HomeMy WebLinkAbout0042 COTUIT BAY DRIVE - Health 42 COTUIT BAY DRIVE COTUIT
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Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Dept. of Environmental Protection
• One winter Street,Boston,Ma. 02108 John Grad
D.E.P. Title V Septic Inspector
P.O. Box 2119
Teaticket, MA 02536
(508)564-6813
WILLIAM F.WELD
Governor ' ,
ARGEO PAUL CELLUCCI
Lt.Governor ,ly S��
(� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A '�
CERTIFICATIONS Y ��£�
42 Cotuit B Dr.CotuR 02635 t Address of Owner: 2 8
Property Address: aY
Date of Inspection: 5/26/98 (If different) �9ysTq 8 _k
Name of Inspector: John Oraci Walter Hargreaves FPT 6ZIP
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000)
Company Name,Address and Telephone Number: -
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 This Inspection la based on criteria defined In Title V
Conditional) Passes code 310 CMR 16303.My findings are of how the system Is
y performing at the time of the Inspection.My Inspection does
_ NeedsjFuhthe Evaluation By the Local Approving Authority not Impyany warranty or guarantee ofthslongsvityofthe
Falls septic system and any of Its components useful Ift
Inspector's Signature: ). Date: &26I98
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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:
A] SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 3W CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
s of the replacement or repair,passes inspection.
Indicate yes,no, or not determined(Y, N,or NO). 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
— CoThpliance(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 Od127197)
One Winter Street • Boston,Massachusetts 02108 a FAX(617)556-1049 0 Telephone(617)2924500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 42 Cotuit Bay Dr.Cotuft 02835
Owner: Walter Hargreaves
Date of Inspectlon:5126fg8
_ Sewa4e backup or.breakout.or. hiQh.static water level observed.in.the distribution box is due to a broken,
or obstructed pipe(s)or due to 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 leveled 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
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 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well.
The system has a septic tank and soil absorption system and 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must Indicate either"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.
Yes No
Backup of sewage in 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 clogoed
cesspool.
SAS is in hydraulic failure.
(revised 0427187)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 42 Cotuit l3ay Dr.Cotult 02035
Owner: Walter Hargreaves
Date of Inspection:5126199
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
,t_ — Pumping information was requested of the owner,occupant,and Board of Health.
x None of the system components have been pumped for at least two weeks and the 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.
_c_ — 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.
x 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 Systens.
x Existing information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is
unacceptable)[15.302(3)(b)]
(revised 0427l87)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Add res s: 42 Cotult Bay 0r.Cotult 02638
Owner: Walter Hargreaves
Date of Inspection:5126199
D]SYSTEM FAILS(continued)
Yes No
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 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers 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 1 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"as to each of the following:
The following criteria apply to large systems in addition to the criteria:
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
- - E
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 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.
(revised 0427)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
1
Property Address: 42 Cotult6ay0r.Cotufte2635
Owner: Wafter Hargreaves
Date of Inspection:5126198
FLOW CONDITIONS
RESIDENTIAL: d./bedroom for S.A.S.
Design flow: 440 g•p
Number of bedrooms: 4
Number of current residents: 2
Garbage grinder(yes or no): Yes
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available:(last two(2)year usage(gpd):
rda
Sump Pump(yes or no): No
Last date of occupancy: nIa
COMMERCIAL/INDUSTRIAL:
Type of establishment: nis
Design flow:0 gallons/day
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: rde
Last date of occupancy: rda
OTHER:(Describe)Ida
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System was pumped In 1991
System pumped as part of inspection:(yes or no)No
If yes,volume pumped:0 gallons
Reason for pumping: Na'
TYPE OF SYSTEM
x Septic tank/distribution box/soil absorptions 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 Information:
20 yrs.
Sewage odors detected when arriving at the site:(yes or no) No
(revlsed 04127197)
r ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 42 Cotult l3ay Dr.CaftM 02035
Owner: Wafter Hargreaves
Date of Inspection:51261913
SEPTIC TANK: x
(locate on site plan)
Depth below grade: 3112'
Material of construction:x concreate_metal_FRP_Polyethylene_other(explain)
If tank is metal, list ageL Na . Is age confirmed by Certificate of Compliance Ho (Yes/No)
Dimensions: LOW-H57"Wil"10^
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle:24"
Scum thickness:2"
Distance from top of scum to top of outlet tee or baffle:6"
Distance form bottom of scum to bottom of outlet tee or baffle:te"
How dimensions were determined: measured
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Septic tank and all components are structumUy sound and fundloning properly.Recommend pumping every two yeare.
GREASE TRAP:
(locate on site plan)
Depth below grade: rda
Material of construction: _concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: rda
Scum thickness:rva
.Distance from top of scum to top of outlet tee or baffle:nfa
Distance from bottom of scum to bottom of outlet tee or baffle:nla
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.)
rda
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 31 t12"
Material of construction:_cast iron x_40 PVC_other(explain)
Distance from private water supply well or suction lineP-
Diameter: 4
Qmments: (conditions of joints,venting,evidence of leakage,etc.)
(revised 0412719T)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 42 Cotult t3ay Dr.Cotult o2635
Owner: Waiter Hargreaves
Date of Inspection:5126199
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: roa
Material of construction:_concrete_metal_FRP_Polyethylene—other(explain)
Dimensions: roa
Capacity: roa gallons
Design flow: roe gallons/day
Alarm level:_roa Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
roa
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: We
Comments:
(note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.)
roa
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)No
Alarms in working order(yes or no)Ye:
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
roa
(revised 04127)97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) `
Property Address: 42 Catult Bay Dr.CatWt 02635
Owner: Walter Hargreaves
Date of Inspection:51261911
SOIL ABSORPTION SYSTEM(SAS):x
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
rda
Type:
leaching pits,number: one 10X?gallon leach pit
leaching chambers,number:We
leaching galleries,number: nla
leaching trenches,number,length: rva
leaching fields,number,dimensions:n1a
overflow cesspool,number:We
Alternate system: n1a Name of Technology:_nta
Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
Leach ph and ell components are structurally sound and functioning properly.Leach ph has never been more then helrfull,and now has 6"In It
CESSPOOLS:
(locate on site plan)
Number and configuration: n1a
Depth-top of liquid to inlet Invert: n►a
Depth of solids layer: We
Depth of scum layer: n1a
Dimensions of cesspool: n1a
Materials of construction: n1a
Indication of groundwater: We
inflow(cesspool must be pumped as part of inspection)
rda
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
nfa
PRIVY:
(locate on site plan)
Materials of construction: We Dimensions: nla
Depth of solids: n1a
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n1a
(revlsed 007197)
.p
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
42 Cotult Say Dr.Cotuit 02635
Walter Hargreaves
5126198
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 •
AA �y
a� jL
o
33 L
(revised04r279T) Page P of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
42 Cotult Bay Dr.Cotult 02635
Walter Hargreaves
5126199
Depth of groundwater 12.
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
Check with local Board of Health
Check FEMA Maps
Check pumping records
1 Check local excavators, installers
x Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS maps and charts
1
(revised042719n ltgo 10 0[ 10
- :4
Fim$.... d................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
�ii r' !...............O F....... an.w,-Ea.dlc
............ ........................................................
Appliration for Dh4paaal Worse C utuitrurtinn trutit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at: Wt
............•-••....... / 8 Cm to c r � .-• .......--•------� �a.....t�"`� .....................
Lee do Address or Lot No.
Address
..-•----•--•..........................•.....
Installer Address
d Type of Building Size Lot.. ? 6. 6.._._____Sq. feet
Dwelling—No. of Bedrooms-__.-'3----------------------------------Expansion Attic ( ) Garbage Grinder (✓f
a Other—Type T e of Building ............... No. of ersons_..'..__................. Showers
G� YP g ------------- P ---- ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------ .
W Design Flow..............3.30...................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity.KSvo__gallons Length................ Width---------------- Diameter---------------- Depth................
x Disposal Trench—No. .................... Width../_........._.... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No-------f----------- Diameter.._f___-__-.---•-__ Depth below inlet.....C2............ Total leaching area-..5.Q_.9...sq. ft.
Z Other Distribution box ( ) Dosing tank ( f
o s. /1 e-
Percolation Test Results Performed by.----- _'------__-__•:___..�.................................. Date... .._.._/--L
Test Pit No. 1....-3--------minutes per inch Depth of Test Pit-----/_-Z......... Depth to ground water_-
(r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O
Description
Descri tion of Soil.....
�.u ,......................
._. '' G_.....►...c,...f�__.._�8_�____
-- �I------------------------------------------------------------
.....................................-------------------------------------------------........................................../ ..... ---------------------------...........---------
w
Z.
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 I i;..;
p 5 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 ealth. C ..
�� �'... � 1..� •
Signed. , ....................
Date
Application Approved By..... ............................... �_La,IfA0--------
Date
Application Disapproved for the following reasons-----------------------•---...----------------------------------------------•--------------....................
---------•----------••-•--------------•-----•------•----------------•-----------------.......--------•---........................------•------------------------•--------------------------•----------•-
Date
PermitNo......................................................... Issued-.....!.. .................---...................
Date
ti
„. N o....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Uhipoiial Vorkfi Tonstrnrtion rautit
Application is hereby made for a Permit to Construct (✓f or Repair ( } an Individual Sewage Disposal
System at
cs- Lnar �'�-
......... ---......... - .....
� Loc ion-Address, �,( y � or Lot No.
•---C•_-.•.•I---•••••----•---....�._ 1/•(•-L--•-•-•F�•.^.0 r•-•------_ ----------------------------------------------------------.................................
W O...... �, /l G(e.'I�d✓�.� Address
Installer Address
U Type of Building 3 Size Lot-----
.__.__ ......Sq. feet
�., Dwelling—No. of Bedrooms................................._..........Expansion Attic ( ) Garbage ( rinder ( ✓�
;a`k Other—' Type of Building No. of ersons____________________________ Showers
YP ng ---------------------------- P ( ) — Cafeteria ( )
Otherfixtures --------------------------------------------•---------•-•••------•••••---••-••-•••----- ---••----•-•••••-•-•--•------ -•---•
W Design Flow._._._:_3.3°______________________•_--gallons per person per day. Total daily flow...........3.3 o___ _ gallons.
WSeptic Tank—Liquid capacity_l gq.gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No------- ------------ Diameter../A............ Depth below inlet...6............ Total leaching area_ 40j_.__sq. ft.
z Other Distribution box ( ) Dosin ank ( //
aPercolation Test Results Performed by.. o.$:-.-........ ....................................... Date_.__
p p Depth to ground water.
Test Pit No. 1.__.3.-._.._-minutes er.inch Depth of Test Pit-_._�?'_._..___ ___..
fZ4 Test Fit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..--_------__-____.----
P --•----•---- ..............................................................................................................
x p —� .
U Description of Soil----------------•--•------- -----------------��-t-�-•-.....................................--•-----•----....----------------------------•-•--•--•-----••------•----
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 I i:L
p 5 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 ofh alth
dE s�cal .
Signed Ptlo �/+ '-�e�.+
Da
Application Approved By !-./�%� _..-�_ ../% .........
Date
Application Disapproved f orz the following reasons:--•-•-••------••••••••••••••-•--•••-•-----------------••••-•-•--•----------••-••••---------•----•••••....._...._
.... .... ...-••-••-•_...-:•-•--•••••--•--•--•--•-•....-•••--••_••_..
Date
PermitNo........................................................ Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD/ �OF HEALTH ,
............O F...«�+p°'r/ark. ir��Y�et ...............................
Trrfifiratr of Tomplitturr
THIS IS TO CERTIFY, That thok1hdividual S wage • osal System constructed or Repaired
bY........................................................------ ...• +s-...•-••-•-------------•••---........--••---
i Installer
has been installed in accordance with the pro isions of T�i'LE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. _GQ-has_________________ da.ted..........................-----_.--.-_.-_-_-_.-.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE._...---•--•----�-- y _..# - ------------------------- Inspector........
---------------------------------------------
�y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Qd ....................OF.. r� 7.0 .
V ® FEE........................
Disposal vrk� �qn��r �rrmit
Permission
hereby hereby granted •-••--••-••-�''................••----- �---------•---•----------------...-----------....-----._....__.....---........
to Construct or Repair ( ) an,Indivi. Sewage D• °sal S stem r
at No.. .e�Qsl ... ----
Street
as shown on the application for Disposal Works Construction� Permit No--------------------- I?ated..........................................
/ /SO areA.Ith,,
DATE............. (
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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GRETE �yGN N PLAN REPERETECE` ` �
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BOHAN.NON
No.'26106
1 CERTIFY THAT T H1: .. .. .
SHOWN� TH;t§ PLAN IS LOCATED Gf20U NND'. '
AS SHOWN.riMON AND THAT I FORMSM THE
i SETBACK 'REQUIREMENTS HE TOWN,bF,:'
WHEN N CONSTRUCTED.
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CONCRETE .COVERS
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EQUIV.)— MIN. PIPE"M;IN.
PITCH 1/4"PER. - LEAGN .;
PITCHA/4"PER.FT. •.PIT "PRECAST
INV F !` • a "LIACHIN 1
` a EL.. •�•4.- INVERT INVERT; + .� :P17 OR.: t
SEPTIC TANK EL..27/3. GIST. ,'EL �.7 • , EOU1W i
o INYER7 t 9OX. �►�-F�
GAL.. INVERT INVERT' �' v.W. :i /4"TO iI/$
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PROR LE- OF GROUND :WATER TABLE
`SEWAGE DISPOSAL SYSTEM • z
NO SCALE
SOUL LOG WITNESSED BY,': ,, �}
DATE TIME. . . . . PAU�= .n� T .R4',:M.P. BOAR'D-0 HEALTH'
TEST NOTE I TEST HOLE 2 .fit
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ELEV" ELEV. .. . A
U. DESIGN' 'DATA
NUMBER' OF BEDROOMS
.. ` .. . , , •ire �>
l- 1� TOTAL ESTIMATED FLAWtA
.'. GALLOI�tS/DAII �;
0 (1 BOTTOM.LEACHING 'AREA, SQ"FT. /PIT ,
F�0Y
SIDE LEACHING ARE/A/� Gam! SO FT./:PIT
Nfr~L1. GARBAGE DISPOS.AL'!t4P1/.../�'
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TOTAL LEACHING 'ARE ��f-�;, 1` 'Sp FT ~�
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y RERCOLATION. "RATE 11�A ,�,ti MIN/INCH
LEACHING AREA ,PER PERCOLATION RATE (SpF`T .
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Nio.WATER ENCOUNTERED
--NU/M��•SEAR OF LEACHING PM ,f��.✓I,�*�.'.//"�J,.�
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APPROVED. . . . . BOARD OF HEALTH * r
DATE
AGENT OR, INSPECTOR'
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VILLAGE
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I N S T A LLER'S / NAWE A �ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED
DATE C 0 M P L I A N C E ISSUED
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