HomeMy WebLinkAbout0072 FARM VALLEY ROAD - Health 72 FARM VAS lg-
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CO3.N1,.%1O.N EALTH OF MASSACHL;SETTS
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_ ! ExECUTIVE OFFICE OF El VIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON hLA 021OF 16171 292-550ki
TRUDY COXE
Secretan
ARGEO PAUL CELLUCCI DAVID B STP.'. HS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 72 Farm Valle Rd.. Name of Owner Sandra Wen ig`
0 s t eyy ry 11 ems, A Address of Owner:
Date of Inspection: �c Y"
Name of Inspector:(Please Print)Wm. E . Robinson Sr .
I am a DEP approved system!inspector rsuarrt to Section 15.340 of Title 5"(310 CMR 15.000)
rn copanyNam,e: Wm. E . Robinson 1eptic Service
Mailing Address: PO Box 0 9. Centerville , MA
Telephone Number: 7� _
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information repotted 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 sew a disposal systems. The system:
_ asses ,
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date:
The System Inspector shall submit a 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
r
revised 9/2/98 Page Iof1I
V. ried or Recvc lid Pane, -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION fcontinued)
Irop"Address: 72 Farm Valley Rd.. , Osterville
Jwrw: Sandra Wenig
Date of Inspection: 2.2
INSPECTION SUMMARY: CheckOB, C, Or D:
A. SYS 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:
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 es, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined•, explain why not.
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.
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
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 9/2/98 Page 2of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION Icorrtinued)
Property Address: , 72 Farm Valley Rd.. , Y Osterville
Owner: Sandra Wenig
Date of Inspection:
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) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 316 CMR 15.303(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 (approximation not valid):
3) OTHER
- ` revise: 9/2/98 of,
Page 3 11
y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 72 Farm Valley Rd.. , Osterville
Owner: Sandra Weni
Date of Inspection: �L-a Y
D. SY TEM FAILS:
You must r dicate either "Yes" or "No" to each of the following:
I ve determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
de ermination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility.or system component due to an overloaded or clogged SAS or cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less-than 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 compounds, ammonia nitrogen and nitrate nitrogen.
E. LA IGE 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
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 II of a public
water supply well)
The o ner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office f the Department for further information.
revised 9/2/98 Pagc4ofII
it __
P,
a
. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.
PART B
CHECKLIST
Prop"Address:72 Farm Valley Rd.. , Osterville
owner: Sandra Wen*i
Date of Inspection: ,i C� G'Z_.o
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:,,
Yes No .
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the stem has been receivin system g Normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection. ,
As built plans have been obtained and examined. Note if they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
V _ The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
_ 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:
Existing information. For example, Plan at B.O.H.
Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)
(15.302(3)(b)]
V `
_ The facility owner land occupants,if different from owner) were provided with information on the propermaintenanr4�_Qf
SubSurface Disposal Systems.
y
rev1sed 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
IropertyAddress: 72 Farm Valley Rd.. , Osterville
owner: Sandra Wenig
Date of Inspection: O"—.2
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 9g.p.d./bedroom.
Number of bedrooms (design) .>Number of bedrooms (actual):►
Total DESIGN flow ?,;L y
Number of current residents:/L/4
Garbage grinder(yes or no): X
Laundry(separate system) 4(ye. or noA C); If yes, separate inspection required
Laundry system inspected (ye or no)
Seasonal use (yes or no):. 1999 227, 000 gal.
Water meter readings, if Vailtable (last two year's usage(gpd):
000- gat
Sump Pump(yes or no):�? r
Last date of occupancy:
COM CIAL/INDUSTRIAL:
Type of stablishment:
Design fit w: ppd 1 Based on 15.203)
Basis of d sign flow
Grease tr present: (yes or no)_
Industrial We Holding Tank present: (yes or no)_
Non-sani ry waste discharged to the Title 5 system: (yes or no)_
Water m ter readings, if available:
Last dat of occupancy:
OTHER (Describe)
Last d f occupancy:
GENERAL INFORMATION
PUMPING RECORDS nd source of information:
Syste pumped as part of inspection: (yes or no),,4-� 0
If yes, volume pumped: gallons
Reason for pumping:
TYPE O 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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other-
APPROXIMATE AGE of all components, date installed lif known) and source of information: /q g —•
Sewage odors detected when arriving at the site: (yes or no) (J
1
revised Page 6of11
,M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C _
SYSTEM INFORMATION.Icontinued)
'rop"Address: 72 Farm Valley Rd..;, Osterville
Owner: Sandra Wenig
Date of Inspection:
BUILD G SEWER:
(Locate n site plan) b
Depth b low grade:_ '
Material of construction:_cast iron_40 PVC other lezplain).
Distan a from private water supply well or suction line
Dia ter
Co m ants: (condition of joints, venting, evidence of leakage,-etc.)
SEPTIC TANK:_
(locate on site plan)
Depth below grade: If
Material of construction:_ oncrete' metal_Fiberglass _Polyethylene_other(explain)
If tank is metal,list age_ Is age confirmed by Certificate-of Compliance (Yes/No) ,
Dimensions: (y `)le /0 'V
Sludge depth: ?i r• �,
,
Distance from top of sludge to bottom of outlet tee or baffle: b
r�
Scum thickness:_
Distance from top of scum to top of outlet tee or baffler ,
Distance from bottom of scum to bottom of outlet fee or,baffle: /.3
How dimensions were determined:
'omments:
(recommendation for pumping, condition of inlet and outle tees'or�b . es, depth of liquid level in relation to outlet invert, stryctural integrity
evidence of leakpge, etc.), J� b-C� )*� / i" J' I O .A �. C �6-ac/ etlT V t
A tf
GR E TRAP:
(locate n site plan)
Depth be ow grade:_
Material f construction:_concrete_metal_Fiberglass _Polyethylene_other(explain)
Dimensio s:
Scum thi kness: a
Distance rom top of scum to top of outlet tee or baffle:
Distant from bottom of scum to bottom of outlet tee or baffle:
Date of ast pumping: A
Com ents:
(►eco mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evide ce of leakage, etc.)
revised 9/2/98 k Page 7or11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
- PART C ,
SYSTEM INFORMATION Icorrtinued)
J,ropertyAddress:72 Farm Valley Rd.. , Osterville
Owner: Sandra Wenig
Date of Inspection:,) 4 aza'`-)
TI TOR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection)
(local on site plan)
Depth elow grade:_
Materi I of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain)
Diman ons:
Capaci y: gallons
Desig flow: gallons/day
Alar present
Alar level: Alarm in working order: Yes_ No
Da of previous pumping:
Com ents:
(con tion of inlet tee, condition of alarm and float switches, etc.)
V
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal evidence solids carryover, evidence of leakage into or out of box, etc.) -
� es cam/
PUMP C AMBER:_
(locate o site plan)
Pumps i working order: (Yes or No)
Alarms i. working order(Yes or No)
Comm ruts:
(note ondition of pump chamber, condition of pumps and appurtenances, etc.)
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'roperty Address:72 Farm .Valley Rd . , Osterville
ot»ner.: Sandra Wenig
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): -1
(locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
Type:
leaching pits-, number.-
leaching chambers,number:_
leaching galleries, number:_ ,
leaching trenches,number, length:
leaching fields, number, dimensions:
overflow cesspool, number:_
Alternative system:
Name of Technology:
Comments:
Inote condition of soil, signs of hydraulic failure, level of onding,/damp soil, condition of vegetation, etc
CESI POOLS*_
(Iocat on site plan)
Numbe and configuration: +
Depth-1 of liquid to inlet invert:
Depth of solids layer.
lepth of cum layer:
Dimensio s of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of inspections `
r
4ondition
f soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PR _
floc to on site plan)
.Mate ials of construction: Dimensions:
Dept of solids:
Com!• ents
(note!condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.
revise 5/L,/7C Pagc9of11
I` .
SUBSURFACE SigWW1' V b§1kiSYSTEM WSPECTIOM FORM
GART*" •.
SYSTEM��ORMATidk leorrtinued)
NopertyAddress: 72 Farm Valley i1d.. , Osterville
'caner: Sandra Wenig
Jate of Inspection:
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)
a
1
v1
revised Page10ofII
• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORIiA
- ' PART C
'SYSTEM INFORMATION(continued)
rop"Address: 72 Farm Valley Rd...,' Osterville
Owner: Sandra Wenig "
Date of Inspection: '.2 '�
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells.
Estimated Depth to GroundwateIPFeet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
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
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
, ��G �� �� y
� 07
kz
revised //9 2 96
Page 11 of 11
BARNSTABLE
LOCATION ��� �r C>®✓�� SEWAGE
n VILLAGE f ASSESSOR'S MAP & LOTl7 ;T 4
V�
,,� INSTALLER'S NAME & PHONE NO. , �4�� �s•�- ��'� ����J�
® SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 64 � (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 1 .�/�•`� 'l�lJ7
DATE PERMIT ISSUED: "/•- � :Sr
DATE COMPLIANCE ISSUED: •7 '�.1 "
VARIANCE GRANTED: Yes No
� � .
�� ��
�----.
�� ��-p �I
� � �
9
��
��
r
•�+, /
ASSESSORS MAP NO• *.
-�� PARCEL WO ��oo
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........Town.......... ........OF....... uo-r,SJAb/c
.....-...............I..............................
Appliration for Diipuiittl World Tonotrurtiuu rrrmit
Application is hereby made for a Permit to Construct (?K') or Repair ( ) an Individual Sewage Disposal
System at:7 �) / �1 L // /� /�
....Y.G./I e. .!r .. �,2f?:!:31.[.�(.�............ ..✓! �S�P=:...a.::.4 �17 !—Ct/�C�� .....................
Location-Address �q y/y� or Lot No: /
�35'lL...... `3�!� S C!d c/ccr:..._P!E�G.lfl.!?%/9YP12zr4...Z, �._..7K 4✓!f.E� ..
Owner ddress
••----•-----------------•--••-•--------•--...-----------•---...-------------------------•--------- ....---------------------.............................. ._..._._.:_.........
.---•--------.--
Installer Address
dType of Building Size Lot... ':.......Sq. feet
U Dwelling—No. of Bedrooms.........Fci,L,.r_--•_____________------Expansion Attic (�) Garbage Grinder WO)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures --------------•------------
W Design Flow......................:.............S .gallons per person per day. Total daily flow.........................!¢?.......gallons.
WSeptic Tank—Liquid capacitvB�__gallons Length_Lp= 4.. Width.;5- '_L le'... Diameter............... Depth.;V:-10'.'
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No------- o...... Diameter-_-_i-o'--------- Depth 'below inlet___-lam........_... Total leaching area..qM'_....sq. ft.
Z Other Distribution box (>C) Dosing tank ( )
Percolation Test Results Performed by.__G hc;n._.A____h�9i_I: ................ 14
as Test Pit No. 1.-:J�-,e..._.minutes per inch Depth of Test Pit------I_Z�....___ Depth to ground water......---
fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..
q,
P' .
0 Description of Soil....... z��� 1.f:.,�iub�ro a.........................
_ ...3'1'EPIJ�iV
x _ ALLYN
--idlTL?��d-• �,
I�tt'3C�L8
U Nature of Repairs or Alterations—Answer when applicable...............................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc dance with
the provisions of TITLE 5 of the State Environmental Code—The unde rther agrees not to place the
I, system in operation until a Certificate of Compliance ha is d b of health.
Signed ------- ....... ... ... ....... .............
Application Approved ....... .......... .......... .....
-- ....... �...:.
...... ....... ............... ....... --......:--..........-.-:............--.. Dace.....---'.
Application Disapproved for the following reasons: ............ ........... .............................................-----.--------....----.....................
------------- --------------------
Permlt No
. '-�-- Issued - �... `.
Dace
�:s t, • ' n
� A
No. l..---- � Fps. %,fr-• p
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-----... ....................................................................................
OF.......�J.or�1s�_...�c•. .. ................................
Allp iratilau for Uhipa'ial Works C onotrurtinu ramit
Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal
System at:-7� .. - __... _
LoT I/6)..t�Gm_..l1�1 t'?s.�-)..Qs�t�1[.�15............. �S���s_o!.5..r�G�1..y�.��II .�a�cc�s�.� ...-
Location_Address or f of No.
llQr�zarsisrt.-------------- AAQxse.. . .
Owner Address
W
I nstall er Address
Type of Building Size Lot___ .......Sq. feet
'-- Dwelling—No. of Bedrooms.........Fc,i,r-_______________________Expansion Attic Garbage Grinder (�1W�,)
aOther—Type of Building _________________________- No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------------------------._.._...-------------------------- -----....--••--------------------------...-------------------
WDesign Flow.....................................55_gallons per person per day. Total daily flow.___.............._....... .0.........................4.4.0.......
WSeptic Tank—Liquid capacity/_$a�..galIons Length_lQ.=.Ce�.. Width_✓�_(O--_- Diameter______ _______ Depth.5�_./Q.'.:
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.....-lu.sa____.. Diameter.....,o.....____ Depth below inlet....4r............ Total leaching area_;��.....sq. ft.
Z Other Distribution box (x ) Dosing tank ( )
Percolation Test Results Performed by..!5kph c,i...A..__Wi_1940 .._;_P10................ Date �.3._.1?���ctri.4�e4:..1_4.9 4L
,al Test Pit No. L-k%. a-_-__minutes per inch Depth of Test Pit___--I.2l....... Depth to ground water...-_—..............
f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..._._.......__...._...
•---------------------------------------------------------------•----------•-•--------•----.................................
Description of Soil-----Q 1..�...� T�z.� i1_f..S.u1zsA_�1......---•------•---------------------••-------------.....--------- . '! -
xll � ►Z� ' Y1� .P t ...5A1.0 ...........................................................----------••
v 1 �A1�rtf�t z
U Nature of Repairs or Alterations—Answer when applicable--------------------------------------------.._................ _.... ilk .. *r
----•--••-----------------------------------•---•-•---•-----••---••-•-•-----•--••---................._...-------•--•----•-------•-•-•-------------•----------•-----...... o.3d2
Agreement:
s.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in c
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to �ie
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed .............................. .. . -- ................................... ........................................
Application Approved ,a /� _ .} nae
if .... /1 -- .......................... -------------- ,/'"�
-- -- '3
Application Disapproved for the following reasons- ------------------------------------/-------------.-------------------------------------------------------------------------
..
.................................................................................................................... . ....... .................. .. . . ....................................... .......................... .....
� : Dare
d.
Permit No. ....�.'� ,.1�. .................. ...-...... Issued �.'
........../----ter -..... -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............................................. OF .... ................................... .................................
Cger#if ra a of (VILTI-oznylianre
THIS IS T CE 1 Y, That the Individual Sewage Disposal System constructed (�' ) or Repaired ( )
by __................ � .....................�..:. �?............................
nsca er ,
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code a described in
the application for Disposal Works Construction Permit No. ., . .: ,yam.. dated ... ... ...��. . -
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE../��.:...f .® . ................. Inspector .__--- .
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
.,�......0....... FEE.
.. ,r > i
Bispn gj orkii Tonotrurtivit Prrutit
Permission is hereby granted----`�.1.�' `°'L ' ��"' ��r � -•--•--------•-------•-----------------------------•-
to Construct 0y�-) or Repair ( ) an Individual Sewage Di�sp�Sal System
at No....... ----- ..... vim-- .... �;`�......- ✓ .1-44.. �''",
f` Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
---------------------------------------------------------------------•----•---...............--••-_...._
Board of Health
DATE--------------------------------------------------------------------------------
Form 1255 H&W HOBBS&WARREN TM Publishers
s
20' MINIMUM OR AS INDICATED ON PLAN vt�i
NOTES-
10'
I
1 . ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
MASONRY EXTENSION TO 12' TITLE 5 • THE TOWN OF -�
BELOW GRADE ., {,,:��s �____—_ RULES AND
TOP OF FOUNDA110N �- BACKFlLL 1MTH REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE;
e- MIN. CLEAN
MASONRY EXTENSION TO 12'A AND THE REQUIREMENTS OF THIS PLAN.
BELOW GRADE
JJJ---- - 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO 4'
z WITHIN 12" OF FINISHED GRADE. '
a- SCH. 40 PVC PIPE ' 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE _ � �J—MIN. PITCH 1/8' PER FT " SHALL BE MORTARED IN PLACE. w
1 4 PER FT. FLOW UNE \
1/8- - 11/2- 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE
10" TEE WASHED STONE
i4-? r MIN Ii '`'p OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR - +.
2'-0- ,
4. GALLON WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING
i 2. MIN LEVEL �,j LEACH
MINO, i.3, 7 PIT 3/4• _ 1 1/2• SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR
LIQUID 1v F WASHED STONE PARKING.
LEVEL DISTRIBUTION L) �nV
_ A Box - 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED l
— W RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL
GALLON SEPTIC TANK OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. LOCATION MAP
6. HORIZONTAL AND VERTICAL_ CONTROL, SEE LEVY, ELDREDGE ASSESSORS MAP Z PARCEL 33
& WAGNER FIELD NOTEBOOK #_�C�_.
UQUID DEPTH IN SEPTIC TANK DEPTH OF OUTLET TEE BELOW FLOW LINE -'
-- BOTTOM OF TEST HOLE
4 FEET 14 INCHES OR USGS PROBABLE HIGH WATER LEVEL�. 5
5 FEET 19 INCHES
6 FEET 24 INCHES
CURRENT ZONING INTERPRETATION: DESIGN CALCULATIONS
SEWAGE DISPOSAL SYSTEM PROFILE MIN. FRONT SETBACK 3o FEET NUMBER OF BEDROOMS
NOT To SCALE MIN. SIDE SETBACK i S FEET GARBAGE DISPOSAL UNIT r ,�
TOTAL ESTIMATED FLOW
MIN. REAR SETBACK FEET ( ilc GAL../BR./DAY X 4 BR.) GAL. /DAY
REQUIRED SEPTIC TANK CAPACITY GAL. j
ACTUAL SIZE OF SEPTIC TANK GAL.
PERCOLATION SOIL TEST P- 834o LEACHING AREA REQUIREMENTS
N SIDEWALL AREA �: GPD./S.F. BOTTOM AREA � GPD./S.F.
DATE OF SOIL TEST GZ Gcccrr4 i ', t, SIDEWALL 27T( • /2)(_—)SF x % GPD/SF = 471 GAL/DAY
TEST BY
1� BOTTOM 7 ( �o /2)T SF x GPD/SF = 7i GAL/DAY
\� WITNESSED BY s� lorr.� G'•67 :f,c 4c� ,,• 1
PERCOLATION RATE t-ao MIN./INCH t�ZZ.
f -:34 SF //c O GAL/DAY
TEST PIT #1 TEST PIT #2 BREAKOUT CALCULATION:
ELEV.= l t.% ELEV.=
,
-0.00 -0.00
_ 20-
i
DRAINAGE
EASEMENT
LEGEND :
e��O ��- �� I / EXISTING SPOT ELEVATION 00.0 X
'' ,� / `—�� .' (!•10 U1a�er I EXISTING CONTOUR---- ---00---- --
f.� : 22i2 ' - - FINAL SPOT ELEVATION 00.0
TP
v� 1 FINAL CONTOUR
vi
SOIL TEST PIT LOCATION
Q catc BOTTOM OF TEST HOLE BOTTOM OF TEST HOLE
()" bo OR WATER ELEV. _-- 3 S ?/GJ�- OR WATER ELEV. TOWN WATER W W
" LOT 117 /`�
_
Ilia ,,� / SEPTIC TANK o 0
I DISTRIBU T!ON BOX ❑
WATER LEVEL ADJUSTMENT-. PRIMARY LEACHING PIT
RESERVE LEACHING PIT R
TEST DATE WATER LEVEL
INDEX WELL - -- — -
/ L-OT 14�&, ° WATER LEVEL RANGE ZONE q 1
INITIAL ISSUE
R; /✓� 5,pg�. F_ `+,� /� ` fir' i DEPTH TO WATER LEVEL FOR INDEX WELL N0. DATE DESCRIPTION BY
0.57 AC. \ \ \ �cP FOR MONTH OF —
`_5718, p.4 ro50 ' BENCH MARK ELEV. WATER LEVEL ADJUSTMENT
SITE PLAN & SEPTIC DESIGN
?�� 6$ j PK SET = 19.47 NGVD
=52.50• ` '�_ -�. - ------ -- DEPTH TO HIGH WATER T
�2a,; oe� / LOT 116 FARM VALLEY ROAD
IN
OSTERVILLE, MASSACHUSETTS
ELECTRIC
& PHONE 18 FOR
E.D.P./ LONGHILL CORP.
-----_ APPROVED: BOARD OF HEALTH STEPH
ALLY
—--
HYDRA T I `� c WfLSOA� t
T _ "�"�NZ�4 f SCALE: 1 „ = 40' JOB NO. 1768 1 ?68
SITE PLAN --DATE AGENT
LEVY, ELDREDGE & WAGNER ASSOCIA'ITES INC.
j PERMIT # ICBM URSCifPI� dCHI]IM Pt1N1i,�S 1>d1�lD SURMORS
L 586 STRAWBERRY HILL, RD CENTERVU-J.E MA 02632
NFW f NGI AND RFPROGR APH;(S K CIfPP! v(-p '-------- -.-- -- ------