ✓r . t r iT U-7tC�-T;7
SEWAGE DISPOSAL PROFILE
N . T. S
Design Calculations as required by Title 5 of the State Environmental Code
0,)) y61 Design for Bedroom House Use ..80.. gals bedroom
l� (o ��� Z FLOW 3 Bdrms x 110 al / bedroom = 330
g gal . required
o SEPTIC TANK x 530 gals. = 495 . gals Use 1000gal Tank
off/ LEACHING AREA Perc Rate C 2 min/ in .
Bottom Area go ! /s f x 516 s f _ 56 gal
Sidewal! Area 2 5 gat ' s 4 x /C00 s f =_ 400 gal .
o GAS" tv - -- 56 -- — - .J Total t ! ow capacity = 4. 58.. gal provided
Use i 6'-6" dia. liner with <� effective depth and ... .�.2. . of
'� crushed stone Perc hole � deep. Date of test �N SEWAGE DISPOSAL SYSTEM FOR LOT 34
vt`,T- fox 5r--rTt(, TAN K I ��' C /\ I :) d\A A D r7 U J 1�-\-' D. L A N D f-A L.L„
----------- -
- -- v ,REEI LOCALE
TOWN
PREPARED FOR
�'L Ar I '�TZ -F'A �U ToE-�i 5E A L. 0 AVE—NA
A 1"F f;F-ouE-jD
F-i f= cx�E9. v�vE-Lt_l rl6-. I SCA LEAS NOTED W.O. -7"-:�-16
T�t)T HOLE- L.00T �-� F~v.�-1- tc�r (5 T".n.��� I pRoir� Date Ju►'lE 5, I9�9 FOLIO NO
C /At S OLI^-T;i- LE., Drawn By PLAN NO. SD I08
y~ j LJr 115' 1`>le). s )CHARLES L . ROWLEY a ASSOC I ATE S
PLAN CIVi L ENG I N E ERS & SURVEYORS ,
Scale I = �J �1 f4. WEST WAREHAM , MASS.
I