Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0007 DANA COURT - Health
7 DANA COURT, COTUIT A= 056 049 '679 6 LOCATION SEWAGE PERMIT NO. DA9A Coum �- VI trn E INSTA LLER'S NAME ADDRESS 01cclo, If ciCA 2UI.LDEN m OR OWNER LaiHe-uNa DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED -�_ ,��_ � rlq® IV • r ...U�.._... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..................................----.....O F......................................------------............_.....__.................•- Appliration for Disposal Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct (V) or Repair ( } an Individual Sewage Disposal System at: -----...--••---------------------••---•--�i--• - / oc tic) • ddress v n Lot No. J/ Owner Ad red sr 0 ner ....-•------------ ---•...-•-•--- -.. _ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._____________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures __________________________________ W Design Flow.............5.5......................gallons per person per day. Total daily flow.......&®...........................gallons. 1:4 Septic Tank—Liquid capacityt4�...gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./-_�.......... Diarimeter__._.� .'._._ Depth below inlet....6....._..._. Total leaching area__2_ C....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by_________________________________________ _______...___________.._..._...... Date........................................ aTest Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............................................._............................................................................................................... 0 Description of Soil........................................................................................................................................................................ x V ........................................._............................................................................................................................................................... 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 TITILj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the b of health. Signed r........ ---.._...._ Da��te Application Approved By-•••••-• --------------------•-•-••-•-- � ��i���------------------ Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•--------------._:_...-------__-- ---------------------•..................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .................... ................O F..........................._.............. .... Appliratiou for Klhip a al Works Tomitru.rttun 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at i ... ...... -----• . ....... ..... .......................................... . .............. .. Wa • F Lot N o. ................ .....4 rooc ti dress .. - • Owner ess -•-- ........ . -------__---• - --- ••- . . .: - • Installer Address U Type of Building Size Lot............................ -----------------------.-.-Sq. feet Dwelling—No. of Bedrooms...... ....................__..........Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin a yp g -=-......- --=_.__.._.____ No. of persons............................ Showers ( ) = Cafeteria ( ) Otherfixtures ----------------••-------------•-•-•------------------••------•-•••--------••••••._....._._..- W Design Flow___________________________________________gallons per person per day. Total daily flow........._ ._ ..........................gallons. W . ' Septic Tank—Liqui(ca�acity............gallons 'Length................ Width................ Diameter._................ Depth________._:___:. Disposal Trench-No...............1.0-f`�idth............. ..... Total Length.................... Total leaching area.................... ft. Seepage Pit No_____________________ Diameter................,__ Depth below inlet___._a_:_e...... Total leaching area....?'.e),0..sq. ft. Z Other Distribution bo/( ) D4 g tank ( ) Percolation Test Results Performed bY............................................................................ Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit,No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ;P4 0 Description of Soil........................................................................................................................................................................ x 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 TA!T12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bergifissued by the of health. ! �. Signed.../V -•--• -.......... • ...... �, , Application Approved By................................... • ...... ,//-,//tte ------------- Application Disapproved for the owing reasons:--•-- ------------------------------------- .._..-------••--•-•-••••••----•••-•--••••-•••-•-••••---••---•...-•-••------•----.._..--•-•--••••-••..._....••••--•...•----•---•---•-•-•---•-•---•--•--------•••-•-------•••-•--•----••••--••--•-•....... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,,,,,r! .. OF...... : rrtifiratr of �aattt t nrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by_........._ .................................Installer•••••-•-•-•-•---•-• ----•-•----•••-_.... ns at. ?, � -•----•- .-- ......_. ---------- .............................................. �+ •---------------------- has been install e adebfdancesi 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----- dated:................:._._______...____............. THE ISSUANCE OF THIS CERTIFICATE SHALL lO RUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. y� l DATE..... ........................./:a't /,� .............. Inspector....._ ,..1)f.l�......--------...---......--------------•---- THE COMMONWEALTH OF MASSACHUSETTS ---- '�' BOARD CIF HEALT :.........................,�.OF..................._._........:...:....._......_......_...._......._.._..._._....._.. O No.__...... � FEE ..................... . �a�� �ark� �.a�n�tr tnn rruttt Permissihereby granted. ..........I-.-•-••••.....•••--•-•••-•••------•••-•••••••-••-••-•..._....••-•......•-•••••••............... to Construc ,r) r epair ( an dlvidual Sewage Disposal Sys at No............. 6/ ...... ..:.:..... ,._ %>^y k Street as shown on the application for Disposal Works Construction Permit No_ .......... Dated.......................................... Board of Health DATE...........................//__--� 7/ FORM 1955 HOBBS & WARREN, INC., PUBLISHERS a b L a ,AFAV jar 10 llf-1 PI-All(��A Dtsr,6 dx o to 4'5aL,c, PJc- } ©US C r cX3�c rO�x� o4iccl I` a i o10 3 cl 1-0 Rr • .4 WALTEf E.co SMITN,JR. s=- <. ' Cif i U4bS r •A YM 4A coSCA er ©N � ?" 4457 ,.r F I(—zv� \ V� ,/)bocml- QIST.,�( 4 U &IA4 loF'r• DIAM. 7+O N p d ba GoNc.L,eAGNswGr Pir. Ccac. d 4 AA. Sep+,' T'q K #4 9Z,zr a AAA e4AA AA r -) K(aSAsd s`M•oro Bor. P�7 91 D 77%M 7i7 C� =V� 5 164 N A-rA �7o Sv b5a�'J. 24 f R.�o:..,o.-rtor\t Rv,T 2„�,�J1/NG�-1 DROP 3 Ber.>Rooms st tic3 G pD 37:O iPD AcNtNC�, ' 6�` 9 Mo C-jArzaAG a DtSP05AL USE .l ooa GAL•Swr-tcTm 9410 pearc, hole CA PAGi-r Ppovipr< !,> St o155 71 to x 6 ,K Z. 5- 471, — P , oTA.L CA FA C !Y I PRO V!PUP S4 7 Ca V D t5 P05At.- �--"`�STE'M t,�R btCINEr> IN t v zo7, t ' L 8vee F `�, o'tx S;RAra ����� a, `'. \.\ Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection ' One winter Street Boston Ma. 02108 itle S at ' 'Title D.E.Y. V Septic Inspector P.O. Box 2119 _ . Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor. ARGEO PAUL CELLUCCILt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A t/ CERTIFICATION •w tJ� �� Property Address: 7 Dana Court Cotuit Map 056 Par.049 Lot 59 Address of Owner: y�o�e t. Date of Inspection: II8/98 (If different) �� ��y99y .j Name of Inspector: John Graci Lauens and Evelyn Bruno I am a D E P approved system inspector pursuant to Section 15.340 of Title%(310 CM 15,000)' Company Name,Address and Telephone Number: y 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 Is based on criteria defined In Title V Conditional) Passes code 310 CMR 16.303.My findings are of how the system is _ performing at the time of the inspection.My inspection does _ Needs Fur er valuation By the Local Approving Authority not Imply any warranty or guarantee erthelongevnyofthe Fails septic system and any of Its components useful life. Inspector's Signature: Date: 718108 The System Inspector shall s mit 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 310 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 of the replacement or repair,passes inspection. 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. i (revised04127)97) v One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 is Telephone(617)292-55010 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r ". PART A CERTIFICATION (continued) Property Address: 7 Dana Court Cotult Map D56 Par.049 Lot 59 , Owner: Lauens and Evelyn Bruno Date of Inspection:7rer9s _ Sewage backup or.breakout or high.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 ISREQUIRED BY THE BOARD OF. HEALTH: r't _ 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 aseptic tank and soil absorption system and is within 501,feet of a-private water supply wells' — i 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 pi�esense 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. e Yes No Backup of sewage in 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`duc to all overloaded of clogged cesspool. SAS is in hydraulic failure. (revised 04R7)97) .SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7 Dana Court Coluit Map 056 Par.049 Lot 59' Owner: Lauens and Evelyn Bruno Date of Inspection:71819s «. 7 ' a D] SYSTEM FAILS(continued). Yes No 2' 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. r 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 s the system is within 400 feet of ay 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 it 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. (revleed M7187) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST• Property Add reSS: 7 Dana Court Cotult Map 056 Par.049 Lot 59 Owner: Lauens and Evelyn Bruno Date of Inspection:719198 " Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: ,c_ — 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. s 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 m 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)] M (revlsedO 27W) c - SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION Property Address: 7 Dana Court Cotuit Map 055 Par.049 Lot 59 Owner: Lauens and Evelyn Bruno Date of Inspection:718198 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 g•p•d./bedroom for S.A.S. Number of bedrooms: 4 Number of current residents: "*x Garbage grinder(yes or no): Yee - Laundry connected to system(yes or no): Ye: r Seasonal use(yes or no): Yee Water meter readings,.if available:(last two(2)year usage(gpd): nfa Sump Pump(yes or no): No n Last date of occupancy: summeruse COMMERCIAL/INDUSTRIAL: , Type of establishment: nla 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: nra ` Last date of occupancy: nra e , OTHER:(Describe)Ids Last date of occupancy: ' GENERAL INFORMATION PUMPING RECORDS and source'of information: nla System pumped as part of inspection: (yes or no)N�- If yes,volume pumped:0 gallons Reason for pumping: nfa 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? a Other: = 4 APPROXIMATE AGE of all components, date Installed(If known)and source Information: _ 1991 byAs•bulR Sewage odors detected when arriving at the site: (yes or no) No (revlsed04127)971 ° SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C ;. SYSTEM INFORMATION (continued) Property Add re s s: 7 Dana Court Cotuit Map 05B Par.049 Lot 59 Owner: Lauens and Evelyn Bruno Date of Inspection:71919$ SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction:x concreate metal_FRP Polyethylene`_other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No) . Dimensions: L12'H6'6'vr6' Sludge depth:3., Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle:6" s Distance form bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: Measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are structurally sound and functioning property.Recommending pumping every two years. GREASE TRAP:_ , (locate on site plan) Depth below grade: rda Material of construction: concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nra Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle:rda Date of last pumping* ra g 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:2-6" Material of construction: cast iron x 40 PVC other(explain) Distance from private water supply'well or suction lin00 Diameter: nia Qimments: (conditions of joints,venting,evidence of,leakage, etc.) (revised 04127)97I s � , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add ress: 7 Dana Court Colult Map 056 Par.049 Lot 59 Owner: Lauens and Evelyn Bruno Date of Inspection:71919a TIGHT OR HOLDING TANK: r (locate on site plan) Depth below grade: Ma u Y. Material of construction:_concrete_metal_FRP_Polyethylene=other(explain) Dimensions: nra Capacity: nla gallons Design flow: nla gallons/day Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda - - - - 4.. DISTRIBUTION BOX: x (locate on site plan) , Depth of liquid level above outlet invert: nra ,n Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc') Na PUMP CHAMBER: = (locate on site plan) Pumps in working order: es or no)No 9 (Y . p ` Alarms In working order(yes or no) yes ' Comments. ' (note condition of pump chamber, condition of pumps and appurtenances,-etc. rda (revised 04)17)971 ;3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Dana Court Cotuit Map 056 Par,t149 Lot 59 Owner: Lauens and Evelyn Bruno Date of Inspection:719198 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: Type: leaching pits, number: 2•to00gelion leach pits leaching chambers, number:his, leaching galleries,number: rrla leaching trenches,number,length: rda ' leaching fields,number,dimensions:nla overflow cesspool,number:nia Alternate system: nia Name of Technology:_nra - Comments: (note condition of soil, signs of hydraulic failure,level of ponding;condition of vegetation, etc.) The leach pits are structurally sound and functioning properly.The leach pits were empty at the time of the Inspection. y CESSPOOLS: (locate on site plan) ° 1 Number and configuration: rva Depth-top of liquid to inlet invert: nla Depth of solids layer: nla Depth of scum layer: Na Dimensions of cesspool: nla Materials of construction: rda ` Indication of groundwater: ria inflow(cesspool must be pumped as part of inspection) nta Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY: (locate on site plan) Materials of construction: Na y Dimensions: nla Depth of solids: nta Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.) nisr (revised 04127)97I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,. a SYSTEM INFORMATION(continued) 7 Dana Court Cotuit Map 056 Par.049 Lot 59- Lauens and Evelyn Bruno 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) F71CO CD .. t ..a ..• t _ .. I 7 s lac +L *. 6c • q r (revised04)27197) Page ! of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 7 Dana Court Catult Map 058 Par.049 Lot 59 Lauens and Evelyn Bruno 718198 » Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation:, F 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 v Check FEMA Maps Check pumping records ' Check local excavators, installers x Use USGS Data P Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and charts u (revised 0lJ27197), Inge 10 of 30 C49 No................ ....... _ _ Fes$ . .............. THE COMMONWEALTH.OF MASSACHUSETTS - BOAR® F CIE T ... .....oF . ... .....:......... ... .......... ..................................... Allp iration for Disposal Works Tnnstrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal system ... Ll.......2L...........42.....................C.....Ld.................................................................................................. .Loc do -Address �j .. _ o No. d!V.N . ------•-•- ..-....----- � t eQa.7_.....�f. - ��Ll. ......Address 5(. —= - wn . ........................... Instal .ler Address Type of Building/ �� > Size Lot./..A c ....S feet �., Dwelling 1Z No. of Bedrooms................�.--:._).............Expansion Attic Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showers YP g ----•----------------------• P ( )--- Cafeteria-(-----)- P4Other fixtures -----------------•-------------•-•-•------------•--------•----------------------•-----•-••------•-----.............. W Design Flow....-5 Z%............ ............gallons per person per day. Total daily flow..............................._............gallons. WSeptic Tank—Liquid capacityt eQ�'gallons Length................ Width................ Diameter................ Depth.......... x Disposal Trench—No. ................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.................�........ Diameter......LQ....... Depth below inlet....... ......... Total leaching area.-3.::- :..sq. ft. Z Other Distribution box ( ) Dosing t nk ( ) a Percolation Test Resul s Performed by.../ ',e� 7 �'I ._..., ../i✓�' ............. Date.....v,,, _.__. __.. �y Test Pit No. 1.A�...minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------..................................... ----------j--------- O Description of Soil... .c a�'1......... :'-- ------------'-•'•• 5--------- .._.: .> v% --'1 ` . x U ------------------------------------- --------------- ---------------- ------------ ---------- •----------------------------------------------------------- •----------- •................................... UW •-----------------------------------------------•------••---------•-------•••-----<--•-.....•------------------------••-•----------------------------------••-•----...--------------------•••-------•--- Nature of Repairs or Alterations—Answer when applicable........................................................:....................................... -------------•-------•----....-------•--...........---......------•-------....----•-.........--------------•----------------------•--------------------------•-......•----.....-•-----•._.........---- Agreement: The undersigned agrees to install the aforedescrib d Individual Sewage Disposal System in accordance with the provisions of iITI.i� 5 of the State Sanitary C9, /�The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beenn"•s ed by t oard of health. Sign G�i�l�. e✓!__._-2cJ ....••-------••--'-------'•-------.-•-- Application Approved By....:_.. . . = ate 9 ate 0� Application Disapproved for the following reasons:----•-----------------------'•----•--------------------•------•----••----------•----•-----•---------•-----...... •-••---•-•----•-----.....-•--•-•---•-•--......---••-----•-•-••-------•-•----------•-----------------•------•--..................-----...._..----•--•••-----------------------------•---------•----_:..._ Date �- �' Permit No......................................................... Issued'.-• ----- -.......................... Date No...... .s ..._ 0- „Fxs .7................. " v 1 THE COMMONWEALTH OF MASSACHUSETTS BOAR® F' HE I T. .............OF............... .. . ... ...,f Appliration for Rapaaal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys em t ''� �` ra va k, G. `-1 v-f �f u , `o 71 � -•- ---••................... ........... ............................ --........--•-••-•-•••...---•----•-•------ - ..........•---•............_..._ L/. LocAa-tion-Address /� l �j /� or Lot Noy. •' C~ — / -j'` /.lY.. ............................................. 4C�� til`��.�5...___ " t Owner Address - ......................................... a ......••-•-------------•--._........._-•--_. .__...•------••••••••-•....................... . Installer Address U Type of Buildi � y� t f Size Lot _ A�:' L:....Sq. feet t. Dwelling No. of Bedrooms........... _______________Expansion Attic (l) Garbage Grinder ( ) Other—Type e of Building No. of ersons..................._........ Showers � YP g •-------•------•------------ P -- ----- - -------- ---- - - -------------•--•-( ) — Cafeteria ( ) Otherfixtures ---- -----------------------------•----------------...-- - . - .._...._.._..------•---............---- W Design Flow____ 5:30..........._______.__...__gallons per person per day. Total daily flow---------_............................_.....gallons. WSeptic Tank—Liquid capacityf� gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........C2........ Diameter.....1.0....... Depth below inlet_.__._&......... Total leaching area_1-3C.C?..sq. ft. Z Other Distribution box ( ) ., Dosing t nk ( ) .���� �"' / � Percolation Test Results Performed b .__ 'E'":_.___.....___�l�/' _______________ Date_______ Y , ............. ,aa Test Pit No. 1_ ?".'___minutes per inch Depth of Test Pit____________________ Depth to ground water........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ll � ............... �O ............. __ _.__.escriptonoo ___ . Ar1_.________�_ {_ _.___ L __ V ------------------------------•--••---------------------- •-•-•------------- ---------•-•------------------------------------•----•------------------------------ W UNature of,Repairs or Alterations—Answer when applicable............................................................................................... ---------------------------------------------------------------------------------------•••••-•-••-------•-----------------•---------•---------------•--•--------------------------------•-••-••••-•_---- Agreement: The undersigned agrees to install the aforedescrib d Individual Sewage Disposal System in accordance with the provisions of TI'l TIE 5 of the State Sanitary Coe T The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been s ed`by t oard of health. /� -Vic'� --a`--•-•-------------------------- a Sign ate Application Approved By.... �.-�� (�E!d!!_ ` - t.------ : �_....._..-- ..._ Date Application Disapproved for the following reasons--------------------=---------------------------------------------------------------------- -----------------•- ..........................•----._...--------•------...---------•-•--------...--------------....--=----------•---------------•-•••----------•-----------------•-----------------•---------------••-_-_--- Date PermitNo......................................................... Issued....................................................... Date � s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tl .........OF.......... ..'.............................................. (9rrtifirab of wiaktplinurr THN If TO RTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) b :tt Y- �.._.. ............ ............. T Installer has been installed in accordance with the provisions of Z-of The State Sanitary Code as described in the application for Disposal Works Construction Per No. �___✓�.____�______._.. dated_.-...�_"__�..."'_ !J' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT EE•CONSTRUED AS A GUARANTEE THAT THE SYSTEM WNI FUNCTION SATISFACTORY. DATE.... ••-•- - 2..........61......................................... Inspector....Z,----------------�� THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALT 3 ......... L..........OF........ .. -......:...... :...... ....._......._._.. � No..........�,......... FEE_---•................... lginpo 1 orko onitrnrtion antit Perm> Sion}hereby granted..... ----- '......... ..... .. ....... ..*-----------------------____-__-----------------_______-------__--___-___--_--_-_--•-•--- v to Construct or Repair ( an Individ '1' Sewa i s st tom' a lr�'Ti+-.`4... ,1..:__.l 'day. ----e •.-�-------- ' }� Street as shown on the application for Disposal Works Construction Per 0._.Ai D ted.__ __.. m__�................... .% �..._.... � e ''� ................._ L / Board of Health DATE.............. ........................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �i ��� ' � ` �,\ S�INAC�"' �3tGv- 8i►3lF73' . \ \ DPI Soil Gob 45 a's5 vgm Auc, z 1978. J tt \\ ix 44 ►„ �ze�, % 3V ro ,lot in � N � b CERTIFIED PLOT PLAN - L.>DCATIOPf SCALE DATE PLAN REFERENCE ►r Gores i y`. Y3 'G'GUI�D Pa. Z6 . S11 I CERTIFY THAT.THE ... p �:V(. - _.. SHOWN ON THIS PLAN 0 THE GROUND AS'SHOWN. HER_ E T-CONFORMS TO THE L/�j-Z Biev,\/p SETBACK R OF THE TOWN OF, p . WHEN CONSTRUCTED. �� Tf ! G�i4C.S1 DATE . . . . . . . . . . . . . PETITIONER: C!J/�1M,q�?Cilp /vJi�}5 S r / REGISTERED LAND SURVEYOR , TOP OF FOUNDATION CONCRETE COVER ' CONCRETE COVERS 0 0 4"CAST IRON 12"MAX. � r 12"MAX. PIPE (OR 4"ORANGEBURG(OR EQUIV.) EQUIV.)- MIN. PIPE- MIN. LEACH ° PITCH 1/4"PER.FT PITCH 1/4"PER.FT. PITTt'. ° 7 INVERTT a e EL.g ,o�... TANK INVERT DLST. INVERT ?a w SEPTIC EL. /58 EOY,2 . 'INVERT BOX .. . p� 01•• • • GAL. INVERT 0 a o 2 EE41,41 INVER77 ,. w w o.EL9e. �C' -. /Z -- 6'DIA. DIA PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE 1914- Z/ I'F78 TIME. . . . . . . . . . . p L. C. �lw�l2 BOARD OF HEALTH TEST HOLE I TEST HOLE 2 �A?Q?Z�. .>� !�!y.� • . , . ENGINEER ELEV. .4l'--! . . . . . ELEV. .. . . . . . . . . r' f LDA"17 P' r , svR-so,4. DESIGN DATA ' NUMBER OF BEDROOMS. . . . . TOTAL ESTIMATED FLOW GALLONS/DAY Hew BOTTOM LEACHING AREA SO.FT. /PIT COTL�F' /88.S S,q�p SIDE LEACHING AREA . . . . . . . SQ.FT./ PIT GARBAGE DISPOSAL .yam+ . . .(50% AREA INCREASE) TOTAL LEACHING AREA . . . . SQ.FT PERCOLATION RATE 45. MIN/INCH LEACHING AREA PER PERCOLATION RATE SQ.FT. � .WATER ENCOUNTERED NUMBER OF LEACHING PITS . . . 'T' APPROVED . . . . . . . BOARD OF HEALTH ac 3'PbnIE O.v AGE,SiDG �•�54 rates' oFSi>5w� DATE . . . . . . . . . . . . . . . . . AGENT OR INSPECTOR THOMAS E.KELLEY CO. (/t(.- L' ENGINEERS-=SURVEYO \ 346 LONG POND DRIVE ���H or 0 SOUTH YARMOUTH,MAS • ��� THO S 4oT''s �t� �S. 02664 v+ Ey No.2420 O v :� ? ' 9oc�G�ST$�� 1 PETITIONER . t