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Home My WebLink About0400 MARINER CIRCLE - Health 40 0 MARINER CIRCLE, COTUIT 0A= 86 i �I i TO WN OF ARNSTA LE LOCATION ` a. All aAAW 3EWAGE # F9- 1 y 2 VILLAGE �' ASSESSOR'S MAP & LOT 070-4 - 0f5'4, INSTALLER'S NAdE & PHONE NO. SEPTIC TANK CAPACITY O .cam LEACHING FACILITY(type) (size) NO. OF BEDROOMS -3 PRI`JA T E.WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED-' VARIANCE GRANTED: Yes No r � � \ � �� // l .. \ L�� 8 � '�s' � / Z � I . . / � ��` � � �� '\ i o � � o Y/6 F.Ric $.....2 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town Barnstable --- ---.-- OF......................................... A;iptiration for Bhipaas al Marks Tomitxnrtiaan Vatuff Application is hereby made for a Permit to Construct ( ) or Repair NXX)Xan Individual Sewage Disposal System at: 400 Mariner Circle Cotuit ----------------_----•----...................................................................... .......---..._...------------------•--------------.._...-------------------------•----------••••-- LOeVugfison or Lot No.Robert F • ....--••......................................•------•------•-••---•--------.._.._...--•---....--- ................•••-•-•-•-------•-•....------------........•--•---•-........_.._......-•----.. Owner Address a J.:_P a.g.Q 1 bex....Jr..........................•........... ---....-•--•••-•--.........-••--••-•--.._..................•--••-•-••------••......--•--••..--•- Installer Address Type of Building Size Lot____--•____________________Sq. feet Dwelling—No. of Bedrooms-__..._3..................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ... No. of persons............................ Showers — Cafeteria PaOther fixtures ..................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. -__----•_---•-.__.__ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box.( ) Dosing tank ( ) 1-4 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---__-_-__--_---_.---..- Q+' •-•----•••--•••-------------••----••--•-•-••-•--••--••••••--•-•--•-------•-•••--•----••••-••-•-_............................................................. 0 Description of Soil...............................................S.axid...............:.............................................................................................. x U W ----•-•--•------ ------------•---..........•-----•-----------......-•---•----------•---•••--••-•--••---•-------•----------•------ --••-••--••••-----•-•-•••-•-•-•--••-----------•-•--•---•-•--•----_.... UNature of Repairs or Alterations—Answer when applicable-----------------------------•-____---_-_------___---_--_---_--.-.-.--.__---___-•---_---_---_-. 1-1000-•-ga11on_..leachin0_..l?. t..... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ii;`. p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by e and of heal .. `---------------• --•-•• Signed 3 2.1.18 9: Date Application Approved By------------- 5 "'� --g- .`. ...------ Date Application Disapproved for the following reasons--------------------------•-----•------------------------------------------------•---------------------•--------- ..-•-•...•••••••----.....-••-•-•-•-•-•--...-•--------------•.............------••-••---------•-••--•---•..._....•-••••••--•-•----•••-----••-••--••-••-••-••••--••--•-----...-•--•---------------•-....... Date PermitNo.---- .' -----------•----------- Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a Uc,n Barnstable .....................-----................O F..........:........----------........ Aplilira#iun for Uiupuual Works Tome rurtiun untit Application is hereby made for a Permit to Construct ( ) or Repair)IFI)X an Individual Sewage Disposal System at: ' 400 Mariner Circle Cotuit ..._.......... ...•••--..........•----•-•---•....---•••----------...... -------•--•-•••-••---------...........-----...------.........----..........-----•----------_...•. ................-- -- Robe::t Loc aoLln .�Z`ar�o or Lot No. ............. .-•------••-•...._........................ ............._......-•-----•---•----•-...... ........------......_...........-----•--- Owner Address C'.r a �.P. c±. err Jr ..------•-•---•----------------------•---------•---------.........-------•----•-----•----•-•-••-.. ..............•--•-------------------•-----................_...---------•----•--......--•-.---•-- Installer Address Type of Building Size Lot............................Sq. feet t U <<Dwelling—No. of Bedrooms........a..................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ....................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank,—'Liquid capacity............gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------- Date........................................ Test Pit No. I................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........................ 94 -----•-•--------------------------•-• ...................................................................................................................... D Description of Soil--------------------------------------------- aand .....--•-------------•----------------------•-------------•-----------------------------------........_..••--- V ...............................................................................................-----•------------------•----------------------------------------------------...---•-•............... UNature of Repairs or Alterations—Answer when applicable...._ ._____..Y._Y.�_._____Y�_----- ,--__-,_----___---- A................... .................................................................................................................................. 1..00 _t...... ......- ....«t,......>. Agreement: The undersigned agrees- to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTi p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issue b/he board of health. ' 4 3 Y.y=' 8 Signed Date--------------- ------------------ Application.A lication. Approved B 1 -----• _-_- Date ` Application Disapproved for the following reasons:-----•---------•----•------••-------•-------•---................... ........................................... ---•-•--------••-••...........•-••-•-----...-•--•••---•••-••-----•--•----••--•-----------•...••-----•-----•----•------------••----•--•-----•----•--------.............................................. Date PermitNo......t_.a =--•L.V:n.---------------------- Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............`l`C.,�,nBadnstable O F..................................................................................... �p�ifirtt#r of- �unt�li�anr�e THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or RepairedY(X) J.P.Mac-utmber ,$r. by_---------- --------- 400 Mariner Ci rclo Cotri Et Installer at..........................................................................•--......---...-----------•---•-•---••--------•--•---•••---•----------•-••--•-•••-•••••••••••......-------------••-.....•. has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ - .?. ........ dated.----------...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEWI WILL FUNCTION SATISFACTORY. g DATE....................... s ----------------------- Inspector------•----•... �---�--- •----.........---- . ._,. ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .................................OF..................................................................................... FEE._$....2 0.:......00....... Disposal 10orkii Tuqutr iun amit Permission is hereby granted......`. ' 1•R�COItl..?r ..g to Constr c 0( NY�i L 1 Pf irC Y an. I vbi I Tta Sewage Disposal System atNo-----------------........................................................................................... •---------•-•---•------------••------•---------•--••••......•---....--•••.......-- Street ppG� as shown on the application for Disposal Works Construction Permit No.D-„y:12 __ Dated.......................................... -----------------••-------------------- ..............................................._ (Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS f Commonweanh of Massachusetts I Executive Office of Environmental Affairs Department of Environmental Protection Wllllam F.Weld Trudy x@ Gorrtwr Argoo Paul Celluccl David B.Struhs LL Gommor + C.0.�r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 400 Mariner Circle Cotuit,Mass . Address of Owner Date of Inspection: 4/8/96 (If different) Name of Inspector: Joseph P. Macomber Jr. Company Na.ne,Address and Telephone Number. J.P.Macomber & Son Inc.Box 66 Centervi•lle ,Mass . 02632 508-775-3338 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: JG Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's S[gna t "�' Date: The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner And copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BI SYSTEM CONDITIONAL.L•Y PASSES: Z/6�_ 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, crackod, structurally unsound, shows substantial infiltration or exMtration,.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 11/03/95) I One Winter Street 0 Boston, Massachusetts 02108 0 FAX(617) 556-1049 9 Telephone (617)292.5500 • a DATE:_'�*�8/96 i PROPERTY ADDRESS: 400 qA";; r P r;rnl a RECEIVED 'Cotuit,Mass APR ? 5 1996 'b263 Z.. _ - HEALTH DEPT OF EARNSTA6LE On the above date, Inspected se I Ins cted the septic stem at the above address. p Thls .system .consists of the following: 1 1"=1'00 - gallon septic. tank 2.. T-D4_stribution box.. 3• 2.-1000 .gallon leaching pits: . i I Based bn my Ins.naction, I certify the following conditions: 1 . This is- a title five septic... sys=te_m- (• 78 Code' 2:.. The sy eptic• system is in. proper workilrg o •dux• -at the present time . I . i SIGNATUR!7 G �( Name:_J_P_M_a'comber Jr._______ COm an J.P.Macomber & Son- Address:_.ge�c_bb------3-- -- I; Centerville LMass__0.2.632 ' •• THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JO]EH . MACOMBER & SON,. INC. nks-CestpoolrLeschilelds Pumped & Installed own Sewer Connection: P. 6' Centerville, MA 02632-0066 i 77.5.3338 775-6412 J3� M d.h• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Adams' Willis Owner. 400 Mariner Circle Cotuit,Mass . Data of Inspeotion: 4/8/9 6 B]SYSTEM CONDITIONALLY PASSES(continued) �IQ Sawage backup or breakout or hA static water level observed in the distribu�a been if with broken due to revel of the Board of or duo to a broken,settled or uneven distribution box. The system will pass pectic ( approval Health): 1 . broken pipe(s)arc replaced „ obstruction is removed distribution boi is levelled or replaced . The system required pumping more than four times a,year duo 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 RE@UIRLD BY THE BOARD OF HEALTH: N v Conditions exist which tequire 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 ENVIRONMENPt �R Cesspool or privy is within 50 feat of a surface water Cesspool or privy is.within 60 feet of a bordering vegetated wetland or a salt marsh. Z) 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 water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. , The system has a septic tank And soil absorption system and is within 50 feat of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 60 feet or more from a private water supply well,unless a well eater analysis for coMrm bacteria and volatile organic compounds indicates that the well is free from pollution from that iacillty,and the preseace of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. 3) OTHER i (revised 11103/95) z • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddreas: 400 Mariner Circle Cotuit,Mass . Owner. Willis Date of Inspoctlon: 4/8/9 6 • D) SYSTEM FAILS: • • I have determined that the system violates one or more of the following failure criteria as dalned in 310 CMR 16.303. 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. AD Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or rurfam waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. w Liquid depth in ewspeei-is less than 6"below invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(,). Number of times pumped _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. j Any portion of a cesspool or privy is less than 100 feet but greater than 60 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: 'r3 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: A the system is within 400 feet of a surface drialdng water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply wall) 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 6.00 and 6.00. Please consult the local regional oMce of the Department for Aut}er information.. (revised 11/p3/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 400 Mariner Cixcle Cotuit,Mass . Owner. Willis • Data of Inspection:4/8/9 6 • Chock if tha following have boon done: ,Pumping information was requested of the owner, occupant, and Board of Health. /Koas of the system components have been pumped for at least two weeks and the system has boon receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspoction. 2m built plans have been obteined and examined. Note if they are not available with N/A. -,6`ha facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow - The site was inspected for signs of breakout. All system components, Ucl uding the Soil Absorption System, have boon located on the site. , The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffios or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has boon determined based on existing information or approximated by non-intrusive methods. Tha facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub. .Surface Disposal System. (revised 11/03/95) 4 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddr•ess: 400 Mariner Circle Osterville ,Mass . Owner. Willis Date of Inspection: 4/8/96 FLOW CONDITIONS RESIDENTLkU • Design Slow: ns pw^c��l • Number of bedrooms: Number of current residents Garbage grinder(yes or no): 4 Laundry connected to system(yes or no):)�3 Seasonal use(yes or no):/ a S Water meter readings, if available: n- ys Last date of occupanry:L COMMERCIAL[INDUSTRIAL. Type of establishment: Design!loss:,�,�gallons/day Grease trap present: (yes or no)a Industrial Waste Holding Tank present: (yes or no)—o Non•aanitary waste discharged to the Title 5 rystem: (yes or no)A Water meter readings, if available:_ AL Last date of occupancy: OTHER:(Describe) f Last date of occupancy: GENERAL INFORMATION PUMPING ORD and so of info on: nsei System pumped as part of ins ion: (yes or no)i Jo If yes,volume pumped: ons Reason for pumping JA TYPE F SYSTEM Septic tank/distributioa bcx/soil abscrption system Vo Siagis cesspool VOverflow cesspool Privy d Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) f4►PP TE AGE of co ponents, date installed (if known) and source of information: I�/P�l1 .�'�Y � �� <Ci(• Sowage odors detected when arriving at the site: (yes or no) � (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontlnued) Property Address: 400 Mariner Circle`.Cotuit,Mass . Owner. Willis Date of Inspection: 4/8/9 6 • SEPTIC TANK/ • (locate on site plan) Depth below grads.0 Material of construction: concrete_metal_FRP_other(ezplain) Dimensions•' ` '/ 6 ' Sludge depth.- Id Distance from top_of sludge to bottom of outlet tee or bafle;_ Scum thickness:f2 A6 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:/rr�Gfi Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,de th of ' level in relation to outlet invert, ,,r�1 integrity, evidence of leakage,W.)- PUM tank ever 2-3 ears •inlet & outlet tees are in place ; Septic tank no signs or iea Septic tank is s ruc urn y sounZI. u Pen oSters be raised on the tank and dis ri u ion box. GREASE TRAP: We- (locate on site plan) Depth below grade:-l2& Material of construction: ooncrete_metal_FRP_other(ezplain) AA Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or be A Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet teen or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address: 400 Mariner Circle Cotuit,Mass . Owner. Willis Date of Inspeotion:4/8/9 6 TIGHT OR HOLDING TANY-J bVe. • (locate on site plan) Depth below grade..&A Material of constiuctiou:4L-concrete_metal_FRP_other(explain) 1R - A3A Dimensions: it7fl Capacity: 10A gallons Design slow:&jd__gallous/day Alarm level:_ Comments: (condition of inlet tee,condition of alarm and float switches, etc.) A)e C�it t.wl��ll5v DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) Distribution box is level with equal flow;No Avidence of enl ; ds carry oyer;No PyldPnnP of laakagP in nr nullf :LhQ box- CG*or- on PUMP CHAMBER (locate on site plan) Pumps'in working order:(yes or no),�1I . Comments: (note condition of pump chamber;condition of pumps and appurtenances,etc.) ,I/d Cc m.ifVT S (revised 11/03/95) 7 SUBSURFACE SEWAOr DISPOSAL SYSTEM INSPECTION FORM SYST::'.! 1.—:': (ooutinuod) Property Addresat Owner: Date of Inspocttons . SOIL ABSORPTION SYSTEM(SASN-Z •t . Oocau on sits plan,if possibls;excavation not requb*4 but may be approximated by non•iatrusiw methods): ,.,>.• j, If not determined to be present,explain: 1sachinY Pits,number? lasahing chambers,number, o k&C111n galleries,number.. (7 leaching trenches,number,length leaching Salds,number,dime ions overflow cesspool,aumberMT Comments:(note condition of soil,signs of hydraulic failure 1-w'! cr condition of ve tatio etc.) Soi1:61 loamy sand to dead sand; No_ signs of hycfrau�ie laliurenor eve of ponding;All vegetation is normal - No • repairs are needed a +.rA r,raeant, time _Reported leak coming from house'. Leaky faucet CEssPOIr w ta closet" on 'the toilet. _ (locats on site plan) Number and configuration• il)14 Depth-top of liquid to inlet invert: Depth of solids lgysr. Ala Depth of scum Dimensions of cesspool: Materials of construction: Il IndiCation of pwadwater: inflow(cesspool must be pumped as part of insyect;z:! II Comments- (note condition of soil,signs of hydraulic Wvro. l„•^1 c'- condition of vegetation,etc.) PFtIVYt 11�b�"� • (locate on sits plan) Material of oonstructl= .4�/� --- Dimensions: Depth of solids: Co :(note condition of soil,signs of hydraulic failur,•, ,., a of vegetation,W.) ��i . .. (revised 11/03/.95)• 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) 4 PropertyAddrosa: 400 Mariner Circle Cotuit,Mass . Owner. Willis Date of Inspection:4/8/9 6 V SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100, Cotuit Water Company 428-2687 . 6 `\ -0 ` \ Sl fl / � loop • DEPTH TO GROUNDWATER Depth to groundwater. L 6' +feet method of determination or approximation: I n s t a 11 e d n e w l e a c h i n Z i t 3/31 /8 9. No Water Annountered 12 ► Tnstg1 j ed her T P Mar.nmhar Pf :4nn Tre _ , f1ng-225-333R (revised 11103/95) 9 STREET ADDRESS 400 Mariner Circle Cotuit,Mass . ASSESSORS MAP , BLOCK AND PARCEL # OWNER' S NAME Ken Willig PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr.. COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street ToNn or City State LIP COMPANY TELEPHONE ( ) FAX ( ) 508_-=-775 3338 508 790 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .-inspection . Tile inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : XXXXXXXSysteui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature / Date 4/12/96 One copy of this ert.ificaticn must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * It the inspection FAILED, the owner or "operator shall upgrade ' the system within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CPIR 15 . 305 , partd .doc Q_Sj . ...c �.. S f z aft soh[ 3r�� THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ' -ion of Water Pollution Control f LOCATION y SEWAGE PERMIT NO. VILLAG INSTALLER'S AIR i ADDRESS �6 \ ® U I L D E R OR 01N DATE PERMIT ISSUED �'� 7 DATE COMPLIANCE ISSUEDp /�; _ ��r wt b1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................:.oF...-.-R ................................. Appliratinn for Disposal Works Tonstrur#'inn Frrutit Application is hereby made for a Permit to Construct A or Repair ( ) an Individual Sewage Disposal y System at: �- �- 'G'�-•� ....... .. .... ..�?�% .:. ,..... .�� ........................ .-•-------.........-----.......-----•---- 1 - ss 1 or Location- ner Ad W ..... r Installer Address d Type of Building Size Lot__4 ..Sq. feet Dwelling—No. of Bedroo -__________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building No. of persons...........4'-�............ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------•---.._...----•---.•-••---•---••-••---•-•--•-------------------._.....-••........--•-•••••...........-•......._... W Design Flow........ '......................gallons per person per,,day. Total dai3 flow-----..53.0..............::__.___gallons. WSeptic Tank—Liquid capacity/ll"06._gallons Length.--,7....... Width.___........ Diameter________________ Depth................ x Disposal Trench—No. .................... Width ...................... Total Length.................... Total leaching area....................s ft. 3 Seepage Pit No......../--------- Diameter_________ _________ Depth below inlet...7!.. .... Total leaching area. 4 Z Other Distribution box Dosing to ( ) ® Percolation Test Results Performed by_____ _ Date_ _sA_ _____ .............. Test Pit No. I________________minutes per inch Depth of Test Pit._.___.....__.a p p Depth to grown water_._��._. ri, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_;_ ............................--•------------------- O Description/pf Soil_._____ ... . w - ------•-----. ----- -------------- ------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------•••••-••-••-•--•-----•••-- V 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 TLITLE, 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 d of health. Signed tip.._ .. ... .__........ j ate Application A" roved B a Date Application Disapproved for the following reasons________________________________________________ ..-----•------------------------.•.................... --------------------------------------------•-----....----------.._..._......----•-•-•-----•---.._...------....-•---------------------------------•--.. .............................................. .................... V ��.re/ f.f t • .. No.........1. .. e F�s. ....�.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r.�1,.1f.._.................OF.......Ift�.:.......:! - ApplirFation for DiiposFal Vork.5 Tonitratrtion Prrutit Application is hereby made for a Permit to Construct (, ) or Repair ( ) an Individual Sewage Disposal System at: � .............�._........... --.........,........._.......-----.................•-•--r------ --•-•••-•-•_•_.... .......................--•--•-••---•--•-•---.....-•--•-----..............._. � Location- ss Addre or Lot,No.....rf, .... , . , i,r ---�' Owner Address 7 Installer Address Type of Building .� Size Lot..........................Sq. feet Dwelling—No. of Bedrooms.........`J.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building./. xlf �...... No. of persons..........2�!............. Showers ( ) — Cafeteria ( ) dOther fixtures .. ------------------------------......----------------------------------------------....----............._..................---- W Design Flow......... ................................gallons per person per,day. Total daily flow..... _ ....................gallons. Wx Septic Tank—Liquid caPacity_� ._gallons Length______________ Width...�., --••-•• Diameter................ Depth................ Disposal Trench—No..................... Width........_ -- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../.......... Diameter........ ...... Depth below inlet...Z. . ....... Total leaching area..,...............sq. ft. Z Other Distribution box Dosing tank aPercolation Test Results Performed by...... l%......'� .t_._. ..' ..........�...-_ Date........................................' Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.._.................wl. LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water. .............. � � Q+' •••-----•-••-----------•-----••--•••--•-•-•--•-•....•••...................••........._....-•----..._......................................................... D Description of Soil..........................:.......... - -----------------------------------------•-------------------------------•------------•--------•---.--------------•-•----•-•--- 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 TILT`.` p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. �r Signed_....:-' `� > t , . .1. t -----•------- ----•-•-- ! Date ApplicationApproved By......................................•-•••--•-••-••........-•--•-•---•...........•-•--•-•-•----- " Date APPlicition Disapproved for the following reasons----------------------------------•---------......_._....--------•---------------•--••-••-•--•••--•--4--_ .................•-•-•-•-••-•.......................•••-•---•................-••----•........---•-•........ _:ea......................... Date PermitNo......................................................... Issued.•................................•--..._...---...••--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH //+f 1 O F........ ..................................::....................................... Trrtifiratr of TompliFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (x) or Repaired ( ) 'f - by.. ......................_...:.� r.� --------------••---•••---•.......--•--•--- ......................................................... ` Installer t :. �......:1.`. ./I :..r_rya /f. ... has been installed in accordance with the provisions of � , j of The State Sanitary Code`a described in the application for Disposal Works Construction Per'mit:N...46 y ----------------- dated .; .._.__.t"y_-._.............. THE ISSUANCE OF THIS CERTIFICATE SHALL-NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL F TION SATISFACTORY. DATE................ �•d_... ...... ._•. ..............•-••- Ins pector............ .. ..._.----------------------- THE COMMONWEALTH OF MASSACHUSETTS �. BOARD OF HEALTH .....................OF.../........_...:..::P`...._... ...:.:...._......................... No ....•..... FEE.u41'd Ropmul Works Tonitrudion_ .rrutit Permission is hereby granted........ 'r .l,! / , .:r /�"rf -- -----••-•-•••-••.................• ---•••---•••---••••••••. to Construct O or Repair ( ) an Individual Sewage Disposal System PP P � Street " f1 .��* as shown on the application for Disposal Works Construction Permit o.......... _. D d... .................... ............ �j DATE........le. ...........r�.....................•--....---............. oar o It.............................................. t s.,. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - F. FL. ELEV.=�1+� -- FINISH GRADE +fGt- FINISH GRADE FINISH GRADE TOP . FOUND. OVER TANK = Gd#So OVER PIT = 4K"►*11 ELEV. _ no,�o C.I. + ' `C CHIMNEY BLOCK 4r� V.C. WHERE NEEDED BACKFILL 3' PEAS TONE DWELLING -: -- -- ____ __ ---- — 411 CELLAR FLOOR 10(:3 D ° 0 1 0 e GALLON . , . c '' d o 0 0 O O of 3/4" TO I-I/2�i ELEV. _ _ REINFORCED GONC. , o O O O o CRUSHED STONE O o a MI ° O O ar .� e �, o o o O O o ` ° " � a _ DIST. BOX � o 0 o d v ? O e A O O� O 0 C XI O O o �- (TO BE LEVEL o a ° ° O O O o °' d SEPTIC TANK —� Q 0 0 O 0 o D \� BOTTOM OF PIT AND STABLE 110 O O O o ° If, Q l/ ELEV. - Off SYSTEM PROFILE M7 > ' NOT TO SCALE) DESIGN CRITERIA LEACHING PIT � NUMBER OF BEDROOMS = 3 �S GALLONS PER DAY 3.'_>o t c�G ^ 1iznKltr►1 F? ri"GARBAGE GRINDER =_—_ 1�}Ci�•.��s '� ,� TOTAL DAILY FLOW = — ---''_ _3� � ,.. ° i •, �,,01`13,�s LEACHING AREA PROVIDED = U,v « - I S� p&woAsL` Al2-4 06. 2,c 7r x d '7. 25 G X t _ 45' 6;1 _ t�1'7 TT'O Mi t�-thy L X O v Q4. -P -E SOILS LOG 011 ELEV. _ f- Ldb•�_ _J f ! r 77P ! �c..F SC.d Lam' 40' Lx A,M Sv65�U► L � � 141Es01 c� PROPOSED SEWAGE DISPOSAL SYSTEM !NSPEGTED BY: EAU( _ M I rye t. / PROPOSED DWELLING DATE ?A0.,45 LLk? (C-CTOI T MASS. — PERGOLALJ,$,A�• NIN. INCH -- -.- - - ----- SCALE AS NOTED DATEr�T ' ,� -...,,�21N.�1F.Q_BY�E[_�A� �c�Z �.�. �,, .c_.T� � TIZCJs'1`• �� N o`,,"�� '� 24Gf>1 . •T 7Fa 0Lz 1 — Q•F. Z NORMAM r .G t A GRt1S5 AN NORMAN GROSSMAN PE., — L_)('Y T, �C.lE..V fti.T� C,J r.� �' T+� t,�• R.L.S _Fft� :k?' C: ►J (rare c3 0 �� p ,�� 226 HOLLY POINT ROAD L::j,- :rM t, �„ �j fig,,.,,��,�.r».�� S3t C.��` C E N T ER V l L L E, MASS.