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Home My WebLink About0099 WILD WAY - Health 99 Wild Way Cotuit Z A = 027 134 t 1 i� I. TOWN OF BARNSTABLE' CC LOCATION �/.�U SEWAGE # VILLAGE o. ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. CIA260 77S ",-W6d SEPTIC TANK CAPACITY LEACHING FACILITY: (type)r4� � �L � S (size) td'K NO.OF BEDROOMS BUILDER.OR OWNER PERMIT DATE: I -2 710 1 COMPLIANCE DATE:�'�r e 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 Teaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by fQv�T AU.fC�'' l � x 3 z 37 ( . Fee • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: '�✓ ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Rppricatton for ;Migpogar *pg;tem Construction Permit Application for a Permit to Construct( )Repair(, --�6pgrade( )Abandon( ) O Complete System ❑Individual Components Locat='on Address or Lot No. 1 r, '/��I e )�t/ Owner's Name,Address and Tel.No. Assessor's Map/Parcel a�^ �(� WC O UK/F ( ��A L) � ��f �ty Install:r's Name,Addre t r al.6hNC0 Designer's Name,Address and Tel.No. 350 Main Street � t Type of Building: Dwelling No.of Bedrooms�� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 gallons. Plan Date 43Z� 3 Number of sheets / Revision Date N/A- Title � <-f)7Ltf t Size of Septic Tank nloon Type of S.A.S. t Description of Soil P,(4 r 1 Nature of Repairs or Alterations(Answer when applicable) C? G4in Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this o d o ea th. Signed Date Application Approved by 411,l_ S r Date - 0 Application Disapproved for the fo wing reasons Permit No. 0 0 3 4.2 Date Issued 1 a No. t U l b fi Fee �TH'E.COMMONWEALTH OF MAQC►SS USETTS Entered in computer: r Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 1pprication for Migog;at *potem Construction Permit Application for a Permit to Construct( )Repair(,,,,)- pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 91 )/�'/ a )� Owner's Name,Address and Tel.No. Asses:.or's MapTarcel a�„ / wl/C O 4 V4�c%} JA V(C, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 9 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �� gallons per day. Calculated daily flow 3 gallons. Plan Date �c3��r��, Number of sheets / Revision Date W/A- Title fJ c ,Size of Septic Tank loon Type of S.A.S. 20 (, C�) ,o hffi Description of Soil, Nature of Repairs or Alterations(Answer when applicable) f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board ofge�a th. Signed J i Date Application Approved by / P�l/- S i Date .2 /Wo -) Application Disapproved for the foil wing reasons ` Permit No. ")003 � a: Date Issued 1 a h-710 I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( graded( ) Abandoned( )by C/4 "i C U at (. A ,4 has,been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.'a n ?-024 dated 7 A Installer Designer A � The issuance of this permit shall not be construed as a guarantee that th s'ysytem illfunction as ,e igned.�e Date Lj 1 4 1 oq Inspector I yG+,. 1(--.)` t tl --------------------------------------- No d)3 -Cr, Fee J�`-� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS miopont bpgtem !6truction Permit Permission is hereby nted tolCot}s Repair rc,� gg{ade( )Abandon( ) System located at 1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons cti n must be completed within three years of the date of this Permit. Date: Approved by r__T f, J TOWN OF BARNSTABLEL LOCATION SEWAGE# VILLAGE C y ASSESSOR'S MAP &LOT 122 -�3 INSTALLER'S NAME&PHONE NO. 12 C4A)60 7 25 "��CSD SEPTIC TANK CAPACITY LEACHING FACILITY: (type)e)--Pb`//��'"�l� S (size) �S/x NO.OF BEDROOMS BUILDER OR OWNER L��E 2 Q -S'10 IANCE DATE PERMTTDATE: 7 � COMPL � 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 f2v,vT vfe-111cUfC' GA2AC-k 7 `7 " A U a • L , I • FAILED INSPECTION T 1 to G _- D AT E :1116103 PROPERTY ADDRESS : 99 U-igd Oay - ---------- - 02635 ----------------- RECEIVED NOV 1 3 2003 On the above date, I inspected the septic system--at the above address. Tnis system consists of the following: TOWN OF BARNSTABLE 1. 1- 1000 ga eion 3egt is .tank. HEALTH DEPT. 2. 1_Di,3.t2 i9u.t.ion Sox. 3. 1- 1000 ga.Pjon /2izeca.6t ieach.ing /?-it. Basec on my inspection, I certify the lollowing conditions: MAP - < 4. 7hi, is a t.i..tiz dive 3e/2tic Zy.6tem. (78 Code ) PARCEL 34- 5. The 6e/2.t.ic �3yz.tem .iz .in hydILquiic �aieu2e. 6. R new ieach.ing a2ea needz .to &e .inzta. izd. SOT = � 7. Owne2 did not want .to /2um/2 .the zys.tem at time .in,3/2ec.t.ion. SIGNATUR Fame J . P . Macomber J r ., ompany : )95tph $Orl, Inc . � 00r2ss ' --@Q�. ----- - QJUSe rY LLlP._ t)a _ _22.632- 0066 Pone _ _508 •J75_ ) ) 38 - - TmIS CERTIFICATION OOES NOT CONSTITUTE A GUARANTY OR WARRANTY a La� . MACOMBER & SON, INC. ks Cesspools•Le+chl►etds Pumped & Installed Town Sewer Connectlons 66 Centerville• MA 026.32.0066 )75.3338 775.6412 COMMONWEALTH OF MASSACHUSETTS i EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:9 9 Gli d gay o u.c a.6z. Owner's NameO ichae e Lea2u Owner's Address: Samv Date of Inspection: 7716103 Name of Inspector: (please print)gos fl n h 2. IL,r n m R e z a2. Company Name: Cnn Inc. Mailing Address: anr AA en eav�Me. Na,3,s. 02632 Telephone Number: 5 0 8=7 7 5—3 3 3 8 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 the inspection.The inspection was performed_based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.3¢0 of Title 5(310 CMR 15.000). The system: Passppl' ' a F.' Conditionally Ppsses Needs Further Evaluation by the Local Approving Authority Fails e. Inspector's Si atuVi; . fr - Date:. The system inspector shal submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If.the sys em is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner. ubmit the report to the appropriate regional office of the DEP.The original should be sent to the systwn owner 5nd copies sent to the buyer, if applicable,and the approving authority. + 6 Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This Inspection does not address how the,system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/200.0 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 99 O iid Oa y ^ Owner: lUchae P Leaau Date of Inspection: 1116103 Inspection Summary: Cbeck A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: yll I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or m 310 CMR 15.3 4 exist. Any failure criteria not evaluated are indicated below. Comments: lhe .Peach.ina R.i.- 1's in hUdltau.P.ia nom Pon A ;nn rinon neeclh ;to 9e .in,6.t ai eed' — B. System Conditionally Passes: X-)Q 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 distribution box is leveled or replaced ND explain: �00 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: 2 raKr.� O1 I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A' CERTIFICATION (continued) Property Address: 9 9 0-i ed Ida y Co.tu-i;t, 1�a�3,3. 0woer: 0j;nc,ioy ['a i u Date of lnspection: 1116103 �..... C. Further Evaluation is Required by the Board of Health: AID 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(l)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: V6 Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the sysr.em 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 surface water supply or rributary to a surface water supply. d The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. Q The system has a septic tank and SAS and the SAS is within.50 feet ofa private water supply well. 10 The system has a septic tank and SAS and the SAS is less than 100 feet but 5Q feet or more from a private water supply well''. Method used to determine distance —Jf This system passes if the well water analysis, performed at a DEP certified laboratory; 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, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: r 3 Page 4 of I I OFFICIAL INSPECTION FORM —NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSALSYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 99 0,i ed iV ay Owner:N chaei Lea2u �... Date of Inspection: 1116103 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no" to each of the following for all inspections: Yes No _ .Inc up 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 A�.4 10 Li quid depth in o*&& ,ol 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 _ /Z Any portion of the SAS, cesspool or privy is below high ground water elevation: TAny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ �4 y portion of a cesspool or privy is within a Zone 1 of a public well. ��y portion of a cesspool or privy is within 50 feet of a private water supply well y 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. [This system passes if the well water analysis, performed at a DEP certified laboratory, 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, provided that no other failure criteria are triggered, A copy of the analysis must be attached to this forma (Yes/No)The system fails. I have determined that one or more of the above failure 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 failure. E. Large Systems: To be considered a large system the system must serve a•facility with a design flow of 101000 gpd to 15,000 gpd• 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) yes no Zthe system is within 400 feet of a surface drinking water supply k-Ithe system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(>.nterim Wellhead Protection Area—IWPA)or a mapped Zone 11 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 99 Li.Pd 61rza Co.tu.it, Oaz�. Owner:Oichaei Lea zu Date of Inspection: 1 1/6/0 3 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 Z- Wre any of the system components pumped out in the previous two weeks ? 1 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,eluding the SAS, located on site? Were the septic tank manholes uncovered,:opened,and the interior of the tank inspected for the condition liquid,of depth li . of the baffles or tees,material of construction, dimensions,de p q depth p of sludge g 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: Y�no " 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(3)(b)] 5 Page 6 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddress:99 U-iid (play o u.�- Owoer:N,ichae e Lea zu Date of Inspectlon: 1110103 RESIDENTUL FLOW CONDITIONS Number of bedrooms (designs); Number of bedrooms (actual): DESIGN now based on 310 CMR 15,203 (for.example: 1 10 gpd x N of bedrooms): Number of current residenu: —J— Does residence have a garbage prindcr(yes or no):&V Is laundry on a separate sewage system ( es or no):&P (if yes separate inspection required) Laundry system inspected (yes or no): Seasonal use: (yes or no):VO Water meter readings, if available (last 2 years usage(gpd))z002=100, 000 ga—teorz 6=273. 98 G%D Sump pump (yes or no): 0,* 2003=110,. 000 gai-eon,3=301. 37 gPD Last date of oeeupusey: COMM ERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 1 S,203): �f d Buis of design now(seaulpenons/sgft,etc.): .� Grease alp present (yes or no): Indusrrial waste holding tank present (yes or no):424 Non•saniury waste discharged to the Title S system (yes or no):,:ty Water meter readings, i(availablc: ) Last date of occupancy/use: .� OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: 41'o- ,/dais!• J4'oi Was system pumped as pan of the inspection (yes or no):,et If yes, volume pumped: 0 gallons •• How was quandry pumped determined? Reason for pumping: TYPE OF SYSTEM Septic. tartk, distribution box, soil absorption system 4 Single cesspool >O Overflow cesspool 4zb Privy ,C(b Sharcd system (yes or no)(if yes, attach previous inspection records, if any) Innovativc/Allernative technology, Attach a copy of the current operation and maintenance contract (to be obtained from system owner) '�kb Tight tank tJ1 Attach a copy of the DEP approval ,020 Other(describe): Approximate aec of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site (yes or no): 6 Page 7 of I I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ;- SYSTEM INFORMATION (continued) Property Address: 9 9 a.6'6. Owner-i'1-ichue.P Lea Date of lnspectloni.4116.103 BUILDINC SEWER(locate on site plan) Depth below grade,: Ig Materials of consrrvctio t Iron _40 PVC 4bother(explaln)t Distance from private water supply well or suctio.n line _ C.ommcnts(on condition of joints, venting, evidence of leak.age,.ctc.) oint�s ppean tight No ev.iclence o- 4,eakaqe The .6y,6 <em i.s vented thaouyh .the ?oo'z ventz. SEPTIC TANK: 4'(locate on site plan) me�0 � DVth below grade: x � Material of construction: r/concrete 116 metal�Ue�fiberglass4 polyethylene �'othcr(cxplain) AIX If tank is metal list age; certificate) Is age confirmed by a Certificate of Comp.fian ee(yes or no):,�(ac ach a copy of Dimensions: Sludge depth: Distance from top of sludge to bottom.of outf or baffle Scum thickness: Distance from top of scuts to top of outlet tee or baffle: y°r Distance from bonom of scum to botto of outlet tee or baffle: F How were dimensions determined: ,�Qle�p, Comments(on pumping recommendations, inlet and oatict tee or baffle condition, structural integrity, liquid levels as related to outlet-inven,.evidence of.lcakage,etc): Once stem ma 2e ailed. Pum the Ae .t.ic. Yank eve-2 ,2=3In Pet outQet tees ate ir yea a suu2 2�. Zound and zhow,3 no lev.edence o eeaka ye. L ecru�d eeve e at the out het .invent is t'•., CREASE TRAW locate on site plan) �, r✓ Depth below.grade:,10 Material of construction.A0concretts mct&P/ ,fiberglas olyethylenee4other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet fee'or baffle: Distance from bottom of sc tP to bono of outlet tee or baffle: Date of last ptunp nv iSr m •-� Comments(on pumping recommendations, Inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc,): �nori �o fnnn J.A nnf nnv Aonf Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 GI,..ed Glut' coiuiii . a,34. OWner:N.ichae.e Leann Date of Inspection: 1116103 TIGHT or HOLDING TANK4�L'r,(tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: W-1i4 Material of construction:J1.4 concrete A* metal W04 fiberglass464 Polyethylene.d�other(explain): All Dimensions: 10 Capacity: W gallons Design Flow: gallons/day Alarm present(yes or no): A14 Alarm level: A�0 Alarm in working order(yes or no): � Date of last pumping: Comments(condition of alarm and float switches,etc.): 7.igU o/z ho ed.ing an , a/te no /27ezen . J DISTRIBUTION BOX: k/(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): Dih.ta.igu.t.ion Sox haz one .ea.te)za.e. 7heaz .ins evidence of zoticlz ca22y ove2.'No evidence of -eea aye into on out 37 the Rox. PUMP CHAMBER <Xocate on site plan) Pumps in working order(yes'or no): Alarms in working order(yes or no): 124 Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): lump cham9eir -ins not /2aezen.t t 8 Page 9 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 GI Led Glatt Cotuit. Owner: tTichae P LeaaU Date of inspection: 111616 3 SOIL ABSORPTION SYSTEM (SAS): i/(locate on site plan,excavation not required) 1- 1000 pai-eon /zaecrz ,f �yrirhin� �nif If SAS not located explain why: Located: .Svv page 9Q Type leaching pits, number: V7 eaching chambers, number: Q leaching galleries,number: leaching trenches,number, length: ('y 4A leaching fields,number, dimensions: 42-5 overflow cesspool, number: 6 V innovative/alternative system Type/name of technology:i!'r e.,Zz)e C`,,kz &2 Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy, nand to mecl.ium - .in 3 / r) le-achinn ni f 1h �aGeCG2e A neW -eP-aChifZa agora nvvr/A clam12. Vegetation iz no2ma.e: CESSPOOLV60fC (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Q Depth—top of liquid to inlet invert: 4)¢ Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): C'g66nnn94 rAQ0 PEI.4L-C�4P1� r PRIVW44 (locate on site plan) Materials of construction: Dimensions: � Depth of solids: 4W Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PlLiL)U iA nol' /1ROilDnf 9 Page 10 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:99 1V-i,4 L 0ay o Tu.c , a-6.s. Owner:/�ichae Leaky Date of Inspection: .9 116103 ' 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. t � / 10 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL., SYSTEM INSPECTION FORM PART C .. SYSTEM INFORMATION (continued), Property Address: 99 Gl.e.ed lay o u.c , a,6�3. Owner(l,ichae.P. Lea zu Date of Inspection: 9 I Z010 3 SITE EXAM Slope Surface water Check cellar Shallow wells a Estimated depth to ground water Q® feet Please indicate (check)all methods used to determine the high.ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: 1116103 14L.S Observed site (abuning properry/observation hole within 150 feet of SAS) &C1` Checked with local Board of Health-explain: NA J .6 Checked with local excavators, installers. (anach documentation) e Accessed USGSdatabase-explain:ht.tQ //.town, gaznz.tatee. ma. u.6. You must describe how you`cstablished the high ground water elevation: Uaed Cah2et y & �l��Qe2 Nods e. 12/16M qzound wa.te�z eteva;Lionz al ove .6ea ieve g. LL,3ecl: IISGS: 0gze2va.tion we.r?i data. tune 7992 Ll,3ecl: LISGS: ZechaircLi Ru - P.- in 92-000- 7 Pia.te #2 ganuazu 1992 Rnnuae zange3 o/ .g,zound wa-te2 e-gev�--ionb. . I up or urouric Leaching ( Pit :ect .72 IT Groundwater. feet Bclow Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bonom of the leaching pit and the adjusted qq p groundwater table is Pero feel. II k:,.rr..nr-:.-n:rT--r�- r•.T-'n:rmm+n.-c,.r..r..r.:-.r.-.•a*r:--r.-.�r�rrc- c:r+sv:r�T.rn1 .. .. .r�T- ,r—r-..._. ._ TOWN OF 13cL1Ln41-aUz WARD OF HEALTH � SUUSURFACF SEWAGE I)ISf'OSAL SYSTEM INSPFCTION FORM - PART D •- CERTIFICATION ...-....r..,_.. -_. -^.c.m.r..-m•rt:>T:r.ro.r.rrrrrT-r-r-•.-+�:rrrtrs--rtrm'�-m*+c-*r nrmrn'a�sv-*cr¢ rsm n•mTrnr<rv�Trr.+rr•rr.•.-.rrrr.�. -. -TYPO OR PRINT CLEAALY- PIIOPERT Y INSPECTED STREET ADDRESS 99 ldiid &lay Co uil-. I'azz. ASSESSORS MAP , DLOCK ANU PARCEL # OWNER' s NAME Nichaai Lea zy PART D - CERTIFICATION NAME OF INSPECTOR Joseph P . Macomber Jr COMPANY NAME Joseph P. Macomber &''ton Inc COMPANY ADDRESS Box 66 Centerville Mass 02632 Street Town or City State I I P COMPANY TELEPHONE ( 508 ) 775-3338 FAX ( 508 ) 790-1-578 R . R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system nt OecoirinendaLioris his nddress . and that the information reported is true , accurate , and omplete as of the time of ,. inspection . The inspection was performed and any regarding upgrade , maintenance , and repair are consistent with my 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 healOi or, the environment as defined in 310 CMR 16 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of .this form , 4/ /System FAILED* The. inspection which I have con ircted has found that the system fails to Protect the Public health and the environment in Accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection./�/Jform , Inspector Signature bate �� ;,Vnbcopy of this� c.ification must be provided to the QWNER , the BUYER re applicable ) and the 130ARD OF 1tEALI'JI , * If the inspection FAILED , the owner or operator shall upgrade • the ayetem with:.n one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 . partd , doc THE COMMONWEALTH OF`MASSACHUSETTS BOARD OFHEALTH _/®,:;42 A)..................OF......:.,69/ !. ! .......................... Appliratinn. for Disposal Works Tonstrar#inn ramit Application is hereby made fora Permit to Construct (�j or Repair ( ) an Individual Sewage Disposal at: - 71.......`---4�........... .....................o�.�.f�..:.........._..----•-------•. _.... _ .4 ow Address .................................... A ............... ........--................................................................................. Installer , Address / Type of Building Size Lot...115k.L6 ...Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.......................I.... Showers ( ) — Cafeteria ( . ) dA. Other fixtures... .--•-•.............................•-......---•---•--•--....-•-••--•-•-•-•--•.......•••...... WW Design Flow.....),a.d0.Q.................:.........gallons per person per day. Total daily flow....J ,,. Z..._................_......gallons. '�✓ W Septic Tank—Liquid capacity............gallons- Length................ Width................ Diameter................ Depth...:............ Disposal Trench—No..................... Wide_._...._.._._._.. Total Length..... ..1........ Total leaching area__.. . _..._.....sq. ft. 3 : Seepage Pit No..................... Diameter...._-•__........... Depth below inlet......_..............Total leaching area-�_�Q,._1__-sQ-ft.6�a Z Other Distribution box (K Dosing tank ( ) aPercolation Test Results Performed by.....Q1,b..I.....Z-416 �1__�(......... Date_._1� -------------- ,.a Test Pit No. 1.6_:.....minutes per inch Depth of Test Pit.... .............. Depth to ground water.. dli , Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------------------------------------=------------------------=-•-- -----------......._............-•----- --=---=----......-- -- O Description of Soil........................................... . ...0••-• ............... .......-- ....... ------------------------------------ ---...................---- w -----------------------=--------------------------------------------------------- ..........--_-.......-............•-•••--------------------..._. UNature of Repairs or Alterations—Answer when applicable............................................................................................... .............. -...-----•-••---------------•---•-------••----------•------------.....--------•---........-----•------ ........-........-..................................................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with jh e visions of TITIE 5 the State Sanitary Code—The undersigned further agrees not to place the system in o ti ompliance has been issued by t li ith• __ ... 7 APpli 'on Approved By - •_. .. : ................. .• - --- a ate Application Disapproved f the f ollowh reasons:--------- ..............................-..........................................................._.... .............•-•-•------....---------------•---•--------.._..-------•---•--•-------..._._......._....:__...---••-----------...-----------........................................------••---------- -- Date Permit No.......--•••-Z=-:• ` -5:7= .._.... Issued------------------------••-••-•---..._................ . Date No. 1. : THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 74. ..................OF......... .......................... Appliration for Disposal arks Tonutrurtion Frrmit (� Application is hereby made for a Permit to Construct ((( ) or Repair ( ) an Individual Sewage Disposal ,., � _S' • !u� .. ......................... ` _.,E.:::t. :� ... ... _.. ... o :� _...6.............. _._.. Loc A-4.� r.��a��:.�.. $.:ahon.l C,T�� /.fl - �� ,?�••/ C/ (>-. /a) t. o !'1 G!1�gu�- -Own Address •V. .. .... ... .. w .................... ..y.. .... ............... ....................................................•.._..................•....................... Installer Address q, Type of Building Size Lot...�. :..�Z�_: /�.Sq. feet U Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria P4 Other fixtures -------••--...••-- --••................................_ Design Flow.....�f.tln�?---- ---------------------gallons per person per day. Total daily flow...... �..............................gallons. Septic Tank— _a• - Disposal Trench iq Nocapacity--.....• dthns._. .Lengt Total Lengthidth............. Total leaching area..D��......sq. ft. x 3 Seepage Pit No.........1.......... Diameter....lz /-_-..... Depth below inlet...` .I .... Total leaching area.:- �1: .sgAt.(� Other Distribution box (K) Dosing tank ( ) �. Percolation Test Results - Performed b b2U)..0.....�,�,d.�.:!`l:.k'J_...!. �: -: Date.._. ! �-j'��.............. Y �. Win......_.. ,.a Test Pit No. 1.. ._d�-----mmutes per inch Depth of Test Pit....�.............. Depth to ground water........................... `- ' , Li. ``�• `K Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C� _ ODescription of Soil. ....................•-•--•-----.....-•••.--......._........................... v ------------------ ---------- ----------------- -----------------------------••-••----- C:!`..... w ..........-•----------------••-•-...---••-.......-••-•--•--•-------••------ . •• . •...----.•- UNature of Repairs or Alterations-Answer when applicable........................................4........................................................ ............................•----•-----•---..........................._.........•...-•----.......--•-•••--•----------••-----••-•---•---••--....---•--...---••---••-.........._.._._................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the visions of TITLE 5 ff,the State Sanitary Code— The undersigned further agrees not to place the system in OP 'ation l-e-�erti€�c Compliance has been issued by the -off health. JyrJ signed ��:.: ....._ � ... .7 Appl>< ion Approved ffr �t�l f � �+- �'= ------------- I / �1........ ..._r,. .... ` Date Application Disapprove f ollowin-,reasons:...............:...................................................................._..................___ ............•-•-••------......••-•----••--•..................................•--......•......---......._.---••-•-•---.......-------------------•----------------------......................_......... . Date Permit No..---- r' `: ..4" ............ Issued...--------•-•-.- ----•••-••......................_ Date THE COMMONWEALTH OF MASSACHUSETTS ` P -- BOARD OF.�,,HEALTH c .1 4'1....OF............ . .xCl/`... ..................................... (Irrtifuttte of Tompliaurr l THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Y ) or Repaired ( ) by....................... ------ -----------....--------------� ' ► : • .a. _ .._._...I. � ....................-........- at.......... , Installer , � ................................. ........................... has been installed in accordance with the provisions of TITLE 5 of The_State Sanitary Code as described in the application for Disposal Works Construction Permit No._. _ _.:.:�_�ram_......... dated__--� (. ." THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. (� DATE..............1..'",4.::.-..�. '�' ...y.-•-•---------------•--............_......._ Inspector---•-----=---=•-----=•----••-----•-----.......... ....-------- P/ THE COMMONWEALTH OF MASSACHUSETTS 1 J `�- BOARD OF HEALTH S O.yt............ ...... ........... Disposal Works Tonstrnrtion Errant Permissio7S) " hereby granted-•--...... ....F. .. ^---------------------------.................................................._.... to Construct or Repair ( ) an Individual Sewage Disposal System at No..�9�. .. ...........• , .. •.. +t�� •-- --_. ... Street as shown on the application for Disposal Works Construction Permit No)n. t�A�Dated..Y...�. ..... ........... l Board of Health DATE---------- ----------------•------•--------.....----.........--------•---...... ! M waKesrE� ASSESSORS MAP : Z1 -�- 4 Rom- i� TES i � HVL E LOC7u NOTES: PARCEL : '1 i) THE INSTALLATION MUST BE INSUBSTANTIAL COMPLIANCE WITH ti T. !4awq� �� elyePW FLOOD ZONE : IV SO 1 L EVALUATOR (�.G "�� . �" THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF o H . u i 0 WITNESS : —�— ?(MVI BOARD OF HEALTH REGULATIONS. WAYTly REFERENCE:AIL g52�o DATE: ll(I�IIU 2) � l r THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, P4 I vp PERCOLATION RATE : L { �i�v(�iI P� SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO lr INSTALLATION. �' '�°"'` � •°� '� TH— I EL.5�,6c7 TH—2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION (,UAn�I�^ k`Blf H�+ f' �7 �- 'e}4!b ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE DETERMINATION. ►. �Q' x.o aaa snviw�tu t'� Fj I�1'� l� t i �j V � (, IV 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS / �.T.S "R� SPECIFIED OTHERWISE) , 0 LOCATION MAP c.�ti r_ 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A ml�D(vM GARBAGE DISPOSAL. 2SY'`y "15 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON A BASE OF 6"OF CRUSHED STONE. 7) t e PtC-H P i T TU BE Pumpe o CR(60t--o P1 UZc> . e] Nd_K,NOW4 P� M vA WeWe7 W1 W 1� of 00Pv56A LeAutf Q- No we: LAfN PS V'41.0 GC' O F PRo Po5E D ItAU4104. SEPTIC SYSTEM DESIGN ,a. FLOW ESTIMATE �FvUAfio�,ry_. i K4� LBED-ROOMS, AT GAL/DAY/BEDROOM -37� GAL/DAY { SEPTIC TANK I \ 33d GAL/DAY x 2 DAYS - 6&0 GAL 1 � , f USE 0,90 GALLON SEPT I C TANK -p-w%7AJG- IZ�►°t� "'/ 1/9�6 Sep 1' k _!r F F�tr t,E�,pq-n��.p o2.UN�J�R�itED. SOIL ABSORPTION SYSTEM E G Ii t 2 27 LeAck 61624 A J 'fb�-6t.a _ SIDE AREA �f2��Z�-�«�z k� x a. )�f 1��. v \ i + BOTTOM AREA: Z� K lax l �1 a s^Ey�ST�Nf� 1 t \ / � SEPTIC, SYSTEM SECTION >3�a X�S� t � 40 Per I I ` � ` At 17w i co EL• S �r/or �J I eX/577r a / ' ride 9 'n, � g.S" Fr 2 10 1 P�c� 1 56,34 , /� Do u blc Gt,�i shed ,L '� _ 7'n�e� P U GAL 5S D-BOX 55, D �- SEPTIC TANK ll�K ferkfrlP� 55 S S3.Ss STV A)E (,Jas>�►� ��AS sq I ZS i. LoxT�sr'hl7L� F.L; q7. 66 7" I S I TE AND SEWAGE PLAN 15 TEf'�� NIT LOCATION : (�)/G� (,O�- o- - i CoTv IT PREPARED FOR : f 1UtA KE U,t a DARREN M. MEYER, R.S. SCALE 5� � C1,� N 43 VINE STREET DATE : / lS U3 `� '4 7 0 DUXBURY, MA 02332 i 3 DATE -H—EALTH AGENT (781) 585-0293 i r� ?oFy O 10N F,_E%e 0�.sc, - --fir .---.. ._._ -_._. _ '._ _... — ••— `- , 4- 8 Z oro I 84.7J 40 a ` a �4 7Z Gg i y NDTE � r x E c /E� A L A L PPL E T il/ C L/9 B - ._.. ._ . exiSfir?9 ter-ounce/ H0�2/Z. NIAMLIOLE GOVC=)25 TO WITH/A! ' Proposed round r ,/e vE ,eT SGf?LE ; / /O 9 P �' /2" OF HED G.er9L�E' i FLOW ITCP&D 40 P :c. 0,Q r 1 �rninimum %.. Per f'oof•) EQUr9L TO SEPT1� plPe To BE 316 pdaS7 bne _ t.3•MrtJ• —Al LEVEL FOR Z'. , rT 1 4_ jk LIQUID6 LEVEE L'D/ST. 5 OX 8 was / \ /000 GAL, SEPT/G EQGP4 PIT ' i 0 / G /�./ T'E S 7- /�--/ O L ' LOG — Is G N� . �L1..,z3, i '7 -R I 3 t3 EDP oo,'�I f-/.ousE DAT�. g8 TEST BY= L Ow V✓ELLE n/G /"I N .B9 of i T K B�, 7 R co 4 ` ` •= � I�f1 T� J 5 ��S -- - --- � G . DAY , - 86 �EPT�c Tr�Nk . b33o x /.5= 495 G.P.S, QQ Y I LOA fj u 5E--. GAL. Tf•�nJ,� , Q p,� Q�� E�C'H/lVG F?reEA . sLlg�olt_ ,A I5/DEWFLL: 150.e, c 2.�5 P..._ _ ..= 37� G' G. D. s 30, >:. \ o / L O.r- 6 Corte z s� 19 5(.5 a IS4KiC) o T \ 7S.GL A 1 ' \ / G E/2T/FY THAT 77-1E / O WAT E R N/ ��2 )P05ED OAJ THE G�2vU O AS EN COUI�T� RE� 3i-10WN O kJ rH/S PLA!`/ DOC,S ! c OA IFO�21%1 TO THE 8LJILD/ti6 SET 1 I TE - S EGAJt,9 G E --- �AC K ,2E QU/l2EMEti/T5 O� THE � ; '-0WA./ OF - �,�RNs7-A ,9 1� .'FO�e oT G .r'i SN OF ��\ Sf� /"iARSTO f�15 M 1 L L S GEORGE . P�2EPARED Fog: .SOu7"rl GAP R FA t_`1"Y LOW. 1R. > �a � 5GF-1LE: AS /VOTED DATE: aJ I O Su -PRAWN BY : RJIL A •30 ) VIEW D 0- o o a x.IS*/ n e /e va-f'�on ' 9 BL DG. SETBACfG o.00 a proposed c /evatiorl �2EG?U/F2EME�JTS : �. o �F o I n G�JEL. -- - - - - - e �tisfinq con-favr•s BOr9r2D OF NEAL7-f-! --e---o -•—e_ e .._ PI"OPO.SE'Q� GOr7-f- /" -714 f",-q//V ST2EET oU s !� MASS• yet,Q r7 O UTH PRoFE55lOrl/f�L ENG/IVEEr25 fT Gi9�JD SUQVE'i'�,25 #86-09,7 , r '