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HomeMy WebLinkAbout0077 CHERRY TREE ROAD - Health 77 CYTIERRY TREE �51 D^.®TUIT I C0MMONWEALTH OF MASSACHUSETTS �fOE�VEQ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTE'CnoO U N ~ ONE WINTER.STREET, BOSTON MA 02108 (617)292-5500` TOWA1 y 'r4 ! Y CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner PART p SUBSURFACE SEWAGE DISPOSALSYSTEM INSPECTION FORM J CERTIFICATION Property Address:77 C lERk'Y T!cEE 96 Name of Owner DrCAMERON Addressofowner: J' GPAZIMACI� ili. H, Date of Inspection: y-15.00 Name of Inspector:(Please Print) EDIAUAP0 C.&0SRECLp am a DEP approved system inspector pursuant to Section 15.340 of True 5(310 CMR 15.000) Company Name: CIJ'yL'r' 0b C, 6QLJSF)EL0 Mailing Address: (Q i V 0063 A V C SAIVO M C I1 Telephone Number: SO.9 ?13 9 E 3 3 CERTIFICATION STATEMENT 1 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 . Fails Inspector's Signature: . / � Date: / oc The System Inspector shall submit 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 /000 &qLt0.rU ! ©nC� Cs�}1�ON C� FOOT revised 9/2/98 Page Iof11 t0 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:?Cg6RRY TfileC AD Owner: p,C,am�,2o�v Date of Inspection:Lj_��^))_o© INSPECTION SUMMARY: Check Aa B, C, o/ A 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: 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. _ 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. _ 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 _ 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 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 CypRQY T2Cc A)r Owner: 0,CAM FROAJ Date of Inspection: u_�S_oo 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 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 (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:7 7 W6RRY TQ60 IQ0. Owner: b,CR m E O A) Date of Inspection: / D. SYSTEM FAILS: _�6 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 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. w '� 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. 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. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. 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 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _7704C OY TPE 20, Owner: D,CART(Poly Date of Inspection: ` /_)S r©D 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. None of the system components have been pumped for at least two weeks and the system has been receiving normat flow rates during that period. Large volumes I O v olumeeso f water have not been introduced into the sy ntothhesy stem recently or as part of this inspection. S6' IS VOy OSCD ^UC/ceVbj4y As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, a 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. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, 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)) _ 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 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p SYSTEM INFORMATION Property Address:-7 7 C H 6'RRY TP,Cc Q0 owner: D r CAMEROMI Date of Inspection: i)2�-oo �i FLOW CONDITIONS RESIDENTIAL: Design flow: /U g.p.d./bedroom. Number of bedrooms (design): Number of bedrooms(actual):3 Total DESIGN flow Liqo Number of current residents: Garbage grinder(yes or&g:- _ Laundry(separate system) (yes or no):_; If yes,separate inspection required Laundry system inspected (yes or no) _ Seasonal use(yes or no): /I�'OT USc13 GV6(Z� DAB{ Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or(6): NO - ,t Last date of occupancy:-51`4-W a.'Ph5p COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: - GENERAL INFORMATION PUMPING RECORDS and source of information: PumPcD COUPLE 1'"VfJrl-5 t460 System pumped as part of inspection: (yes orb YItO If yes,volume pumped: gallons Reason for pumping: TYPE SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: rS V rS Qc f pp � Sewage odors detected when arriving at the site:(yes or(o MCI ,. revised 9/2/98 Page 6of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:77 C14 RP'N TP-EE �D• Owner: Q,Om Ooty Date of Inspection: BUILDING SEWER: (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 Comments:(condition of joints,venting, evidence of leakage,etc.) SEPTIC TANK:X (locate on site plan) Depth below grade: Material of construction:Xconcrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: ��c�+L KV lo"WK�5 1 Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: 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: How dimensions were determined: Comments: (recommendation for pumping,condition of inlet apd outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) 45P IC 7741( K IS ALL UQi1i0 . VERY CL64&V CQAX C-7'E &V:FZ45 (ISC S b �' u '?bEr COVE LI V14 is T ,C Tm" D�Cs�'7L�% ipc GREASE TRAP: (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 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: b,GAr►IER01V Date of Inspection: )S-oo TIGHT OR HOLDING TANK: (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) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: A PiPC Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box, etc.) ONE PIPE AVV- Opt.'f PIPE OU i r NO SOUOS LIE122 C.C.EAN PUMP CHAMBER:_ (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 9/2/98 Page 8ofll - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:-7-7 C gGROY T2C6: /gyp. Owner: �:LA�1trQ�Gii Date of Inspection: L/-. _00 SOIL ABSORPTION SYSTEM(SAS)\C (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type teaching pits,number16FOOT iwo 6ALICn0 L,e a�LC4 A7' : leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) L`AQ-( pit 44 ; b/L.'L( 20 I AX_4S OF OQUO jA)S1 QE,r\)Gt2 boon 4,1-0 2K.I N G CAN 61rroN CESSPOOLS:_ (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:_ (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.) revised 9/2/98 Pagegorlt - o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /7 Cqt;RR r REG RO Owner: p: (-A06RO(L) Date of inspection:y DD 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) TA y3 �3 i revised 9/2/98 Page 10of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C —7 SYSTEM INFORMATION(continued) Prop"Address:� ! c4ePPY ?2EE 1\n Owner:. Dio4tk i;ROA) Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 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 Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) G12ouroo cote' MPFPl 7DPO 44AP revised 9/2/98 Page 11of11 No...8... FRs.... �................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH o c,/h.4...............OF'......p,�..A.....4'1..14-�...�?...1-A W.1..... ................... App iratilau for Disp.a,13a1 Works Toutitrur#iuu tirrutit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at: -�••oT---►.............!f �Q .T.lz v'�` -----• .......................... ---------------------------------------------------------------••---. ocation Add or Lot No. j.Q..h E�1.....................................................` G �—t L c r� Ilo G�.1`v�!�....� .... Owner Address W Installer Address U Type of Building Size Lot_._._��,� lJa...Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------•---•-•----••----------••••-•------------------------------------•-------•---•-------...-••••-•------•...........---- d W Design Flow...........V!�..........................gallons per person per day. Total daily flow........... ........gallons. WSeptic Tank—Liquid capacityjAW..gallons Length_ _.__ Width---------------- Diameter_.-------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------I---------- Diameter......1o_.------- Depth below inlet..__._.......... Total leaching area__v.J.S__!...sq. ft. Z Other Distribution box (✓ ) Dosing tank ( ) Percolation Test Results Performed by._hTt:loN___ ��-1-........_.'IZ:____._.-_ �_._..�__.__ .._.. � �-------- Date----------�--3 $ Test Pit No. I...G2.---minutes per inch Depth of Test Pit.....���.__._.__._ Depth to groundwater----N.P_i.4 Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •--------------------------------------------------•-----•--------------..._.....-•---------•---•--------..........--••--•---•.......................................................... 0 Description of Soil...........0'--L1.......n e * `�`��� v�V -- -- ..... .A l21 �h&..-...�.5 `�1P.................... x W ._.••••----•--------------------------------------------------------------------------------------•-------------------------------------------------------------•----------••••......---•--............. U Nature of Repairs or Alterations—Answer when applicable................................................................................................. ...........................-----••...•--••-•••---•-----•--•-•••••••---------------••----------•••--••--..............---•--•----••••----•----------•••-•-......--••-•••--••-••--•......•............••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITILE 5 of the State San' ary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian has be n issued b th b rd of th. a �- Signe -• . D to Application Approved By............ ._.,........ ....... .. .... ............. ----•- --- .... .................. Date Application Disapproved for the following reasons:................................................................................................................ --••---••-•-•••--••-•--•••--••-•-...--------•-----••----••--••----•••••---••-----------------------•-•--.I--••----•--••--••••--•--••••-•-•--••--•••--------------•-••••••-------•----•••---••---•-----... Date PermitNo......................................................... Issued........................................................ Date No................_....... Fmc............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................----------------...........------------•-•-- Appliration for Bhipoii al Works Toaastrurtivaa ramit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at: ..v f .. �..I............................................�p ........ T.................•---._........-----••-----•--------.........-------- ocation-Addre s �-- or Lot No. <• i� Lv ((1 ItJi�f4 1/ Gt`'���� : HLJ � iJ NA �'17-,'1 ......................-.......................................................................... •......----••--•---••••--••-•--•---•-----••-•----....._.......----•-•• ........--- Owner Address W Installer = Address UType of Building Size Lot----- ....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building ._._.... No. of ersons---•-•______________________ Showers a g -------------------- P ( ) — Cafeteria ( ) 04 Other Atures ..--••-•-•---•---•-----------------•--•----••-•-•---...--•----------•-•------------•----....-•---•---•-•---•- W Design Flow............../..............................gallons per person per day. Total daily flow................ . ...................gallons. 9 Septic Tank—Liquid capacityV-_e.gallons Length_''_Tp:._.. Width................ Diameter---------------- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........I---------- Diameter.._._!_E_.__..... Depth,,below inlet.... ........... Total leaching arez L��...sq. ft. z Other Distribution box (*/ ) Dosing tank ( )k Percolation Test Results Performed by..,''--- -- ` G-' `__ .� ___...-. l /_-...-- _..-.. . ----•-•'--- Date----------------•..... a Test Pit No. I__G__'��___._.minutes per inch Depth of Test Pit----1?............ Depth to ground water...►) _! li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------•----- ............................................................................................................. O Description of Son.......... ` ` { 1�> v1 l r 2. �! `M x --------------- U .._......----•-••••...............•---•--•••-------------•--•----•---------------•--------•--••--•------•---•-----•----------••----- W ...._.------------------------------------------------ •-----..---------------------•--•--•------•-•---•---•-•-----------------------------••-•------•--•----------•-------...-•----•--..---•--..••...._ U Nature of Repairs or Alterations—Answer when applicable......................... ..................................................................... --------------•--------------------------------•---------------•-••---------------------------------...-- Agreement: The undersigned agrees to`install the aforedescribed Individual Sewage Disposal §ystem in accordance with the provisions of'T T T E 5 of the State S 4 ry Code— The undersigned furtl er agrees not to place the system in operation until a Certificate of Complian e has b n issu d try t e/b(�ard of lth ...............is .. at ApplicationApproved By•---------•---•--- -----•--•-•-•-- -- ..................... ... --- ................... Date Application Disapproved for the f olloing reasons:................................................................................................................ --••--•--•••--•---• .................................................-...........................................------•-------------------------------------------------------------------------------- Date PermitNo......................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ., ..........................................OF....................._............................................................... %Clertifirab of f ompli aurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by... !------.. �_.E_.�.----- .... �"�- -------------•-- ••............-••---....--------------••..•. •---..._......._.....-----•---.--- Installer at.---••-••--- -I°?'�'• '-'-...- . --•• ---•--- . $................-~ --`..................'----------------•------•------.... has been installed accordance with t ie rovisloiis of Ti r ` 5 of The Stake Sanitary Code as described in the P ! r application for Disposal Works Construction Permit No__________ ___ _________�..... dated---------------------- .._:.:-_,,"_ ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................... .�_�.�°� .............. Inspector.............. v ` -----------•-------------•---------••-•------••---••--•-•--•--• THE COMMONWEALTH OF MASSACHUSETTS { I BOARD OF HEALTH 7....- `8t. ................................OF.................................................... �``' +•.. FEE...sx✓................. Permissioni ereby granted---- .0 ' = .................. .11........... ................ .................................................................... to Construc �ya2epair n Ind' idual Sewn e Disposal st atNo........... ------•-• ............ .. .. ..... Street t - as shown on the application for Disposal Works Construction Permit No...:................ Dated...:............ ...... ......... Board of Health DATE:._.... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - SITE PLAN SHEEr i of 2 SCALE: /"_ o T ,� $ - I I FP-' FF- ` Q ad -zoo a o N _..__ zo.00 A1T1;5T piT G� alb �L.,q'7•�o.'® [� �Ox�N �j Q , l�1 Ivob 6-A1--, hraPT14.TANIL. ' , OF N4 _ I • v ' "WILLIAM M. °ram o WAi Wicx � N A j No:19771 ' 4 G%e%�1'3GC�ct�cJ FOR Ci,5 f 44 S G .-A t L D tll J REGISTERED LAND SURVEYOR - L vT l0 GI-k�I�R`; TW-r-- ZON E 6,0-ro T I,A PLAN REF. DATE M L` 'f- ►4, le)$44 BENCH MARK DATUM �`�%' '-�"^ WM. M. WARWICK 8 ASSOC., INC. DOMESTIC WATER SOURCE Tpwnl w IttT V-n BOX 801 ' NORTH FAL MOUTH FLOOD ZONE. No I„1 - }1 ,A 7 A F, p �" MASS. 02556 - (617) 563-2638 1 S�F�r z o�z L EACHINf ijAS/P/_....SECTION NOT TO SCALE. �._- , •I'"� i Mll �OVIFK - - IAK CUUKSES - EaKr/l�frcc -� \ ,� B.Y/CK AND MOK AS NEJ'D TO BRING 17�,\'\ \ COVER t0 GRADE 2 A8 TO/2" WASHED PEAS TONE FREE OF IRONS, ^( FINES AND DUST IN PLACE '~ l J14" TO !%2"WASHED CRUSHED STONE FREE OF OPENING W/TH 4/y" IRONS, FINES AND DUST /N PLACE OUTER DIAMETER AND 13/4" INS/DE " 17 DIAMETER I. CONCRETE TO BE 4000 PSI. 28 DAYS • 2. REINFORCED -WITH 6"x 6" NO. 6 GA. W.W.M. 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS 40" I` 2,' 6 0 I Z 4. NUMBER OF PITS REQUIRED SNP MIN. - EFFECTIVE DIAMETER ; NOTE: EXCAVATE TO ELEVATION 5•o OR fNOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL WATER TABLE - LOAM AND CLAY BENEATH PIT. REPLACE � moi.,e '.T C-l-• 5'40 EXCAVATED MATERIAL WITH CLEAN TYPICAL PROF/LE GRAVEL TO DESIGNED GRADE. FL..EL.Af9.0 lB"STO. LT WGT. C.I. MH COVER /19 O •• 47•D 4"C/.fP/PE 4"B/T.FIBER PIPE OUTLET LEVEL OWL TIGHT JOINT OWEL L/NG ;; TO FIRST JOINT --;-�••r-, r._;t;_• --- /4; O 00 1IU �O01 ► 44' d 1 1 0 0 1 1 ,2 g5•oo C.I. TEE y3 It DoOIOO l l l i 5 :STD. PRECAST CONC. `�A• 0/ST BOX TO Be �i�(.00 ' 1 000 00 1 1 IDaOGAL.SEPTIC TAN : INSTALLED ON LEVEL, 1 000 00 0 1 I I ' ' "' '•'= STABLE BASE 1000 0011 � \SEPTIC TANK TO BE 1 0 0 0 00 1 1 I ; INSTALL ED ON LEVEL' it 100(00 1 1 , STABLE BASE. i 1 0 0 0 0 0 0 1 i1000 00 01 „ A HIND-- A /N i 1 4 p O 0 0 D I , , BASE TO BE L EVEL 11 8 O O 1 1 El•39•o SOIL AND PERC. DATA PERC. RATE MIN. /IN. 0 TEST PIT NO. 1 0 TEST PIT NO. 2 � Top/ SvvJhvl� TEST BY : hT�T4o/y W a LL_ a. 5. WITNESSED BY: J. JAeaOf TE9T PIT GR. EL.47 DATE —' NO G,RNvwArEa 35 U DESIGN DATA GENERAL NOTES BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. DISPOSAL ►.iol.ts SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD EST. TOTAL DAILY EFFL.2210GPD• PRECAST REINFORCED CONCRETE UNITS. SEPTIC TANK t000 GAL. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE-5 OF THE STATE ENVIRONMENTAL CODE, $IDEWALL AREA GAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA I GAL./SQ.FT. SANITARY SEWAGE EFFECTIVE ON JULY 1 , 1977. LEACHING REQUIRED I�� I SQ.FT. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL LEACHING AREA OF HEALTH. 1 5'�fSQ.FT. AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINOS I/4" / FT. UNLESS INDICATED OTHERWISE. y , I ,�EWAGE DISPOSA L SYSTEM o WAR IN `.�� .�� v„ r E . Fay' J .O 5 E h 5 G L1 ti! L d ti t . ��;� 19 i _ I 1 IZEE .R,0,8. p 1�23417 Q Y d Gf-(Ji� c.� n, c'/s�-t�`� �:� GOTJ► T �ARrJtiTAP>I.ir- MA55 �''►v'6"V1�a�F""�'° SCALE AS 1N0/CATE9 DATE 6/14 !SA WM. M. WARWICK 8 ASSOC. INC. 80X 80I - NORTH FAI:MOUTH MASS. 02556 - (6/7) 563 -2638 PROFESSIONAL ENGINEER CS FIELD SHEET SEWAGE DISPOSAL DESIGN DATA Joseph., Scanlon Owner's Name .............. 1, —....................................................z.. Tel. ........................ Date 6/3/83 ............ Owner's Address ..........I......................... ........... ................. Builder Tel. ..................... . ................................ ............................ .......I........:............... Town ................................ # of Bedrooms ........ . .. ..... Domestic Flow ... ............... Garbage Grinder Total Flow .......... .. .......... # Pits ........................ Leach Field ........................ Sq. Ft. Leach .............. Depth to Ground Water lKo.IrP...than...1 Estimated .................... ........ Septic Tank ......... Lot # 10.. ..................... gal. ............... Sub Div. Plan ...... ............................... ......... ........ SKETCH OF LOT, WELLS, LOT LINES, SEPTIC SYSTEM, HOUSE, CONTOURS WATER COURSES, WATER, SERVICE, RESERVE AREA, NOT To SCALE. LOT CERTIFICATION #1 #2 Soi I Log This is to Certify that on -June 3 1983 , 0 I performed a percolation test on,the above lot and it meets the requirements of Regulations 3, 3. 1 . 3. 2 and 3.3 of Title 5 of the Mass. 0 Environmental Code for percolation. It.NA" 1,2 N No 0 Percolation Test Pit Rate Per Inch le-s.s..than. 2 min. Pit #..................... Rate Per Inch .......... 1/4 Ft. Remarks: LOCATION 1 oop-671 SEWAGE PERMIT NO. 14r/a "e0oy filt—Irl4e 1?9 VILLAGEsE �7 co P I N S T A LLER'S NAME i ADDRESS i r d2AI7f)' D.,f A I?cjV RUE 1 S f Al95-'QZ6e M.y a p2t4, SG�NL��f BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �o 6WRAOY