HomeMy WebLinkAbout0595 POPONESSETT ROAD - Health 595
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COMMONWEALTH OF MASSACHUSETTS r
EXECUTIVE OFFICE OF ENVIRONMENT AFFAI A O
DEPARTMENT OF ENVIRONMENTAL PRECTIO D
ONE WINTER STREET, BOSTON MA 02108 (617) 292 500 ocr
. 81998
WILLIAM F.WELD +'See CORE
� � cretary
Governor
ARGEO PAUL CELLUCCI B. STRUHS
or s ti Commissioner
Lt. Governor
�Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
0 ®�—_ �Z� CERTIFICATION
1. s i,
Property Address: S`1S ����+N'C�S�e—� t Address of Owner: V),Luo P �i (�r1S(�`r•! e
Date of Inspection: (�`ACV (If different)
Name of Inspector: B tc"r"t� eC;.
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) jQ�p�
Company Name: r L Q;?05 b
Mailing Address:��in ��r, �� � ,4_th r t M►� Cj2.��CA
Telephone Number: C r\T*—
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:
Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ F 'is q
Inspector's Signature: 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:
Aj SYSTEM PASSES:
I 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.
COMMENTS:
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.
Indicate yes, no, or not determined (Y. N. or ND). Describe basis of determination in all instances. If"not determined", explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection. or the
septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exftltration, 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 04125/97). Page I of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
� ."�` PART A
V CERTIFICATION (continued) .
Property Addre�`si,a /
Owner:
Date of Inspection:
B) SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or
due,to,it.broken. settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health).
Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or.obstructed pipe(s). The system will pass inspection
— r'
if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
i`
t
i
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
i
Conditions exist which require further evaluation by the Board of Heal fin 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 DET> 'MINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
. MANNER WH-CH WILL PROTECT THE PUBLIC HEAL AND SAFETY AND THE E\'VIRONNIENT:
_ Cesspool or privy is within 50 feet of a surface wa r
— Cesspool or privy is within 50 feet of a borderin vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF ALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETETVvUNES THAT THE SYSTEM is FUNCTI VG IN A MANNER THAT PROTECTS THE PUBLIC HEALTH Al
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil a orption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
_ The system has a septic tank and so' absorption system and the SAS is within a Zone I of a public water supply well.
_ The system has a septic tank and it absorption system and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and oil absorption system and the SAS is less than 100 feet but 50 feet or more from a private
water supply well, unless a wet water analysis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that cility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
Method used to determine distance (approximation not valid).
3) OTHER
(raised 04/25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORT
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
DI SYSTEM FAILS: t
You must indicate either "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determin what will be necessary to correct the
failure.
Yes No
_ Backup of sewage into facility or system component due to an overloaded or logged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface w ters due to an overloaded or clogged SAS or .
cesspool.
Static liquid level in the distribution box above outlet invert due to an verloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available v ume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due't clogged or obstructed pipe(s),.
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 rface water supply or-tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well
Any portion of a cesspool or privy is less than 100 et-but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has b en analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, a onia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the followi g:
The following criteria apply to large systems in additi n to the criteria above:
The system serves a facility with a design flow of 1 ,000 gpd or greater (Large System) and the system is a significant threat to public
health and safety and the,environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a s face drinking water supply
the'system is within 200 feet of a ributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/2S/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: n S
Owner: �'j 1 W5 (-
Date of Ifispectton:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
NoPumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
v _ The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
7r
Y _ All system components, excluding the Soil Absorption System, have been located on the site.
7 _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, naterial 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 been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
1 J/7 Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable)
[15.302(3)(b)]
(revised 03/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: �� f 01 a
Owner: � 15)p(L J
Date of pection:
yr� l`4 a
FLOW CONDITIONS
RESIDENTIAL
Design flow: JQQ p.d./bedroom for S.A.S.
Number of bedrooms:
Number of current residents:
Garbage grinder (yes or no)::�
Laundry connected to system es or no):4
Seasonal use (yes or ho): 1 I
Water meter readings, if available (last two (2) year usage (gpd): Imo'
Sump Pump (yes or no):-
Last date of occupancy:4L'ij-w u, VOf-
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow:_ allons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GE\ERAL IN'FORM,,kTIOti
PLTNIPIlVG RECORDS and source of
formation: u
System pumped as part of inspection: (yes or no)•t _
If yes, volume pumped: gallons
Reason for pumping:
'I Y� OF SYSTEM
1
Septic tic t tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date'installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no)
(rerised 04125/97) Page 5 or io
SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:.5�5 P� FA1Ije(J-r I1
„v
Owner:%" 8 9 J A h
Date of Inspection:
BUILDING SEWER:
(Locate on site plan) t� °
Depth below grade:
Material of construction: _cast iron _40 PVC _other (explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
•SEPTIC TANK;
�J
(locate on site plant'
Depth below grade: �Ztl
Material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal, list ace _I Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions: KO
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:—ill
Scum thickness:—
Distance from top of scum to top of outlet tee or baffle: Iy
Distance from bottom of scum to bottom of outlet tee or baffle:__
How dimensions were determined: 1 n�-Q
Comments:
(recommendation for pumping. condition of inlet and outlet tees or baffles. depth of liquid level in relation to outlet inven, st tural integri
evd nce of leakage, etc.) Cr
cci� IU ✓1JPid
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity.
evidence of leakage, etc.)
(revised 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
( SYSTEM INFORMATION (continued)
Property Address''S�) d o`Ljejjt
Owner: �(f
Date of Ins ion: a
TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete metal _Fiberglass —Polyethylene —other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level: Alarm in workine order _ Yes: _'No
Date of previous pumping: "
Comments:
(condition of inlet tee, condition of alarm and float switches. etc.) .
rISTRIBUTION BOX:U
(locate on site plan) /
Depth of liquid level above outlet invert: U{.�t U'J�1 i/ I �' It
1
Comments:
(note if evel nd distri uti n ' equal,, 'de of solid arryov , ev'd yl ea c i to or out of box, etc.)
1 11`J t d '�rL -
PUMP CHANIBER:
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
,
(revised 04/25/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavatiorinot required; but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number: -,
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number.length:
leaching fields. number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note co dition of soil. signs of hydraulic failure, lev I of po ing, c dition of ege on, etc.)
tie 'szc v v' `
CESSPOOLS:_._0�43
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 04/29" Page 8 or 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
CIO O Q SYSTEM INFORMATION (continued)
Property Address:
Owner: 'C Ct
..� Nb
Date of I spectton: 5
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or,benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
S1 S 1
` 2
�y
p
(( 3
� 6� , 6 ``
u •
(revised 0412S197) - Pagc 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: *tiu
Date of Inspection: J
Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators. installers
Use USGS Data
Describe in your own word ow you established the High roundwatq Elevation. Must be completed)560
`
(revised 04125/97) Page 10 of 10
TOWN OF BARNSTABLE
Li7C'ATi6N 5 �0'PO N CS�4.�1 SEWAGE #
VILLAGE L&(� ASSESSOR'S MAP & LOT �
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY VSO C)q V,
LEACHING FACILITY: (type) Z (size) %0 00$prr
NO.OF BEDROOMS
BUILDER OR OWNER STUN SN 1
PERM T'DATE:_ I rl l�l COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Remo,of Eeselth.15 Feeility Feet
Private Water Supply;Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) 1 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within 300 f et of leaching facility) N(A Feet
Furnished by �G��
Sys
Z
A%
AS-sb MI6l
A��- Ir
'� �- l.S`
91 Q S
- �g4OWN OF BARNSTABLE
LOCATION 1Q2 SEWAGE # ;Z
10
VILLAGE. C'o �t i �� 6
�� ASSESSOR'S MAP & LOT :, �
INSTALLER'S NAME & PHONE NO. kl& L19/01,, fe -7 "
SEPTIC TANK CAPACITY cr
LEACHING FACILITY:(type)_ ��f3C ����(size) 16ye c/,iq
NO. OF BEDROOMS y PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: 1'o1A& ��
DATE COLIPLIANCE ISSUED:
VARIANCE GRANTED: Yes No ��
33 Papf 0A/&1.-0
8? � °•� Joao 6�C Pal
� Q ,
J �
0�
No..;,�.`. xI72 Fxs..........J.&d.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................OF... rn3 ............
:....... ................
Appliration for Diopostti Works Tonstrurtion ramit
�+b Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
................__..`..ca; � ...�`. ................................... ------------........................ -•--•----• ......-•---................
...............Locatio -A dress / ..........-•---••............................Lot No.
..........�.l .tea .. _ .................... •.....� ..&�--._..-. . S.
d
Installer Address
Type of Bui ding Size Lots__ ' .......Sq. feet
Dwelling—No. of Bedrooms...............!Z........................Expansion Attic ( ) Garbage Grinder ( )
44 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
WPaOther fixtures --------------------------------------------------------- ---------•------..-..-------.... ........._._..._....._....
Design Flow.....................: ........__.gallons per person per day. Total daily flow__..,...__._..__y6 �?._______._._gallons.
WSeptic Tank—Liquid capacityr���gallons Lengthy �. ..`_�_ Width.s........... Diameter................ Depth... /_
x , Disposal Trench—No..................... Width.........y...... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter... Depth below inlet:...::.°....... Total leaching area..:S3.?-..s . ft.
Z Other Distribution box (X) Dosing tank
Percolation Test Results Performed by._ �ip_ __ _ 'sl cj_... 'k � {.�� Date.. °;y...F` _ Y
al Test Pit No. I..... .....minutes per inch Depth of Test Pit---- S .... Depth to ground water.......e!nA
Test Pit No. 2..._.n....minutes per inch Depth of Test Pit... _.. Depth to ground water..._..I—,,/ ....
0 Description of Soil......4.
—36 7~ 5 =s'' 6 a ..... 3'_"...__..... =
........................
Afe
.,� --------------------••�•--•.----•-- ---
W ••-•....--•------------------------•-•-••--•---...-•---•-•--•--•..... `'J ..�QG✓.4''�'�..._..._.�"!ceo.''.. YYi t6,Q----......--•--•••---...
UNature of Repairs or Alterations—Answer when applicable._...............................................................................................
-•---....-•---•--------------------------------........................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The and igned further agrees not to place the
system in operation until a Certificate of Compliance has been issued bb d of �x �q1G
Signed .,------. .... .. ..... ........ ....... ............ .....................................
Date - re
C
Application Approved By........--- _ L
Dare
Application Disapproved for the following reasons: ........................................................................................................................................
....................................................................................: ......................................................................................................................... ........................................
Permit No. ..:.... ...... ... .` .r Issued
Dale
Date
6C
t..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD_ OF HEALTH
r � c�'.F'r...................OF..... ,:r <' l' ............._........_...................................
Appliratiun for Disposal Works Tonutrurtiun Prrutit
Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal
System at: _
Location Address or Lot No.
.......:�_ .!.. '2.......................'.-` -= H. .!9.!` ....... -----.....------..........................- ....................................».»...
Owner Address
W
Installer Address
Type of Building Size Lo& ..........:_:-..........Sq. feet
U Dwelling—No. of Bedrooms................/..... ..___Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of persons............................ Showers
Oa yP g -------------•-•----------- P ( ) — Cafeteria ( )
a' Other fixtures .................................
d
WDesign Flow.............................................gallons per person per day. Total daily flow..................... .............gallons.
WSeptic Tank—Liquid capacity?�:` ':''gallons Length Width.S-'!-_.`.- Diameter................ Depth_`... 7.
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No------ ------------ Diameter.._ Depth below Total leaching area._. '.'.:sq. ft.
Z Other Distribution box (x Dosing tank
aPercolation Test Results Performed ... ..f._ ._...............:=-:qty-.x-:c:aDate...n2:t_...'
a Test Pit No. 1.....4::.....minutes per inch Depth of Test Pit.... '.L..... Depth to ground water............. t_....
LLt Test Pit No. 2.....(:....minutes per inch Depth of Test Pit... Depth to ground water......1114?%.----
04
O i .S'-o // r.`Y. S t) l 4 J S o t 0.` G r i
a
Description of Soil.....:.....................................•------------•---•----------•----....----------------------••------------•---..............�.......:_.._.._....--------.Z�--
V �.
........................
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 TITLE 5 of the State Environmental 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.
Signed.................... ........ ....................................................................... ........................................
Date
Application Approved By ......r ,r..,..a:at ' -.. f �r
Dare t
Application Disapproved for the following reasons: ................................................................................................•---..........---------..............--
....................................... ........... ...................................................................................................................................................... ........................................
Date
PermitNo. ................................................................... Issued .....---------.......------------------------.............----------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...... OF .........t.. ...�,,:.,.f...E... .E.................................................
x1ertifirate of (gomplianre
THIS IS TO CEIJ-TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ............�.................................................................................. .........................................J----............................---............---.........------------------------------...................
Installer
at ..........1 a--------------------------------------
............................................................................................
has been installed i accordance with the provisions of TITLE Hof The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .....1--�.. ........... dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...... ls .......... Inspect ... ,� Y.........:-.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C.� L �G(i/ OF.. Y.S.?
No...lA. �......... FEE. ...... ..........
Disposal Marko Tunstrttrtiuit P>Qrntit
Permissionis hereby granted..........................................••--------------•.......------•-----•-••-•-••••-........-•-•--------........................._....
to Construct.,(__) or Repair ( ) an Individual Sewage Disposal System �
. r _
`J Street
as shown on the application for Disposal Works Construction Permit Ng2Y, �!'..... Dated..........................................
...................................................•....................................................
Board of Health
DATE................................................................................
Form 1255 H&W HOBBS 8 WARREN rnt Publishers
S ,13 TEM );Vf--,fL TM
NOT TO cr`. 4LE
i
TOP FDN. FINI SH GRADE � - ca FINISH GRADE OVEREL . R
FINISH GLADE OVER DIST. BOX L_sue - z
FINISH GRADE O E
SEPTIC TANK
a ,s 2� LEACHING PIT
XANI�
���'�••o; 32" MAX.
yo: q'a r. , r. . o..". ' ' �;' ::.�: : °:::;•:,;. :, '.: , j• ao MI
3" OF 1/8" - 1/2" 92" MatX� PRECAST CONC. OR
o; s:, �• s•i;
•e:� :� a ASHED PEASTONE' :•.�Q.,�-�•�°;�, .�.�• °' 4
: ": • ".. BRICK G MORTAR
3" "� s OUTLET PIPE LEVEL 't.;:; TO 12" BEL ON GRADE
FOR 2 FT. MIN. °•..°: ' p:"o o.o'd;'P.''o•r:•
'°:.•q.�s a ._ 'o ° :c a
T" fir,r
o p..'.d. 2�.t95` "e' ';`'y.. r .O'o:.0:'.�:
C. I. OR PVC TEES5 c9!�` g �!�B °::a'b ''p p.p •D ..p,
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BSMT. FLR. .1500 GALL ON "T T D,� . ` UTION BOX 10.3
PRECAST CONCRETE /� ,INSTALL ON LEVEL BASE 3/.4" TO 1-1/2"
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SEPTIC TANK
INSTALL ON LEVEL BASE %NOTE:• EXCA VA TE TO ELEV. /z.o—'OR ° ° :• "« . :e 4 a
� Q S 7<,, \~ LONER TO REMOVE ALL IMPERVIOUS
MATERIAL BENEATH THE LEACHING AREA 2 '-0" 2 '-0 "
\'k REPLACE EXCA VA TED MA TERIAL NI TH B ._0
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1
o -�,t. \CLEAN, CLAY FREE SAND ' 10 ._0 „
ze -_._. ___� `�/\ �. d' EFFECTI VE DIAMETER
. " L EA CHING PIT
G 'N RA L O TES INsrau ON LEVEL EASE
J. AL L EL�"VA 71ON.�� SHOW ARE BASED ON NG VD
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71 � 8� , � a- L PIPES IN THE .�YSTE'M MUST BE CAST IRON
� L' �' �/ � 2. A L .
`' 3�° t� Xl� a� SCt EDUL E 0- P YC. - BSER V/A TION PIT
'� 3. THE BOA PD OF "SEA L TH MUS r BE NO TIFIED
t X �- /HEN CONSTRUCTION IS COMPLETE PRIOR P-8224
!� r� PERCOLA TION RA TE.'
TO BA CKFIL L INS
�4. ANY CHANGES .IN THIS PLAN MUST BE APPROVED 2 MIN./IN.
Zo �` •' A - � �� BY THE• BOAF0 OF HEAL TH AND CAPE C ISLANDS I/ITNESSED BY.•
o
SURVEYING CO., INC. EDWARD BARRY
BE IN
3 a Jam'. M.�. TERIALG' ���NE`:Ir r SHAL�TALLA TION L
BRO. OF HEAL TH
COMPL IANCE" WITH THE ,STA TE SA NI TARY BARNS -SIG AI DA. TA
�. CODE - TITLE V AND LOCAL APPLICABLE DATE.• 1yA.Y24 499.4
RULES AND REVULA "IoV a
_c \" �. S. FORTH APPO I S' FROM RECORD PLANS AND 0 „ NUMBER OF BEQROOMS 4
�
Y Z IS NOT TO BE USED FOR SOLAR PURPOSE'S TOPSOIL 6 GARBAGE DISPOSAL NO
° 7. FLOOD HAZARD ZONE C kg� Y-f HAZARD) SUBSOIL DAILY FLOW
440 GAL .
8. NA TER SUPPLY TOWN A TER SEPTIC TANK ! �£ �D. 1250 GAL .36 SEPTIC TANK PROVIDED 1500 GAL .
a i' s "� '� L EA CHING REGUIRED 440 GPD
_ N MEDIUM
oSA ND
SIDEXALL AREA ." 188 S. F.
�•� o y /,,� o S. F. X 2. 5 G/S.F. 471•,,GPO
ro f �' �, q BOTTOM AREA 8,S.F.
Z� �� � �, LEGEND -Z6—S. F. X 1. O G/S.F.
/ - L EA CHING PRO VIDEO GPO
9 5'49 GPD
_--- --—_-- --- tv PROPOSED EL EVA TION 152" NO GROUNDWA TER
EXI.S TING CONTOUR
L oT .3� - z•�/ h
OBSE•RVA TION PI T
DISTRIBUTION BOX "oti or
PROPOSED SEWAGE DISPOSAL S YS TEM
LEACHING PIT �I Ian+ zvs�� �
PREPARED FOR
.i o SEPTIC TANK 5, ; .
s �y <.. PHIL IP S TA SHENKO
L O T 33 POPPONESSET T ROAD
;RP) RESERVE\ ,0 Of` CO TUI T BA PVS TA BL E — MASS.
AVI
HARLES
•� =� � o s 6 o e .-5• _ ;�/� PIPE INVERT ELEVA TION SArvICKr
28085 DA TE.' M4y CAPE 6 ISLANDS ENGINEERING y7
, PLOT PLAN _- �`- `�- _ ����'sTER`�° 'j' SCALE AS NOTED -
133 FAL MOUTH ROAD SUITE 2E
Z `3 0_� �n 7 `rr (� \`�N . LAND 1� i ��
F SCALE.• 1 " �-- -� . s r , - PLAN NO.so s����•� MA SHPEE, MASS. ��z
. MAP SEC PCL L r HSE