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0174 SCHOOL STREET - Health
174 SCHOOL STREET, COTUIT A= 020-070 i TOWN OF BARNSTABLE LOCATION 5QI001 ,S/L SEWAGE # VILLAGE�QD4U/ ASSESSOR'S MAP &LOT D Ala 7t� . \ INSTALLER'S NAME&PHONE NO. ./�GyG ©Gj'c /' SOGL 0 SEPTIC TANK CAPACITY_ APOO C7L� LEACHING FACILITY: (type)o� (size)`'/Dd'q NO.OF BEDROOMS BUILDER OR OWNER Idyl PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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) At I A Feet Furnished by y � a ='s` �e9 .. � `� 4 f.� ' .. f3 � s �/' ,��/ �3� �,�i^�D �� �'i .®�� No.------••=�- /.. FEBJ....3 0 0 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration fur Diipmial Workii Tomilrnrtiun tramit Application is hereby made for a Permit to Construct ( ) or Repair X(XX) an Individual Sewage Disposal System at: 5 C H 0 0t ............1.74..inn...S-tm_eet---Catu i b--•-•--...-•----••.._... -----••----•-•-•-••---• ------------------••--------•--.-._..---•------------------•-•-•----••-- Location-Address or Lot No. ..••-•-.....BQYax................••--•-•-••••-•--------•---•••-••--•--•••------•••••----- •-•------•---------------------------•----•--------•--•--•-••--•-------......----------•---...--•- W Owner Address W J,P•.Macomber Jr Installer Address UType of Building Size Lot---0_5H..............Sq. feet t-, Dwelling-X- No. of Bedrooms.---------- -------------------------------Expansion Attic (NO) Garbage Grinder tq ) aOther—Type of Building -----------0----------.._._ No. of persons------2___________________ Showers (2 ) — Cafeteria ( ) Otherfixtures --------------- -------- -------------------------•-----•------------- W Design Flow......5.'J. __________________________gallons per person per day. Total daily flow....... 30-----------------------------gallons. W Septic Tank X-Liquid capacityl_OAA-gallons Length -.6"____ WidthA'_1.0_'1_ Diameter--- Depth5'7"--_- x Disposal Trench—No. _XXX----------- Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No------I ------.- --- Diameter-----6............. Depth below inlet---_4.__.__...__._ Total leaching area..................sq. ft. Z Other Distribution box (X ) Dosing tank (Nq Percolation Test Results Performed by--------- ---------------------------------------------------------------- Date.................................... Test Pit No. I................minutes per Inch Depth of Test Pit----------------- __ Depth to ground water_.__-_._-__.-__-_-_--_ fT4 Test Pit No. 2----------------minutes per inch Depth of Test Pit.-.-_._______---___. Depth to ground water........................ Gd ---------------------- -------------------------•--------•-•----•-•-•--•-----•-•---•----••--------•---••------•----------- Description of Soil....Salad..........................................................................................................................--.............. x U ................... W V Nature of Repairs or Alterations—Answer when applicable.-_Adding 1 1000---gallon leaching.......... Apt to... _>l.._ex _a . nq bank box_-and---pit 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 b en 'sued by the b and o health. Signed ... � to c Application.Approved By / ------------------------------------------------- ...7/-. i .------._.. ..- -..._.....__.--_._......... Date Application Disapproved for the following rearon r- ----------------------------...........---------------................----------------------------..---------------- --------- ----------------_........................------...........----------------------...._.-- ---------.._.. ------------------- ........ _..-... Permit No. - �� /-.-----..--- Issued 7 ��/ o.� e - ------------------------ Date 1 �,' Fss..�........ ............. No. ..0.0 THE COMMONWEALTH"OF MASSACHUSETTS BOAR OF HEALTH ..� ,TOWN OF BARNSTABLE ,� 1trtt#i>att fnr , in �a� nrlt (n� trr#iun rrmi# Application is hereby made for a Permit to Constj-uct ( ) or Repair NX)� an Individual Sewage Disposal System at ............ '= = .............................. .. ...--•---_.• •..----- ------•--------------............•-•--•----••-- Location-Address 1 I or Lot'No. Owner « Address a Jet,P.Macomber. J a Iustaller ' • Add ess..................................................... UType of Building _ ~ SizerLot---0.19.8..............Sq. feet �-' Dwelling n No.-of Bedrooms....... s'G G -------------Expansion Attic (NC) Garbage Grinder (q ) Oiher—.Type of Building -._---..-__� .,w-.._.. No. of persons------?---- ----------- Showers (2 ) — Cafeteria ( ) r Q Other fixtures ---------------------- -------------------------------- Design Flow....5.9-3. ...........:a_'_............gallons per person per day. Total daily flow._.-__.3Q....._____---_--------------- a]lons. WSeptic Tank"Liquid capacity,1: 11-0.galIons Length,.° "____ Width.4-'-1-0.'-- Diameter---........__. Depth5:.17"--__-- x .Disposal Trench—No. .XX.......... Width.................... Total Length-------------------- Total leaching area.t.--...,_Z.......sq. ft. Seepage Pit No------1.............. Diameter-----6.1.......... Depth below inlet---4.............. Total leaching area,-r'`.._.._._......sq. ft. z Other Distribution box (X ) Dosing tank (NG) r. `-' Percolation Test Results Performed b .a Y Date. - Test Pit No. I----------------minutes per inch Depth of Test Pit--------------------- Depth to ground water........................ (%q Test Pit No. 2................minutes per=inch Depth of Test Pit.:------------------ Depth to ground water........................ 0 Description of Soil....RA!qd.................................................................................................................� U ......... _..._..•--••----•-•-••-••---•-----•••---•••-------------•-•-------•... ' .. - ........................................................... -----------------•----...-•-•--------•---------•--------••--------(--------•--•----------------•---------r •.1 ' Adding 101000 a1lon =leachin , U Nature of Repairs or Alterations—Answer when applicable... _ ..__..__ ............................._.___............_. ___..........oit____ ito an ex ,s !ina_._tank box and . 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 beemissued by the board o health. Signed ------ --- ._:.. L �.._..---- E 7, :1 �.�9-5-------------- ....... Application.Approved By . ....... ------------- �--............_..�............................ ..- �, Dare Application Disapproved for the following reasons: --------------------------- -------------------------------- --------------------------------------------- -"..... .............. ..... .... ......... .__...._.. ... .. ......... .. ._.......... . . ......... .... - g Dare Permit No. ................ ... �` - Issued - Dare . THE COMMONWEALTH OF MASSACHUSETTS Y . BOARD OF HEALTH TOWN OF BARNSTABLE %191.Er#ifi atjP of Clumjjfianre. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedk`(XXX) by J.la.Macomber Jr� • .._ ... ----_ - at ------- 174 ,c o01 Street Ca'tui ..... ........ ........_..._....._..__...._---------------------------------------------------------------....-------............---------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in- the application for Disposal Works Construction Permit No. -'._ �.....�..._.........._ dated .._ y � `. .._-........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. -- DATE---------------------7.".. f/------ -, —----------------------------- Inspector --- ------- r ... ..... . ....----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE - No. .. ..�... 1.. FEE..$ 30.0 • . 0......... Permission is hereby granted-..3,,F,,->Macomber-_�? ..................................................................: \ �• to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at No.174...ar_hool.. Street Cotuft.- _•-•__== S^� = ....._ Street �f .7r_/� f� . as shown on the application for Disposal Works Construction Permit N _.__ __�._�_.f_f,.r_,, D,atd�_p___!!.......... - ....................... .-! f /''.- =.p.----"- 1---------------------------------------•- �f Boa d of Health DATE...................... . 7/ FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IM ^ACC DATA \ 4. ANY CHANGES THIS PLAN MUST- &E AP AAO BY THE BOARD HEAL TH AND CAPE: 6 I3LA 1 SURVEYING NBS ,_ ' ALS A ST ' �� "� 5. MA TERI ALLA TIC ShG4LL� "BE .1-l�+Y �0 T t 4- . COMPLIANCE THE 3TA,TE SANI.TARY' -` CODE TI TL AND LOCAL 'APPLICABLE. . RULES AND; TIalI1/S . NORTH ARROW.. o - 6. NO RECORD PLANS ; AND - IS NOT �ZAB FOR SOLAR..PU�aOSE3 7. FLOOD H e . B. MA TER SUPPL 2 c q ?a.e i rx r i soon;ALL V `, __y® N6 CO naECA�s SE NTOUA TAWBU N, A TION PI T '¢-r- 13 TIO N BOX { p � PRECAST CQNCRET LEACHING PIT ... 3 o o STANK ��s 5o.coVi!ER.T ELEV ..... .p 33-0 ATION .Q nr PLOT PLAN „ SCALE. J SEC PCL LOT cs�,- CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, J.P.Macomber Jr. , hereby certify that the application for disposal works construction permit signed by me dated 7/1 0/9 5 , concerning the fCiYomL ... property located at 174 l street' Cotuit Mass meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: 7 1 0 9 5 LICEN SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 1 ASSESS6RSMAPNo: ;F6 �.. PARCELIX 0 DATE: 613_0�95____ -7a PROPERTY A <- I DDRESS:_ 174 School _ Cotuit,Mass . ------------------------ 02635 - ----------------------- . 4 On the above date, I inspected the septic system at the above address. This system consists of the following: tank. 1 . 1 -1000 —gallon septic 2 . 1 -distrib-ution box. b1 12 I 3 . 1 -600 gallon leach pit. 1 b Ti 101 Based on my Inspection, I certify the following conditions: i 1 . 'Tliis is a title five septic system ( 78 Code ) 3W- w 2 . The system is in failure. Leaching it full above leaching holes in pit. t � � 3 . g p WOOL RECOMMENDATIONS s0 1 . Raise cover on leaching pit. ( 2 collars ) 2.. Install an additional 1000 gallon leaching pit 9 5 :moo the existingkseptic system. SIGNATUR _ •r N a m e: ,1,pjM&oo.mb-e.r_,7r�_____-- i i Company:_J_P_Macomber_& Son Inc. Address:_ Box 66__ Centerville,Mass. 02632 --------------------- Phone: THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY r JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachf colds Pumped & Installed Town Sower Connections P.O. Box 66 Centerville, MA 02632.0066 775-3338 775.6412 7 SUBSURFACE SEWAGE DISPOSAL CYSTEM INSPECTION .FORM Address of property 174 School Street Cotuit,Mass . Owner ' s name Thomas Tierney Date of Inspection 6/29/95 PART A CHECKLIST Check if the following have been done: _— Pumping information was requested of the owner, occupant, and Board of Health. Yes 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. YES As built plans have been obtained and examined. Note if they are not available with N/A. Yes . The facility or dwelling was inspected for signs of sewage back—up. YES The site was inspected for signs of breakout. Yes All system components, excluding the SAS , have been located on the site. YES 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. Yes The size and location of the SAS on the si'%--e has been determined based on existing information or approximated by non-intrusive methods. YES The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance ,.of SSDS.' 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential 3 number of bedrooms 2 number of current residents NO garbage grinder, yes or no, YES laundry connected to system, yes or no NO seasonal use, 'yes or no If nonresidential, calculated flow: Water meter readings, if available: 1993=34, 000 gallons GPD= 93. 15 1994=77, 000 gallons GPD-210.96 Present Last date of occupancy GENERAL INFORMATION Pumping records and source of information: From owner. Pumped 2 vears ago 1993 - NO System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system XXX Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy No Shared system (yes or no) (if yes, attach previous inspection records, if any) ' Other (explain) Approximate age 'of all components. Date installed, if known. S.ource of information: 8 years Owner n Sewage odors detected when arriving at the site, yes or no . 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �C(�`-�j IL DATA ' 9 SUBSURFACE SEWAGE DISPOSAL 87^" 'M INSPECTION FORM PART B SYSTEM INFORMATI...' •:tinued SEPTIC TANK:1000 gallon tank (locate on site plan) depth below grade: 12" material of construction:XXXX concrete r,�tal FRP other(explain) dimensions: H-5 ' 7" L-8 ' 6" W-4 ' 10" 4" sludge depth 34„ distance from top of sludge to bottom of: outlet tee or baffle 1 „ scum thickness 31' distance from top of scum to top of o!"t ) et tee or baffle 14„ distance from bottom of scum to bottrr-: c:f outlet tee or baffle Comments: (recommendation for pumping, condition of '. -t and outlet tees or baffles, depth of liquid level in relation to out' ,vert, structural integrity, evidence of leakage, recommendations for ors, etc. ) _Tank .clops not need p umi•i ng Tnl Pt- Outlet tees ok_ 4 ' 6" No leakage, ar� p ca t i C t?nk�niim=r�r� nnr•a every 3_ Fears _ DISTRIBUTION BOX: XXX (locate on site plan) NO depth of liquid level above t invert Comments: .(note if level and distribution is equal , ' 'ence of solids carryover, evidence of leakagge into or out of box, endation for repairs, etc. ) Box level no solids carried over. No signs of leakage. PUMP CHAMBER: Nn (locate on site plan) pumps in working order, yes or n~ Comments: (note condition of pump chamber, conditi - pumps and appurtenances, . recommendations for maintenance or repa . ) 1 C; iNSPECTION FORM PART B INFOiU-i-ATION continued -C)!,' SYS'! Y E S Iocace on Slt,c; plat, , if possible ; elXcalvat'01', not. required , but may be a 1)p r o t e d b non- intrusive methods ; no, 1 -600 gallon leaching pit 11, 1 Cj Clfl L)C: pac in s one. 1 0:1.c f" 1 1 e a Ch ...... ............ o""2:1, 1:1 0 ------ Comments : ( note Ccnd-; tjoj-- (-.)f- Soll , lq-'ls O failure , level of ponding, on d i f hydraulic "ecommendaticns for 1 1 itenance o airs etc. -No....s.ig. na-o fi over ) h 'f_hydraulic failure. The pit is lle, -LeaJ iifif hole .Tn--ttre--pit--.--Pipe--i-s, -i-n---r-ise-r-s---t-hat---are--5-'-abo-v-e--t-laa-tpp_ of 16aH cqi��.,,4�qhiqc�_pit must be added to existing system. Pit. P.I all I nu!7-i b e a r,d ----------- NbNE depth 3! S.0 1 1 dep ------- e.S (cesspool be part of inspecr�ic-,", C om.-;o!l r ev ! condiricr. c.: Of ponding, ful fl,,a'-, ntenancee or repairs etc ( locate on site materials of cons,. dimensions dep,.,,. of so?. ids NONE Comments : n o e. c.c.: hj,dra-,llic failure , level Of ponding, for iia i ritenance or repairs , etc. 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' .� VY, I ' DEPTH TO GROUNDWATER depth to grou,.dwater met d -of de ermi tion or pr xi at 'on: 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) NO Backup of sewage into facility? NO Discharge or ponding of effluent to the surface. of the ground or surface waters? mn Static liquid level in the distribution box above outlet invert? NO Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? NO Required pumping 4 times or more in the last year? number of times pumped NO Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? ) Is any portion of the SAS, cesspool or privy: NO below the high groundwater elevation? NO within 50 feet of a surface water? NO within 100 feet of a surface water supply or tributary to a surface water supply? NO within a Zone I of a public well? _No within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? NO within 50 feet of a private water supply well? No less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water anal . for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. TOWN OF Barnstable BOARD OF HEALTH i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION FT.:T.�•��:i����T:f�.�L�.TLT'��:�-3i��Zif':�:TS��T'�tC�=��ITZ����:5--..-��-TC��t TT.^..--_..�1T.:T...��L�St�.:.!'•tS..'::�:i�. T-... —TYPE OR PRINT CI.EARLY— PROPERTY INSPECTED STREET ADDiZfZS -1''74 School Str@et Cotuit,Mass. 02635 ASSESSORS MAP , BLOCK AND PARCEL # 20-70 OWNER' s NAME Thomas Tierney PART D - CERTIFICATION - NAME OF INSPECTOR J P Macomber Jr COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632-0066 Street Town or City State ZIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa71 system at this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with ►ny training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . XXXxSy-stem FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . / 1 Inspector Signature Date One copy of this c tification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTI1. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doe r Water . Conservation SAVE Tips ME. CHECK FOR LEAKS Water Loss in Gallons Due to Leaks Leak this Loss Per Day Loss Per Month Size 120 3,600 • 360 10,800 a 693 20,790 1,200 36,000 1,920 57,600 3,096 92,880 ® 4,296 128,980 ® 6,640 199,200. 6,984 200,520 8,424 . 252,720 9,888 296,640 11,324 339,720 AWL 12,720 381,600 qp 14,952 448,560 CcmmenweeRn cf Mess=�:ae7s ExecuTNe Office cr EnvlronmenTc; Affc.,s Department of Environmental Protection ' water Pollution ccnTrd Tecnnlcet paswcnce and Training Sections WIWam F.Wsid Gor•rnor Trudy Co:s s•u•ory,EOEA Thomas B.POWWO AC"C4MMWWorrr 06/12/95 ATTN: Joseph P. Macomber, "r . Joseph Macomber and Son PO Box 66 Centerville, MA 02631.- Dear Joseph P. Macomber, Jr. , _ I am pleased to inform you that you have attended training, met the experience qualifications, and have passed the Title 5 System Inspector exam, pursuant to 310 CMR 15 . 340 . The passing grade for the exam was 39/52 or 750 . This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15 . 340 . You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at the following address : Kimball Simpson D. E . P. Training Center 50 Route 20 Thank you very much for your time and consideration in this matter. Sincerely, Kimball T. Simpson, DEP Training Center Director (2409 Routh20 Millbury, MA 01527 FAX 508-755-9253 • Telepnon• 508756-7281 t 1-7 THE COMMONWEALTH OF MASSACHUSETTS �' BOAR® OF HEALTH ./..¢;.w .....................OF...... r`!s 7.�E. 1. ........... Appliration for Disposal Works Cnnnstrairtinn Prrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: . !�! .$ ss�ss- /� -------------------------- o tion-Address .• or Lot No. ••O�!.'2,__..'!f_�_...... - yl ................................... ... ......................................... Owner Address a ................ ..................•......... ------••-•-------.................---..........-•---...............------•-------- \�\ Installer Address d Type of Building Size Lot....--.: ....Sq=fvet Dwelling—No. of Bedrooms.................................__..._.....Expansion Attic ( ) . Garbage Grinder -( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ W Design Flow......................✓fir.....____gallons per person per day. Total daily flow............... 3..O.............gallons. WSeptic Tank—Liquid capacity/i?49_.gallons Length.. "Ar.-_. Width_��' Diameter................ Depth.•1_�_."Z.-" x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area,::___:; .........sq. ft. Seepage Pit No......../---------- Diameter.. Z..`�6_w Depth below inlet.y .�.N.. Total leaching arm.:*.,�e:;'.,sq. ft. Other Distribution box Dosin tank z (� ( yea,;:':,:.,• - . Percolation Test Results Performed b ..... Date_`��•_-- Z✓ Test Pit No. 1...... ..._._minutes per inch Depth of Test Pit...../`a/.�___. Depth to ground water.___1j�a__rr_-e_. Test Pit No. 2.....Z....minutes per inch Depth of Test Pit..... Depth to ground water.-__-/Y!r :. a �r . s`{36"-36y yu . 7 '' .. ....�........ o.// o. - - ......:------------------O _ .Description of Soil..........................•-•-� i o�yS ;f... `.. ............. --••--------•--------------•---------------•----•---------•-----•-------------.......---•----- It '� . , �v !?G ---•-•-••--------------•-----•-•--------------••---•-•--••-•-•---------------....:/...•.-_._ ................................. .s.:.-- 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 iIT11 5 of the State Sanitary Code The undersigned further agrees not to place t syst m in ..,, operation until a Certificate of Compliance has ed by therrofhealth.Si ed / 3..... ............ ... ----------•---•----••------ ------------Date...------.... Date/ Application Approved By............= "....................................................... Date Application Disapproved for the following reasons:...............................•------------------------------•-----------------.........-•-------------------- f ............................•-----................------------------------•-----............--------.......------.._......-•------------------------------------•------------•••--•----------------_..._ Date PermitNo.---•----•-----•................. .............•-------. Issued....................................................... Date No.... ........... Fimw.THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................... ................................................ .................. ...................0 F....... -$Ze�4VIe Appliration for Disposal Works (foustrurtiou Vrrmit Application is hereby made for a Permit to Construct ()<) or Repair an Individual Sewage Disposal System at: - ' 4 —c e.5 5 '1�96 ................. ................................................ ........... ................... ............. .. . =n Address or Lot No. .............................................. .................................................................................................. Owner Address, Installer Address " Type of Building Size Lot........ sq;=f ft-t ----------------Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow_______________________ .........gallons per person per day. Total daily flow..............� ..C) .... .................&ajlons. " Septic Tank—Liquid capacitye.!?V�.gallons Length..!��./ ". Width.-' Diameter________________ Depth.:J`'_...."....7.... Disposal Trench—,.No..................... Width_____..___._.______ Total Length________.___.__.____ Total leaching area....................sq. ft. Seepage-Pit No________ --------- Diameter...!A...... Depth below inlet_ ...... .... Total leaching area..................sq. ft. Z Other Distribution box (/) Dosin; tank ,) Percolation Test Results Performed by.... .............................�1�7. ...�� Dat......................................... 4 . ..... 6, -e Test Pit No. I......;?......minutes per inch Depth of Test Pit____.Z�.... Depth to ground water...__ ...... Test Pit No. 2......gz_....minutes per inch Depth of Test Pit__.__ Depth to ground water_____ G......... ... ............................................................. ---- ---------- ...............*...........** 0 Description of Soil...............................0................................. ....... 14 /V,/" �/: ---------------------------*----------------"...... U .............................................................3,..................................."i�'...................................... -------------- ....... .'? ----------- ...................................................................................../�/5a....... /1Z.........� -e_.�I.�r.......... ...........------ ........ ....... ......... 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 Sanitary e undersigned further agrees not to place thw syst in e The he I rrd-of undersigned operation until a Certificate of Compliance has Code d by t I 7;r4 Sligped.. �.................. ......... ................ ........................... .......................... ,ram — / Date --Application Approved By.__....._._ —................................................................................. .............. Date Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo.:_........4k.... .................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF................ .. ................... THIS IS TOERTIFY, That the Individual Sewage Disposal System constructed or Repaired, by..........................�L am .................................................................................................................. Ynsta�ler (-;±�_-T...............................................................................................at ........................... --------------------------------- ----------------- has been installed in accordance with the provisions of TITI&_----5 of The State Sanitary Code 4s described in the application for Disposal Works Construction Permit No.............ts(_0 /.f -1.......................... dated__...____-P..2,/g6............... THE" ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL/FYNCNION SATISFACTORY. DATE................01.9.11 ...................................... Inspector....../M.................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............OF.............................................................I................. FEE....... ............ Disposal Works TFAInstrurtion Vprrmit ___4z�v 19f'?C_<' Permission is hereby granted._______ ..........ei........................Z................................................................... u r an Individual S�.wage Disposal System to Construct o Repair atNo................ ----------------------------------................. --------------------*...........'------ " Street -7. as shown on the application for Disposal Works Construction Permit No.__�..... Dated......',_�> ............... ---------- ------- '177,77........... Board of f H'ealth.... ------- ," DATE................... ................... FORM 125,5 HOBBS & WARREN, INC.. PL,BLISHERS i ASSESSOR'S MAP NO. D.®70, PARCEL Q Q.: ; �� " 0 LOCATION I SEWAGE PERMIT NO. st- W I L L QDINS;TA Ll R'S NAME i ADDRESS C e U I L O E R OR OWN ER -o�n -m C 6 ne DATE . PERMIT ISSUED �� 2' �� DATE COMPLIANCE ISSUED - Jg/� ;�, r.� � ��., M1 ,� . 1' � 3� � � t 9- S YS TEM PROFILE NOT TO SCAL E ' TOP FDN. EL . �'Y =" FINISH GRADE ' - ` FINISH GRADE OVER :o:..°e::i: FINISH GRADE OVER DIST. BOX FINISH GRADE OVER °' °•' SEPTIC TANK LEACHING PIT -3�'.® VARIES.0: o' 6. '' '�0;•'p;• :a' .e..' :t •�::'.e .e:..:e:. e.o•.:p.`:i.•. i:e:•?.:o': •;d.•e:e:i •O 3" OF 1/8" PRECAST CONC. OA,.o•:.b' :':' ASHED PEA STONE -,?ip. :: o•' BRICK 6 MORTAR a OUTLET PIPE LEVEL " TO 12 BEL ON GRADE FOR 2 FT. MIN. `'`` 0•. .: o'.e 6: :m ,. u, i' •'°:::.•:•.i..•e••.•' �o.'e;.0'.:0:�•O:o: .a :.°• Q.°,. �; O O� •► •4 iJ� o • a'.e: � C. I. OR PVC TEES 13� 400 o• •0;0• :O.D•.D.p,4:p: BSMT. FLR. �':' GALLON ' ° ' : DIS TRIBUTION BOX EL . o'. :o• b.. I PRECAST CONCRETE " INSTALL ON LEVEL BASE 3/4" TO 1-1/2 °o.°o.°.•:e°:o: �: o'.. o. e ° PRECAST :;: °-.•°'. o. e:c: q WASHED H— 0 REINFORCED CRUSHED a CONCRETE lot0• d: e.o.o• .. o-o':o:..a:o:::o-:o e•p.p•Q..'q.:Q.op'.e:.::.�':'6. 'o.•b 10 STONE .b:.o: o.c:.o.o?.o:ov .o,00.,_c :q o.o •e,00:oo. .e:.o:.•ob:° s H— 0 REINF. SEPTIC TANK .e ` INSTALL ON LEVEL BASE ,� 'O' ° ° { 4' G OR LOWER TO REMOVEALL IMPERVIOUS MATERIAL BENEATH THE LEACHING AREA 1� 3 N REPLACE EXCA VA TED MATERIAL WITH V \ CL EAN. CLA Y FREE SAND ( � N �, EFFECTIVE DIAMETER �. LEACHING PIT / _ n (, GENERAL NOTES INSTALL ON LEVEL BASE 1. ALL EL EVA TIONS SHOWN ARE BASED ON \ 2. AL L PIPES IN THE S YS TEM MUS T BE CAS T IRON _ OR SCHEDULE 40 PVC. OBSER VA TION PI T 3. THE BOARD OF HEAL TH MUST BE NOTIFIED r5 7' � WHEN CONSTRUCTION IS COMPLETE PRIOR � TO BA CKFIL L ING PERCOL A TION RA TE: \� MIN./IN.� ?-� 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND CAPE G ISLANDS WI TNESSED BY.• 1 SURVEYING CO. , INC. \ 5. MATERIALS AN0 INSTALLATION SHALL BE IN oT ` COMPL IANCE WI TH THE STA TE SA NI TARY f'F l' =- BRD. OF HEALTH DESIGN DA TA CODE — TITLE V — AND LOCAL APPL ICA DA TE- <_� = ='_"' BL E , , o, 58 •4c r RULES AND REGULATIONS ______ __-__- ,4, I 6. NORTH ARROW IS FROM RECORD PLANS AND T,P s �, E NUMBER OF BEDROOMS \ \ IS NOT TO BE USED FOR SOLAR PURPOSES GA RBA GE DISPOSAL 14149 S b�.. , 3ubsoa , N � 7. FLOOD HAZARD ZONE =-' DAILY FLOW tZ_ 3i 3 2•a A Q 8. WA TER SUPPLY r SEP TIC TANK REO D. o o Q .' ' SEPTIC TANK. PROVIDED oo ' LEA CHING REQUIRED -� `y 3 Be1r•,., /! t . A. � Mae.;•..•++ j\/; G.^�" ', -5�,"G = i� 7 S.F. \ � � SIDEWALL AREA f o F S.F. X r 4"G/S.F. _ e ?Z GPD BOTTOM AREA = /ZJ S.F. L EGEND " S.F. X 42G/S.F. _ / J GPD � a l ' A+cr + LEACHING PROVIDED = GPO � PROPOSED EL EVA TION s a o 000 GALLON \� �J/ !PRECAST CONCRCT EXISTING CONTOUR SINGLE FAMILY RESIDENCE cS > SEPTIC TANK 6 S OYSERVA TION PIT yff \ , \ f • v, t : � 1, y , ❑ DISTRIBUTION BOX PROPOSED SEWAGE DISPOSAL S YS TEM h° f n� PRECAST CONCRETE `\\ �� O / JAMES LEACHING PI T +1 - O 80MAND PREPARED FOR No. 29374 �G o o SEPTIC TANK '` ` �,,\w Mc SHA NE CONSTRUCTION CO . ©�.o t R P) RESERVE LOT 14 SCHOOL S TREE T DA ID BA RNS TA BL E — CO T UI T -- MASS . PIPE INVERT EL EVA TION :1 SANI ,sc�� c7 _ DATE.' 28085 PLOT PLAN c, �„� w� ;. CAPE 6 ISLANDS SURVEYING, INC. SCALE.' 1 � .� SCALE A S NOTED P. O. BOX 334 "_-=' '::, r'� �:, �� �,° �� ' '- - ' • PLAN NO. =�' TEA TICKET, MASS. 2 MAP SEC PCL ILOT I HSE -.