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HomeMy WebLinkAbout0029 CHEOH ROAD - Health '29 CHEgfj COTUIT !1 A= 1 g I. F- 9D 3 r �000 COMMONWEALTH OF MASACHUSETTS ®rL 4 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 29 CHEOH RD COTUIT, MA 02635 L182 B Name of Owner GRANT E.ST.JOHN Address of Owner: 66 CLAYPIT HILL RD WAYLAND MA.01778 Date of Inspection: 8/18/00 Name of Inspector: JOHN GRACE /am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 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 Passes _ Needs Further Evalua By the Local Approving Authority Fails Inspector's Signature: Date:8/19/00 The System Inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If th 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 "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life:" THE SYSTEM PASSES TITLE V INPECTION'.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. , r revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 29 CHEOH RD COTUIT, MA 02635 L182 B Name of Owner GRANT E.ST.JOHN Date of Inspection: 8/18/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: a X I 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. 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. Wa 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. 13& 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 u/a 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 f revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 29 CHEOHiRD COTUIT, MA 02635 L182 B Name of Owner GRANT E.ST.JOHN Date of Inspection: 8/18/00 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. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is wit-iin 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 n(a(approximation not valid). 3) OTHER n/a Jy revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 29 CHEOH RD COTUIT, MA 02635 L182 B Name of Owner GRANT E.ST.JOHN Date of Inspection: 8/18100 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 Q. 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 compounds, 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 11 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. y, revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 29 CHEOH RD COTUIT, MA 02635 L182 B Name of Owner: GRANT E.ST.JOHN Date of Inspection: 8/18/00 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 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 29 CHEOH RD COTUIT, MA 02635 L182 B Name of Owner GRANT E.ST.JOHN Date of Inspection: 8/18/00 RESID_ ENTIAL: FLOW CONDITIONS Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:0 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO r J Seasonal use(yes or no): YES Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMER IA 1INn VcTRIA Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a . ;i System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X 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) _ VA Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a i APPROXIMATE AGE of all components,date installed(if known)and source of information:1990 1 Sewage odors detected when arriving at the site:(yes of no) NO - I revised 9/2/98 Page 6 of 11 f - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 CHEOH RD COTUIT, MA 02635 L182 B Name of Owner GRANT E.ST.JOHN Date of Inspection: 8/18/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 30" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 30" 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 Age: n/a Dimensions: 1000G L 8'6"H 6'7"W 4'10"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" 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: n/a 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.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY ONE YO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. �. GREASE TRAP: (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a 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.) n/a revised 9/2/98 f, Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 CHEOH RD COTUIT, MA 02636 L182 B Name of Owner GRANT E.ST.JOHN Date of Inspection: 8/18/00 TIGHT OR HOLDING TANK: _(locate on site plan) (Tank must`be pumped prior to,or at time of,inspection) Depth below grade: n/a Material of construction: _concrete metal Fiberglass _Polyethylene _other Explain: n/a — — Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITHBOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a t .. k S1 ) t f revised 9/2198 t Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 CHEOH RD COTUIT, MA 02635 L182 B Name of Owner GRANT E.ST.JOHN Date of Inspection: 8/18/00 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: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)nia Alternative system: n/a Name of Technology: n/a 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 APPEARS TO BE FUNCTIONING PROPERLY.THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) -F� Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 CHEOH RD COTUIT, MA 02635 L182 B Name of Owner GRANT E.ST.JOHN Date of Inspection: 8/18/00 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) Ac SO G 1 f revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 CHEOH RD COTUIT, MA 02635 L182 B Name of Owner GRANT E.ST.JOHN Date of Inspection: 8/18/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO 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 X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET F. revised 9/2198 Page 11 of 11 �€ TOWN OF B STABLE eOCt'�TION C f6V SEWAGE # ,VILLAGE co' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNERC� i PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells 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 leaching facility) Feet Furnished by cxC r) . AA V ® A� q 7Y ��,2, ..._.: s ss....f ................... No. THE COMMONWEALTH OF MASSACHUSETTS �O BOARD OF HEALTH a � r,✓n......._oF.......... ......... ... . .... -----=---.-.-------- ------ Appliration for M-4pagal Workfi Tumtrnrtion ranfit Application is hereby made for a Permit to Construct (V5110r Repair ( ) an Individual Sewage Disposal System at: .....a ,k........................................................... ...................i ----•-. Locati Address or Lot No. ... .. . i. }� L ............................................. O er Address W /ill.. ���.,. -- Installer Address d Type of Build g Size Lot.. _25�.. q. feet U t.$welling—No. of Bedroomr .......•_._f ...................Expansion Attic ( ) Garbage Grinder �[� PL4 Other—Type of Building _.1!.iU��.l_i''� _ No. of persons............................ Showers ( ) — Cafeteria ( ) P-4 Other fixtures ------------------------------- W Design Flow.................. ------•.....____gallons per person per day. Total daily flow------------- ...........gallons. WSeptic Tank—Liquid capacit}/_r--aV_.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width ........ Total Length.................... Total leaching area....................sq. ft. .._-- Diameter...--?o-LIP'_ Depth below inlet_._...6.-.._..... Total leachingar ._'Z�.�p...s ft. Seepage Pit No.____.../-___ p r q• Other Distribution box ( y( s Dosing�tapk ( Percolation Test Results Performed by....1N1�-t_.!('1_..GU ..................... Date..... i .__7.Y-.. µ4._.___. Depth to round water.._._431ow j 04 Test Pit No. 1...__________---minutes per inch Depth of Test Pit-__ ' p g (i Test Pit No. 2-5'_43?f-_minutes per inch Depth of Test Pit-_J__ Depth to ground water.____ .. O ,t ;1 ---rr-�, -----•------•-- ..................jj ------------------------------------------------- --------- Description of Soil---- T -•---`:=-••---.......�- 1......fi►? �4 9_ ! •.... ... 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 of A i 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 lier�c Signe .•---/ ?' r�/� --•--•-J•-•-• . -----•.........:.:............ Date Application Approved By---- -�!� +1. ................ --- °Z y`r7_( Date Application Disapproved for the following reasons-----------------------------•--------------------------------•---------_-•-----............................. - - Date Permit No......................................................... Issued---- 'J® 6'� Date i Vp 7 No................---.-� �FFs..............t ."'-"""�• THE COMMONWEALTH OF MASSACHUSETTS OARD OF .............. ... .................OF......................:.... .............. Appliration for UtnVooal ? ox (� oo ttr iott eruct# Application is hereby made for a Permit to Construct or Repair an Individual 'pp y ( ) p ( ) Sewage Disposal System at: 1 j� dL c-------- ------------•_-________ -....... Lb�'ati�n-Ar€ss/ '1✓t'VY4f _ �r � ..............•I•� .-......--............ .._-_----- ... ........ _---------- ..._ _.._..-------------------------------- ............ ...•..... ................................ ....... O r li Address aW ...........................f j�--__•.----.._----._-_----.._-__-_----.__-__-_•---•------.-_ --...---------------•-----••------•---------_------•-----••------•---___--•_._---.__..-..---.---- Installer M Address 4# V Type I401 wilding 15 Size Lot____ _}.AVq, fee�tj� a Dwelling—No. of Bedrooms__. 441 h V ..............Expansion Attic ( ) Garbage Grinder ( rVo a Other—Type of Building ____________________ o.- of persons............................ Showers ( ) — Cafeteria Other fixture, ..__ 3-- -v--•--------------------- W . Design Flow...................................... per person per day. Total daily flow................... .............._.........gallons. WSeptic Tank—Liquid'ca acity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. _______________ Width__ ?_"'.( `._ Total Length.......... t_ Total leaching area.......... y q. ft. Seepage Pit No________ ___ ________ leter._______.______._._. D pth inlet__.___t jl! otal hin ar ft. z ( g � ) t Other Distribution box Dosing t ,,����C-/C. aPercolation Test Results *Performed by............................................ _Vy__+._______.______ Date.......... _ Test Pit No. 1.....2��404mutes per inch Depth of Test Pit------,, :UDepth to ground water......... __-- (s, Test Pit No. 2... �r minutes per inch Depth of Test Pit___________ ______ Depth to ground water........_.............. . D Description of Soil `' AQ ` r 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 T provisions of T` p 5 of the State Sanitary Code— The undersigned fizrt a reaes�ot place the system in operation until a Certificate of Compliance has bee • d y the board of Ieal � 4�! gned ---••-• -••---•-- D Application Approved By-••-•- - - --------------------------------• --- -*-•-•---•-- ................. . Date Application Disapproved for the following reasons------------------------•----•---------------•---------------•-----------------................................. ---------------------•----------------------------------------------•---......--------._.....------.......•----- -----•----------------------------------------------........................ Date PermitNo......................................................... Issued..---••----•--------------•-----.........---------•--. Date THE, COMMONWEALTH OF MASSACHUSETTS BOARD OF EA LT�H� �•' ..........................................OF...............................................................•-.-....... ......._ r#if-, ab of Toutpliatta :vidual Sewage Disposal System constructed ( ) or Repair ( ) f�Lj,� -----------------------•--------- .------------------------------------------- has been installed in accordance with the provisions of TI' j (7ft State Sanitary Co e�asrdvribed in the application for Disposal Works Construction Permit No•___ ___________________________________ .............................................. ,THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................4 ..-------------------:...__....__---.. Inspector._... --`•------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH' .....................•------..._......._..................._...._...:_...._......... No....:.................... FEE........................ Permission i/<ereW gr nted. --•-•------ ----- - ------ --- t' I to Constru ep , ( � In Sewa 1. os stems . Z Street ` 7 as shown on the application for Disposal Works Construction Perm __.._ ........ .................. ............ . .................... -•---- -Board of Health DATE-------- ------...... c,-1 FORM 1255 HOBBS & WARREN, INC., PUBLISHERS H LOCATION Dus� 2°� SEWAGE PERMIT NO. �o7—/S� C , eo z)1-- 79" 78.;7- VILLAGE CoTyi / INSTA LLER'S NAME i ADDRESS i //y R UILDER OR OWNER (; E7'- 5r Jo�w DATE PERMIT ISSUED G -� 12 J/ 72. DATE COMPLIANCE ISSUED j► _� � oil ,6A c Ko f flogs e So` G " . � Ak$ SITE PLAN T YPICAL PROFIL E SCALE' — l " = NOT rO SCALE /8 STD. L T. WGT. C.I. MH COVER 3 C P 4"C.1. P/Plf' 4"B/T. FIBER P/PE T/GHT JOINTS 4G FLOW L/NE ' ' LET LEVEL TO /BST JOYN DWELLING cB � /p" �.. O O 27•SO C.I. TEE C/ TEE •`, 7. 5 -� 27.6, STANDARD PRECAST 27.42 CONCRETE/�Q"LLON ° s SEPTIC TANK " DVS rR/BUr/ON BOX TO BE INSTALLED OW ` LEVEL, STABLE BASE. SEPTIC TANK TO BE INSTALLED ON LEVEL , STABLE BASE A 2 - 1/8" TO 1/2" WASHED PEAS TONE L EACHING PI r J Jj '�iC ALL AROUND FREE OF IRONS FINES AND DUST /N PLACE BASE TO BE LEVEL 'S BRICK B MORTAR COURES '� �`�- AS REIXJ/RED TO BRING 3/4 TO l-//2 WASHED CRUSHED I n �f-G g i y� e U COVER TO GRADE 24"C.I. MH COVER STONE ALL AROUND FREE OF /� ' AND FRAME !BONS F/N£S AND DUST /N PLACE vvi4 ,�c L O T 4,132 9% ► , 44, 5,7 0 � s O\�. l4 ET` , �8 FLOW LINE T T � _ LEACHING PIT SECTION- -. I 29x8 CD `moo PIPE I. CONCRETE TO BE 4000 PSI 28 DAYS rN , 2. REINFORCED WITH 6" x 6" N0. 6 GA. W.W.M 3. 2' AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS. OPENING W/TH 4-118" 4. NUMBER OF PITS REQUIRED 570, P�5CA37 Q j OUTER DAME TER B ` ioo �o NOTE EXCAVATE TO ELEVATION ��'•��OR LOWER AS c©-vc ;-: vsio,�i 1 ` 1-3/4„ INSIDE DIAMETER �, 1`-aCNi �'�T -'km'�T+""l - `•- (m _ 3 REQUIRED TO REMOVE ALL LOAM AND CLAY BENEATH c!�r �x29x9 Z I PIT REPLACE EXCAVATED MATERIAL WITH CLEAN SEi'TIG 7A h GRAVEL_ ?0 DESIGNED GRADE E ,COT /8.c? P&Ofx pw� v) `i 4,_O„ f UC.4 ti/AE'+C ��OQi4Gd�_ 4) MIN. j EFFECT/VE DIAMETER �,q�sc..•f�o us�as) 9 43I (NOT TO EXCEED 3 TIMES EFFECT/V£ DEPTH) . 9 5.3 E 00 0 0. -- •�-�. WATER TABLE 9iT Pvn7r. 2.�X e vo Err: C 7- v ' SOIL AND PERC. DATA GENERAL NOTES PERC. RATE 2 MIN. /IN . NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. SEPTIC TANK, DISTRIBUTION BOX , LEACHING PITS TO BE STANDARD t "SIB f `;` TEST BY: PRECAST REINFORCED CONCRETE UNITS WITNESSED BY !�� ' �i'I�h' '�r" /� 6N ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE 4 TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE , v�, '• TEST PIT GR EL.: = �� DATE '!���`�!` '� MINIMUM REQUIREMENTS FOR THE SUBSUFACE DISPOSAL OF TEST PIT NO, I TEST PIT NO. 2 SANITARY SEWAGE EFFECTIVE I JULY 1977 0 0" ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH. / 04 ---- -------1,0 - - -- - AT COMPLETION OF CONSTRUCTION , PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. A7�=AO PITCH ALL SEWER LINES 1/4" / FT UNLESS INDICATED Y O OTHERWISE. DESIGN DATA BEDROOMS DISPOSAL EST. TOTAL DAILY EFF. 3o GALS. LEGEND — SEPTIC TANK I�'`00 GAL '=LA-'f'AL' SIDEWALL AREA 4•f,2 GAL./SO. FT BOTTOM AREA 7• o0- GAL./SQ. FT. O X o0 EXISTING GRADE LEACHING REQUIRED "L L2 -SO.FT. SEWAGE DISPOSAL SYSTEM ZONE: �' F . ._=f-,:5 Z) ?E_,c� r,.q� } 2;, Co 0o FINISHED GRADE ACTUAL LEACHING AREA - �- s SQ.FT FOR 7-p r �,�,'Ek' O . O INVERT ELEVATION L�-I �QJ1+rC�Ld 14 , 7- f,71 DOMESTIC WATER SOURCE -- -- a - -- -- - _ 4PROPERTY LINE "OF F PLAN REFERENCE AO ��:.�Z2 �� ��r /Sz � roc - '� MEAN HIGH WATER . = RAM s SCALE' AS INDICATED DATE _I'/.30179 WARWI x t BENCH MARK DATUM: ,l' �5 A �e MARSH 3 ; N !w771 ;� .., svte� H+ c e- ,a/ o�Q WM M WARWICK 8 ASSOCIATES v?• ` �` 4Fc�sFEP� W i BOX 80/ -- NORTH ,r'AL4fOuTH MASSACHUSET TIC, 02556