HomeMy WebLinkAbout0160 AUDREYS LANE - Health L
udreys L
ane
Mills F/R
7 088
r
COMMONWEALTH OF MASSACHUSET�T'S'��D ''vSPECT�Q�
l` EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
RECEIVED
k,°QED l0
JUL 1 b Z003
TITLE 5 TOWN OF
HEALTH DEPT.
OFFICIAL INSPECTION YORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 160 Audrevs Lane
Marston Mills. MA 02648
Owner's Name: John&Bridget Kourafas
Owner's Address: Same
Date of Inspection: June 17, 2003
Name of Inspector:(Please Print) James M. Ford
Company Name: James M. Ford Map:027
Mailing Address: P.O.Box 49 Parcel: 088
Osterville,MA 02655-0049 Lot: 76
Telephone Number: (508)862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Nft Further Evaluation by the Local Approving Authority
✓ F 'Is
Inspector's Signature: Date: June 21, 2003
The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.'If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
f
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 160 Audrevs Lane
Marston Mills. MA
Owner: John&Bridget Kourafas "
Date of Inspection: June 17, 2003
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: :60 Audreys Lane
Marston Mills, MA
Owner: ,'ohn&Bridget Kourafas
Date of Inspection: .tune 17, 2003
D. System Failure Criteria applicable to all systems:
You.must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or 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 '/s day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion.of 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 1 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. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd-
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
_ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection-Area-IWPA)or a mapped
Zone II of a public water supply well
If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 160 Audreys Lane
Marstons Mills, MA
Owner: John&Bridget Kourafas
Date of Inspection: June 17, 2003
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection ?
✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ Was the site inspected for signs of break out?
✓ Were all system components,excluding the SAS,located on site?
✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ _ Existing information. For example,a plan at the Board of Health.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 160 Audreys Lane
Marston Mills, MA
Owner: John&Bridget Kourafas
Date of Inspection: June 17, 2003
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): n/a Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 5
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage 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 2 years usage(gpd)): 2001 -56,000 Qals.;2002- 121,000 Qals.
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIALIMUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): _____gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Never pumped-per owner
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: _gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Jun. 20186-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 160 Audreys Lane
Afarstons Mills. MA
Owner: John&Bridget Kourafas
Date of Inspection: June 17, 2003
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 20"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 Qal.
Sludge depth: --
Distance from top of sludge to bottom of outlet tee or baffle: --
Scum thickness: --
Distance from top of sum to top of outlet tee or baffle: —
Distance from bottom of scum to bottom of outlet tee or baffle: --
How were dimensions determined:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Liquid in the tank was above the outlet tee and up to the cover.
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 160 Audrevs Lane
Marston Mills..MA
Owner: John&Bridget Kourafas
Date of Inspection: June 17, 2003
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Above
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
Liquid was above the D-box. The D-box was not dug up.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
I
Page 9 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 160 Audreys Lane
Marstons Mills, MA
Owner: John&Bridget Kourafas
Date of Inspection: June 17, 2003
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 1 -4'x 6'-600 gal.
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
The liquid was up to the top of the leach pit and up into the riser. Liquid was backing up into the tank. The pit was in failure.
The bottom to grade was 9'. The cover was 1'below grade.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid.to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 160 Audreys Lane
Marston Mills. MA
Owner: John&BridQet Kourafas
Date of Inspection: June 17, 2003
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
13AU1 a
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a
A
15 �g
3r-7 (oa
y q0 gy y
10
Page 11 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 150 Audreys Lane
Marstons Mills, MA
Owner: John&Bridget Kourafas
Date of Inspection: June 17, 2003
,SITE EXAM
Slope
:Surface water
Check cellar
Shallow wells
:Estimated depth to ground water 50 +1- feet
Please indicate(check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked, date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours maps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately
50'+/-to ground water at this site.
This report has been prepared and the system inspected and failed of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report.
11
TOWN OF BARNSTABLE
LOCATION Llani^ SEWAGE # _2do 3 — 5'G 7
`JMLAGE MIWSms ff l IIS ASSESSOR'S MAP & LOT27^
INSTALLER'S NAME&PHONE NO. SdSs-y2D-9'73 s�o� D� c��yv S
SEPTIC TANK CAPACITY /DOa /
LEACHING FACILITY: (type) (size) 41. G
NO. OF BEDROOMS
BUILDER OR OWNER ✓'�Lie� k's�vr ��
.PERMTTDATE: COMPLIANCE DATE: 7- �'O
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 leachi g faci 'ty) Feet
Furnished by
� �� �'
a
�q I n�=c1C��� j
. � ' �
(1�'
° � �tr►�
No. {� r p Fee
THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: �----
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pprication for Digpozar *pgtem Con!truction Permit
Application for a Permit to Construct( epair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. /(oQ �� ��y s' r/7/� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
�7- 8 0 �l � .� ���� �, �W, it
Installer's Name,Address,and Tel.No.S"p$_C/20—g738 Designer's Name,Add s and Tel.No.S-69-,fo-272 3
J05-C"0Li �� a�a p"5 �t?i'
AOXW 4 6Li0P r0,0s �l� s >5 sv 157- �r I J'�iav3
Type of Building:
Dwelling No.of Bedrooms d Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Natnz of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Poard oj Health.
Signed Date
Application Approved by _ lei Date �- ?
Application Disapproved for th ollowing reasons
Permit No. :2 na a p-�f 3 2 Date Issued 3—0_'
/! No. '� n Fee
THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION v TOWN OF BARNSTABLE, MASSACHUSETTS
Z1PP1icationjo-r414oga1 *pgtem construction Permit
Application for a Permit to Construct( �Reparr( )Upgrade( )Abandon( I O Complete System ❑Individual Components
Location Address or Lot No. 160 1#adl^1:t/ Owner's Name,Address and TeL No. �
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No.�d� _4/20. 77 Designer's Name,Addrs d Tel.No. J-09-
Jos��y U �r s i ij mot? /,�hsi�
R ~-e 772 t"40v5 rCl,,'S ` ,11 /6- ,,Lvd/f T" b1r I !=' jxw^e i o!e r
Type of Building: -
Dwelling No.of Bedrooms- Lot Size sq.ft. Garbage Grinder( )
Other .•7 "'..Type of Building No.of Persons Showers( ) Cafeteria(
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs orAlteration/s(Answer when applicable) f. r�/.f '� .�IJO 6,W1 Zire4,,-h,sW
IOF Date last inspected:-
Agreement:
' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certify-
-- cate of Compliance has been issued by this oard of Health.
Signed . _ // l..P"a �i/.r�.�lfi�-ti' Date.
Application Approved by v ,L� w jS- Date - L 03
Application Disapproved for th following reasons
Permit No. 9 t),Q 3 3 2 Date Issued
---------- ----------------------------
THE COMMONWEALTH OF MASSACHUSETTS
' BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(�Repaired( )Upgraded( )
Abandoned( )by .� r. 2/1 s � ..-ii s
at �!3 �r U ru s ,'/ has been constructed in accordance
with the provisions of Title 5 and the for Dispo al System Construction Permit N,o. QUO -L/3,2 _dated �-
Installer ��n c��v—/—� ��as �^r�5 Designer /� L `lr. .�r=r►11�/=5 lri�rllrT�i
The issuance of this permit shall not be construed as a guarantee that the s ste a• nc 'ofi d-
in
g Y �
Date 9�-.�- 03 Inspector
---------------------------------------
No. a U d 3— L/ Fee ."tea i
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION . BARNSTABLE,, MASSACHUSETTS
migw6ar bpztem (Construction permit
Permission is hereby granted to Construct( 4)4eparr )Upgrade( )Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of s 5, 7�
Date: g- O Approved by hn� _S.
TOWN OF BARNSTABLE
LOCATION /GD �6/ �>3��ii Ls���% SEWAGE # 2d2 3
VILLAGE HAwlT+mS ASSESSOR'S MAP & LOT27^
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY AM l/
LEACHING FACILITY: (type) 3^• DfJ 614fll_L'�I16-A-W(size) -3 � f X .l°1• G
NO. OF BEDROOMS :L
BUILDER OR OWNER ✓_t9Lis� ���s��' �-�
PERMITDATE: ^0 3 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 faci •ty) Feet
Furnished by
i
Q
✓ LK
I
1SSES9 F1AP 'N PARCEL
L , ! EriP f
'• V-iLL �gUC
I M S T A L 's NAME ADDRESS
60
UiLDER OR ow" E
LIY16,ves
DATE PERMI. T
'SS?U�t D � ze
D ATE U 0M i' L i A PE G E I S UE U�
Nc.K
Bt
r
F ,
L-0 C A T ION SEWAGE PERMIT NO.
V I L L A G E ASSESSORS MAP NO:
PARCEL NQ..,
1NSTA LLER'S NAME i ADDRESS
s U 1 L D E R OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
0
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THE COMMONWEALTH OF MASSACHUSETTSV
BOARD OF E TH
�1 .. ...................OF.../ ......... .G.......
Appliration for Di ipaiial Ularkui Tanintrurtion 1hrmit
Application is hereby made fora Permit to Construct ( (-4 Repair ( ) an Individual Sewage Disposal
St
. ..........._. .P
..................•--.._........... ..............................................
0.
.. .. •Address................................../�C,..�t� / ... No ............
ow
Address
. ......----•--------••-------•----.... ............................................... ....................---..........---..........
Installer Address
of Building Size Lot.; .l�°0 .:......Sq. feet
Dwelling— No. of Bedrooms../.....13...............................Expansion Attic (//4 Garbage Grinder V11
Other—Type of Building ...!?�E'i'�..:............ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures .....................:.................................................................................................................................
Design Flow...................... ....................gallons per person per day. Total daily flow.....s13.�.:......................gallons.
Scptic Tank—Liquid capacity/ .gallons Length.-Y..K..... Width..Yf:..�'`�... Diameter................ Depth....>....
Disposal Trench--No..................... Width.....I.............. Total Length.................... Total leaching.area....................sq. ft.
Seepage Pit No....P!?��..... Diameter-.:[:?......:. Depth below iiflet....`�........... Total leaching area.'L�L.;�
.... ....sq. ft.
Other Distribution box ( v Dosin t c.( ��
Percolation Test Results?/Performed ............................................................... Date..3.��....................
Test Pit No. 1. ..........minutes p ' Depth of Test Pit.................... Depth to ground water........................
Test Pit. No: 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....
Description of Soil..............'j`�� ................
...-...............................................................
........ .I.........-• -•- ..... ....................................................
...............................................
. ... ... . .. .
1.....---- ...�.. ... .�..... .� _... .......................:..........................
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 LITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Comp'a has bee ie board of health
• �/l Dat
��...�.......APPlication Approved BY ..... ............_.._....... ........ !:.._ ................................
Date
Application Disapproved for the following reasons:...................................................................................... ............
................................................................... ..................:........................_.......__...............................••••............................................
Date
6--.?_
PermitNo.. ................... ..--...... Issued..................:..................................... .
Date
Al V........................ . 1L
1 THE COMMONWEALTH OF MASSACHUSETTS '
BOARD OF E TH
. ....................OF.. ........................ ..................................................
Applirtttiott for Dlri Tmml Work i Taitintrurfintt 11mitit
_ � Application is hereby made for a Permit to Construct ( �r Repair ( ) an Individual Sewage Disposal
Sys. _............... ................................................ ..
.....L..at'
... .... ..: ..-•••-•.....................................
.. ..... . . .. rZ10 X�4
o
64- 1 Address
of Building Size Lot.Ai?.fr-. ........Sq. feet
Dwelling—No. of Bedrooms.. .... ............ Expansion Attic (��j Garbage Grinder ( j
—Type g -.•.. No. of persons............................ Showers
Other—T e of Building .:........... ( ) — Cafeteria ( )
Otherfixtures .....................::.......................................................................................:..•--.........._......:................
Design Flow..................,6Al .................gallons per person per day. Total daily flow....s32.j2..........................gallons.
Septic Tank—Liquid capacity/M. ..gallons Length.K.1..... Width..Y . Diameter......... ...... Depth..-'�/........
Disposal Trench—No..................... Width....,............... Total Length.................... Total leaching.area....................sq. ft.
Seepage Pit No....Q;.wI ..... Diameter...lt?............ Depth below inle't.....`. ........... Total leaching area.a .:�.....sq. ft.
Other Distribution box ( X Dosin t c.'(X7 /
O(v
k
Percolation Test Results Performed . .. ;!-�:........................................................ Date. ... ....................
Test Pit No. L K..�ninutes pe i S epth of Test Pit.................... Depth to ground water........................
Test Pit No: 2................minutes per inch Depth of Test Pit.................... Depth to ground water....:...................
............................................................•••.................................................................-•-..........................
Description of Soil.....................
....................................................................•...................................................................................................................................
..........................................................................••---•-•-•..............................................................................................
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 TITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compli has beenj&sjted0 board of health.
ied............. ..........----•--.....�,1� ................... ../.. •-••-•__........
_. Date
Application Approved By.......... ................................................ ---.._...
Application Disapproved for the following reasons:.............................................................................,0F..............................
............................................................._.......................................................................•-•.....•••................................................._
Date
Permit No.......... �. .�'Z ......... Issued..................:.......:.......... ......:.........
t Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
:< 1. .......................OF......64�j
......................................
Trrtifirtttr laf Tlim Slittnrr
T f, S TO CE IFY, That �e Individual Sewage Disposal System constructed or Repaired
by....... — -• t ..........: � t �ageJc .... ( ..>............... .......(._..>.
nst
has b n in a11Ad in accordance with hrovions of IT of The State Sanitary Code a )epcdbed in the
application for Disposal Works Construction Permit No..... dated.................. ./. .............
<�
THE ISSUANCE OF THIS CERTIFICATE SHALL-NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIO _ SATISFAC ORY.
DATE....... ....... ..............�p/................................. d�. Inspector....... ••..... .....................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF �HEAL H
7.NTo�.% . f ,r�........................OF.... (,G�.?t�2 -{�-• ................................._............
t �... FEE.. 5d=_ . .47)...
t� tol ttIU rft, Il11,ntrltrtiva rnmit
Permission is reby grant :.. ...................................
to Constr`uc or Repa . ( an divi 1 Sewage Disposal System
at No.. ...... 71n.. t
Street
as shown on the application for Dis osal Works Construction Permit — Date .....
.................. . ... .
DATE_ •
�
III
FORM 1255 A. M. SULKIi• INC.. BOSTON
0. . .. .. . .
TOP OF FOUNDATION
CONCRETE COVER
.,• CONCRETE COVERS
4..CAST IRON 12� a VXo
OR SCHEDULE 40 12"MAX.
P.V.C. PIPE 4 SCHEDULE 40 P.V.C.(ONLY) �'
PITCH 1/4"PER.FT PIPE- MIN. LEACH
PITCH 1/4"PER.FT. PIT
°• ° PRECAST
o' INVERT i0' iy . t-w -� LEACHING
.....
SEPTIC TANK INVERT INVERT p . e•; PIT OR
e • EL 76X��. ., DI ST. EL:ZJ�X.?3 EQUIV..a INVERT BOX ;i'
. ...... GAL. INVERT
•`� EUJX�J. INVERT ww :!: :/4"TOIIAEL�.yeft �� WASHEDw STONE. ,/'0 ZS �' p
• /® DIA. HII PROR LE OF do GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
�- 57 5'/
S 1 L LOG WITNESSED BY :
DATE . .�� �..... TIME.. .� .� (!�E��! . . A. BO RD OF HEALTH
TEST HOLE I TEST HOLE 2
u ENGINEER
. . . . . . . . . . . DESIGN . . .
DATA :
o-` T An _ NUMBER OF BEDROOMS
i S TOTAL ESTIMATED FLOW ..33,Q, , , , , GALLONS/DAY
v,, BOTTOM LEACHING AREA . . . SO.FT. /PIT
SIDE LEACHING AREA . . ./�s� , , SO.FT./ PIT
GARBAGE DISPOSAL (50% AREA INCREASE)
TOTAL LEACHING AREA SQ.FT
PERCOLATION RATE �r`s 5„ a. . . . . . MIN/INCH
LEACHING AREA PER PERCOLATION RATE .. SQ.FT.
AA. .WATER ENCOUNTERED
NUMBER OF LEACHING P!TS . ,OeV&-
z
APPROVED . .. . . . . . . . . . . BOARD OF HEALTH Ttk 3'/�: ^S� ?Y�Sr•�'�• �5�.� ��/� QoTidn
f '
DATE . . . . . . . . . . . . . . . . . . . . . . . . . T TAB 3 92 GPO
AGENT OR INSPECTOR - u"
OF Af 4 aa's
0
4e?
A OBT 76-. . . . . . `
.04
)L)e �r� 4rkv.-t!a: . . . . . . off JA
o, NA
,r.
PETITIONER
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1
1
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183 LONGVIEW ;DRIVE
/60 �l uD/d Sys LwvE �y^ f S
C. PALTSIOS . E - SON CENTERVILLE, MA. 02632 SCREE w � APPROVED DRAWN BY:/�
DATE: REVISED
771-1410`
j E LICENSE # 006653 DRAWING NUMBER
.I . BUILDING . & REMOD �..LING
N£W ENGLAND REPROGRAPHICS&SUPPLYCO. _ q
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a
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133 LONGVIEW DRIVE
AN 7�
CENTERVILLE, MA. 02632 SCALE: r, ">�'�lj.,'� APPROVED OV: DRAWN BV:/®f2rL�,fjriS
PALTSIOS E S021"lk vDATE: ,� REVISED
771-1410
BUI-LDI G & '. , .REM0D'Ll:NG
LICENSE �f, O®66V C 3 DRAWING NUMBER
"
NEW ENGLAND REPROGRAPHICS&SUPPL Y CO. -
'_.TOP OF
FD UNDATION
EL
Q TA N.T A R D NOTE
. . GROUND SURFACE E �
. GROUND SURFACE E
MIN
. 1 .THIS PLAN IS FOR THE WSTALLATION OF A SEPTIC SYSTE
. . OUTLET PIP E LEVEL
• 2 ALL INSTALLATION PROCEDURES A1411 MATERIALS SHALL ONF ' F' StAr,E
D VENT REQUIRED 'r
C ORM TO 310 CMR 15.000, Trl FNYll>'ONMENTAL CODE,
FIRST TWO FEET �j N
• � TOP EL TITLE 5, AND THE TOWN OF __,6 _ .,�,_. SUBSURFACE DISPOSAL REGULATIONS.
LIQUID. . QUID I£vFL.
3 NO DETERMINATION HAS BEEN MAD AS TO COMPLIANCE' OF A VAIL AB PROPERTY INFORMATION WITH RECORDED DEEDS
MIN 2 LAYER DOUBLE WASHED � £+ LE O D
D-BOX 1/B'- 1/2' STONE
10 OR ZONING REGULATIONS.
INVERT EL r
14
z, q , �
� 1 .. ..._. _.,.. ,..: .. :.._ _... 4 TOWN: WATER SERVICES THIS PROPERTY.
_ -* EFFECTIVE )
GAS BAFFLE AT OUTLET S.c�
_ INVERT EL -7 SIDEWALL 5) THERE ARE 1V0 KNOWN PRIVATE WELLS ON THIS PROPERTY OR WITHIN 100 OF THE PROPOSED SOIL ABSORPTION SYSTEM.
. . . . . SMNE
WVERT EL
\L3/4
-A CO S OF Y TEM COM NENTS HALL BE B OUGHTINVERT EL 6) LL VER S S PO S R TO WITHIN 12 OF FINISHED GRADE, WITH 0_VE COVER OF THE
e. . .D - Boa : �{�- Z 1/ ' D UBL
1 2 � E
„ INVERT EL l _ ASHED STONE 7 ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY
N 6 +STONE BASE ( ceI) Cv►a C f�L Gt'{A 9`r+ jr J INVERT EL
U
C ,
( w 5 +I C- � � _ UPON OR ABOVE' THE COMPONENT ACCESS LOCATIONS, WHICH WOULD INTERFERE A7TH THE PERFORMANCE, ACCESS, INSPECTION
10o d) Gal Septic Tank
P BOTTOM EL
PUMPING OR REPAIR.
(Typical) ,
8 NO DRIVEWAY :PARKING OR TURNING AREA OR OTHER IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION.
—� r
BOTTOM r BEEN P O OF-TEST HOLE SYSTEM, EXCEPT WHEN VENTING HAS R VIDEO. ..
r R SING CHAMBERS N S AC N
fi.:
9) SEPTIC TANKS, GREASE TRAPS, DO B S AND DI TRIBUTION BOXHS SHALL BE PLACED O A 6 STUNE BASE
I, �,.
: TO ENSURE ,STABILITY.AND PREVENT SETTLING.
1 OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENGTH.
. 0)
11 ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H 10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10
Assessors Ma
OF DRIVEWA YE OR PARKING OR TURNING AREAS IN WHICH CASE H 20 COMPONENTS SHALL BE USED.
P
182 Audre Lane
3's 12 ALL BUILDING SEWER LINES SHALL 1114 VE AN INNER'DIAMETER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC.
Parcel Assessors Map "
27
P Exist 13 THE .DEPTH OF THE TOP OF ALL S3�TEM COMPONENTS SHALL NOT EXCEED 36 UNLESS VENTING HAS. BEEN PROVIDED.
94 : � 27 Well
. No well located
14 IN THE AREAS OF EXCAVATION EXLSTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS
Parcel ) ,
0 m thin 15 _ 89
I 15 IF SOILS ARE ENCOUNTERED DURING THE EXCAVATION OF THE SOIL ABSORPTION SYSTEM THAT DIFFER NOTABLY FROM.
5 38 581? r
THE DEEP OBSERVATION HOLE LOG, ..CONTACT THE ENGINEER BEFORE PROCEEDING.
16 CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES.
- 160.45
J ,
I I
SED LEACHING FACILITY
_ - PROPOSED .� -
-
deep ti 114
Three 4. 6 X � 5 X ,24_ d I I _
P
bers or slmllar
Z
concrete dram / � d
( i
DESIGN DATA
stone
, I -
wl th 4
t — 3. S x 12 �
L
47 Russels Pa h Total Area 3 � DEEP OBSERVATION
I
Assessors M o < I I Number of Bedrooms. `1
P � HOLE LOG
27
� ,
t� O Test Hole 1
t 1 �O� Gal Garbage Grinder. N�
Parcel. . � �cl o� EX1S , p I 1 g
h q
93 I 1..Test Pit# Septic Tank � �
s n Design Flow: � 0
l' r, g e� Soil son o I
I I gg
Ca tl on ., �n it Hodson Tezture Color
_ p I 110 Gal/BR/Dayg Number of BR
_ (USDA) (Munaell)
� rov2
No well located 0 -`-E
Septic Tank.. ! .. 1$"1 ,oy,as J
P
within 150
_
a _ C�sS•n
Minimum Design Flow x 200%
r O o V
co 4 a 2
� sib �. 5Y7
ti 4
I ' l 3 Audre Lane
Leaching Area.
o /'
b
16 6 •
: \
m I I Assessors. Ma
P
w ,
1, oo � Side all.
\ � �
12.6 � I : [ _
� I 'v , 27 r z
p
t
. . 3 3
Parcel
Parc ''� 4. Sldewalls x Ft g Ft + � r
f
-- ) Dee Obs Hole Date.
ro 17 E c o r•J
1 Soil Evaluator.
.. h _ 83 r o S
B Z
gL
4
t
t as .t\2 tLj
Wi ae ed_ Endwa s x Ft x F
V
ll
—, Pero Rate..
� 4. It
3oA SurveyDescription: CARYRF2
0
r Bottom:
f.�
�1 S�t � Geo
logic c Mnterlal OUTi/ASH
. _ _ Exist g1
_ _
. .. . � h to Standing Meter. NA
. — 3 � Z r Dept dins
- r l
7J, d
----F't x ---F't
EL v _ We11 )
'. I De th to Weeping Maier. NA
- I ST C P P 8
_ .••. ..•• , .- � „ Depth to Yottlins(Color). NA
f - p
I
150 . � �-- p Nl Lon Term Acce tance Rate LIAR . 0. 74
Est Seasonal High OW. NA
0 — _ _ _ _
pr
_ _ USG3 Observation W . NA
. to weld
- Ra dl us 1
_ Leaching' Area Design Capacity. Date of •
. . .. : g g P Y' Da iaat Measurement NA
. .. .. .. _D BOX
`I t1
f `I I f F Comments
Sidewall Area + Bottom Area g LTAR
ro im I I I )
I L
_ r ;
o I f
ed
No .well loca t sue, Aa m 3 :
"- °t4.10 - a eow e.
within 150
O
rnmo..d ..vutrM
qq,
J
151 Audre Lane
i
•ys •
a►._
N 4315 35 W 160.DO
Assessors Ma
I '
I
P
28 '
i k �
23 Russells Path' -
�' 148 Audre Lane
,' Parcel
w .I's .
Assessors Ma a. 84
P / , cr Assessors Ma ` _
P O,
Asse p
27 _.
27
Parcel o e1
Parc
92
#87 Ni7, \
a � _
p v
r .
PROJECT LOCATION
w p, .
2 '1
"-•--, ASSESSORS MAP. LOT
-A.P LICANT.P
PAS ,
�S
J�
q
_ L o c-v,4 PREPARED BY.
q
A & M Land S'ervzces
, 15' Sunset Drive
rmouth MA 02664
South Ya ,
508 394 2723
S -
1
,
r
SCALE. l DATE Cr t
f
d v-c 1 l A
'� I
1 � '
REV. _.
LOCHS MAP
{i ^,
'1
`.� 1
O. D ff SHEET. OF
DWG. N 7
t UVA .
3 �
.,..•• _. ...__........-.,. Vim,.,...,»