HomeMy WebLinkAbout0016 FURLONG WAY - Health aa/o iS
- - - - - - -- -- -
COMMONWEALTH OF MASSACHUSETT,S
EXE-,UTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL-PROTECTION
a
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM°
PART A
f(F, Fc CERTIFICATION
Property Address: ANE COTUIT,MA 02635
Owner's Name: TOM MEIGELLb'
Owner's Address: 8 WOODVIEW.WAY,HAMTON,NEW YORK 11946 '
Date of Inspection: 7/24/01
Name of Inspector: (please print) JOHN GRACI
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813 FAX-508-564-7270 „
CERTIFICATION STATEMENT'
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system
inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system:
TA
X Passes S<' h
Conditionall
y Passes _
Needs_ -urth valuation by the Local Approving Authority
_ PP g
Fails , F
i",
Inspector's Signature: • Date: 1/24/01
The system inspector shall submii copy of this inspection"report to the Approving''Authority(Board of Health or DEP)within
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 DEP. The original should be
sent to the system owner and copies sent to the buyer,if applicable,and the approving authority.
Notes and Comments u
SYSTEM PASSES TITLE V RECOMMEND PUMPING EVERY TWO,YEARS-TO MAINTAIN SYSTEM EFFICIENCY.. .
****This report only describes conditions at the time of inspection and under the conditions of use at that time.This a
inspection does not address how the system will perform in the future under the same or:different conditions of use.
� fe
Perm W1'S/�
Title �5'fncnctinn f)fl(1 ' � �
Page 2 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635
Owner: TOM MEIGELL
Date of Inspection: 7/24/01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
SYSTEM PASSES TITLE V RECOMMEND PUMPING EVERY TWO YEARS TO MAINTAIN SYSTEM
EFFICIENCY.
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.
Answer yes,no or not determined('f,N,ND).in the for the following statements. If"not determined"please explain.
n/a The septic tank is metal and over 20'years old* or the septic tank(whether metal or not) is structurally unsound,exhibits
substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced
with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating
that the tank is less than 20 years ol.J.is available.
..t
ND explain: n/a
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of
Health):
_ broken pipe(s)are replaced
_ obstruction is removed
distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
_brokeri�pipe(s)are replaced
_obst.-uction is removed
N0 explain: n%a
14
Page 3 of I I
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
s: PART A
CERTIFICATION(continued)
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635
Owner: TOM MEIGELL
Date of Inspection: 7/24/01
C. Further Evaluation is Requ red by the,Board of Health:
_ Conditions exist which require farther evaluation by the Board of Health in order to determine if the system is failing to
protect public health,safety or 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 public health,safety and the environment:
a�
_ 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.
i
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,safety and environment:
K
_ 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 to-nk and SAS and the SAS is within a Zone I of a public water supply.
_ The system has a septic ta€k and S'AS and the SAS is within 50 feet of a private water supply well. -
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water
supply well". Method used!to determine distance n/a
"This system passes if the well water analysis,performed'at a DEP certified laboratory, 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,provided that no other failure criteria are triggered.A copy .
of the analysis must be attacied'to this form.
3. Other: ;
n/a
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Page 4 of I l
f
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635
Owner: TOM MEIGELL
Date of Inspection: 7/24/01
a ?;
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each oflhe following for alLinspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due town overloaded or clogged
SAS or cesspool i
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped 3/8/98 PUMP TICKET-
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
_ X Any portion of cesspool or privy iswithin 100 feet of a surface water supply or tributary to a surface water supply.
_ X Any portion of a cesspool or privy is within a Zone I of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet.from a private water supply well with
no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP
certified laboratory,for colifor.m 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,provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.]
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310
CMR 15.303,therefore the system fails'The system owner should contact the Board of Health to determine what will be
necessary to correct the failure. ;
E. Large Systems: "
To be considered a large system the"system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
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)
yes no
X the system is within 400 feet of a'surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen+'"sensitive area(Interim Wellhead Protection Area IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
°yes"in section P above the large g5tem ha§f IN:Thp owner or opmtor of ony larg@§y§t@m con§id@r@d a§ignifiEant thrm
under Section t or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
Page 5 of I I _
,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635
Owner: TOM MEIGELL
Date of Inspection: 7/24/01
Check if the following have been done. You must indicate "yes"or"no"as to each of the following:
Yes No
X _ Pumping information was provided bythe owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X Has the system received normal flows in the previous two week period'?
X Have large volumes of water been introduced to the-system recently or as part of this inspection `?
' oll -
X Were as built plans of the systt em obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwellilg inspected for signs of sewage back up?
X _ Was the site inspected for signs,of break out?
X _ Were all system components,excluding the SAS,located on site
X _ Were the septic tank manioles uncovered,opened,and the interior of the tank inspected for the condition of the
baffles or tees,material of construc-:ion,dimensions,depth of liquid,depth of sludge and depth of scum ?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems`? ,
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X Existing information. Fore`"x'ample;'a°plan at the Board of Health.
X _ Determined in the field Of any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable)[310 CMR 15.302(3b)J'
is ,
Page 6 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635
Owner: TOM MEIGELL
Date of Inspection: 7/24/01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330
Number of current residents: 0
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)): n/a
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/apd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information:3/8/98 PUMP TICKET
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons-- How was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from
system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
Approximate age of all components;date installed(if known)and source of infon-nation:
1975
Were sewage odors detected when arriving at the site(yes or no): NO
Page 7 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635
Owner: TOM MEIGELL
Date of Inspection: 7/24/01
BUILDING SEWER(locate on site plan)
Depth below grade: 14"
Materials of construction:_cast iron —40 PVC Xother(explain): 20 PVC
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 8"
Material of construction: Xconcrete meta!' :fiberglass polyethylene other(explain)n/a
If tank is metal list age: n/a Is age :onfirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 150OG L 10' 6" H 5' 6" W 5' 8""
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle:32"
Scum thickness: 1"
Distance from top of scum to top of'outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 17"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING
EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE
GREASE TRAP:_(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommend-it ions, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,,etc.):
n/a t
' l
II
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635
Owner: TOM MEIGELL
Date of Inspection: 7/24/01
e
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX: X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments(note if box is level and distribution'to outlets equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
DISTRIBUTION BOX IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.
PUMP CHAMBER:-(locate on site plan)
. j
Pumps in working order(yes or no): NO;
Alarms in working order(yes or no)NO
Comments(note condition of pump:hamber, condition of pumps and appurtenances,etc.):
n/a
tl
1
i
. � I
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635
Owner: TOM MEIGELL
Date of Inspection: 7/24/01
SOIL ABSORPTION SYSTEM(SAS):.X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 2
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
;! Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil;condition of vegetation,etc.):
THERE ARE TWO LEACH PITS BOTH ARE STRUCTURALLY SOUND AND APPEAR TO BE FUNCTIONING
PROPERLY.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) '
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure level of ondin condition ;II
f p $, of vegetation, etc.):
n/a ;
t
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a I
Depth of solids: n/a }
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a 1
it ..
Page 10 of I 1 v,
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635'
Owner: TOM MEIGELL
Date of Inspection: 7/24/01
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet. Locate where public water supply enters the building:
+.t
k 33
. x
k. . _
' J(1
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 55 TROUTBROOK LANE COTUIT,MA 02635
Owner: TOM MEIGELL
Date of Inspection: 7/24/01 '
SITE EXAM
_Slope
_Surface water
_Check cellar °
_Shallow wells
Estimated depth to ground water 10+feet.
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system d''sign plans on record-If checked,date of design plan reviewed: n/a
NO Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Boa-d of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
YES Accessed USGS databaEe-explain: n/a
You must describe how you established the high ground water elevation:
USGS MAPS AND CHARTS-10+'FEET
Y
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No.......q--q--- --- . Fms....�10:,00.........
OZ 0�HE COMMONWEALTH OF MASSACHUSETTS
l
BOARD OF HEALTH
.........OF.......BaMS.table, Mass.
Apphrtttinn -for M-q aoat Workii Ton rnrtion Vautit
Application is hereb made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: J�j 1.17'tm(� (,{�
= :_._-.Cotuit Lot #32 _ '.HIIS,CRST"
----....
SEA LAM CORP:cation-Address P.O. BOX 264, Sian adi, Mass.
•-----------------•------------•---.............---...._....-----'----•-......•......__._......... - -
Owner Address
a ---------NO3=.23ya te......................................................... ........176..M=1 _j$ _Sandwicli....
Installer Address
Type of Building Size Lot......3.8,c=-------Sq. feet
U Dwelling—No. of Bedrooms-------TWO------------------------------Expansion Attic (X ) Garbage Grinder ( )
Other—Type of Building ._------- -------- ------ No. of persons. ---_--------.-----. ----- Showers ( ) — Cafeteria ( )
dOther fixtures --------------------------------------------------- - ---------------------------------------------------------------- ------------------------------
W Design Flow............J�Q-----------------------gallons pp r person per day. Total daily flow.._.._-��j4�--------------------------gallons.
W Septic Tank—Liquid capacity.?"galeW Length_______________ 1_ Width---------------- Diameter-.-_-....--_.-- Depth �,�t.
-----
x Disposal Trench—No- -------------------- Width._._..... �4oxl
Len --- Total leaching area _ft.
Seepage Pit No---------------- -- Diameter.1 - � 1 �- - . Total leaching area sq. ft:
Z Other Distribution box (X ) Dosing tank ( )
aPercolation Test Results Performed by-----AlaII-.hT..-.Jc eS...................................... Date..ApXj1--- 0,.--M....
Test Pit No. I----------------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........--.......------.
P4 ................. --------•------------------------------------------------------.....................................................................
Descriptionof Soil = -f/ ... 9 ----------------------------------------------------------------------
x � f ....,�,�
...-- --- ..............................
-------------
--------------------- --- ............ ------------------------------------------------------------------------------------------
VNature of Repairs or Alterations—Answer when applicable................................................................................................
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------•------ -----------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code— The undersigns further agrees not to place the system in
operation until a Certificate of Compliance has een Issued by the board o ealt
Signed �1-�-- •--- ---------------
�� Date
ApplicationApproved By.......... --•------•--•-•----------•----•---------------•-'-• . ----•-••--•-•--•----
Application Disapproved for t tie following reasons:---------------------------------....-...-•---•------------------------•--•---------•---- Date->...........
•-------•-------•-•'-----------------------------------------------------------------•-------------------••---------------------
Date.
PermitNo.-------•- ------------•---------------•--------............................. Issued...... � OX 007.................................
Date
- Fl�>c....$19...��........
.No..
THE .COMMONWEALTH OF MASSACHUSETTS
,e BOARD OF HEALTH
........ OF.......Barnstable -Mass....................................
Appliration for Bitipotial Workii Towitrurtion Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Troutbrook-.lad;- Cotat--------------------------------- ........ at.#32•_-__nHILT `....--------------------.._...----------
im cowL.cation-Addresssm- P•O• BOX 2641 Ai ty_& , Mass*
•------------------------------•---------._.....__...------...----................................ .•
------......------................. Lo--N------•---•--......-----•--......-----•-----
Owner �+ Address
W ate-----------------------_........................•.... . ........ 7 .St:FS?F�rf._
a
Installer Address
Type of Building Size Lot....... 8,220.......Sq. feet
U Dwelling—No. of Bedrooms-------2iD-----------------------------Expansion Attic (X ) Garbage Grinder ( )
Other—Type of Building _____________________•_.___ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfi�rzt�res ------------------------------------------------------------------------------------------- -------- (too-------------_------------------------
W Design Flow---------------_._____•----........4j,*gal1jSW0r person per day. Total daily flow--------------------------------------------gallons.
Septic Tank—Liquid capacity---_--------gallons Length--__-------- Width................ Diameter_-__...-._____- Depth._.._.___..._.
xDisposal Trench—No--------------------- Width-------------------- Total Length......_------------- Total leaching area--------------------Sq. ft.
;.,Seepage Pit No---------------_---- Diameter---_-______-_-_____ Depth below inlet.................... Total leaching area-____._ _______-sq. ft.
Other Distribution box (X ) Dosing tank ( )
ZPercolation Test Results Performed b Alan_ --------------------------------- Date-.APr?-1 30 1975
Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth`to'und water._____ _____._--
(i Test Pit No 2 .: __minutes per inch Depth of Test Pit.................... Depth to ground water_.•.--..-_________....
#` --•••• �s' v ----- -•-- --------- --
-------------------------------------------------
Descriptionof Soil --------------- -- .......................................................C.4f� .................. -----------------------------------......
c., ....
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 Article XI of the'State Samtary Code--The undersigned further agrees not to place the system in
operation until a Certificate of Compliance Chas.b3 issued by the b rd f health
s
Signed.�,�-^�---`'.----- -------------------------------- ----- --`� -(i'`-c�------------------'�--- ------'-
Date
Application Approved BY----- - r -------•--- ----------- --------- ---- D
' Datt
e
Application Disapproved for Me following reasons-------------------------------------------------•-----------------•.....------------------.........--•--•---••--
---------•---------------------------------------------------------------------------•-•-•............................................................ .......-.........................................
Date
Permit No.-----./................................................. Issued.........................
................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH X �J
.....................................OF........................................ ............................................
h,
Tertifirttt,e of Tomplittnrr
THIS. T�A4TIFY, Tali Dual Sewage Disposal System constructed ( )_or...Repared` (: _r)
by............................. --
y T
4V
at .........
has been installed in accordance with the provisions of.Article: f The State Sanitary Cod •-as�lese . m the
-<
application for Disposal Works Construction Permit N ...._._....__��................... dated -------- ~:___..._. ................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM W1# FUNCTION ACTORY
DATE
Inspector
-----
A.
THE COMMONWEALTH OF MASSACHUSETTSX
►C /.f
BOARD OF 114EiALTH
OF................
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No.........--------........ FEE-------....:...........
inpval�lVarkii �larryi'aitrrmit
t
Permission i hereby granted.........................................
to Construct ( ) or air ( ) an I i idual Sew Di, P al Syr
. .........................--...................................... ---- --------------
-
t a+Street -
_ r.
as shown on the application for Disposal Works Construction mit 'o �'►__ ____ Dated_____ ._.
/ (/ Al
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DATE......� --------------------=---=------<_-:,------•-- -t> =.• `��� oaxd,�
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ,l
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ALAN W. JONES & ASSOCIATES
CONSULTING ENGINEERS
Carleton Drive
East Sandwich, Mass. 02537
Telephone 888-3154
TEST PIT AND PERCOLATION TEST
30 April 1975
To: Sea-Lake Corporation Personnel Present: Paul Murray
Route 6A & Tupper Road Norman Ayotte
Sandwich, Mass. 02563 Alan W. Jones
Re : Lot #32, Trout Erook .Lane ; Test Location: 95' into lot from
Hillcrest Trout Brook Lane
Cotuit, Mass. layout
000" Ground surface
110" TO Soil
210" Sub-soil
Loose, medium to coarse, .
yellow .sand; trace
gravel and small stone
L
N OF
�FP s 12 1 O"
� h
{x _iz AN No water encountered
o Majiy Assumed Percolation Rate:
I o 100 1" drop in less than 2 min.
/STE
Water levels indicated, if any, are those observed when test pit was
excavated and do not necessarily represent permanent ground water levels.