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HomeMy WebLinkAbout0023 TOPSAIL CIRCLE - Health 23 TOPSAIL CIRCLE, COTUIT A = 018 096.2 TOWN OF BARNSTABLE LOCATION � \ SCe A,1 C__,��(o,� SEWAGE # VILLAGE. ASSESSOR'S MIA LOT La � INSTALLER'S NAME di PHONE NO. SEPTIC TANK CAPACITY //11 LEACHING FACILITY: (type) (size) dV NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: C®� S9A ci la �7 Separation Distance Between the:- Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility,(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by SCGG i Fo1/!YI I /fig� Ac ag AD at Qa a s F)c 31. �o yt 1 � 8 — r r 1999 COMMONWEALTH OF MAS 'ISETTS EXECUTIVE OFFICE OF ENVIR I AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Name of Owner CARL REDFIELO Address of Owner: n/a Date of Inspection: 219/99 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: John Graci Title V Septic Inspection Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 Telephone Number: (608)664-6813 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: X Passes The inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:2/10199 The System Inspector shall#ubmita copy of this inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2198 Page 1 of 11 I SUBSURFACE_ SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:219/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: _ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection 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. NO 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 exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. NO 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 a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed _ distribution box is levelled or replaced NO The system required pumping more than four 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 revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:219199 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa_(approximation not valid). 3) OTHER nLa revised 9098 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:2/9/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nta. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is 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 analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:2/9/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X 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. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 11 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. e i revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:2/9/99 FLOW CONDITIONS RESIDENTIAi; Design flow:-=g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):n& Total DESIGN flow: Q Number of current residents:11 Garbage grinder(yes or no):MQ Laundry(separate system)(yes or no): MQ If yes,separate inspection required Laundry system inspected(yes or no):JLQ Seasonal use(yes or no): YES Water meter readings,if available(last two year's usage(gpd): n& Sump Pump(yes or no): NQ Last date of occupancy: WA i COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: n&gpd(Based on 15.203) Basis of design flow: Wit Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): rt.Q Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) n& Last date of occupancy: nLa GENERAL INFORMATION PUMPING RECORDS and source of information: nLa System pumped as part of inspection:(yes or no):NQ If yes,volume pumped n/a_ gallons Reason for pumping: n1a TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n(a APPROXIMATE AGE of all components,date installed(if known)and source of information: SYSTEM IS 12 YEARS OLD, Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:219/99 BUILDING SEWER: (Locate on site plan) Depth below grade: ILE Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) nta SEPTIC TANK: X a (locate on site plan) Depth below grade: Z' Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene other(explain) WA If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): MQ n/a Dimensions: L 8'6"H 5'7"W 4'10" Sludge depth: 1"" Distance from top of sludge to bottom of outlet tee or baffle: IK Scum thickness:Q Distance from top of scum to top of outlet tee or baffle:X Distance from bottom of scum to bottom of outlet tee or baffle: Wa. How dimensions were determined: MEASURED 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.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nLa Dimensions: nla Scum thickness: n(a Distance from top of scum to top of outlet tee or baffle:j3/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n& 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.) nla revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 16 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:2/9/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) IVA Dimensions: nLa Capacity: n& gallons Design flow: nla gallonstday Alarm present: NQ Alarm level: n/a Alarm in working order:Yes_No—: NO Date of previous pumping: nA Comments: v (condition of inlet tee,condition of alarm and float switches,etc.) n& DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQUID LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): MQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n& i r revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:2/9/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nla Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: ..n/a leaching galleries,number: _nLa leaching trenches,number,length: n& leaching fields,number,dimensions: n& overflow cesspool,number: n& Alternative system: n& Name of Technology: _nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY PIT WAS EMPTY AT THE TIME OF THE INSPECTION NEVER MORE THAN 2'OF CESSPOOLS: _ (locate on site plan) Number and configuration: n& Depth-top of liquid to inlet invert: n& Depth of solids layer: n& Depth of scum layer. nLa Dimensions of cesspool: n1a Materials of construction: nLa Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nta PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:n& Depth of solids: Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla revised 912198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:2/9199 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a fE,ur4g c R �S Ac o� BP 91 revised 9/2/98 Page 10 of 11. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 TOPSAIL CIRCLE COTUIT MAP 18 PAR 96.2 Owner: CARL REDFIEL Date of Inspection:2/9/99 NRCS Report name: ida Soil Type: Wit Typical depth to groundwater: n& USGS Date website visited: n& Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers XUsed USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) GROUNDWATER DETERMINED FROM USGS MAPS AND CHARTS AND VISUAL revised 9/2/98 Page 11 of 11 ;i ASSESSOR'S MAP NO. ( b PARCEL L` C A, T 10N aJ� S E W A GE PERMIT NO. Y1LLAGE 5 - L' Comuc IN 'STA / LER'S NAME i ADDRESS e U46 D E R OR OWN Ell DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �; .\\\. F \ i1.� a _— �' h o; j � � � � _, -� i _ r ` b��' _� ASSESSORS MAP NO: 0 No..��. ..`.9( PARCEL NO.:—L>&3 Fly$...............©. ` THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF OF HEALTH .. oF...... P - -........ -- ---- ------ ........................ Appliration for Disposal Works Tongtrurtion Frrmit Application is hereby made for a Permit 'to Construct (Kor Repair ( ) an Individual Sewage Disposal Is.,= at:nll BJ�fL-7,•..lep ILL IBC IS l..�t'T'12-1-T..................................... .............. - -• ¢ r ...................................................... Location-Ad ss or Lot No. l'I ...... ........................... ..........•...............-•-•---- -•----------•-----------------------.........--•--- O ner Addre Kss a C7.1`.... ......cm.&.5 .............................................. ............. .... .. .K.t------- A............................. ...... Installer Address A,C_ d Type of Building Size Lot.3..............................!374-=fw%- U Dwelling—No. of Bedrooms......... ................... Expansion Attic Garbage Grinder --•- Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Q' Other fixtures ...................•-----•---•- W Design Flow.............. . .....................gallons per person per day. Total daily flow......... ....................gallo . WSeptic Tank—Liquid capacity.1C60gallons Length .G._.. Width.+71C.. Diameter-`--------- Depth..S'_.-.'Cj. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. f Seepage Pit No..................... Diameter......1Z_........ Dep h below inlet.....__._....... Total leaching area.3 $�...sq. ft. Z Other Distribution box (Y46 D�ank ( � AA '' I '-' Percolation Test Results Performed by'�� .. .._K�N_G...F.��....._.. Date.�3_.�� 8 .........:... a , ` Test Pit No. l_L..�__._minutes per inch Depth of Test Pit....��------,. Depth to ground water_. 6_�_ Col"TGEbp f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ at - - - -----•------ ---------- ---- ------- -.-•-.... Description of Soil...O".Z........ -o/ Ul!`_. ?__......... �� �� . --• ------� kZ--- .. --- -- ------..._.. x ---------------- ---cs �-----.....---------------------------.........------------------------------------------------------------.............-----...--------------------------- U W .---•• .. ........••......----•---------•-----•--• ............................................................•--------------•-•---- x 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 Code— The undersigned further agrees not to place the system in operation until a. Certifi to o C plian has been issued b the board of health. _.__.. . 17—u Application Approved By.. --•- --•....... .•--- ...--••••-•-- ate Application Disapproved for th ollowing reasons:------•-------------•--•----•--•-----------•----------••-----•-------•-----.....--------------------------•---- ...-•----------------•-•---•--•---•-----•----.....--•--......-•--.-•.................----••------...-•----------------------------------------------------------. // Date PermitNo............ ..................... Issued-........................................................ Date No................_....... Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applira#ion for Disposal Works Tonstrnrtinn Pumit Application is hereby made for a Permit to Construct ( Kor Repair ( ) an Individual Sewage Disposal System at: y� y 9/L1 Y: L/(�s� ` i 1,j l:, i7 t �^sC-ar C� f` v- LT.......................................I_Ca 1 -- J.................-................ .. ..--••------......................... U 1 T .................................................. Location-Address or Lot No. ......................—........................................_................................. ............................................... W Owner Address .......... ^^ ._ .......... Installer Address _ Type of Building Size Lot..........�.�_.____.... " �-, Dwelling—No. of Bedrooms--_-----__3..............................Expansion Attic MP Garbage Grinder ("C.) a'4 Other—T e of Building .............. No. of ersons.....................__.____ Showers Other—Type g --------•••--• P ( ) — Cafeteria ( ) d ,,m r .... y Design Flow-...Other fixtures -----------•----g-----------P person -----y.----------•-------y-------••--•-•------,.�� .................... allons er erson per day. Total daily flow._._.._.__.......___.......__.............._gallons. WSeptic Tank—Liquid capacity_1CT allons Length.Ea__�-:�_.. Width._--•k- Diameter____- --__- Depth.f� Z. Disposal Trench—No..................... Width-................... Total Length............ Total leaching area_._..........__sq. ft. Seepage Pit No..................... Diameter......1Z........ Depth below inlet...._L.......... Total leaching area..-0.2...sq. ft. Z Other Distribution box (y)Z j Doei dank ( )C Percolation Test Results Performed b .__:��K_��=' ' Date.._.__.. Test Pit No. l._ -...minutes per inch Depth of Test Pit..... . ....... Depth to ground water.._1L1�E_t=&kCC:v► 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-__--__-----••----______ D Description of Soil...® c�At Z 12' ��--� -!J � x -. .k.t -------------------- ------ w --------------------------------•-------------•-------------------------•--------- -----------------------------------------------------------------------------------------•-••-••......---------..... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..---••----•-•-------•---••--------------------------•------------------------------------------•---••.....---........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.j 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complian e has been Eai;F th. A�f.!' - �' '�. igned. ------•-------•------------- - 0Application Approved By--•.•.....----••-••...----••--•--•--•--- , 4 D to Application Disapproved for th flowing reasons----------------------•-•---••---•----------•-----------------•------------------•-----------••-••---.........--- .......•-----••-•-•.....................•-•••-•--....--••----...-••••-•-------•--••-----•--•-•-•••-•---•---••--•-•--•---•-••--••--•-•--•---------••-••--------•-•-•----•-•------••------••••-•---•------ Date .e . -G/ � Permit No.................. Issued_ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........................ (9rdifiratr of TuntpliFanrr THI IS TO C RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----------= . at ............ - 4�G6?-.-•---C�. \ -- e-A!14, -`-------------•---------------•---------•---------.....----•-----......•-----------. has been installed in accctfrdance with the provisions of TITIE 5 of The State Sanitary Code as_ escrib'ed in the application for Disposal Works Construction Permit No.... (G?.:'__G7 ..... dated....... _.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN�CTION SATISFACTORY. DATE................ :.. t7/� � .... Inspector....::.._!__.. ................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A,jj/ /_� ...OF...... � .. L L. .--.......No.. ...... EE......................... Disposal Works %Tlantrudialn rnmit Permission is hereby granted...........-......A.`c,--------------- Disposal System atNo............ _ _�.............1 ej....----. ......r Street G as shown on the application for Disposal Works Construction Permit Now ___.. __ Dated.....•.............................�__.... ..................•••---•---•........_ i (�r� l V ' l&f Gtn 1�7�1G�S _ Board of Health � DATE----------------- ------------•------ ----------------•----------......__... _ '� -/ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Fps THE COMMONWEALTH OF MASSACHUSETTS 100Z' � BOAR® OF HEALTH O ....."..............OF..... Q! .�J.�$ r .��17C............................. Appliration for Uiipnsal Works Tomitrurtiun Vamit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage-Disposal System at: /�_r c ...s.gt. C rcr/ C ................__Z............. /p .. ..................................................- ......-•-------..............-•-•------- Location-4jie.2.ss �y or Lot No. N_e.r........... "�I,$�!^(/GL.`�2:?7........ ........•.^•--------....'_.__................................................................... Owner Address a -- :..... ....... ^" ........................ � Installer Address �3 �� d Type of Building Size Lot_._----_, ......Sq. feet g— ___________________Expansion Attic ( ) Garbage Grinder ( ) V Dwelling No. of Bedrooms_________________________ aOther—Type of Building ......:.................... No. of persons___--___--_•--___•---______- Showers ( ) — Cafeteria ( ,-) a' Other fixtures ............................ . d •------- 0 --•-•--------------•------ ` Design Flow------------------------47 ........gallons per person per day. Total daily flow_-__-_......._.3 3..0........._..__611ons. Septic Tank—Liquid capacit)�oao gallons Length �G.°_ Widthy �a Diameter________________ Depthr`_.74 W Disposal Trench—No. .................... Width..........__.__.. Total Length._...............Total leaching area....................sq. ft. � Seepage Pit No......../--------- Diameters?................ Depth below inlet.__............ Total leaching area...._. _.571"'_sq. ft. Other Distribution box ( 00 D yin tank ��ii / "� - 'C 7/Z-- 7 Percolation Test Results Performed b ._.. ._C ._../.31- ._.S�!✓✓�y!�_ .. Date_Fi�-_G,t.� �....... a Test Pit No. 1...'Z._-----minutes per inch Depth of Test Pit--/:t/ ------ Depth to ground water__,t�' Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ---------------------------- ......---.....-.............•---•-..........._......................... ... Description of Soil 3 ....---C sov b s o .. cJ. --- - -- - ----- W ...........I............. ................................e6......... �q� --------- -- ---------------•------------ UNature of Repairs or Alterations—Answer when applicable................................................................................................ ---...-•-------------------•----------------------•----•--•------------•--.....---•--..........--------•-------------------------------------------------------------------------------............._.. . Agreement: The. undersigned agrees to install the aforedescribed Individual ge Disposal System in acco dan e with the provisions of ITIE 5 of the State Sanitary Code The un rs'gned further agrees not to pla�e� s to operation until a Certificate of Compliance has b e b r ii 3 2, Signe ................ ... ....... --- •----•--.. ......................--- 6 Da te ApplicationApproved By............................. ------- ..................... -- ............... ---------�-- ..... Date Application Disapproved for the following r ons: = ............................................................-............................................................................................................................................ Date PermitNo....................................................... Issued_....................................................... Date No..... THE COMMONWEALTH OF MASSACHUSETTS FEB.. (.D.......... BOARD OF HEALTH ,:,, ., _;;Z �r ...................0 F...... .. ... . r �..`./. ........................................ Applird.fivalor Disposal Works Tonstrurtion "umit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ....................I.................................. ........................................................................................... Location-Aedf-ess /,,V or Lot No. ......... C' -/ 1_/1'__ 6f- .............��2I ......................n....... .................................................................................................. Owner Address ...... .. ........ Installer Address 2' Type of Building U Size Lot__ . ..........7.Sq. feet Dwelling—No. of Bedrooms......................................._..__.Expansion Attic Garbage Grinder 04 Other+-Type of Building ............................ No. of persons............._.............. Showers Cafeteria Otherfixtures ............................................................................................................. ---------------*----------- Design Flow_________________________5-j- 0 ..................gallons per person per day. Total daily flow._._............_.. gallons. el?(). --, z.'-'; " -r-" 7- 04 Septic Tank—Liquid capacit/�......gallons Length.'."K. . Width:�.'�. .... Diameter................ Depth. Disposal Trench—No..................... Width.....__............. Total Length.................... Total leaching area....................sq. ft. ell Seepage Pit No......... ........ Diameter .?.. .... Depth below inlet..� ..... Total leaching area_?.�.t__sq. ft. Other Distribution box ( X) Dosin tank Z Percolation Test Results Performed by.__-_-.�------ r .............................. ........." Date_"a__�... %........ Test Pit No. I ......minutes per inch 'Depth of Test Pit... ...... Depth to ground (X4 Test Pit No. 2................minutes per inch Depth of Test Pit..._.__............. Depth to ground water.....................I P4 ..............................7....................................�y I.............f............................................................. 0 Descelption of Soil.... ................... ................................................................... -----**................................................ /4/1,/" W4 -/I , ..............................................................................!n................................. .11 U ...................... ...................................... ------------------------ ------------------------------------------------------------- ......... ....... ........................ U Nature of Repairs or Alterations—Answer when applicable--- ........................................................................................... ............................................................................................................................. .......................................................................... 1: Agreement: The undersigned agrees to install the aforedescribed Individual Swage Disposal System in ac o�rance with The unq rsigned further agrees the provisions of LZ 5 of the State Sanitary Code es not to play' ej�;Y/tem in $s be b6,arj#.k sue,d operation until a Certificate of Compliance has be uecl�,V �) 7 t Signed................... '_1.......... ---------- ............................. ...........Date .....................D ate Application Approved By.................................. .......r ..... &- A--� ... ............. ------------ Application Disapproved for the following re ons:................................................................................4............................... ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................ . . ...... Qwwrtifiratr of Tompliaurr THIS IS TO CERTIFY, at the Ind;.vkt e a System constructed or Repaired by------------------------------------------------------(Yrwl�-------------- .............................................................................. Installer at....................................................................................... has been instilled in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated__...-._--....._._._..._.....____........__._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRNED AS A GUARANTEE THAT THE, SYSTEM WILLfPNA#CTI0)N SATISFACTORY. L-A :a/'V7 ......... Inspector.......... -#-10-------------------------- ......................... DATE................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL }��, ^�� ....................................OF............. . ................................................................. FEE.No........0.3?. ... .................... Disposal rks 015.11ustrurtion "Prrutit Permission is hereby granted--------------- ....7t&&."�A ...................................................................... to Construct ( yf or Repair an Individual Sewage Disposal System atNo........................... Z_�................ 1+ ................................................... Street as shown on the application for Disposal Works Construction Permit No_?-.J _�_4AIated..... ............ ................................ ....................... Board of Health DATE........... .................................I............................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS u� G 4 Z- x S65- &zP T •�� 's 1 44 tzc Y. t I \ e ,tom:`-�`r'i*;,.G�"T/G�'�K:_� �^��5.,��'yi Y f�,` _, -' �•--�( r in 4 G d L. 9 I 51 T E 3L z� 1 t .6 k:.,-•'Y✓ oc=� • T/�7�L1?� Ti�Y`� /��'�� Jai '�� ,�+ s4" ��► s � `��`�� C �� � i e���` �� �� / �/�1�ra t S. `U.'%.� /T� "!Y"'Cm-'•-''i✓' G_..G /'_iL.'�' di°�i'`.a.. 7 T/�'y'• 1r M , .F� i�r�v`, � Ors "7;� T�I-F- C>,=-• �' �.�F F:;.� C`r'�^''.�'`�.,•. ��"'-.° '�•'tJ�" ,'.�':' .: e sj� Pf'TER SULMAN No, 29733 4;;' ' 4 ✓' /A! /:% t �4 _S%�/C�!..•!C„J ,itrD7'"`�''.�►'•.�"' L1 "d.7 �...• .G��%'��''•�•� '�{l;�IT�" ,L�J T� �'r'C�'. i m SYSTEM (PROFILE NOT TO SCALE TOP FDN. FINISH GRADE :!!!4 o FINISH GRADE OVER EL .- AZ570 _e_..°; ,; FINISH GRADE OVER ;.e... DIST. BOX -47. FINISH GRADE OVER °'•' °.' SEPTIC TANK .r°.o:'b• LEACHING PIT o., 10 VARIES p, 0:0 •o e.�. .•e b:e•.' o':'•e:•i'•o'::o :..o..a;i:;e•,e•::.. e:. �.�; •.e �. — ';. .:'o;:a. ..e..•.;: . .•.e;:.e:._•.e::••.•.•:. .p. ::.•.•..a:. ...o:. .:a:'6:e:::•a, 3" OF 1/8" 1/2" �2 PRECAST CONC. OR „ e OUTLET PIPE V SHED PEASTONE BRICK"6 MORTAR L E I E L E EL TO 12 B L ON GRADE FOR 2 F T MIN . .• ., .o• . . o•oe..:o:d�.� �:b:4o: ova: ;, o• __- -- -e..-__ - __-__. __ _ .°.:, a:e°:°� ".o,.,e Q0.D • . 77. � o C. I. OR P VC TEES Piz o'• •�• .e o••� to • o; b•'a e: , • I �'"" `�' ei BSMT. FLR. o o'o o,: 6000 GALLON DIS TRIBU TION BOX INSTALL ON LEVEL BASE 3/4" TO 1-1/2" a PRECA S T CONCRETE PRECAST o I °~ P WASHED H— /0 REINFORCEDI CRUSHED CONCRETE e. STONE a O:e; A:o-o,':o•...e:o:::o-':o,e•,o.e:o;.•p•.:a:'p'•Q••e::::.•a'::d.• o.• b. o•,•o; I: �Q •°! '�.'. .O::o.'o. o•.o.o?.o:o A•.o.•o.o.,:c•,•o,•,o.o;••O,o o•:o•o•.• :•o. . o:._o•o.:°:: • H— /0 REINF. SEPTIC TANK INSTALL ON LEVEL BASE y f_ •� ° r!O TE: EXCA VA TE TO EL E V. . . • OR L.;° ° °' 4O,SO LOWER TO REMOVE ALL IMPERVIOUS = ° •' :o_o'_� y:°',: E� .tNA TERIAL BENEATH THE LEACHING AREA - REPLACE EXCA VA TED MATERIAL WITH 6 CL EAN, CLA Y FREE SAND I2 ;o» EFFECTI VE DIAMETER GENE SAL NOTES L EA CHING PIT _ 0 1. ALL EL EVA TIONS SHOWN ARE BASED ON F�E�U �✓ r`' INSTALL ON LEVEL BASE 2. ALL PIPES IN THE S YS TEM MUS T BE CA S T IRON JJ OR SCHEDULE 40 PVC. OBSERVA TION PIT 3. THE BOARD OF HE A L TH MUS T BE NO TIFIED j 1° 4� WHEN CONSTRUCTION IS COMPLETE PRIOR 5712 �` TO BA CKFIL L ING PERCOL A TION RA TE: 4. ANY CHANGE.'. ':N THIS PLAN MUST BE APPROVED < MIN. /IN. BY THE BOA Rij OF HEAL TH AND CAPE 6 ISLANDS WITNESSED BY: / �- . �Z SURVEYING CO. , INC. / t 5. MATERIALS AND INSTALLATION SHALL BE IN �- 4?- �2 COMPL IANCE JVI TH THE STA TE SA NI TARY .5.R•�Nf. BRO OF HEAL TH DESIGN DA TA , �, ,► .yacf. ._ CODE — TITLE V — AND LOCAL APPLICABLE DA TE.: RULES AND AEGULA TIONS V 6. NORTH ARROIV IS FROM RECORD PLANS AND o" �'✓ 47 6— NUMBER OF BEDROOMS 3 IS NOT TO BE USED FOR SOLAR PURPOSES GA RBA GE DI SPOSA L NO i A`� l000 �LLON 7. FLOOD HAZARD ZONE C ,�' DAIL Y FLOW 334 G.o� q PRECAST CONCRETE �` 8. WA TER SUPPLY 7-�" �� vg TES ;.,45 ,��/;:� SEPTIC TANK REO 'D. i000 GqL. SEPTIC ��nn� s�� SEPTIC TANK ,PROVIDED /,000 GAL. PRECAST CONCRETE', L o T ,!�/ --e�'� LEACHING REQUIRED 30 pt� L EACHING PI T Q T .e t ° ; ., SIDEWALL AREA /5'/ S. F. x 3 7 7 GPD BOTTOM ARE 113S. F. M1, LEGEND 113 S. F. X / 4 G/S. F. _ 113 GPD `\ LEACHING PROVIDED = 4 s o GPD 4& PROPOSED EL EVA TION EXISTING CONTOUR OF VA PIT r,�, SINGLE FA MIL Y RESIDENCE 6 O '- , "� O D. 'BUTION BOX .M; 1 -99 -- PROPOSED SEWAGE DISPOSAL S YS TEM a / s ✓ _ OO L=RCN. •7- RXHARD JAMEi R RND PREPARED FOR % o o SEPTIC TANK MCSHANE CONSTRUCTION CO. (Rpi RESERVE V%OF��� LOT 2 TOPSAIL CIRCLE BA RNS TA BL E CHI — CO TUI T — MASS. q5.Sra PIPE INVERT EL EVA TIONh . ' r DA TE: Mae'• PLOT PLAN �`� s - ' ' CAPE 6 ISLANDS SURVEYING, INC. SCALE: 1 =40 + SCALE AS NO TED P. 0. BOX 334 MAP I SEC PCL LOT HSE c='� -. �. PLAN NO. .f8 TEA TICKET, MASS. z3