HomeMy WebLinkAbout0086 JASON'S LANE - Health 86 JASONS LANE, OSTERVILLE
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COMMONWEALTH OF MASACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIR ,
DEPARTMENT OF ENVIRONMENTAL PROTECTION"
ONE WINTER STREET BOSTON MA 02108(617)292-3500 +
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI - DAVID B. STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION q
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK.GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Address of Owner: 205 WEST WIND CIRCLE OSTERVILLE MA.02665
Date of Inspection: 9/11/00
Name of Inspector: JOHN GRACI
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536
Telephone Number: 608-564-6813 FAX 508-564-7270
CERTIFICATION STAT M NT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.-The system:
X Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: - Date:9/19/00
The System Inspector shall su it 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 ;
"The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings we of how the system is performing at the time of inspection.M,
inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life."
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE.
RECOMMEND RAISING THE COVER TO THE LEACH PIT.
revised 9/2/98 Pape 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM'
PART A
CERTIFICATION(continued)
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Date of Inspection: 9111/00
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
X 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.
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 o
the replacement or repair,as approved by the Board of Health,will pass.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances. If"not determined",explain why not.
n/a 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.
nta Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o
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
n/a 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
' f
revised 9/2/98 Paoe 2 of 11
9 ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Date of Inspection: 9111/00
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,
safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM I;
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 aseptic 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 nta (approximation not valid).
3) OTHER
n/a
revised 9/2/98 Paoe 3 of 11
SUBSURFACE SEW
AGE AGE DISPOSAL SYSTEM INSPECTION FORM
PART A +
CERTIFICATION(continued)
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Date of Inspection: 9/11/00 -
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
= I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent io the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day.flow,
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nLa.
X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply:
X Any portion of a cesspool or privy is within'a Zone I of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water
quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS: -
You must indicate either"Yes"or"No"to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health
and safety and the environment because one or more of the following conditions exist:
Yes No
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply
well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of
the Department for further information
revised 9/2/98 Paoe 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
c CHECKLIST
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M12.1 T117
Name of Owner: PATRICK GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Date of Inspection: 9/11/00
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
E.
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health.-
X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that
period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
X As built plans have been obtained and examined.Note if they are not available with N/A. "
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X _ The site was inspected for signs of breakout.
X All system components;excluding the Soil Absorption System, have been located on the site.
fir•E
X The septic tank manholes ere uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material
of construction,dimensions;depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site
has been determined based on:
X Existing information,For example, Plan at B4O,H,
X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)J
X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal
Systems.
c4
revised_9/2/98 4 Pane 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART C
SYSTEM INFORMATION
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Date of Inspection: 9111/00
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom
Number of bedrooms(design): 3 Number of bedrooms(actual):n/a
Total DESIGN flow: 330 gpd
Number of current residents:0
Garbage grinder(yes or no):NO
Laundry(separate system)(yes or no): NO If yes,separate inspection required .
Laundry system inspected(yes or no): NO
Seasonal use(yes or no): NO
Water meter readings,if available(last two year's usage): n/a gpd
Sump Pump(yes or no): NO
Last date of occupancy: n/a r
COMMERCIALIINDUSTRIAL
Type of establishment: n/a
Design flow: n/a gpd(Based on 15.203)'
Basis of design flow:n/a
Grease trap present:(yes or no): NO
Industrial Waste Holding Tank present:(yes or no): NO t
Non-sanitary waste discharged to the Title 5 system:(yes or no):NO
Water meter readings.if available: nla
Last date of occupancy:n/a '
OTHER: (Describe) -
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n/a
System pumped as part of inspection: (yes or no): NO
If yes,volume pumped n/a gallons
Reason for pumping: n/a t
TYPE OF SYSTEM f`,
X Septic tank/distribution box/soil absorption system
_ Single cesspool
_ Overflow cesspool -
_ Privy
_ Shared system(yes or no)(if yes.attach previous inspection records,if any)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:n/a `
APPROXIMATE AGE of all components,date installed(if known)and source of information:
`1981
Sewage odors detected when arrlving at the site:(yes or no): NO
_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
revised 9/2198 Paoe 6 of 11
PART C.
SYSTEM INFORMATION(continued)
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Date of Inspection: 9/11/00
BUILDING SEWER:X
(Locate on site plan)
F
Depth below grade: 30"
Material of construction: _ cast iron X 40 Pvc _ other(explain)
Distance from private water supply well or suction line: n/a
Diameter: n/a
Comments: (condition of joints,venting,evidence of leakage,etc.)
TOWN WATER
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 24"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_`other,
explain: nla
If tank is metal, list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: 1000G L 8'6"H 5'7"W 4'10""
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 32" t
Scum thickness: 1" 1 .
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: n/a
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc.)
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS.
GREASE TRAP: _
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:nla
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of
leakage,etc.)
nla
rs R
revised 9/2/98 Paoe 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Date of Inspection: 9/11/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons '4
Design flow: n/a gallons/day
Alarm present: NO
Alarm level: N/A Alarm in working order:NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
� 1
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert: nla .
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
n/a
PUMP CHAMBER: _
(locate on site plan) '
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.) ,
nla
revised 9/2/98 Paae 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Date of Inspection: 9/11/00
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location maybe approximated by non-intrusive methods)
If not located,explain:
nla
Type.
leaching pits,number:(1) 1000 GALLON PIT
leaching chambers,number: (n/a)n/a '
leaching galleries, number: (n/a)n/a ".
leaching trenches,number,length: (n/a)n/a
leaching fields,number,dimensions: (n/a)n/a
overflow cesspool,number: (n/a)n/a
Alternative system: n/a
Name of Technology: n/a
Comments: `
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE'PIT WAS EMPTY AT THE TIME OF THE
INSPECTION.RECOMMEND RAISING THE COVER.
V -
CESSPOOLS: _
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a,
Depth of solids layer: n/a
Depth of scum layer. n/a t
Dimensions of cesspool: n/a
Materials of construction: nla
Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: n/a Dimensions: n/a
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
revised 9/2198 Paoe 9 of 11
-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK GOGGINS TRUSTEE CIO DARBY MCQUILLAN
Date of Inspection: 9/11/00
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)
he
law -------------------
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revised 9/2198 Paae 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C '
SYSTEM INFORMATION(continued)
Property Address: 86 JASONS LANE OSTERVILLE, MA 02655 M121 P117
Name of Owner PATRICK GOGGINS TRUSTEE C/O DARBY MCQUILLAN
Date of Inspection: 9/11/00
NRCS Report name: n/a
Soil Type: n/a
Typical depth to groundwater: 'n/a *'
USGS Date website visited: n/a t .r
Observation Wells checked: NO ;
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 12 Feet+
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
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, i6s6llers
X Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
USGS MAPS AND CHARTS-12+FEET
n as
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revised 9/2/98 , Paoe 11 of 11
g
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No....4A., �. � Fm334......................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
1.G U/ ''�.................O F.... ..!1/`h.J U.1.1:'.............................................
Appliratiou for Bi-qpniial Works Tomitrurtinn atui#
Application is hereby made for a Permit to_Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address o Lot o.
i/ 1 ` ' Qwner Address
...........l 1'�4!.1 tt.l. .lG-.y' ..................................... ...............................
Installe Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms......3--------------------------------Expansion Attic ( ) Garbage Grinder ( )
��' No. of persons............................ Showers — Cafeteria
Other—Type of Building �+r,.............. p (� ( )
Other fi3tures ...--------•----•-••------------
W Design Flow..........9-.5...........................gallons per person.p%r//day. Total daily flow......... ---:k:P.....................g-allons.
WSeptic Tank—Liquid capacityf ..gallons Length__._...(_.._.. Width___..../ .-.. Diameter________________ Depth__.._ .....
x Disposal Trench—No..................... Width_........._....... Total Length.................... Total leaching area...... _____sq. ft.
Seepage Pit No-------I Diameter........_...... Depth below inlet...... .... Total leaching area_. .............sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) pp
`"' Percolation Test Results Performed b 1 .�► s �•hr1kJNCnm rrt � ------- Date--.��� ---___`---•-..
Y-•-
minutes per inch Depth of Test Pit.__J,Z.!..___.. A
,..a Test Pit No. 1.�_fi.� p p epth to ground water. ..."�.
Test Pit No. 2.._ 1A._minutes per inch Depth of Test Pit./// .._... Depth to ground water... ....._._
•---•---••-•-•-- ..........................................
••--••--•-•-•-••-•............••-_...r..
O Description of Soil....................................... i-r sal.
p
V ;� -- -- ---- --------•--
--- ------- ----- ----------- ---------------
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 TI'�ilLi 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of pliance has b issue by e board health.
Si ed. r ® v. �--��------
IWe
Application Approved V
..`...... .... ...Z... v
Date
Application Disap ov owing reasons---------------------------------------------•---------•--------....------------------------------•--......-----
---------------------••... •--••-..••--•-•--------------•---••-----•......••--------•--•-••-•--•-•-••-••--•----•-•----••--•••-•--•----••-----•-•----••----•---•-•---••-----------•-................
Date
Permito ..........•••--•-----•-••-••--------------------------- Issued-......................................................
Date
,w
:a
A
No._ Fps ... .........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
h
Alip irFatuan for Biipusal Workfi Tomitrn.rfinat amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: f
...` e........_ _ ......= 5.�:� ............................. �'_:.`rC'�',> .::- �' J- _�:.^. :.t :_•--------------------------------------
Location .
...._ ..
-Address. or�Lot.No.
y — I Z ��f/ ��✓.
�- ;`._.a.........-r.. ✓ -��-C T -•�r '7.:.� 1 .
owner Address-
W
F Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.......�................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building __3 cn ............. No. of persons............................ Showers (Z) — Cafeteria ( )
a Other fix
tures .
---------------------------- -----------------------•---------....................•--
W Design Flow..........`__`...........................gallons per person per day. Total daily flow.........__X'.. .....................
ix Septic Tank—Liquid'capac>ty�_�.'__�...gallons Length?"! .--... Width`)(Jr2... Diameter________________ Depth.L2
W Disposal Trench—No..................... Width__................. Total Length.................... Total leaching area......--___--_-.____sq. ft.
x
Seepage Pit No..._................. Diameter......4 ......... Depth below inlet.._..._.......... Total leaching area._.._- .....sq. ft.
Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by... }� '�. .... L. �Y _ r..
Test Pit i To. 1.124, Z-&minutes per inch Depth of Test Pit l. .r•� -• Date.......................................
i../-.............Lh
a '� •p p _ Z,_�. depth to ground water_/�^�:;.._�-✓�•����''��.
(i Test Pit No. 2... , ..minutes per inch Depth of Test Pit_V�i�--_-_. Depth to ground water._ � --%�---_-_---
W' -.-- ` Z� ----------------•••-•••••-••••--•-••----•----•••••••••• ------
•----
•----.-----
W - 0 ..•�O Description of So11----------------------- -------- -------------•.-.^----- -------••----•----------------------•---••--............................
--------------
------------- __ ----i"_ ..�-. ...._._...................._...._._......................------.....
............................. ...........- ....
'.../..
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 M provisions of ITI i�
p 5 of the State Sanitary Code— The undersigned furtl er agrees not"to place the system in
operation until a Certificate of�c�n pliance has�nn issu by he boar f health.
le
Application Approved ` f✓"� ---------------- ...9 ?Date
Application Disap d%f or�
,rov `the following reasons----------------------------------------•----------------------•----------------..._......--•---.................
r'
....-•--------------------=- ...-----•-----...........----.............•----•--------------•--•---------------...---------•------•-------------.......----------•-------------........._
Date
Pero ....................................................... Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
' ..........OF.... �G, -sr?..5�.:`�..�..........................................
................................Gam
Tatifiratr of TrrmpliFanrr
HIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
r' ") 1 / Installer
+.� _
... ........................�/1�i_,1..._•___................. ...____•__.....___•__...
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cod as escribed in the
application for Disposal Works Construction Permit No.. :>-. y't ,o.............. dated-- _�.. _..�y-_._______._._.__.._..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--•-•-••• .... .J.l7.V.----...._•-_----__ Inspector....................... ... ml....----..............-••---..............--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................................................................
w.•...
i rr �a1 nrk.5 Tnn#r inn rrmit
Permission is herebygranted r.! .4
to Construct (� ) orrRepair ( ) an Individual Sewage Disposal System
- ,�
at No.- ---- ----.----- f .. ......� = - =- --�
Street
as shown on the application for Disposal Works Construction Permit NaF.
_. __'Dated_j_12r .2c.................
l ...........................•-•-••-----. //..._.............
.................
Board of`Health
DATE........................................ .._...(/...---------••------• !/
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
A i
•_� - ., is .
0`
ZN OF AI�s,
v
119,
43
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-991,4 —
0o
P001 � . �� �xlo►Exal►+�
fbCOL
V 1 K
IAJ
M\ �AL�E �4 '- FLAY 102• N �p
TEST
q6
_
S-S
101.0
LaT /i3
gs
1 96,+ 26
EXISTING SPOT
GELIEVATION 0x 0 4"r .� CERTIFIED PLOT PLAN
EXISTING CONTOUR -- 0 -- —_ o'`' ABBE
FINISHED SPOT ELEVATION 1-0 T //3 ✓.q s-,E LA NE
FINISHED CONTOUR 0 ---,— PE " D57 '�`* I'` /`` ��
No.10:11 O
APPROVED BOARD OF HEALTH, r'A9�fs6�5TEa��� IN
S/ONAI .. S A JI A S to S L Jl,A ASS+
DATE AGENT SCALE, / "==30 ' DATEt
(EL DREDGE ENGINEERING Cat IN. ieANGo
CLIE,NT, __�_____ I CERTIFY THAT THE PROPOSED
EGISTERE REt319TE,REp JOB ,NO. TO 0f 9 BUILDING SHOWN ON THIS PLAN
CIVIL LAND' . GR.flY= ��„0 CONFORMS TO THE ZONING LAWS
%ENGI VE OF BARNSTALE, MASS.
712 MAIN STR mcm By,
H YA N N I (A
Sv MASS,. ,,` p,.
SHEET.,.!.OF � DATE ( REG. LAND SURVEYOR
E /F E/TNER "NE SFPT/C TANK OR
M//V. 1Y07 7
=ACN/NG P/T ARE MORE 1Z"SEL0w
/O I•T /►f/N r.RAOE� A 24'OlAM ETER CONCRETE COT%'E
4'i•vC P/PE SHALL BE BROUGHT TO GI�AOE. 6f+,V EXTRA'
CONCRETE N E`4 V Y CIA 7- /RO/Y C O{iER Sh'A L L 3,F U S E.0
E// k
LcL ,. /D 2 ,5'' M./N. P/TCN
CO HERS yB"PAZ,Q FT /F/N DR/VE 11/A y
CD/VCRETE
=of CUVER CLEAN .SA NO
dAGJCF/LL
2 LAYR 4•II'lmom PIPE / O O D G.4L. v o o rya E o v G1F ��8•-'��B
4,Al. FT. SEPTIC TA/VX D/ST. eb i • • . . . o e,�� WASHED STONE
BOX
e • •EFFECT/VC •
' . 3�a'- I �2•
e ► • • pEPTH • • ' • o WASNAF0 STONE
n/T C 4.P,,+-c/rj✓ • v. • . • • • • . • p •••, PAEG45T SEApAGE
INVff9r ELENAT/DNS / FTC x ---.f 470 ° ►_ ' • • • • ... . A e o P!7 OR EQU/V.
/NYERT AT 8u/LD/NG. /0 a,6 FT 7 Sr x 1,o ' 8- `Fr PlAM. •
/NLET> SuEPrIC .Ti4NK `j_ `j,7 FT, 4 � FT O/�4M. C SEE TAB[/LATJON}
OUTLET SEpT/C TA V O< 2 FT.
/INLET O/STR/6.11T/DN BOX 9`�• 3 FT - GROUND W,47,eR TABLE.
SE_CT/ON OF
ouTLfTo/STR/B�i-/oiv eo�r 9 g.2. Fr. SEAVAGE O15.=aS'A L SYST�/y
//vcET `99;� Fr. TAXJLATlON
LEA CHI/VG iP/T
s /:D D/HENS/ON 2,S FT.
DRS/G!d Cdq 7ER1A seAL E 6 FT'.
s D1. ex5lON $
N[/M®ER OF BEDROOMS 3 D/HENS/ON C—g_F T. M�^/'
0
GARBAGEo/5P05.41-c%Vir - SO/L LOG
TOTAL E3T/M.�47"ED FLO*V 3 0 GAL.1DAY.. DSO/L TEST 0! SOIL TEST#2 �4�L TEST
NUMBER QF 4-ACHING P/TS I FCEK l0 l,D
S/®E4ZACH/A/G PEi?P/7' t 8- ,s� RT ELgY. DATE OF 50,,,L
-� RESULTS WITNESSED BY JR E, Jet cogs/.
aoTTOM 404cN/Nri PER P/T $Q, FT. PERCOLAT/ON.IIATE�E/ Liss
TOTAL LEACH/NG AREf4 26 SQ. FT. '�/'s o/L PEN COLAT/ON RATE 2 7-P A-I/ Ml N.�INCH
RESERVEGB4G"NIN6AREA SQ. FT.
MED cIAl
SN OF M �N OF M -
,D4�`' AssgO so 'S L�4NE
AL ER
S y o MORSE
29874 No.10951 O S"t ��
e� ��°� A9�`��IsT�`�� ��� ELOREDG.E ENG/NEER/NG W,INC.
h'D$UR��'y�+ o�FrS/ONAI �a�\� CG U 7/2 MAIN ST. , HY.9NA//S,
NO GROUND yN,4TER . .NCOUNTL�'R.sr0 . C4/ENT:F7,TA n/Co DATE : 9
Q Gm UND J-VA TER AT EL_e V _
$O O 4 9 SHEET?-OF Z
TOWN OF BARNSTABLE V
LOCATION SEWAGE #
~VII;LAGE v ASSESSOR'S MAP & LOV� to Q—
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER C
PERMTTDATE: 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 leaching facility) Feet
Furnished by
B
d . �
C a�
0-6
L O-,U T ION SEW A G E PER ' MO•
VIL-LACE
, IMSTA Cl tRS MAM ®®& �," NESS
r
. BUILDER OR OWOE6t .. _.
DATE PERMIT ISSUED �� �/ �
DATE COMPLIANCE ISSUED t
_ r
Z
3Z
14 3�
33
�z
z�
• _ f. � Ali
�vo Y..`:�. ....... Fps-3 0.......,_'....
THE COMMONWEALTH OF MASSACHUSETTS
Appliration for Uiipniial Workfi Tnnitrurtiun Prrutit
Application is hereby ma fo Permit to Construct (K or Repair ( ) an Individual Sewage Disposal
S stein at: '
....... . ....._._ -------------
• ocation-Ad - or Lot - ..Yk.
Owner Q Addre
w • - .....
•..... ........ .. cr ..
'• •----•••••••••••••---•-••••••••••••.._�......__••-•••-
Install Address
U Type of Building 0) Size Lot._7 !�.�?:� ...Sq. feet
Dwelling—No. of Bedrooms_____________ .........................Expansion Attic Garbage Grinder ( )
Other—T e of Building ............................ No. of persons____________________________ Showers — Cafeteria
Q' Othetares
-------------------•-••---------------••-•-------•._....---•--•-------••• ----------------------------------
-
w Design Flow....... __________________________________gallons per person per day. Total daily flow------ .__........................gallons.
WSeptic Tank—Liquid capacity/_06...gallons Length--------------_ Width---------------- Diameter................ Depth................
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area_.--._.________..___sq. ft.
Seepage Pit No...../------------ Diameter.......0......... Depth below inl t___________________ Total leaching area_Z4�'__...sq. ft.
Z Other Distribution box ( ) Dosing tank )
Percolation Test Result Performed by.... __._ _ t!4�/__ ....... Date.... ...................
Test Pit No. 1......_____ ____minutes per inch Depth of Test Pit._0„1=_ Depth to ground water.......____.............
Test Pit No. 2.._L'........minutes per inch Depth of Test Pit_a, ! Depth to round water .._____________
P P ��--•---------- P g
= t <= ---- ----------------•-••-•-----------
Description of Soil---6 'A-,__:Y- . 0 - - �I --- •
x
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'T1j.L7, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b en i sued by th ,b o alth. ?;
Si ed •�= �. ...__
-
D
Application Appred -=- ••. yy
Date
Application Disar the following reasons---------------------------------------------------------------------•.•.•.----------...........................
• ••.•••••••••••••••-•-•-•-•-•-•••-•••••••-••-•••-•-•---••••••-••••••••••--••-••--••-•••--••--••••-_..
Date
iPermit No......................................................... Issued.......................................................
Date
...... � Fps.Vie....................
•-�-•-•----•-- -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HE'A H
tip
..----.' ^....�-'.............OF.......................................---
Appliratiou for Uhipoiia1 Work i Toutitrurtiou Prrmit
Application is hereby made for a Permit to Construct (d or Repair ( ) an Individual Sewage Disposal
System
at: .. .................... .IAI .
1, ocation-Add --....... :...--------•-• -=-F'� �Sr ..� e:�,..ri..:or•Lot N .!:7.fi � ..
6 - Owner Addre
W ---e�--�.l� ..._ .......................................... ------------------------.
Installer Address
U vP g l ...Sq. feet
Type of Building Size Lot..:=.._-�..�. -
_, Dwelling—No. of Bedrooms._...........________________________Expansion Attic ( - ) Garbage Grinder ( )
Other—Type of Building .y........................ No. of persons............................ Showers ( ) — Cafeteria ( )
P4 Other. tures --------------- --------------- - -
.14
W Design Flow.......___I..1............................gallons per person per day. Total daily flow....... _; .....gallons.
WSeptic Tank—Liquid capacity✓ 0...gallons Length-------_------- Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----- ------------ Diameter_.____ /.... Depth below inlet..................... Total leaching area... :fb!......sq. ft.
Other Distribution box ( ) Dosing t k ) r,
j�z Percolation Test Results __ Performed b ..!---�!!�,f. -� .- ?. .__........ Date___-�__ _f_..........
Y ,:O-I
0a Test Pit No. 1____�..`:_..minutes per inch ' Depth of Test Pit__/:'.............. Depth to ground water- r77=_---_-_-__.
(i, Test Pit No. 2___ .. "..minutes per inch Depth of Test Pitj! :..f.......... Depth to ground water. vn........_...
j =r --- ----------- = F......................................................................
D Description of Soil _ = = %'w" '�'�` ^r new-" }f-.'" ; Z "` ° '`
V ...-------•--•-•--•----------•-•••-••-•----•-------•••••----•-----•---••---•------------------------------------------••-----------------------•-••-•-•--•-----••----•-----------••-•---------•--•------
W ---------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------•-------------------•---
VNature 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 T-T p of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been.i sued by the o ealth.-boa4 s
•-- . _ � �
d /} f
Application Approved Y9 / '�
Date
Application Disap ro r the following reasons---------------------------------------------------------------------------------•----------------._..........--
....................................................... ----------------•-----•-----------------•--•......-••----•-•----•••----•--•--•--•----•--------•----•••-•--------------•••---------•--------------
Date
PermitNo......................................................... Issued......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
r�
�... i1...........0F.. .' ,1: .1 ...............................
C9rdifira tr of Toutpltatta
THIS IS TO CERTIRY, Th the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by---------
y � ,,,/ Installer ,
at_.._._ - ._ : .......l` r................... i'' A �" �.............................................
has been installed in acconce with the provisions of T�9 LE j of The State Sanitary Cod as cribed in the
application for Disposal Works Construction Permit No _/___'".� /................ da.ted__f s°. .._�� ....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE N RIDE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
v
DATE......AP..'a........ .. Inspect _. .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ,OF HEALTH
......: !;..;-Z;.'1•'!b::2..::...........OF..I,.��.,..�C .:".' :-".?"°' .f'-'"°f�.� .•,y ............---... �,-
No.��'S6�........ FEE....1 ...........
Dispoll tl Works To, rrmit �
Permission is hereby granted---- > �- = !T :........
to Construct or Repair ( )ya Individual Ae�,age Dispos ystem
o.
,
at N �
~ eet ik�,as shown on t e application for Disposal Works Constru io P r it N /-y10�_____ Dated.__ ._ �...............
-- .. `•-- • ...................................... .......................................
Board of Health
DATE..............4............. ... ....................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
a
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uz
LEGEND <� ► 7Iry
EXISTING SPOT ELEVATION tl0 �NOF, CERTIFIED PLOT PLAN
EXISTING CONTOUR --- 0 y. 1.Or 2. J,4_5_0/ ,s Z,.Af lc
FINISHED SPOT ELEVATION �, OST ✓i�
FINISHED CONTOUR 0
h .b IN
APPROVED BOARD . OF HEALT Q1$TOt ` AA9A81A.0 ' jib _N vs Is
�
N� SURV �I 2Evr� .t� is 9
DATE AGENT SCALES / = U DATES 3/ —1
LDRED6E ENGINEERING CQ /N T'JN�-
CLIENT I CERTIFY THAT THE PROPOSED .
Afte REGISTE-REO JOB NO. gb� BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TQ THE ZONING LAWS '
DR-BY' A d. M• Ass..
ENGINEER RVEY --------- OF.-, BARN STk E ,
712 MAIN ST.
CH. 8Y q q g
HYANNIS, MASS.' Z DATE. - EG. LAND SURVEYOR
$HEFT.;._.;, AF
#`v 1'd AT ~IV. _ /VOTE 1-owZ/17-M Ar Ti a SEPTIC TAm,#< OR `•.
04- .40ACi,l/NG PIT ARE MORE` 7-,"A/V /2"e!•LOJeV
�►.:M/�/• ---" - aRA0AF�,A 24'O/AMETER COiyCA.ETL= COvt��P 1
Pie-
SJVi9LL B.F ®R006N7 TO GRA pie �i4N EXTRA
CONC/e '� t/E.4vy CA ST/Ro Y Go v�,r Sh+AL L BE US F!�A'f/N. P/TC/I
' EL: tOCp.O GDYER.S %b•PZR40=r. /FIN OR/VEy1/Ay
i
a vE CO vER CL EAN SANG
' - BAC.Ae
.s tAST 2*1-AYER
IKON P/PE I O�O • • o .40 . • G1F �'-'�/6'
-- 3f pon PT. SEPTIC TA/V/�C D/ST. •'• f • • • • • • • IN, • ALWitSHE;D 57t?NE
BOX i to
•f $• . • •• • ••• •`
314o-
�_ • i f f • • • f • • WA50,FP STONE
AD
t8 .5 x •5; = 4-t i 6,P,D. ss • f • • • • •• f ;� �� PRECAST SEjaejoE
IAli�e `EL�✓AT/O/Ys . -rg 6.�, t s ►.• e f • • s •.•• • is a P/T OR tVU/V.
74.E "x:1:o
/N3/ER"T .�T:BI!!tD/NG. L . o FT RT �.�1:DYA/�T.
E L G:-7 (a
9 �.P.J3.
-;- /�tt� SiEPT/oC` TANK t o3.4 Fr. ��oAcrN �- : +�0 FT. oi.4M. - ;C(s�e rr�/uT,Oav�
;: TZE`T 3EPT/C TANK ro3:(a .F. f-
"''lA►LJET DIST/X/6!/T/ON 80X 1.0 3-•� FT .SECT/ON OF: GROuNO /t�4TER T�tdLg
o rDt1T/tietl7 ioN BOX t o3.2 FT .SEWAGE ®/SPATA L SK ST&^I
IAraCET LEACN/A!G I'?/T to3.o FT 7ilBllL./9TI0AI
LFii4Cd"//V!s► P/T'
DIMENSION A 'Z JWT-
�ES/6/eI CR/7,644 seALE /4 _ / -o
. 0/rfAW-510N D C-0 FT.'
v4vAf4wR Of ®tEO1900M.5
2, D/MLWS/o/Y C i 3 F 7.
GARBAGE.D/SPO.SAL UNIT O SOIL LOG
rD7Al- FLosv 22o 49.41/AA4Y SOIL TEST A/ SOIL 72EcS77402
i1lUMQER C>� L,E�ACN/A!T P/TAT ( t. �"L�LEY��-7 TEST - 3 . i�I9 i
S f"LCACHI/VG PFR P/T 1-W
®oTTOML4VICNIN&F R6R P/T �� ` RES�/1TS h//TN�SSED dY_J �E��F�
S4 �T -.L sue► AlIM /lAT3f#/ L,..Lf /►!/I1�//NCH
TOrA4 I.AC'H//VG •4REA ESQ /rT. �.. flWMCOIAT/ON RATE AZ � M/N.�/NCN
.¢ESERYE L&4CN//Y6 A,QEA Sop
as s
p � r
ZA0i3mT'... O wAT� eE1!ISED O� . t j
-+ F
EWI
ELDREDGE EN&1MWR1N* CO/IVC.
712 RAIN sr.
I E HY4NNl3y MASS.Vi � EU
Q GIoCOUNa W.47 AL.Q /IT ELEI/.
J046 NO. SHEET OF �.-