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HomeMy WebLinkAbout0040 ROOSEVELT ROAD - Health ,r L40 R6b-kVelf,6d-d ` - — Cotult i ry Ufa... A-'- 039 �132l j Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Fortin-Not for Voluntary Assessments' 40 Roosevelt Rd L I�� Property Address Lucy Denton3 Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forts may not be altered in any way. ,* . A. General Information _ 1. Inspector. Shawn Mcelroy V. Name of Inspector Shawn Mcelroy Enterprises Company Name 29 Atwater Dr t Company Address E. Falmouth V ' 'f MA "' f' 02536 Citylrown state Zip Code 1-508-495-0905 S13971. Telephone Number t.icense Number B. Certification n! I certify that I have personally inspected the sewage disposal system at this address and that}the information reported below is.true,accurate and complete as of the time.of the inspection. The inspection was performed based on my training and experience in the,proper function'and mai4tenanc"f on site sewage disposal systems. I am a DEP approved system inspector pursuant to tion A340W, Title 5(310 CHAR'15.000).The system: ® Passes ❑. Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority. 1-30-08 Inspector's Sigilature Date The system inspector shall submit a copy of this inspection Deport to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 4 ""This report only describes conditions'at the time of inspection and under the conditions of use M at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp•o8m Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of back-up. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Feral -Not for Voluntary Assessments 40 Roosevelt Rd f Property Address Lucy Denton ,w Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. City/Town _ State Zip Code Date of Inspection B. Certification (cunt.) -� . • . B) System Conditionally Passes(cunt.): , ❑ r distribution box is leveled or replaced ND Explain: ❑ .The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ' ND Explain: C) Further Evaluation is 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 public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: J " ❑- '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'(arid Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply1 . . ❑ The system has a septic tank and SAS and the.SAS is within 50 feet of a private water supply well. t5insp•OWN Titfe 5Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to 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 SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: . ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or El ® tributary to a surface water supply. t5insp•08M Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. City1rown State Zip Code Date of Inspection B. Certification (cunt.) - D)••System Failure Criteria Applicable to All Systems (cunt.):,.. Yes No Any portion of a cesspool or privy is within a Zone 1 of a public well. :0 ® 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 160 feet but greater than 50 feet < from,a private water supply well with no acceptable water quality analysis. [This ' system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence ' 'of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis r- ,, T: and_chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with'a design flow of 2000gpd- 10,000gpd. The system fails. I have determined that one or more of the above failure El ® criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be -_ necessary to correct the failuie.r' E) Large'Systems To be considered a large system the system must serve a facility with a •design flow of,10,000 gpd to 15,000 gpd.•-,,• - _,; .r a , For large systems, you must indicate either"yes'or"no'to each of the following, in addition to the questions in Section D. Yes " ` No, ❑ , the system is within 400 feet.ofa surface drinking water-supply Ej 0 the system is within 200 feet 6f a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—MPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp•08t06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 °r 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as.built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Tile 5 Official ,Inspection Forte , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a = P 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name ; information is required for Cotuit t MA 02635 1-30-08 ' every page. Cityrrown State Zip Code Date of Inspection D. System Information �Y is Residential Flow Conditions:. Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based or i310 CMR15.203 (for example: 110 gpd x#of bedrooms): 330 • ••Number of current residents: .� - _ • 0 Does residence have a garbage grinder? F ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? El Yes ® No Seasonal use? w ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)):,_ Sump pump? ❑ Yes ® No Last date of occupancy: 12-07 Date Commercial/industrial Flow Conditions: , Type of Establishment: 'Design flow(based on 310 CMR 15.203): ,, , .. . _ ' - , _ , Gallons per day(gpd)4 Basis of design flow(seats/persons/sg:ft., etc.): z x Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? - ❑ Yes ❑ No 1-Non-sanitaryyvaste discharged to the Title 5 system? - ❑ Yes ❑ No Water meter readings, if available: Last date of occupancyluse: .'P - • Date Other(describe): t5insp•08/O6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Roosevelt Rd Property Address Lucy Denton Owner owner's Name information is required for Cotuit MA 02635 1-30-08 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) . General Information Pumping Records: Source of information: Owner never pumped. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1979 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08/06 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 li Commonwealth of Massachusetts {.. Title 5 Official-inspection Fdit • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments,* 40 Roosevelt Rd L Property Address _ w Lucy Denton Owner Owner's Name information is required for Cotuit .. MA 02635 1-30-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) t. - ,•° • , F Building-Sewer(locale on'site plan): Depth below grade: _{ 12" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting,evidence of leakage, etc.): Good condition. Septic Tank(locate on site-plan).- 6" Depth below grade: feet Material of construction: ; ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: , years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- ♦ � . Ft.:.. . r .. .SIR Dimensions: 1000 Gal Sludge depth: 15•' •, Distance-from top of sludge to bottom of outlet tee or baffle=. , ' i 17" 6" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee,or.baffle 13 How were dimensions determined? Tape t5insp-08106 Tine 5Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora " Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Recommended pumping for solids. In good condition with baffles in place. Grease Trap(locate on site plan): Depth below grade: feet 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: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): t5insp•08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts .. *: Title 5 Official -inspection Fora Subsurface Sewage Disposal System Form-'Not-for Voluntary Assessments ,M 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name information is required for Cotuit _: t MA 02635 1-30-08 - every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Tight,or Holding Tank,(cont_)£~� ; ;,. , • .. Dimensions: Capacity: gallons Design Flow: 'gallons per day ' Alarm present: ❑tYes , ❑, No. Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan) Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of,solids carryover, any evidence of leakage into or out of box, etc.); Good condition. Pump Chamber(locate on'site plan): Pumps P . Pumps in working order: - El Yes El No Alarms in working order: ❑ Yes ❑ No t5insp•08t06 a Tine 5 Official Inspecton Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit in good condition and empty at inpection. Historical stain line at 36"of bottom. t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): f 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 ❑ Yes ❑ No 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.): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 official inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Roosevelt Rd Property.Address Lucy Denton Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. /41 GD � 4 6nsp•08/06 TitL-5 Offidal lrtspedion Form:Subsudace Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Roosevelt Rd Property Address Lucy Denton Owner Owner's Name information is required for Cotuit MA 02635 1-30-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water. 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show groundwater at 20'. t5insp•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Dot System•Page 15 of 15 Town of Barnstable OF THE Tpk ti�P� ti� Regulatory Services BARNSTABLE ; Thomas F. Geiler,Director 9Q 1 6 9 `erg ArEo �A Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with h any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual . number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. TOWN OF BARNSTABLE LOCATION I 005e[)e � kd/ SEWAGE # V�t.LAGE C d �i ASSESSOR'S MAP&LOT INSTALLER'S NAME&-PHONE NO. / SEPTTCJANK CAPACITY LEACHING FACILITY: (type) (site) 61C� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 f leaching f cility) / Feet Furnished by G✓y/ /( ����aU 7LjV 510, �aG K 3o' o g-p_ 3(o - 6-0 - ��' L O 't AT ION SEWAGE PERMIT NO. ,4��7- e ® ose VI L=LAG E INSTA LLER'S NAME & ADDRESS ew B UILDE R OR OWNER DATE PERMIT ISSUED -3-123- 7� DATE COMPLIANCE ISSUED -Z,7�. 3t G 70 N. .......... `�... Fiza..............................a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H -......-� -------OF..............�/ Appliratiun for Disposal Works TuffiArnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: COOS,tj61 T' d2/� dal-v�°T ...---- --.._. _.._........._ .. . ...................................... ................................. ..... . L cation-A Tess or Lot No. ..1.1'l�x ,� . . .................................... .... Owner ress w '�M G[�4..w..a Y...- ---------•--- --•-----•--• .....••... --C e v��c/------ a _._.. ----•...................... Installer Address UType of Buildings- Size Lot............................Sq' feet Dwelling—No. of Bedrooms-___3..................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons....:....................... Showers — Cafeteria PA PA Other ures ---•-•-••-----•--••----••-----••-•-••-••••-••••--•••--.................•--•--......-•---- ............................................................ W Design Flow.._5..._. ........................gallons per person per day. Total daily flow.........=.�S. ....................gallons. WSeptic Tank E Liquid capacity/00.0.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—�To...__.----------...__ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../.......... Diameter..../...0........ Depth below is�let......_. �t...k Total leaching area...2-4.-�?..sq. ft. lj Z Other Distribution box ( �` Dosing k ,f7. XC '-' Percolation Test Resul Performed by__.... .. .,_... 1^.`r tx ,.... Date... '.��. ��" Test Pit No. 1. `Z------.minutes per inch Depth of Test P' .................... Depth to ground water........................ 114 Test Pit No. 2............./._minutes per inch Depth of Test Pit.............•...... Depth to ground water........................ ......... 1 -y _. F.......,... r r ............... f /� 0 Description of Soil.. O..'x.. J- =.............., V ..............................•••---••...............•-•-•-•••••....•--•••.........•••---••-••-•-••••••••--------••.._......•---•••--•--•----••..........••--........_ W UNature of Repairs or Alterations—Answer when applicable............................................................................................... -----•........•••-•••-••••••••.....••••-- Agreement: The undersigned agrees to .install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITTIZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee * sued by th and of health. Sign --------------------•-•-•.....•••....... ................................ Date Application Approved By........ -- •. ... ... -•-••••• .. f. YI Date Application Disapproved for the following reasons:.............................................----------------i................................................. ---------------------•-------------._.....-----•-----------.....---------------.......-------•--------...._....---.........------ ---------------------------------------------------------------••.•.... Date PermitNo........................................................... Issued-.-•--•--• -- .-•J.......................... Date y �9 - , No........... Fss.............................. f• THE COMMONWEALTH OF MASSACHUSETTS 1` BOARD OF I-1 E A L Applira#iun for Bispm ai Works Tonstrurtiun Vrrmit ApplicatiGn is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at . .. - ..... ......... ..... - ,C '............................. .......................................... --- c lion•A ress or Lot No. ix -......., .. .... .............................................. ---- Owner Address } W Installer Address Type of Building,,. Size Lot............................Sq. feet Dwelling e No. of Bedrooms..: ..................................Expansion Attic ( ) Garbage Grinder ( ) 44 Other—Type of Building. ..... ...................... No. of persons............................ Showers ( ) — Cafeteria ( ) P� Design Flow___. .-._. ._._._....`:............gallons per person per day. Total daily flow..........4rZ.0.................:.gallons. W . WSeptic Tank Liquid capacity/00.0.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No........ . ........ Diameter__. ....... Depth below i let._..... ✓_. Total leaching area.. 4 A..sq. ft. Z Other Distribution box ( Dosing Q. .• � '-' Percolation Test Resul Performed by......t ._ .,_... �^dAt3... Date.. >P.__--�`. ": N minutes per inch Depth of Test Pi .................. Depth to ground water.........._.........._ . Test Pit o. 1_ .2_.___. rs, Test Pit No. 2_.__.,, ....minutes per inch Depth of Test,Pit.................... Depth to ground water........................ x ? - I! + ,O Description of Soil........ ! ---' U .--------------------•--..---•--•-----... ._....-.---._........................._------......-••---.----.------.....•---•----•--------------.....--•-----._................__.----.------.•----------- UW ------.--•--------------------------------=--------•.-----.--------------------------.......------------------------------..--------.-----•---------..------.--------.------..----......_....._...------ Nature of Repairs or Alterations—Answer when applicable---------rv'=:_______:::':"'_: ----••. •---------------------••---•--••--•----------------------...---------•----- :---•----------------•-----•------- Agreement The,,undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with, the provisions of'T`:L p 5 of the State Sanitary Code—The undersigned.furtl e-wees not to place the system in operation until a Certificate of Compliance has'been issued by'the'board of`health: g - -----------• -- ----• Date Application Approved BY------ --'�-..... .................... .............. Date Application Disapproved for the following reasons:.............................................--•----------------------------------------- -------=----- _ • ..................f..........................•------•----.._...---•--------------........_-------- ----------------------------------------------.................................................... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS, BOARD OF HEALTH `'�... 1 1!t!? 1..........O F..:....... .J. :C�� .....•..................... Tutifiratr of Tompliatta T I$ IS TO61.1 RTIF , That the Individual Sewage Disposal System constructed ( �or Repaired ( ) by �'. .... / ........................='_.. ..-- -- Y..................... -- .. / P 1 .. Ins=alter ril(r! /IY at. Ke �` " . _.444• 1. -•------------ -- -------has been instal in accordance with the provisions of j of The State Sanitary Code;as described in the application for Disposal Works Construction Permit N :% ------/--p-o----=�----::.__. dated--1. _.a.:3---7- -------------------- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT,BE CONSTRUED AS A GUARANTEE THAT THE SYSTim" WILL FUNCTION SATISFACTORY. DATE.................... . .. Inspector:---- ?----------- THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1...........OF....... .. 118 . ... .. vJ No._._.....f. ....... FEE.2.......... ....... ' 13isp Inr War s rnr#iun rrnift Permission •0ereby granted_s. ...... . . .... ..�.� ......._.... _---. ...----•- to Constru� . ( ) or pair ) divir3 al ewage Disp stem f at No..- d 1 �� � ........_.� t.. `�1�. ._... !✓x� El1-.- .�._ .... ... Street as shown on the application for Disposal Works Construction Perm"" No____ ,.___. l__ Dated........................................... 7,/. Board.of Hea I t DATE-- --1�--�'-{- -. ......................................... „.. "a FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS . . F I No... -..... .... .. i rA -- '� �zw .... THE COMMONWEALTH OF.MASSACHUSETTS 4 y BOARD OF HEALTH Town Barns. . .t.able. O F................................ . Appliration for Bigiviial Works TouB rurtinn Vamit Application is hereby made for a Permit to Construct (X) or Repair ( } an Individual Sewage Disposal ,System at: ...... ._Ro�seyelt Road ........................Lot - 0 Location- dd. d ..° Lo J .wMx_..� ! y � .... -------•-•••-•---•------.... .!- . ._.... .. .• ---------•- ..... . - wner Address a Insta er Address Q Type of Building Size Lot21z 000____ _ Sq. feet Dwelling—No. of Bedrooms............. ..............................Expansion Attic ( ) Garbage Grinder (no) Other—Type T e of Building 1 a yp g ............................ No. of persons.._..._.____.___.._..__..... Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - • - W Design Flow................55.......................gallons per person per day. Total daily flow..........330..........................gallons. WSeptic Tank l Liquid capacity100.0..gallons Length.£..-1j".. WidthJ !.-1II'tDiameter________________ Depth...1+f--G" x Disposal Trench—No._-___--------_ --- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------l---------- Diameter----ZQ ......... Depth below inlet.........6!....... Total leaching area...-2b7......sq. ft. Z Other Distribution box ( X) Dosing tank ( ) Percolation Test Results Performed by._Capp...C.QLL_-S11rmey...CQMSI].1_tantbate....12/-U/".78- '�.a Test Pit No. 1....2----------minutes per inch Depth of.Test Pit..........Ut... Depth to ground water-----none......_ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................... x D Osawnd. A Description tonoo _...-. :: : u : : cer ---�----- s-:::: : :::s : s9 U ...................................................-................ ------.. --•- ����� -..RLI6ERI tiCOP .it -- -- -------------------••--•------••-----•----------•----------------•---------•--........------------•--------•--........................ S F. �1 ;Iv DAYLOR rCn` U Nature of Repairs or Alterations—Answer when applicable.___________________________________________________________ j.......1Jo: 874i Agreement: ° The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a S l lie the provisions of TIT ,;,�. 5 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. Signed . -•------ • -----•-------- ` Application Approved BY ........................... -�1-7�• Date Application Disapproved for the following reasons------------------•--•---------------------------------•-------...-------------------•-•-•----------------------- ..--------•---....--•-•------....--•------------------------•...-•---•----•------•--------••--------......---•-•------------------.--------------------------------------------------------------------- Date PermitNo....................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHU SETTS BOARD OF HEALT .6' L ................O F. .......................... %Crrfifirtttr of Tomptiana HIS IS TO C IF hat the Individual Sewage Disposal System constructed (or Repaired ( ) �j ye.z . . ........&/ .. .. .. ..................................................... A Intallers. at.. //�/ 1� • . ......._...7 'a ° 3 -,dT "a' 1..'C�r has been installed in accordance with the provisions of T i. 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.�. ...._8_S. ............. dated___.; 72 __ .711__.____._._._ . . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector--•-•-•----•-----------------------------------................................... 0_1q No. �.. ! > . " vow `^ THE COMMONWEALTH OF MASSACHUSETTS F. BOARD OF. HEALTH ".. ......... ...Town.......... .....OF...........8$ ' t ris able... AvvIirdtion for Disposal Works.�Tonstrurtion amit Application is hereby made for aa'' ermit to Construct (X or Aepair ( ) an Individual Sewage Disposal System at x ................R0.o6—mait..RO............................................ -- .y____-----IdOt.--�0---------------- ______ ............... LocatyQn Qd �y- /d � --..d... ..dQ . ..............................--.• ......• hn r f Address a '{ Inst ler 'a, Address ` Type of Building ;_ Size Lot21y_C100!D.......Sq. feet aDwelling—No. of Bedrooms °________ . Expansion Attic ( ). ( abge Grinder (gyp) p, Other—Type of Building ... ....................... No. of persons............................ Showers ( ) — Cafeteria Otherfixtures ..;.. -----------------•--------••--••-------•--••-•--......-••--•--------- ---------•------------•------.............................--- W '. 3 `._ ..gallons per person per day. Total daily flow__________ _�p ___:_-___-____gallons. Design Flow,............. WSeptic Tank—Liquid capacity�WO.gallons Length .t_.;, j1L. Width 4..t.�j.()!tDiameter................ Depth...4._t.;;att x Disposal Trench—No...................L Width.................... Total Length_.____.__ ......... Total leaching area....................sq. t. See age Pit No-______. _.. Diarneter '_�;.d.t.__._... Depth below inlet........ Total leaching area_____ sq. ft. P g 267 Z Other.Distribution box (X) Dosing tank ( ) '-' '� Percolation �t ,,Results Performed by._CaP&..�a S�uIrAre Gomsu}tantl ate_... 2 f ............. a-a Test: it No 1 ..a......__..mmutes per, Depth of Test Pit-; }. .L.. Depth to ground water.____ ���_...__- (i, Test Pit No. 2______ ________minutes per inch Depth of Test Pit Depth to ground water........................ -------•.... .___..--...................................�i ... N O F N O Description d"Soil •C3 1:G WDOd 1Qam� .`.fl 2. t311b 0 ,_--_�...Q .2.�' DQ x 1 ®cam sand. U t o� ' R6� R1 GG� W ------- tP ••••••••••---------•••----- . •. •--•..•.. __.. .. _----•• •. .........-• ----------------••••......- a x Nature of Repairs or'Alte ations—Answer when a h able_..__.._ r,, F CU P PPl ©axe©A y� Agreement: ;��* ... � i•----•-•---•-•-•---- -� F �� The undersigned' agrees to install the aforedescribed Individual Sewage Disposal System in a >r I ,., ,the provisions of TIT .^. 5 of the State Sanitary Code— The undersigned fur�tl:er agrees not to place t in operation until apCertificate of Compliance has been issued by the board of health. --•---•..................•-.._..._............... --••- •••-- E S n d -........... � - /Date Application Approved ty-- �' L1� --'............................. x t. Date Application Disapproved for the following reasons:................................................................................................................ .......................•...... ... ......................... k.......... •------•--------------•-•................................---- _. Date Permit No................................ ------------------• Issued_................................. ..................... Date - - 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H OF Z Tirtifirab of TompliFanrr HIS IS TO CG TI That he ndividual Sewage Disposal System constructed or Repaired ( ): b -------- ! ,�. ' Install ` �Q��.�(f�/fjj. /q at ' • . � eezm. has been installed in accordance Withthe provisions of0.7,J�ILE 5 of The State Sanitary Code as described in the application for Disposal VVorks�Construction Permit 1 .......��_s- ..... dated_. �-�..�__-_.�_�>'................... THEE ISSUA,�CE OF :THIS 'CERTIFICATE SMALL NOT BE,CONSTRUED AS A GUARANTEE THAT THE S7STEId V!!I FUNCTION SATISFACTORY. DATE... ........................ .................................... Inspector............................................... -•----..._......-------••••-- ----- :.::.{ ......-•...._......•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... No ,/1.5....:V T OF FEL9.tV ...... Via pop I Works Taa traartinn Vamit Permission is.hereby granted--- X�....... r -------------------•---•-----------------•--•------- to Constr ct ( ' r Repair{ ( an Individ al ew age Dispos SystGli at No. ___. --""' t-ee 'a -. ----------------------- `Jl-moo rr- ,dt� d + ' tree as shown on the application for Disposal Works.Construction. Permit ................ Dated.... 2. ................. l ,•T 1. DATE-------= ------••------=•`---...:.............. •-•--•--..._..•••---_-•••- t ' ; FORM 1255 HOB'BS & WARREN. INC.. PUBLISHERS - P' t SOIL LOG 2."PEASTONE LOAM 6 FILI — 12�MAX ' ''•� '/ ' -� ell u A to o . . • . I 1000 L[:BOX I;.••. .° 1000 GAL. I ° • I ( �. • o TIO'MIN, GAL. lee ma's PRECAST OR I . ' �' 24 ° • o . 1 Tu/7- SEPTIC -- I. . .• BLOCK I ° MIN pwcc 9/" Z I,4;e��oo SEEPAGE ' � ° . : I 7",�:%'r" S1 �� PIT ° • ° ° I �_ C. 2 0' MIN. — -- . d I � . a/,I E/e. FOUNDATION i 1 %2" WASHED STONE `* I 1 ELEVATION SKETCH f-------- 10' P E R C. RATE: SCALE : I" = 4' TEST BY :_ ;�:. P»:'t?�+ro •+,A� TOWN INSPECTOR Z ��` � L:Et'7/Fy TM��7 Tt� FQGr.SiO�7�Ov BACKHOE OPERATOR: 1-10 Bar�y .•r� .ti' Cs.ur � s L c n?-TAX 4J /iv TM TEST MADE O N /'L,�� p •` 19 doovC, 80el,4,' c 6 Q. Fro a 77 4& 00 o IeR.q ♦ 4. lt5m D(�' i � l � � � ICJ �� � v TdM• c F4.-100,00 CPS$ �r o ,, 07 $9 2 C,6ASi N _3 t3� �>ao•G428Y �� �Q���� 1 k l/0 COL/8, le. = 330 <i,R D. d 2) /hAX• 4440GroQ,34.E• 0A )l-Y 1=L0cc� Fart 7'-HIs -1YJ-r&-r1 .¢70 G,pp 80 Tr a-pig 7 9 S, x � 1 � �,P•o/S.r 7_ P,2 o�p s �� Co�'roc.r 7-v-r.4LS•- 2c.7 5•F. 64 9 W • .i ELEVATION SCHEDULE t�. �_. PROPOSED SITE PLAN I. INV. AT FOUNDATION = 1?6, 00 a 2. INV. INTO SEPTIC TANK = 95• SEWAGE SYSTEM DESIGN IN 3. 1 NV. OUT OF SEPTIC TANK = �' 55 �yG' 3 4 '—/q �G'OTC//-r 4. INV. INTO DISTRIBUTION BOX = 7 S, I$ SCALES I"= 00' D,�G11978 5. INV. OUT OF DISTRIBUTION BOX = 24 C - 773-S 6. INV. INTO SEEPAGE PIT = '¢ •?) CAPE COD SURVEY CONSULTANTS ROUTE 132 7 BOTTOM OF PIT HYANNIS ,MASS. t„ e i •4JL- . LO_G • S0 - / PEA3t ONE LOAM 6Q lltl- MAX SI {oo• 5 nox a4 C.I1000 l,•. 0 1000 GAL. • • e : 1 4� _ _?.�' 10'MIN. GAL. e PRECAST OR o �' 24" SEPTIC ! %.• BL0 C K , ' e a 1 MING... �J I TANK s' �; SEEPAGE • '.. : I37P' faw } PIT • 20 MIN. •...•.I •FOUNDATION I 1 %2" WASHED STONE' I 1 - ELEVATION SKETCH Io' ---� PERC. RATE: Uws�Ei z,�. �►.�l, SCALE 1"= 4' TEST BY : ` TOWN INSPECTOR: '%'✓ BACKHOE OPERATOR: r TEST MADE ON : i "ob c TOP l-0yC°,�Au�'Q ,F,Ca 92, 7'5 • � � � �, For/N G 5 o ST,k�`hli. as CIAO -- - P #his ; " ��F . .� �•f�,, { f _ �" '� �.o-! LEA yitil6 � . • • * . a. � =_Yp.} '.fit .o�„�, � {�.�y Irk tp �' . ,• 'f 61e9 .. , ,¢ $ ;!•.'a\� `fig /'pf,�" n/G/�'' & +4 ' ,�� • G+ +ems.� � •.N..rd ter' -:, .... -:: ,' °�••��"Y' - .'Cz-SE'-h''i'M '*5„e+�,,� � '�� 4 �y , -. .. F2 cao5 v' , L 98Xao ;, 17' �9.. Z, C.e9siw Als C?,o/4 y 4140w .3 +�• �No,64R�►Rt'a6• fil�l�►Dt}� k 1/OGpf.�$.le. = 33o G.PD. L AC? a"0 2) Mqx. 444,o i+A9 S 04 )(.Y trLO ew FOIX TH�r �Y.S-t'&M , ! 117 Ex/s7i�✓c� Co.vTou�' t 66 S,F, x• 2, 6,P.A/S,9, 47d G,RA. _____ -fd f p2oFc,S a'a c4m* oui2 QoTr crag 7 9 S, F, x l,r� SIP v�.s•f' - I T�Y'ALS 2 co 7 S•F. S4 4 Cr P Q of ROBE T ' - h Na :' J4t.� t�. f j •1 �,�h` �j �f�I 12 '? E LEVAT ION SCHEDULE -PROPOSED SITE PLAN • I. INV. AT FOUNDATION a 1 SEWAGE SYSTEM DESIGN 2. INV. INTO SEPTIC TANK = g�'�'Q IN 3. INV. OUT OF SEPTIC TANK = _ .55 4., INV. INTO DISTRIBUTION BOX = 5 r5 SCALE : I"= 00' Z;tfz, 19745 5. INV. OUT OF DISTRIBUTION BOX' _ 2_11 C - 7`3S 6. INV. INTO SEEPAGE PIT = 14 ,7 CAPE COD SURVEY CONSULTANTS ROUTE 132 f 7. BOTTOM OF PIT = 8-6'77 HYANNIS ,MASS. ti