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HomeMy WebLinkAbout0361 POPONESSETT ROAD - Health 361 Poponessett Road Cotuit R A = 019 117 i TOWN OF BARNSTABLE � LOCATION 3l0 dpea�r3S��� �7J SEWAGE #, 04P-/ VILLAGE ASSESSOR'S MAP & LOT -7 INSTALLER'S NAME&PHONE NO. Jr&,1,1 ,- Ca V/"Y/ S�4-Y53 C SEPTIC TANK CAPACITY /f'�411 /4Z LEACHING FACILITY: (type) -77v-"'71-oo4n7t C S�_ (size) //,K 39 i .2 NO. OF BEDROOMS BUILDER O WNER PERMITDATE: 3 dd - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ��`' Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 4/v4, G�ik✓w�as _­_., 00 No. FEE COMMONWEALTH Of MASSAC14USETTS 2 Board of Health,�1{( ra$-('G, � ,MA. (cu-�C)t f� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepairkUpgrade( ) Abandon( ) - "Complete System ❑Individual Components Location -IQOwner's Name 9443 U 7i Map/Parcel# Iq — ZZ !7Address ` 53 .0 Roce Lot# ' Telephone# N tf P A,t y ZS�3 Installer's Name ° C Designer's NameWEIRRY ENGINERIN6 ASSWIA` ES INC. Address ,©t �� Address County oPlYMP1011, MA ' 367.7 Telephone# {� f Telephone# 781-585-I I K4 Type of Building !J(A,�I I�Vi cw Lot Size Zq&j/ s ft. 9• Dwelling-No.of Bedrooms y nO Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures ,� Design Flow (mi .re•uired) �f(1 gpd Calculated design flow� Design flow pro d 4 k gpd Plan: Date 1 �CI (� Number of sheets Revision Date /;ide O� Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluatiom,lkl H Of k4 DESCRIPTION OF REPAIRS OR ALTERATIONS f C 11 R I'STOPHRR RACKA, 1 . `^ � CIV The undersign ees install the above described Individual Sewage Disposal System in accordance with �P t `and further agre not to lac a operation until a Certificate of 711M a has been issued by e' or'd'ofw i ealth., 7Signed Date �-� 170 Inspections No. +1 f Board of Health, r}Y`Y�S�Q R7�(� �' CJ(tJl � a ' APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT J Application for a Permit to Construct( )'Repair( Upgrade( ) Abandon( ) - '*1omplete System ❑Individual Components Location Q Owner's Name 6 Qy ci PA U(,A MA e 7/27 Map/Parcel# D 9 +' Address 53 In"I/ Oce- Lot# S$ Telephone#.`� jJy1 U;Me ilJ if 9 Installer's Name � Designer's Name N ` ASSOCIATES, INC lau Address ,(�♦ ?U �G ('S Address P1ylTlplt)tl, MA.Q?3g7 Telephone# Telephone# -585-1164 {� a�Type of Building J(A 1Q I I I VI cw Lot Size 2U e/ sq.ft. Dwelling-No.of Bedrooms y )b Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (mi .re uired) gLlU gpd Calculated design flow 14 O Design flow pro `1 ided 60 gpd Plan: Date �Cj 0 Number of sheets Revision Date Title Description of Soil(s) { Soil Evaluator Form No. Name of Soil Evaluator we Date of Evaluati lSH OF 11 %k,,_,,T DESCRIPTION OF REPAIRS OR ALTERATIONS 1O1-1I� VERACKA N0.2523 The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with d further agrees o not to, lac ` e s sy t m-in-operadon until a Certificate ofColnplian a has been issued by a oa Signed Date Inspections ,. No. FEE COMMONWEALTH OF MASSAC14US ETTS Board of Health, GYVI.Sf C,�Je MA. Co- ulf� k CERTIFICATE ®F Description of Work: ❑Individual Component(s) ❑Complete System The and igned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired Upgraded ( ),Abandoned ( ) -by: r4i ua, �c1Y1S at d e has been installed in accordance with the pl)rovi ions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to, application No. date U Approved Design Flow (gpd) Installer i Designer: Inspector: "V" Date: �Q r' The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. ^//Z/- FEE Board of Health,)ZO Gib , YM. (Cd-1�J DISPOSAL SYSTEM CONSTRUCTION PERMIT Permiss�io/n`isf here�(bpn)op granted to; Construct( ) Repaie UpgradeO andon( ) an indi-,idual sewage disposal system at Jl 1 as described in the application for Disposal System Construction Permit No. dated / Provided: Construction shall be completed ' hint ree years of the date o t mi All local conditions must be met. ! RForm 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Dat oard of Health ' q { TOWN OF BARNSTABLE 'c LOCATION _ 36/ �a�P�a�rJ Apt � l SEWAGE # VILLAGE_ ( ASSESSOR'S MAP&-LOT � INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /J'rxr G,4c 'B 4- LEACHING FACILITY: (type) NO. OF BEDROOMS (size) /J X 3g iza BUILDER 0 WNER PERMITDATE: 3—ad COMPLIANCE DATE: 3—:Z7—o:2 , Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and LeachingFacilityFeet on site or within 200 feet of leaching facility) any wells exist Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leachingfacility) . iLty) ---_ . Furnished by Feet 00 i I FORM I I - SOIL EVALUATOR FORM Page I of 3 No, Date: Commonwealth of Massachusetts 3qr n5�0�j , , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: .. 5*. Date: WitnessedBy: ............I.J:Ae.......................................... ....................................................... .......................................... ..... ........ ............... Addruc,ud Co+U Tck$*m/ y rxUu7J L ew Construction El Repair V `' Office Review �I Published Soil Survey Available: No ❑ Yes Year Published 9>9.......... Publication Scale 1:z0,OC4•... Soil Map Unit G,�................ DrainageClass ( ...........:. Soil Limitations .s1!3.1 .4.................................................................................................. Surficial Geologic Report Available: No ® Yes ❑ Year Published Publication Scale ...� GeologicMaterial (Map Unit) ............................................................................................................................................._.......... Landform .............................................................................................................................................................................. .................._......... Flood Insurance Rate Map: •Above 500 year flood boundary No ❑Yes ,9 Within 500 year flood boundary No Pies ❑ Within 100 year flood boundary' No �es ❑ Wetland Area: National Wetland Inventory Map (map unit) ............................................................................................... _.�...._.... Wetlands Conservancy Program Map (map unit) .................................................................................._............. Current Water Resource Conditions (USGS): Month -- Range :Above Normal ❑Normal OKelc�v Normal ❑ Other References Reviewed: DEP APPROVED FORM•12/0710S f i FORM'11 - SOIL EVALUATOR F RNI Pagd2of3 �/ Location Address or Lot I40. On-site Review / Dates,q Ij q�ol Time:.. Weather Deep Hole Number _ ... _. Location tide ity on site plan) tfu�.x..�.�ls��'•• �� ��` •" " '"" ,,.. .:. ., .. (%) Surface Stones Land Use Slope Vegetation - IV4r)00 ...... ... . _. . Landform Position on landscape (sketch on the back) Distances from: feet feet Drainage way Open Water Body property Line ..�. feet Possible Wet Area ... feet Drinking Water Well feet Other DEEP OBSERVATION HOLE �.OG� Other Depth from Soil Horizon Soil Texture Soil Color $oil Gravel) (Inches) • .(USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % IZ 20 �oou 12,0 7/y sand DepthtoSedrock: Parent Material(geologic) �rMP Weeping from Pit Face: Depth to Groundwater: Standing Water in the Hotel -- f Estimated Seasonal High Ground Water.------------� DEP APPRo\,XD roltA1.1210719S ' • 1 t FORM-11 - Soil. L•VALUATOR F0101 Page 3 of 3 Location Address or Lot No. J ' Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole.. inches ❑ Depth to soil mottles inches AO ❑ Ground water adjustment ..%J. . /0. feet Index Well Number ................. Reading Date ................. Index well level ......... . .. Adjustment factor ................... Adjusted ground water level .................................................. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on 4/95 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CM 15.017. Signature Date WEBBY ENGINEERING ASSO CIA TES. INC. Civil Engineers & Land Surveyors 180 County Road - Plympton, MA. (781)-585-" UEP APPROVED FORM•1:107/9S '- FORM 11 -'PEACOLATION PEST, Location Address or Lot No. - -- COMMONWEALTH OF MASSACHUSETTS Massachusetts (CO40 1��'� Percolation Test' Date: Time:, Time:. Observation Hole # Depth of Perc ri Start Pre-soak End Pre-soak' Time at 12" C n/ P.s Time at 9" Time at 6" - Time (9"-6") Rate Min./Inch Z�M))hCl . Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ .............._r._»__._ --.... ...�. .....». Performed By: Witnessed By: Comments: .. . ..... . . ._ _... .._..�_ .. .. ..._. .........� ..... . .... . ..._._. .._ .._.. . ' nv w•r�o��row.+•Nro�ni • IT --.r- tf ra. . 5+" x c - _ = __.. tieV�ePtic Instl gectof _r P O. Box 2119 �Departntent _off. - _ :Teati&et-.M-A_0 536 v r n mental Protection sE. - -.�""` - - ,:,s..=,:a= '�---�.-.��"- -:%.�- .._..�'�-"'�_.�.,.�.- "�z-�'•_ .�` �'�"�<� :3se�v� - �..,�' -sue:,".; . — _ SUBS111KIF F_`SEWAGE DISPOSAL SYSTEM INSPECTION FORM 60 CERTIFICATION u ' y d fin. Property Address: 361 Poponessett Rd. Cotuit- Address of Owner. Date of inspection:10121196 (If different)• Name:of Inspector:John Grad'' '4 John Coughlin.60 Solder Brook Rd.'Wets l Company Name,Address and Telephone Number 5 ' R s .' CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate cand:clomplete^as of thetime ofrinspection. .The inspection was,performed based on my traming'and,-experience in.the pro.per.function,and r. maintenance of on-site sewage disposal,systems T;he.system: - £ X_`' Passes _ Conditionally Passes NeedsFurthj6r valuation By.thelocal Approving Authority Fails Inspector's-Signature: a, Date: '1inne The System Inspector shall submit a copy of this rnspection report to the Approving Authority within thirtyp(30)days of completing this inspections. If the system is a;shared`system or has'a design flow of 10,000 gpd orgreater, the inspector,and thesystem 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,Q .or.D: .` s r 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 B] SYSTEM CONDITIONALLY PASSES One or more system components need to be replaced or repaired. The system;upon completion r 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,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 Soacd.of,Health. (revised 11115195) One Winter Street. ,e Boston,Massachusetts 02108 . FAX(617)556-1049 • Telephone(617)292-5500 r, 4 --- ,..�' x�.��`- ,#` "- �- •e-'c` ,-.r °^ ° -L,,, +..s�T C4 `- - - — r`�,.F,. "..:.' h..3 "� ti '"r' zex, ,.v �'-_„: � SUBSURFACE SEWAGE-DISPOS,AI SY-STEM INSPECTIONJFORM � , `" _ Ei�C,�LO�Ec4ait�lA.w a �z- .�- r�-_-�— -�•-� ' Z. s ^+;4 �"-�e^•&+�'+u.' � _ .�'"�"++. �-� � CAA.._ c?e`— .x_"rn * s. - .,.--- ---+. .fd-�.r�'`_ _ ..;�.•-�-a� _ �",.--r ..--ram,rx. ` ,. . �,_•_ � __-� .ITT �_ r � m Property Address 361;PoponessettRd..Cotuit " V k Owner John Coughlin 60 Bolder Brook Rd Welsery 6a#sotns action -7ol2t19B _ -- - •FOr e __ ��a-- - l�@-f0-a�6FA C{�ik9F3, F ._� " �°� � -_�- ettfeQe+_e�_t � R0e sys assnsp� oar -- "� w - - disteibution:box Is:leveled or.:replaced' , � `" „�; , '` - The system required pumping more than four times a year due to broken;or obstructed pipes) The.: system will pass=inspection if(.with approval-of.the Board of Health): broken;pipe(s)are replaced $ obstruction isremoved x. C] FURTHER EVALUATION 1S REQUIRED''BY THE BOARD OF HEALTH. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public..health,,safety and the enaironment: 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING,IN A MANNER WHICH WILL PROTECT THE PUBLIC,HE_ALTH 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 s stem has a se tic tank and soil absor tion syste y p p m and is within.100 feetto a surface of water supply or tributary to asurface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil'absorption system and is within 50 feet of a private water, supply well: _ The system has a septic tank and soil absorption system and'is less than 100 feet but.50 feet or more from a private water supply well, unless a.well water analysis for coliform bacteria volatile organic compounds'indicates that the well is free from pollution'.for that.acility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm: - 3). OTHER D] SYSTEM FAILS: 1 have determined that the system.violates one cr 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. _ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to.the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 1 III 5195) 2 . Y ke�k";�'r t °'% �' _.`�tlk OR SUBSURFACE SEWAGE'DISPOSALSYSTEM_ INSPECTION fORM t -- a y PART A J r 7 r ' 70 Property Address 361 PoponessettRd CO { aW}1er.a unhn Coughlin 6D Bolde_r Brook Rd Welsey 1 _ _ - _ Static-liqurd=level in the=distnbutfon box:ab�: ove au#let in r dti<e to aci oveiToade�ar clogged SEES urcesSpool� 4 Uquid~depth irrcesspool is less.1 an:'6"below invert or available Volume is less than 1/2 day, flow; Y Required pumping more than 4 times in the lastyear NOT tlue to clogged or obstructed pipes) Numbers of tunes pumped ,r Any port on}of the Soil.Absorpti.on SysterYl cesspool or privy.is.below the high groundwater eledatlon } Any portion of a cesspool or privy is within.100°feet of a surface water supply or tributary to a surface water supply ew 'Any portion of a cesspool or privy.is within a'Zone 1 of a public we11 _ Any p-ortion of a cesspool or privy is within 50 feet of'a pnvate,water supply,well. _ Any portion of a cesspool or privy is less than,100 feet but greater than 50 feet from a private water suppiy.well with no r: 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 inadditionto the cnteria: , s em an d the system is a significant threat to } ' The system serves a facility with a design flow.,of 10,000.gpd or greater(Large Sy t ) Y public health:and safety'and the environment because one or more of the following conditions.exist: the system is within'400 feet of a surface drinking water supply _ the system is within'200 feet of a tributary to a surface dunking water supply r' _ the system'is located in a nitrogen sensitive area(Interim Wellhead.Protection Area (IWPA)or a mapped Zone 11 of a pciblic 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 6.00c Please consult the local regional office of the Department for further.information. (revised 11115195): _ . ,. 3 r' r , -t3=_x.`,� .-, y x 'wa,X•.�Yc.��3aL`�Sc�'-Rgia�r7,o"''�' .fir,,��"s __rj� ����' -..� -• .-w „_ - *.-y"14�--•� yam-, -c -a r��e.:ter' '-r"�'"""` .r �x� : £SlbBSUME- RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM--— y =;"" ��� •� -�`�=�"�-"�,.,.�'^ ,".-.n�..-` �'_r."'"'y-r. _=Q�rg��_��.„,.� .ter - •:-�2Sv�.� r�._��'"�"£--r�-.cfiy 'a" �3'.���;�.�`-'-"Ci'*-s.�.. Property Address 36a-PoponessettRd cotuIt k —�QY1ftf_ .tahcFCoughllR-6�Bo�deuBcook�Rd Weisely ` � � 3 _ , Check ifthe'f-olibwrng $ x Pumping information was cequestedVof the:owner,occupant;.and Board of Health X' None of'the system components have beep pumped;for at least two weeks and the`and the,system-has been receiving normal fi.ow rates during that period. Large volumes of water have-not been introduced into the system recently or as part of this E inspection:. ..,• ':: „_ :,... -!a—As built plans have been obtained`and examined 'Note if they are no t available with,N/A - K X The facility or dwelling was,inspected for-signs.of sewage back-up x :1 he system does receive non-sanitary•or industrial waste flow X The site' inspected for signs;.of breakout x All system components;exclud: the Soil Absorption System,have been located onahe 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 thesite has been determined based on existing information or approximated by non-intrusive methods. ." x .The facility owner(and occupants,:if different from.owner)were:provided with information on the proper maintenance of .Sub Surface Disposal.System: ` A rc. :. e t (revised 11115195) . x �` 4 zs r : .:'SEA` a.;1�4cm6. - G - _ — LtB_StkfFi4E SE1�1lAC):U3lSPaSLS�t S�tEM INSPECTION.FORM #-L*rop�rtAres �3�7�opor�essettRtl Cotutt _ R — � V � ���- �se�-. _ - R-"e _-._-'�m�..a+ 9-'.9L6..,�...�- -aay.i'`&f.�„'� �y-�=+ncc�c �"'!:,'..=Y I» by t+ � •,p_��_4'" _.Wc-er ._ ..._ ...::c" -.....---raR.. � -Lm',..-r>.. -K-u.- „�.____. 'Lna.•.x� �ry4 .wl?.estgnflo�at �V �a~Its�it,� ° - t _ rs Number of currentresidents. u_ h Garbage grinder(yes o.r.no)`. No Laundry connected to system(yes or no) No Seasonal use(yes;or no): No Water meter_readings,if available.',nla i Last date of occupancy: 1995 t''• COMMERCIAL/INDUSTRIAL , Type of establishment: nla Design flow:4 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, i,f.available: Na Last date of occupancyt.nla OTHER:'(Describe) Na n 9 Last date of occupancy' ' GENERAL-INFORMATION r 4 PUMPING RECORDS and source of information : System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)No If yes, volume pumped`. U gallons. Reason for pumping: n1a :.. TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system x Single cesspool Overflow cesspool Privy Shared.system(yes or no) ( if yes, attach�previous,inspection,records,if any) Other(explain): - APPROXIMATE AGE of all.components, date installed(if known)and source information'. 35 years.. Sewage odors detected when arriving at the site: (yes.or no) No (revised 11115195) t OV "rt '[dye a €x SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM -PARJ - —_�_ .--�.•: �_P .�..�. _ ,-- —. ._.._, a _�__ .-`y`_ -� PropeityAddress 369'PoponessettRd Catult "- OyyRer Joan Coughlim.60 bolder Brook Rd.Welsely y Material of constructwn:X concreate metal FRP other(explam) 7. Dimensions: rira Sludge':depth:nla Distance from top of sludge to bottom of outlet tee or baffle.•n!a F Scum thicknes Distance from top of scum to top of outlet tee or baffle. a 4 Distance form bottom of.scum.#o bottom of outlet tee or baffle n/a mot, , Comments ':.. ;. (recommendation for pumping,'condition of inlet and outlet tees or baffles;depth of liquid level in relation,to outlet invert,structural.integnty, evidence of leakage,%etc.) . nla GREASE.TRAP: (locate on site plan) 41. Depth below grade: nla ` Material of,construction, _concrete :metal_FRP_other(explain) Dimensions. nfa _ Scum.thickness:rda Distance from top of scrim to.top of outlet tee'or baffle:n1a -Distance.from bottom of scum to bottom of outlet tee or baffle:nia 4 Comments: (recommendation for pumpmg,.condition:of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert structural integrity,.. evidence of leakage,-etc.). . nla (revised I Ill 5105) w, — SUBS RPq OM WP,GE DISPQS�L<SYSTEM I�ISEECTLON FORM _ _"=�-'_r�, _ .�.' __=��:-�`�-'=.-.:� fir-'r`-- s`-.;__._ _.... _�.:.:�...j-��__,�„ -�•'.. `--%�,.�.�. — ,�. �y-.,.��--..z---.� �,'��`_ --' - , - —•i.,- may.:, � -� .--^.__--�.�_.. '�,,,,,�. — �...,-'-�--`.,°—.� —•,—�� - _ ..,,«,.,s,: a R _P�opert)��Cd[fress 3PoponeSsetCEd ^ ...-�..=�-+.rn, xwm. -.s. � i.,4�..—� R�-`-„"' m._=,�Y'—a y-''i_�..�.utl:ii,+r_-• =--'� -�?�<=?' a .. ..�.._.. �.. � �",._„.�'•-4c. :..-rye.. .. ,.5�+�..z. `s.a✓-- - - - _ - (locate on sife:;p an q 'Depth below grade: Na - � � - Material of constructio.n;_concrete_metal_FIR other(explain) y_ Dimensions Na , ;- Capacity.. nra gallons nla gallon a Design` flow: 9 Y Alarm level: nla s: Comments: (condition of inlet tee;condition of alarm and float switches,.etc.)`' $ Na _ DIST.RIB77 UT►ON BOX: (locate on-site plan) Depth of liquid level above outlet invert: Na Comments (note if level and distribution is equal evidence of solids carryover,evidence of leakage into or out of box etc ) Na s PUMP CHAMBER: (locate on site plan)' , Pumps in working order(yes or no Comments' (note condition of pump chamber, condition of pumps and appurtenances, etc.) nla (revised 11115/95) _ -c F W'i 4'_''- � ,. ..� `—* '3"--i;,y ..� �; .tee. ,--'°+: � "r_. tx _:. �^` ."' c 'li o i--r"'..�.•:�, �.-., '^''r".—•'-«•.�^ ,''" �"A y... .y �� = t SUBSDE /!�E SEVIGRC�DISPQSAG SYSTE INSRECTION FORM M � •�.,� --,�-�— — ,�-. =�"u,�s: = :.,,,,.,-�'.�r Wit- -- Tzj.,�.t' _ -a'— �y-'��„r .n- ,�x .`rc -'�—._ k _ r --OW ?f5-- -�:-� ��4h`r4'iton9[�llt�'fiErB47`der8rool�Rd-.161etsel�r - : R 9 h i r ,r SOIL.ABSaRPTION SYSTEM - — _ (locate on site plan If posslble;'excavation not r'equlred,but may..be approximated-by non-intrusive methods) If not determined to be"present;,explain Na �y Type y �t fi leaching pits,:number: n1a k - leaching cham.bers,:number.n1a - ".:` leaching galleries,:number: nra x leaching trenches,number, length Na:` I _ leaching fields, number,-dimensions:n1a ,. overflow cesspool, number:nla; ° t .. a Comments:(note conditlon.of soil, "signs;of nydraulic`failure level of ponding "condition of vegetation etc.) t w . 'r CESSPOOLS•x (locate on site plan) - Number and configuration one ?' Depth-top of IiquidAd.inlet invert: empty Depth of solids layer; n/a Depth of scum layer, n1a Dimensions of cesspool: ' 4'x5' 4 Materials of construction: black Indication of groundwater: '. none . inflow(cesspool must be pumped,as.part of,inspection) Na Comments:(note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Cesspool is structurally sound It has some roots in it Itwas empty at time of inspection because house has been Vacant for one.year. PRIVY: (locate on site plan).`= Materials of construction. nla Dimensions: nla Depth of solids: Na 'Comments:(note condition cf soil. signs of hydraulic failure,level of ponding, condition of vegetation etc:) PrivyComments '. (revised 11115195) . _5 t ? 4 -� say ' A —� l r na 4—. .. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION_(continued),; Property Addiess :361 RoponessettRd Cotud Owner John Coughlin:66 Bolder Brook Rd.Weisel y �h Date of.lnspectton::1ar2u96 - w -`SKETCH OF 5 ' FC' GEQISPasn�lTt=M n4jnclude<tres to atleaSt-LW permanent references landmarks or tienchmarks , ` locate ail wells within 100' { . T. PC' 5 t y - 1 �t q � i It yY Y LiFk VAT a�' FN. 4 f r i 44 fr Y � f 1 C t f � f is DEP TH TO-GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USCS Maps and Charts (revised 11/15195)