HomeMy WebLinkAbout0196 BUMPS RIVER ROAD - Health 196 BUMPS RIVER RbP(O-OSTERVILLE
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TOWN OF BARNSTABLE
09
LOCATION SEWAGE #
VILLAGE '6 5 f U L 1 R . ASSESSOR'S MAP & LOT 1,a* o�7
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY o o
LEACHING FACILITY: (type) 10 (size)
NO.OF BEDROOMS o2
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of 1 ching facility) Feet
Furnished by 1 i..J,: l t :.� g It .7, /o 0
,y,6u
37
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- 07-
TROY WILLIAMS
SEPTIC INSPECTIONS
Certified by MA Department of Environmental Protection (508) 385-1300
19 Hummel Drive
South Dennis, MA 02660
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL'AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
'rrrLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
PrdpertN Address: 196 Bumps River Road
Osterville,MA
Owner's Name: Eileen Pickering
Owner's Address: 196 Bumps River Road 0 � �
Osterville,MA 02655 0
Date of Inspection: November 2, 2000 O
Name of Inspector: Troy M. Williams .A O� //�
Company Name: Troy Williams Septic Inspectionst?t �� i
Mailing Address: 19 Hummel Drive 111 `rr /
Telephone Number: South Dennis,MA 02660 °yam ?000
(508)385-1300
CERTIFICATION STATEMENT
1 certify that l 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. 1 am a DEP
appros ed system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system-
Vto Passes
Conditionall\- Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:
Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
Although system meets the minimum requirements set forth by the Massachusetts Department of
Environmental Protection,certification is not to be construed as a guarantee of future working condition
of system,piping or components. This inspection represents the conditions of the system on the Date of
Inspection noted above.
****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 6/15/2000 pace 1
Page 2 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
196 Bumps River Road
Property Address: Osterville,MA
Owner: Eileen Pickering
Date of Inspection:
November 2, 2000
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
V/ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:At119
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
indicatine 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:
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
Page 3 of 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 196 Bumps River Road
Osterville,NIA
Owner: Eileen Pickering
Date of Inspection: November 2, 2000
C. Further Evaluation is Required by the Board of Health: /VI-7
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ 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
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more froth a
private water supply well". Method used to determine distance
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria 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:
3
I
Page 4 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
196 Bumps River Road
Property Address: Osterville,MA
Eileen Pickering
Owner: November 2, 2000
Date of Inspection:
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_ Backup of sewage into facility or system component due to overloaded or cloeeed SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clo2eed SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/,day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
,vim Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
.tq Any portion of a cesspool or privy is within a Zone l of a public well.
,y A Any portion of a cesspool or privy is within 50 feet of a private water supply well.
A 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 eater 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
Alb (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as
de�,crihed 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: A/1A
To be considered a large system the system must serve a facility with a design flow of 10,000 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
_ the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim 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 I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 196 Bumps River Road
Osterville,MA
Owner: Eileen Pickering
Date of Inspection: November 2, 2000
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
P.:;:-,ping information was provided by the owner.occupant,or Board of Health
Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection?
A11A Were as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up
Was the site inspected for signs of break out .
Were all system components,excluding the SAS, located on site?
y _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on.the site has been determined based on:
Yes ✓go
Existing information. For example,a plan at the Board of Health. Al/'
_ 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 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 196 Bumps River Road
Osterville,MA
Owner: Eileen Pickering
Date of inspection: November 2,2000
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): a Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 2 0
Number of current residents: O
Does residence have a garbage grinder(yes or no):wo
Is laundry on a separate sewage system (yes or no): ,4o [if yes separate inspection required)
Laundry system inspected(yes or no):N14
Seasonal use: (yes or no): YV S
Water meter•readings,if available(last 2 yearslLsage(gpd)): 0o- .?,a no s� I l r fey= 23,aou f ti iio ti
Sump pump(yes or no): Alp
Last date of occupancy: Q
c G u.S Q v.c.� J S t 4�' /'�. S T7 rN<•
COMMERCIAL/INDUSTRIAL Allq
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons!sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system (yes or no):_
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:No n,, ,,01 N 4, ��_✓G w*, I .
Was system pumped as part of he ins ction(yes or no): ��
If yes, volume pumped: gallons-- How was quantity pumped determined?
Reason for pumping:
TYKE OF SYSTEM
�[Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy.
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
Other(describe):.
Approximate age of all components. date installed(if known)and source of information:
454.-A— i. 5 UV: ;rt ot� •-� �Ow�/_ �y: I o.i/ol2.aA. /963 .
�T
Were sewage odors detected when arriving at the site(yes or no): A/o
6
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 196 Bumps River Road
Osterville,MA
Owner: Eileen Pickering
Date of Inspection: November 2,2000
BUILDING SEWER(locate on site plan)
Depth below grade: 18."�
Materials of construction: _cast iron ✓40 PVC other(explain):
Distance fron-, prig ate water supply well or suction line: nil,?
Comments(on condition of joints,venting,evidence of leakage,etc.): 1
F{I✓Shc�,r � NLS 4Nc� �i�,1� G. tc.�.r � � �t J� 1'r'li u {' �'h)PtL �iOh
SEPTIC TANK: (locate on site plan)
Depth below grade:
Material of construction::;/—Concrete_metal_fiberglass_polyethylene
other(explain)
If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of
certificate)
Dimensions:
Sludge depth: y
Distance from top of sludge to bottom of outlet tee or baffle: .? '8"
Scum thickness: % "
Distance from top of scum to top of outlet tee or baffle: 6
Distance from bottom of scum to bottom of outlet tee or baffle: /5+"
How were dimensions determined: P.-o be.
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
aasT related to outlet invert,evidence of leakage,etc.):
GREASE TRAP:N/4locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
f
7
{
Page 8 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 196 Bumps River Road
Osterville,MA
Owner: Eileen Pickering
Date of Inspection: November., 2000
TIGHT or HOLDING TANK:n/ /.)(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass__polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Floe: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 4-
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.):
. vJt.� `�ti✓� L 1 �c.h wn c� � �.,�u✓ i a r.�c✓
FnJ-Jk '4U 4- r n ✓— }. ek
sl,yc,t►y a'p1 ' >rlao �
PUMP CHAMBER:A(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 196 Bumps River Road
Osterville,MA
Owner: Eileen Pickering
Date of Inspection: November 2, 2000
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number: t
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.): I 1 r F� , ih'u P, w %1,
r
u.�hre� 3�' ? ' •r. 6 + .. /Vo `v '�eti ��' Lr !:
y y^w✓
'-f-L�.I.�.✓.�_ cir to ra O t�_ ..3 ,ti '�i �O ar.f ✓c.--t:. �i.�..l �.-..f.�.. t y i- �j, s -F� .�•.�
CESSPOOLS: /t//A(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth--top of liquid to inlet invert: .
Depth of solids layer:
Depth of scum laN er:
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.):
PRIVY:rin (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): .
9
Page 10 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
.SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
196 Bumps River Road
Property Address: Osterville,MA
Eileen Pickering
Owner: November 2, 2000
Date of Inspection:
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.
Ock`r .
�DDU y41�d
-7 G`'
3y '
z► ' y�
io
10
Page 11 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 196 Bumps River Road
Osterville,MA
Owner: Eileen Pickering
Date of Inspection: November 2, 2000
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water -�'20t feet
Please indicate(check)all methods used to determine the high ground "ater elevation:
Obtained from system design plans on record-1f checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation)
,,7 Accessed USGS database-explain: US6S
You must describe how you established the high ground water elevation: / l
, i✓ t ,! / 3 ' 6 t / �..✓ L u-+fy w, /e ti. 11 .-,c� A d, J1'O... A
4✓✓V�.. -1- L L Vta."� U N G
ll '
Fps.. . ................
•1
THE COMMONWEALTH OF MASSACHUSETTS •--
,y �J BOAR® OF HEALTH
.... ...
Ijv trFaftuat for Uiipuual Works Tuawuttruott Prrutit
Application is hereby made for a Permit to Construct (>Q or Repair ( ) an Individual Sewage Disposal
System at: I n
..... ....05. e, .ram- i'11.�.....d-'!�s ................... ........
`i Locati n.Address �j or Lot o. i_i
b..lD. ..._ .....!'r�..S7JGC.�...................... .... L - l�7 t C4.1.:^.�. ....�. ✓-�. 1. � �- Ater-:. ?a1r ...-._.:
r r Owner ,Address
----------------------------------------- ------•----------•..................--------••----------•-----._.......-----••-•.........---------
Installer Address
UType of Building Size Lot............................Sq. feet
1.4 Dwelling—No. of Bedroom;..........................................Expansion Attic ( ) Garbage Grinder ( )
4 Other—Type of Building _ j:X.ct�.L_k....... No. of persons____________________________ Showers Cafeteria
faa
Other fixtures ------------------------ ----------------•-•------•----•--••-------------------------.... --•--------
W Design Flow....... ..............................gallons per person per day. Total daily flow.._...... ..............•.•....gallons.
Al
WSeptic Tank—Liquid"capacity ..gallons Length 0__G...... Width...i.1(G.. Diameter---------------- Depths-_��._-.
x Disposal Trench—No. .................... Width.....f..._.._._._.. Total Length........,+...._... Total leaching area......... �......sq. ft.
Seepage Pit No....._1_____________ Diameter.__..._6......... Depth below inlet................... Total leaching area..........sq. ft.
z Other Distribution box ( ) Dosing tank l
`-' Percolation Test Results Performed by._ .IrQ.r� ... .� �h J..... Date....___ .I
a Jr� Y_1'z114
Test Pit No. 1_.<..Z!Ominutes per inch Depth of Test Pit.....�.Z_.:...._.. Depth to ground wate
Test Pit No. 2._�j4__minutes per inch Depth of Test Pit---1114---- Depth to ground water-.-�14........
x ...........V V---I------- ............. ----..........................................................................................
ODescription of Soil........... •-r.......... -•--•..... Win'`......t.... .0 --..------------------------------------------------------------------•-
W
V 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 TI IT 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been isseud b the boa d of health.
Signed._& v ..........
!� /Date
Application Approved By.......... i�4_. ---.--•-------------•-------•-----•-- /5 ..................
Date
Application Disapproved for the following reasons---------------------------------------------------------------•--------------------......_...---•••-•••--------.
................•-•-••••••-----••-•--•-•-•-•------••----•••-•------••--••.....•••--------••••••-•-•------
----------------------------------------------------------------------------
Date
PermitNo......................................................... IssuedL.......................................................
Date -_
Fm3_3..5................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
a f tJ�ti �1 OF. il"(.''
..-•--�-
Atipfiratiun for Diipuiial Workii Tamitrurtiun .motif
Application is hereby made for a Permit to rC�onstruct (� or Repair ( ) an Individual Sewage Disposal
System at 5 I a ( - lJ C:
......f _......._.................... ? • ... •--•- ........................................................... - ...............
s Location-Addres`s,`'•- Lot Pfo.
CJ'-•�^ / C �\ ; �' 'v...... .................................e- . .. 1 j
{ , Owner Address
-•......................................................................................
nstaller Address
4 Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms_______________________________________Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building 1` "E 1"' No. of persons............................ Showers — Cafeteria
Other �,Ntures .........•__ ...._----•--
W Design Flow....._?___y...............................gallons per person per.day. Total daily„flow............................................gallons.
cS
WSeptic Tank—Liquid capacityWV_gallons Length_ �__"__._ Width_-__-..-_._`.... Diameter---------------- Depth................
Seepage Pit No..................... Diameter_._..-._...-. -_ Depth below inlet.................... Total leaching area__ C� sq. ft.Disposal Trench— o................ Width....................pTotal Leng,h_-____.__•__I___._.. Total leachingarea_.__._____.__ sq. ft.
Other
bution box
Dosin
Z Pe cola ionr1Test Results ) Performed by... Lk'to ( ) r Date....FT)i �
Test Pit No. L_<._Z:2mmutes per inch Depth of`Test Pit._-_-�_L__,_._____ D p h to ground
(i Test Pit No. 2..y*:'�._niinutes per inch Depth of Test Pit.... /T!�___. Depth to ground water....�d ! .......
-------------............................................... .._-•••-----------•.....•••---••••--.....................................................
Description of Soil.........= ,� .........LZ24� ,ru.:_._..:r-•--3 r `' -=----------------------------------------------•-•----•------•-----------
V ----•---••-------------'`- Z..:'.. ------------------....._._....------------.......------•---....------------
W ----••------------------------------•------------------.....------------------------ .................................................................................................................
UNature of Repairs or Alterations—Answer when applicable................................................................................................
---------------------------------•---•-------••--•••--•••--.•..._.._....._-.....----•-•------•----------•---------------------------•---------•-------------..-----------------------------------•--•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ITT 1:,�. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
_�/�.?Z�✓!? '
Signed � 61-
Date
Application Approved By-__-___.___,, ,,I �r p ....------. --------------------- ---------------
A'. .0 Date
iLt'.
Application Disapproved for the follotving reasons:................................._..............................................................................
.................•-•----....••--•-----•-••-•-•----••••---•----•---•-•---•--•-•••-•.._....._....--•••---••--•-•----------------------•-•-••--•--•-•----•--•-----•--•••••--•-••---•-•--------••---•--•----
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. .'' ................OF...... .'�;✓�•c •i 1 d.. ........................
�nrtif iratr of TuutpRattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by... C�ir�:.�. i----- �_.. ....._-•--••••••-•----•-----•--•----•--------•-------•--•.......:.....:......................................••••••-•...---•-•••---••••--•••-••_••-
tjy i I' l ((`} Installer `
? I
has been installed in accordance with the provisions of TI T�4 j 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 CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFA TORY.
DATE................................................. Inspector...._'l')
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
I)
(r� L n`1 `-...La.... OF.... `; ? i . �{:.::<....�r^:` '.......................
No.......... .....
FEE........................
Dispoal Vorkg Tu�,notrudiun rutit
Permission is hereby granted-----� tr, ••-P_i-:..t1, =
to Construct ( or Repair ( ) an Individual Sewage 40sal S . tem
,
at ....... ...... cX�............. r..--......�---••---------..__.............
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
----•-------•--••-------•------- ----------------•_------••--•--•--••••-
Board ofV:a�llh/
DATE...............................................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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LEQEND
E11'CYlN® .SNOT ELEVATION 0S0 P0,6OFM ss CERTIFIED PLOT PLAN.
ISTING CONTOUR ___.® _..._ ��� o�yG•�
OFIUISHED ' SPOT ELEVATION �-- � 7
`IISHED CONTOUR --- 0 —
No.A No.10951�p�� I N
APPR01/ED# BOAttD " OF HEALT1t �°,Fssos��.`'���N �
� ATE AGENT SCALES / '= 3 0 DATE:
05T, sNwl. 7 77
KjLbftEDeE N6/NEE�/Ne C�' /N CLIENT` I CERTIFY THAT THE PROPOSED .
F7
EGtSTEIIE REE3ISTE tED ,o® NO. ' &UILDING SHOWN ON THIS PLAN
a CtYfL LAN® CONFORMS TO THE ZONING LAWS
o�:�Y � ,
E_4 R R� ' -� OF BARNSTA LEt, MASS.
J. t
} 7I2."MA:
I N STRE,ET I BYE ;
HYANNlS, .MA,$ � .
SHEET.,LOF.:. DATE -,AEG. LAND SURVEYOR
„ /Y07� : /F E/TNER 7Ale S�PT/C TA/V
14
a✓w(:7 PIT ARE MORE /2"BE40Jt/
F .
l0 P'T. M/N .1,RAOE� � 24 �O/AM ETER G'aNCR.ET� COVER
!.F---- I SNALL BE BRDUGNT To G)TAOE. `.;,✓ EX7-,e,q
CGNCRCTE / t/Er4Vy CA ST /ROJY Co{/EI? Sh'.4 L L 3E USEc7
A-L E-V, I D O O _ M/N. P/TCN
er
COVERS �B”oER OR/vE'lwft Y
��.. _ Gt,�oE Cc� ✓E�r CLE,4w SA,1/O--------------------
I
t L1941/0 LEVEL
• 14: 2 LAYER
� ; • /RONP/PE .. �OOJ G�L. • • oo � � ' � ° �� GLF ��8 --�%B�
b M 1/i/. P/TCN e • • • • • • o •
�S �'`• ► I4 PER T7 S�PT/C TA/VEC D/ST, ° •�b • • • • • • • WA SHPD STONE
_ • • � • • D�PT/+' • • e ' • 0 1-✓,43h/E0 STDNE
�/e -ti • • • e • • • • • • • o 0
/if�,r ? 5 ' 4?a s • e • • • • • a . d PREG45 T SEE.PNG E
lNYCRT �'L EYATIONS 7 � �`o ?5— . �i a• • e . . e e .''o P17 CR EQu/V.
6T.-A L.l r , ,, . a SLL✓, �9�
1NYERT A.T Bu/LD/NG '34 n FT. 6 t T. D/.4M.
INLET I SEPTAC:-T"4lVK 66,S FT, L FT O/s4M. C(SEE TAL5L14 4T)ON,
OUTLET SEPTIC 7ANN FT. ,-
-INLET DI57R14011 /ON BOX . 9 •O FT �.'E'T/O/V s7F GROUND WArEK T.481—E
OaTLETD/STR/BanoN mx S�,. F?
INLET LEACN/NG .�/T., 7�'>> FT S=JVAGE 0ISP4-SA L SYST&M
1.EACHI/YG =/T "Ti4e?UL.ATtD/V
YCAL E %4~ _ /= O� DIMENSION A 3 FT.
DES16M CRITERIAT.
NUMBER.OF BEDROOMS
G�+R5A4GE0/5PO.SAL UNIT N �'N� SOIL LOG
T07'A4 e3-r1A ATEG GLOM/ 3 3 y 0,44.IDAY SO 1 L TEST At/ S014 71�S7-#2 SO/L 7W5 r ?
rn YUMBER aF LEACROVG R✓TS_ f^ELEK 9S3 �`-�LEPY,
OATF OF SOIL, TEST
SIDE L1•AGHING PER P/T �SQ, i*T. U �z RESULTS w/T/YESSED BY J fr`'�' � CC r��oTt-r�
3oZrOM LEr1CII/NG PER P/7` � S4• F7", !.., ,� �,. _ PL`RCGL/ T/0J IAT
M//V•/1NCN. ;
TOTAL 4EACN11YG AREA FT.. %cT�s�i� FWRCOL,►T/CN RA7W A
RESERiiEGEAC'NlNGAREA SQ. FT. J Z �- /� 2. :�
o •
r� tAOF�gs •1 �P��Nor ,l�.gss�. . r .��.' 407-
Ain
o MORSENIL N
4 O o No.iml DREDGE ENG/M Cr A6)?1 CO,/MC.
FQ/gTgE��O� o- �GrsTE� > EL 3 . 7i2 MA//Y ST. ffygAIAZIS, M.9SS.
�ND S.URv�y �FFSS/0 Ak- �NO GROVNO kVA7,eR,�lVCOU1VTER50 e':L/E/VT:0 7T. i (iz DRTE
Gl LINO yVA GRO _
.J045 ND.' $D `I SHEET - OF z
i
09`7
t' �..---•---•---•-------.-.. Fay..............................
• THE�C®M�®A®C F�� SETTS
BOARD f ALT�
0 ...... .� .. . .. . ........... ... ............
Appliration -for 13iipn, ial Workii C owitrurtion Vrrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
-------- ----------------•-----------------•---------------------------•-•--------•••-••---•--••---.....---
///�7� Owner Address
--•-----------------------••••••-•--••......
Installer Address
Q Type of Building Size Lot.2 ............ __._._Sq. f�eet
Dwelling—No. of Bedrooms-------3--------------------------------Expansion Attic ( ) Garbage Grinder 46)
Other—Type of Building -........................... No. of persons-________.__________________ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------- -
Q ele_m.oey----------------------•-------------- ----•-----------------------------------•---•---•-------
W Design Flow----,//sue__________________________gallons pe-_pea:.�-per day. Total daily flow....._.._.__._.__3 _.gallons.
WSeptic Tank—Liquid capacity/.®gallons Length_.."p______._. Width---- Diameter________________
x Disposal Trench—No-____________________ Width.................... Total Length___________._____-.- Total leaching area_______.____-_-_____sq. ft.
Seepage Pit No.___/_____________ Diameter____Z t._�7 Depth below inlet...__.o•_®�__,__ Total leaching area.zg�__ sq. ft
z Other Distribution box ( � Dosing tank �`}`/�`9�
aPercolation Test Results Performed by---- 1-q......4V. S_-4s_�F_�_______________________ Date__.
Test Pit No. 1_ ._Z--_minutes per inch Depth of Test Pit.1'_�KY.y.-. Depth to ground water.Ns?w.,4,��-___-_--
!� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__. ---------- �
---- --------------------------- - ..............................................................••-•••-••--•••-•--•-•-• --------------------------
0 Description of Soil----d ? 4 _------Go
,• ((JJ�/ ---------------------------------------------
Ux d.4_�_/(--Cl/.4.. __._._____ _ .__...!=f- "`-� ___�_�_-�__ ________________________________________-.
. -------•-----------------------
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
S• ned- ------------------•-------------•-------------------------------------- ------ _.. ..................
D
�i
Application Approved BY ��' C 1 � r ------------ �Gl
' Date
Application Disapproved for the f ollewing reasons:----•-------------••---••-------•------•-------•------••--------•-••-•-----------••--•-•------------------------
--------•----------------•-----•---•-•----------------------•--•-•---------------------•-•-----••---------------------------•-----•------------------------•----•-------------------•-------------------
ey Date
Permit No........................................................... Issued--- == z L
�.�- -- - -- j---�--- Date-------------- -
s.
THE COMMONWEALTH OF MASSACHUSETTS
>, BOARD OF HEALTH
OF
Appliration -fur Uiipooal Works Towitrurtion Verutit
Application is hereby made for a Permit to Construct ( - Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
Owner Address
W
Installer Address
Type of Building Size Lot_: ------'_-:_4�.Sq. feet
Dwelling—No. of Bedrooms------- --------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
0.' Other fixtures ------------------------------ - --------- -----
d
W Design Flow___.,,ef ...........................gallons per_p=_&w�per day. Total daily flow................. _ ------.-.-gallons.
1:4 Septic Tank—Liquid capacitv`�'p2gallons Length...1J......... Width...Z� ........ Diameter................ Depth-,,-."._._. .
xDisposal Trench—No- -------------------- Widtli._......._............ Total Length-------------------- Total leaching area-.--.--_----._--_-sq. ft.
Seepage Pit No----�_____________ Diameter_... ---- Depth below inlet--- Total leaching area-? .----sq. ft
Z Other Distribution box ( Dosing tank ( ) `e/,
CR j %c l w " �'-'? _.---••--------------- Date...{'�3! t <- ------....
W Percolation Test Results _ Performed by---- � I
a Test Pit No.y Lam.__ ._minutes per inch Depth of Test Pit.r �;al.z-_"._. Depth to ground water..- ,<q� .------.
f=1 Test Pit No. 2................minutes per inch Depth of Test Pit.--.---__-_______- Depth to ground water--.--__`------a.'_°--- f7
W4 --------•---------------------------------------------------------------------------------------------------------------------------------------------------
D Description of Soil---- -�- ._� = C:c } �' ^�s °` �, c% .
--------- ------------
------------------- -------- -- ---------- -s --------------- -----
--------- --------- --------- --------- ---- -----
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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
7S' ned`-�'`-------------- ---------------------------------------------------
Da
Application A roved Br/ .� ---•------------------- .ti.. ..I„
PP Y ,% !- - - - Date
Application Disapproved for the following reasons---------------------------------------------------------------`--------------------------------------------------
----•-------------------------------------------------------•---------------------------------------•-•--'--------------------------------------....----------------------------------------------------
Date
Permit No. ---------•--------.=•----•-•-----_.._.. Issued -------- - r--.--------- =-----••-••--:
y - Date —
f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........................................OF..................... `..:............................................................
i
Q.,rrtifiratle of flzomplitturr
�. THIS IS21) RTI Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
bY...................... ----- ---------------••--•-•••-......•--•--------•------- . ----
Installer
at------------•-----------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of cle XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit N ........................................ dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector--------------------------------------------------------------------................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF"'HEALTH
OF............................... ....----...------------------------------.........
No. T4 ••----•--••- FEE........................
Ro:VonVri �uutrurtion " rmitPermission is hereby granted----- -----------=---------------------------------------------------------------------------------------------
to =
Construct - or Repa- ) an Indiv• 1'Sewag is o Syste
atNo. / ?s --!-P� -------------------------------------------------------------------
> y
Street
as shown on the application for Disposal Works ConstructionP i_ tttINN ___ Dated-.__---------------__-__----_-_-------------- �/ ./L B! _._ � i�- {---------------------------------
DATE--------------------------------------------------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
�v
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9rour?d profile ' T- 10AJ
-� -c-� -o- proposGc/ c�rounol Pr-ofi/e
SCHEO. 40 P V. C. OAP-
Equ,94- To $EPT/G r»,n�rnvm %� per- foot )
washev! Sforse
_TRA/K�
AP
7
\ v 6" Sump e
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AV
/00 O GA+L, SEPT/G T�gNK = of �4 - /fit I •
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h fora v� C ._ E3E4>R00 M H O US
-9TE : — 3p ? TEST BY
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'!j _ j � l _._ M!N. /A.!C
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7-,9A✓.,* TEST How LG : TCST NO(_ E #f
Y
N el. 3
LEACH P/T' �— y W
EFF. G�lrq �j��• . /oGr.m i
rn �d r �� EFF. OErPTH -
4 d'y11�? s r� ��• ) _ _t4 c 10.9 4. q y 30
7-07-.9L 1.18 GAGS. �0.9Y
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�• GO/t/FOCN! TO THE- ESU/LO/tl/G SET- ForE 7 ? �. P� �:�.-•' � J�7
B,AG/� �E'EQU/rE'EMEn/TS OF THE-
T O kv" O F 4E-�/9 rEt tl.'S T/B L 5 A J 7 E-� V/ �. � ,r✓F-�
..
/E'EQU/�E•MEAJTS >: "� }.� � �,� PrE' EPr9le ECr 6ca,2 . L ? Y G� '
F�OAJT 30 FT- ?' • crake tvFRErr
iE'EA � = IO ,r C F4�STtiR�4Q`I � Q�, 13230�Q �U SGAL_ E : r95 Sf/ 4WiV+' O so —
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S�ONAt tt�
7� G Hti lr—�- A.Aj/V/eL/eS ld:�? 5 S OG / ATE- S
cam. ZAJ Iq 6 c.-- S Y S T ---- 5 T- o 44C- A-/Aj S , M/9 S S.
rgPPre0VE D :
- - — — — G Aist/r7 d7 Corn*oc/r-s
— BOA� � O� HE'f�LTH
-o —o—o-o- prepos�ed eor7tnurs 8/9/ENSTf�BLE MASS. , �3/