HomeMy WebLinkAbout0261 HICKORY HILL CIRCLE - Health 261.HICKORY HILL CIR4"6STERVILLE
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Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
r Environmental Protection ,��� t12/
1AIIIllamm�FF.Weld
Trudyt,oxec
S�er•tary.EOEA JU'Y
David B.Struhs 1 Q
commissionermot. �
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO 99�
PART A �l
CERTIFICATION
Z ( 0�., Address of Owner.
Property Address. �. 8 5
Date of Inspection: S fig_ , of different)
Name of Inspector: tna,Q(XJ
C7-pp�
ny Name, Address Telephone Number:
� 5
CERTIFICA TION STATEMEN� /�� ��2—3 O
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
C--*P-a-sses
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fa s
Inspector's Signature: \c _n__ Date:
The System Inspector shal submit a copy of�this inspection report to the Approving Authority 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.
INSPECTION SUMMARY:
Check A, B,C, or D:
A) SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, 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, 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 conforming septic tank as
approved by the Board of Health.
(revised 6/15/95)
' One'Wfrtter Street + Boston,Massachusetts 02108 a FAX(617)SWI049 a Telephone(617)292•SM
Printed an Rwy"Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
-- . CERTIFICATION (continued)
Property+Address:
Owner:: /,?
Date'of Inspection:
B]SYSTEM CONDITION A LY PASSES (continued)
Sewage ckup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s)'or ue.to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Ith):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system req fired pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(wi approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIR BY THE BOARD OF HEALTH:
Conditions exist which require fu uation by the Board of Health in order to determine if the system is failing to protect the
public health, safety an nviro ment.
1) SYSTEM WILL PASS UNLESS BOAR OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLI HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or priory is within 50 t of a surface water
Cesspool or privy is within 50 f of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD O HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANN R THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT.
_ The system has a septic tank and soil abs rption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
_ The systeni ha, a septic tank and soil absor lion system and is within a Zone I of a public water supply well.
_ on system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorp'
_ The system has a septic tank and soil absorpti n system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for co'form 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.
D] SYSTEM FAILS:
I have determined that the system violates one or more of the lowing failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health ould be contacted to determine what will be necessary to correct
the failure.
Backup of sewage into facility or system component due to an overloaded or dogged 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.
(revised 8/15/95) 2
I
r �
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
D] SYSTEM FAILS(continued):
Static I' A level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid dept in cesspool is less than 6" below invert or available volume is less than 1/2 day flo .
Required pumpi more than 4 times in the last year NOT due to clogged or obstructed p' (s).
Number of times p ped
Any portion of the Soil sorption System, cesspool or privy is below the high gr ndwater elevation.
_, Any portion of a cesspool or ivy is within 100 feet of a surface water sup or tributary to a surface water supply.
Any portion of a cesspool or privy ' within a Zone I of a public well.
Any portion of a cesspool or privy is wi in 50 feet of a private ater supply well.
Any portion of a cesspool or privy is less tha 100 feet b greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well h been alyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, a is nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in dition to the criteria bove:
The design flow of system is 10,000 gpd o greater (Large System) and the ystem is a significant threat to public health and safety
and the environment because one or m e of the following conditions exist:
the system is within 400 f t of a surface drinking water supply
the system is within feet of a tributary to a surface drinking water supp
the system is to ted in a nitrogen sensitive area (Interim Wellhead Protection A a (IWPA) or a mapped Zone II of a
public water pply well)
The owner or operator of a such system shall bring the system and facility into full compliance with the'groundwater treatment program
requirements of 314 CM 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/9s) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
ru
Property Address: b �� C�ttJ� v
Owner: - pa.
Date of Ins ion:
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of Health.
'- one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
built plans have been obtained and examined. Note if they are not available with tf�The-facility or dwelling was inspected for signs of sewage back-up.
_. f- a system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
'All system components, excluding the Soil Absorption System, have been located on the site.
C�_Tfie 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 or
approximated by non-intrusive methods.
facility owner (and occupants, if different from m ner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 8/15/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM, INFORMATION
�`
Property Address:
Owner: I
Date of Inspection:
FLOW CONDITIONS ,
RESIDENTIAL:
Design flow: 3 Ilons
Number of bedrooms: 3
Number of current residents: :5�
Garbage grinder (yes or no):
Laundry connected to system (yes or no):
Seasonal use (yes or no):-
Water meter readings, if available: 4� ! �—
Last date of occupancy:Z
COM UINDUSTRIAL:
Type of establis ent:
Design flow: ns/day
Grease trap present: (yes or
Industrial Waste Holding Tank present:
Non-sanitary waste discharged to the Title 5 sys : (yes
Water meter readings, if available:
Last date of occupancy:
OTHER: (Descr'
Last date of ccupancy:
GENERAL INFORMATION-
PUMPING RECOR S and source of information:
System pumped as part of inspection: (yes or no)/1 „
If yes, volume pumped gallons
Reason for pumping:
TYPE OF SY EM
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)
Other(explain)
APPROXIMATE AGE of all components, date installed (if known)and source of information:
Sewage odors detected when arriving at the site: (yes or no)
(revised 8/15/95) 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SEPTIC TANK:
(locate on site plan)
Depth below grade: W
Material of construction: concrete _metal _FRP_other(explain)
Dimensions:
Sludge depth: l- X„ le
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: 'Z t, .
i
Distance from top of scum to top of outlet tee or baffler {
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping, condition o inlet and outlet tees or baffles depth of liqujfi I el in lation to out le invert, structur
integrity, evidence of Jeaka e, etc.) j4
o�.c,
GREASE TRAP:_
(locate on site plan)
Depth below grade:
Material of co struction: _concrete _metal _FRP_other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee ffle:
Distance from bottom n+srom t, bottom outlet tee affle:
Comments:
(recommendation for pum g, condition of inlet and outlet tees or �es, epth of liquid level in relation to outlet invert, structural
integrity, evidence of I age, etc.)
l
(revised 8/15/95) 6 y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
Kau,
INFORMATION (continued)
Property Address: i,u, �:
Owner: jCs f ft
Date of Inspection:
TIGHT OR HOLDING TANK:—
(locate on site plan)
Depth below grade:
Material of construction: _concrete_metal _FRP other(explain)- _
a _
Dimensions: Y
Capacity: gallons F
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee ndition of alarm and float switches, etc.)
*r
DISTRIBUTION BOX:
(locate on site plan)
tt a
Depth of liquid level above outlet invert: _
Comments:
(note if I vel and dis ibuti r is equal, evidence of solids carry r,)!o evidence of.leakage into r out f box, tc.) d
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order.(yes or no)
Comments:
(note condition of pump chamber, condition of pum �ndappurte , etc.)
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
e
Property Address:; (
Owner:
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): cl
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
leaching pits, number: /,:�>O 6> G;,G'- - �
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
f
Comments: (n to condition of soil, signs of pydraulic failure, level of ponding, condition of vegetation,etc.)
CESSPOOLS: _
(locate on site pl
Number and configuration:
Depth-top of liquid to inlet inve .
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part o nspection)
Comments: (note condition of soil, signs of hyd is failure, leve ponding, condition of vegetation, etc.)
PRIVY:_
(locate on site plan)
Materials of con coon: _ Dimensions:
Depth of solid
Comments: ote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, )
(revised 8/15/95) 8
I '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
L SYSTEM INFORMATION (continued)
Property Address: �b ft C�JL�,C, � /- e��
Owner: OYA- Pic..
Date of Inspection:
5-��-'-7
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
Ito/ ff
O �
DEPTH TO GROUNDWATER
4
Depth to groundwater: feet -
method f determinat'on or proximation:
(revised 6/15/95) 9
TOWN OF BARNSTABLE
LOCATION ae t SEWAGE#
VILLAGE.- ASSESSOR'S MAP &LOT
&PHONE NO.
SEPTIC TANK CAPACITY c3®C
LEACHING FACII.TTY: (type) size)
NO.OF BEDROOMS
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200'feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feetil leaching fa 'h Feet
Furnished by
TI - C� �s iG �/ ® C
■ Complete items 1,2,and 3.Also complete A. Si ture
item 4 if Restricted Delivery is desired. X Agent
® Print your name and address on the reverse Addressee.
so that we can return the card to you. B. R e' ed by(Prin ed Nam) C..Date of Delivery
to Attach this card to the back of the mailpiece,
I or on the front if.space permits.
'I D. Is de very address different from item 1? ❑Yes.
I 1. Article Addressed to: If YES,enter delivery address below;, Q No
I �
q�anine Paula Boston �� I
f x 8 P;artridke,Trail � ,.
1 3. Se ` e Type I
;Sherman, CT�`06784 Certified,Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
;p 4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number
(transfer from service laben 1`7012 : 10 DID 10 0 0 0 2 8 5 0 8 7 3 9
( - : . . . . -
PS Form 3811.February 2004 Domestic Return Receipt 102595-02 M 1;540
UNITED STATES POSTAL SERVICE First-Class Mail
Postage&Fees Paid
USPS
Permit No.G-10
I • Sender: Please print your name, address, and ZIP+4 in this box •
I
't'sfl�si�f}ti�IitFl:it}iijFl}I II Itl}i�{}II�Ilt Islii�;�Flll} i �
1
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Y.
Certified Mail#7012 1010 0000 2850 8739
�IIK*E Town of Barnstable
o�
Regulatory Services
IARNSfASL&
v� MASS. `0$ Richard Scali, Director
p�fDiiAA'�A Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
September 2, 2014
Janine Paula Boston
8 Partridge Trail
Sherman, CT 06784
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION,
The property owned by you located at 261 Hickory Hill Circle Osterville, MA was
inspected on September 2, 2014 by Timothy O'Connell, R.S., Health Inspector for the
Town of Barnstable. This inspection was conducted on the basis of the Town of_
Barnstable Rental Registration Ordinance.
105 CMR 410.450—Means of Egress. Observed a room being used as a bedroom
within basement without proper second means of egress as required by 780 CMR
3603.10.4.1of the Mass State Building Code.
You are directed to correct the violations listed above within twenty four (24) hours
of your receipt of this notice by removing all beds from basement and ceasing and
desisting from using any part of basement as sleeping quarters.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten(10) days after the date the order is served.
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable '. .
QAOrder letters\Housing violations\Rental ordinance\261 hickory hill oste 9-2-14 r
')
No. ��- l FEs.....Z_->...........
THE COMMONWEALTH OF MASSACHUSETTS
ID11 BOARD O,F.,`�.HEALTH
........-I btU.�.�i ..........oF..... I�,�1 .�V Jt ........................
Application for Uiipniittl i0orkfi Towitrixr#m 11trutit
Application is hereby made for a Permit to Construct �( ); or Repair ( ) an Individual Sewage Disposal
System at:
----------- .4-------------------
Location.Address or Lot No.
.......... .............................................
' •^ -6'avrfBT" _l) . Address
................................... -•-•--•-•-......_............--_.....:.......:._ ........................... .........._..... ...
In taller Address (� ��
Type of Building Size Lot........... . .........Sq. feet
Dwelling—No. of Bedrooms.................. IS..........................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building
.........:. No. of ersons............................ Showers — Cafeteria
G4 YP g :. P
a' Other fixtures ( -------------------•
------
W Design Flow......... 1D.:..gallons per 1ersen pFr._ k ay. Total �iow.....................••- ------ �ff
G4 Septic Tank—Liquid capacity.�CO gallons Length. _ .... Width;0, ... Diameter......:..:...... Depth.-- ill....
W Disposal Trench—No..................... Width...._.._....._.... Total Length............t...__. Total leaching area....................sq. ft.
x ------
Seepage Pit No......... _. Diameter........i...:_. Depth below inlet.... .....Total leaching area1V.j...A..sq. ft.
z Other Distribution box ) Dosing tank ) nn
Percolation Test.Results Performed b ...:. idt� �...• ` PEA........... Date....�__.�.� _ .........
Y �. a
Test Pit No. 1...L ..minutes per inch Depth of Test Pit.....��.___....... Depth toground ater..Ko ..
tz, Test Pit No. 2...�2-.:minutes per inch Depth of Test Pit._.._. 2....... Depth-to,ground water.:......................
it
O Description of Soil......( .,��..............�1".-��r1..`7� . ...:_._.�-!�U_.._�..� �4��•-
'..... --- ....--- ....` �......... ...............•---•.------.�----......... ....---..........
U .
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,I':LZ 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.
Signed........................ ................................................. i
-...
:_._ .. .. 4 ..
te.. ......Application Approved BY---•--•.•----• '....... :...�.`"c................ x
Date
Application Disapproved for the following reasons._..--•..........................•----...--......--•--•-•--•-•---------•-----•--•--------......................
••-•-•.......... .............••••--...........••---------•------•_..............•-••••......--•.................... ----.......---_...........................---......... . ............_
Date
PermitNo......... �. `. ..�.......... Issued....:...................................................
Date
NoZ........... 7 FEs...... c '•
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH '
t .
Appliration for Dhip al Works Tomitrurtion Errant
Application is hereby made for a Permit to Construct�(�O or Repair ( )'an Individual Sewage Disposal
System at
...14._G r �= ----- ---- -• .............
Location-Address or Lot No.r
W � -Owner r.Am T'Q PpAQj"p 11)p A dre s
Installer Address
Type of Building E' Size Lotj.5_.14 ......Sq. feet
Dwelling—No. of Bedrooms............................_.. .._.__..Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Buildin
a Other—Type g ------------------ No. of persons.............................Showers ( ) — Cafeteria ( ) '•
aOther fixtures ..•. •-•-•---•-••` rt"r .................. .......................................
Design Flow......... .....gallons per W-s@n per day. Total dail low................�...�.. :? ....gallons.
Septic Tank—Liquid capacity(()gallons Length.-'��--�.01... Width{'_ Diameter........:.....r Depth. I��.
x Disposal Trench—No. .................... Width...... ........... Total Length........... r.................... Total leaching area...... .sq. ft.
Seepage Pit No......... .. Diameter........ ...... Depth below.inlet._... Total leaching area.201.t..Isq. ft.
Z Other Distribution box tX) Dosing tank ( ) q'
'•" Percolation Test Results Performed by... fk). ��: ......_ Date._.. ..._� ��a.� .__.___....
y .:. f- •-•••
Test Pit No. l...;:;-..minutes per inch Depth of Test Pit.--.. �. .. Depth to ground water f tit
f=. Test Pit No. 2--- ..minutes per inch Depth of Test Pit....................Z._...:. Depth to ground water........................
0 . q............ -•--•- •----
....it....... ••---.--•--� �escnptono Soil......
.-- ------•-•---
. ... ..." c _
.............
V ........................ ---------
........
.----------------------
..............
.-.----- ----.... --•----------•-----•-•-----......-.- ---...._..__. .
.....................•-----••......•........._....... -----• --•------•------•-......-•--------.......... ....._.....................
0 Nature of Repairs or Alterations—Answer when applicable.......................................................... ...._...
...........................
...----....----•-•-•--..---•• ••-- --•----. •-- •--• . ..........--•-
Agreement: T
The. undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance..with
the-provisions.of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system.in
operation until a Certificate of Compliance has been issued by the board of health.
Signed :..,.:....:......../::...... ......... ....... ...... .. ......
` ..
/. D
Cate
Application Approved By.......... --. •---•-_.. .............---•--.._...--•-.... ....---•-•----•......... .. /
Date
Application Disapproved for the following reasons:....... . - ,..
....................................... .............• ......--------•--..............._.._ ........................................•.........•---•- ...... -
Permit No......... ._..... .... ..... .......... Issued:.. ..........I..............
---Date......
Due
�...e..�....#..:a n,. ..,...:.., ..:.. ................ ...a .. .�-..� ...f.� .,..,....
THE COMMONWEALTH' OF MASSACHUSETTS
BOARD OF HEALTH
............................:.............OF............................................................:............... �-
(Irftif irate of Toutplitturr
THIS IS T Q.CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
+ f '' C I�ialley r
at...•••....._.�__ _....r---- -- .....Tom?. -t .......................�~_ .....
y _... .. .....
has been installed in accordance with.111L-p ovisions of Tl T Q j of The State Sanitary Code as described to 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 UNCTION SATISFACTORY.
DATE....... �.1�. �. . .. = ................... Ins ector t^� f� _
p
............w . ......... •- .n r-�ro a. i.• . a
'r
THE COMMONW.E�ALTH66F MASSACHUSETTS s.
BOARD OF HEALTH
`r ... OF.:.................. ........ ..................._.........................
'7 ( . s :��..:.....No.... �?.:. FEE.
Disposal Varkii Tunitrurtion rnmit
Permission is hereby granted................. . j f.. c
to Construct ( ) or Repair ( ) an I dividual Sewage Disposal System
at No..........� c?-, 4f -,` c.� ` ? �!. �-• l �� �. ... ...........................................................
if. J Strcet �� I ;
as shown on the application for Disposal Vl'orls Construction Permit No.. Dated....... c�11�.1....................
`
DATE.......i�: .. . ....- Board of Ilealth
"
I A'
SECTION SEWAGE I r
� I "
I
-SEPTIC TANK- Lf t -"D"BOX L�I -LEACH DI7
f TOP OF FDN / Jul
(,Sw.` _..2..OF TO 4a•'
WASHED-STONE ��' QQQ _ QF
_+'TF
01
1QQ�G OUT• IN- OUT• IN- /D / / / �I •��
211YL `� SEPTIC
TANK I �Y
ELEV. ELEV. ELEV. ELEV. . r \. �,,
ZS (o t // l
ELEV. ELEV.'
, 1
WASHEDSTONE V
6,3
2 ly
TEST HOLE LOG IA e
.TEST BY � �(?BARN K7
p �rJ WITNESS J
TEST DATE (� DESIGN BEDROOM HOUSE
T.N: �► 1 T.H. * 2
ELEV. 1 ELEV
-•� .. I�I�
�O"3 :��. t NO `/
LIJp,p( 5 ,{ L V e • G 2 DISPOSER DISPOSER /
24. Z<F'I PERC RATE MIN/IN.
FLOW RATE (GALmAv)
SEPTIC TANK
REti'DSEPTIC TANK SIZE
LEACH FACILITY
SIDE WALL = I (Z,S) 31 .d .G/D.
q3 o (alp 1� sOTT M I ,O) . 50, 3 G/D. ' Diz I� 1.1A4� I _ T a�
,41 I�4�{ TDTAL ,I—�Tq-
USE: ��� LEACHING PrT
►�� .. t
WATER ENCOUNTEREDob
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NOTES: (UNLESS OTHERWISE NOTED)
1.DATUM(MSU:TAKEN FROM ` !I T QUADRANGLE MAP 0 I _ �� L-�T 3 ---- j/
2.MUNICIPAL•WATER �7- nVAILABLE `N f i y7p{�
3:PIPE PITCH:4"•'PER FOOT ����� S�
4.DESIGN LOADING FOR'ALL PRECAST UNITS:AASHO- •44 ARNE H. � +
S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(2)FT. OJALA I r_5d I L V I Q Cq G✓E"r�jQ GI!!�
6.PIPE JOINTS SHALL BE MADE WATERTIGHT CIVIL
•+
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. NO. J79 " F OQ T ; go, i'tK Uf MgSr
STATE ENVIRONMENTAL CODE TITLES
8. Te-�ve3t�-r- �pSL 1au�Js EDFo.L-a te7Y Q�.7 izC.�o-�c�..�[•+`Ck�o�..'.C�IC_c�r��b.t�a.�..t.0.-�+-40�,�� �O�F S'r .`'•
^, — SITE
• E � N
IC * IL),4 AFtHF : GIFGI:�
H. N VSTI:KVILLE ui 55 ;
9, ALL- Vh1�Ut"(p�jtG {�Q-SrCi1Z1AL "�O 7 QfGMO�I REG.PROFESSIONAL ENGINEER 0.1 N26 3 �
V�(1-T'(4 CAOAt4 ).�.E0t L)M CnA . <y l':1 �p 48 o REF: �' r 3I
'rFs
down cafe en 1#7 r1ag s�0 PREPAAEO FOR: L�e>
CIVIL ENGINEERS '•' �' `1
LAND SURVEYORS ------------
BOARD OF HEALTH + REG.LAND SURVEYOR �
(EXISTING).............
! 9" main SL SCALE III = 26 � �' .f- go�
CONTOURS (PROPOSED)-o-o-o-o- APPROVED DATE MA I 111". DATE o ei- `-""