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HomeMy WebLinkAbout0112 BLACK OAK ROAD - Health (2) { 1�12�B�LACK OAK ROAD'; MIARST`ON MILLS k r A' 1a01�- 102 �� •�,� t � °, �-�yr �� • Commonwealth of Massachusetts /L9/ r /0")_ Title 5 Off Coal Onspection Conn Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd m Property Address ND Marilyn Santia Owner Owner's Name �is every Marston Mills MA 02648 5/42017- Pam- Cityrrown Stage zip code Date tnsp ion -ti•7 Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. 'miWt "form A. General Informationflu f i a3 D i on the computer, use only the tab 1. Inspector key to move your cursor-do not Paul Martin use the rerirm Name of Inspector key_ Cape Cod Septic Services m Company Nam 350 Main St Company Address W.Yarmouth MA 02673 Citylrown State Zip Code 508-775-2825 S15016 Telephone Number i t.icense Number B. Certification 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 CNIR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/11/2017 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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. *"*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. 15ns•sn3 role 5 OBdal f Farrtc SuEsirraoe Sewage Deposal Sy am-Page 1 or 17 Commonwealth of Massachusetts Title 5 OfficW Onspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia der owners Name inforrItafion is Marstons Mills MA 02648 5/4/2017 p uWed for every City/Town state Zip Code Date of trisped B. Certification (cont.) Inspection Summary.Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System in working condition 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. Check the box for"yes','no"or"not determined"(Y,N, ND)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 efitraation 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. ❑ Y ❑ N ❑ ND(Explain below): t5en-3113 Title 5 Official Inspection Fomr.SLMsuftce Sewage Disposal System•Page 2 of 17 Commonwealth of LUssachusetls IFTitle 5 OfroC6aO Onspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Owner's Name 1dr°m'ation is Marston Mills MA 02648 5I 2017 p�- ���`` City/Town state Zip Code Date of inspection B. Certification (cunt.) ❑ Pump Chamber pumpstalarrns not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CUR 15.303(1Xb)that the system is not functioning in a manner which will protect public hwith, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.3M3 Title 5 Official Inspection Form&bw face Sewage Disposal System.Page 3 of 17 Commonwealth of Massachusetts Title 5 OfficW Onspection [dorm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia owner Ownees Name is qui'm b Marston Mills MA 02648 51 2017 required for every Cityfrown s'tw a Zip code Dame of lnspee B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or dogged SAS or cesspool ® Discharge or ponding of effluent l o the surface of the ground or surface wafters 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 %day flow t5t,3M3 Title 5 oftW Fom[SWmafaw Sewage Dmposal System-Page 4 or 17 Commonwealth of Massachusetts Title 5 ®ffocW Onspection [dorm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Ownees Name Udbmmfion is Marston Mills MA 02648 5/4/2017 d for every page Cityrrowm state zip code Date of trrspedion p�- B. Certification (cunt.) Yes No ❑ ® 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 vrater analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ ® 10,000gpd. ❑ ® 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 Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either`yess or`no"to each of the following, in addition to the questions in Section D. 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—WA)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. t5im-W13 Title 5 Official WgX=bw Fom Substufaae Sewage Dispose!Syrstam-Page 5 of 17 Commonwealth of Wassachusetts Title 5 Official pnspecti®n [dorm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Ownees Name irdormation is Marstons Mills page MA 02648 W412017 required for every Cityrrown state Zip Code Date of Inspection Pa9e- C. Checklist Check if the following have been done.You must indicate"yes'or"no"as to each of the foNov ng: 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? ® El available 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 d different from owner)provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The sae and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330gpd t5es-3113 Tdle 5 Offic ud kopschm Fomc&onoface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 OffuclaE Onspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Owners Name mfoenabw is Marston Mills MA 02648 51 2017 reqwred for every page- cKyrrown State zip code Date of hrspechon D. System Information Description: 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(include laundry system inspection ❑ Yes ® No information in this report) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No 2015=19gpd Water meter readings, if available(last 2 years usage(gpd)): 2016=8gpd Detail: Sump pump? ❑ Yes ® No Unknown Last date of occupancy: Date CommerciaUlndustrial Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): Gabris per day(wd) Basis of design flow(seais/persons/sq.ft,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5rie•3M3 Title s Offiasr hupediai Fame Stmrbw Sewage Otsposat Syaten•Page 7 d 17 Commonwealth of Massachusetts Title 5 Offidai Onspection Dorm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Properly Address Marilyn Santia Owner Owner's Name requirediffibmwition�y Marston Mills MA 02648 5I 2017 Paw- Cayfrown State zip code Date of Inspection D. System Information (corn.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: No Records Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gailons 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.Atfch a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5im•W13 Title 5 Offidal kmpwm Fomr.&Aosibm Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Q WHIM Title 5 ®ffod ap Onspection Dorm UNOZAW MW Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Owners Name information is Marstons Mills MA 02648 5/M2017 `Pap-equmW for everycityrrown state zip code Date of Insped ion r�- D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 1984 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sender(locate on site plan): Depth below grade: fee Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: +10' feet Comments(on condition of joints,venting,evidence of leakage,etc.): Line checked with sewer camera and was found to be clean, property pitched with no sign of root intrusion. Septic Tank(locate on site plan): Depth below grade: 1 W feet Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: 4-61 t5dw•W13 ride 5 official hWection Famc Subau(ace sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Offocoal Onspection Corm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Owner's Name required lb is Marston Mills MA 02648 5/42017 required for every Pam- Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt) Distance from top of sludge to bottom of outlet tee or baffle 0" 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 How were dimensions determined? Estimated Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 1000Gal tank in good condition. Concrete baffles in place and solid.Tank at normal operating level. Covers 7"below grade Grease Trap(locate on site plan): Depth below grade: feet 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: Date t5ft•W3 Title 5 Official Inspection Form:subwtface Savjw Disposal system•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Onspection G;onn Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Owner's Name information is Marston Mills MA 02648 5/4/2017 pa for�� Page- Citylrown state Tp Code Date of hnspectiort D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(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: gam Per clay Alarm present ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of lost pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•W13 Title 6 Offiaal Uisp�Force Stbaurace Sewage Disposal System•Page 11 or 17 Commonwealth of Massachusetts Title 5 Ofrociag Onspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Owners Name infoffnafion is requb dfb Marston Mills MA 02648 5I 2017 required far every page- Cityrrown State Zip Code Date of Irrspef�ion D. System Information (corn.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" 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.): H-10 DB-3 with 1 line in and 1 Ine out in good condition. Box is dean and solid with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 14"below grade. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): *If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: 15bM•313 Title 5 officid kqX cbm Form&ftwface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 ®ffudaO Onspection [ion Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia owner Owner's Name edfor every is required Marston Mills MA 02648 51 2017 pne- for Citylrown e, zip Code Date of Inspection � D. System Information (cont.) Type: ® leaching pits number. 1-6x6 ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number. ❑ innovativelattemative system Typelname of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): 1-64 Leach pit with stone. Pt found dry at time of inspection with stain about 1'. No sign of overloading or hydraulic failure.Cover 18"below grade. Cesspools(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 ❑ No t5ins•W3 Title 5 Official Form:stftwlace Sewage Disposal Systarn Page 13 of 17 • Commonwealth of 07assachusetfs Title 5 O ldaP Ms ecti®n Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Owner's Name reto required is Marstons Mills MA 02"8 5/4/2017 required for every State Zip Code Date of Inspedion �_ City/Town D. System Information (corn.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(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.): t5ft•3113 Title 5 Offidal bspee6on Form:Sdbafaoe Sewage Disposal System•Page 14 d 17 • CommonweaM of Massachusetts Title 5 OffidaP Pnspecction Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd_ Property Address Marilyn Santia Owner owners Name ntOm'dion required tar every Marston Mills MA 02648 5/412017 r page- Cityrrown State ZipCode Date of Inspection D. System Information (cons.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 fleet Locate where public water supply enters the building.Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately Wins•3113 Title 6 Olriaal Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Off cW Ens ection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Owner's Name requirenform. for is Marstons Mills MA 02648 5/4/2017 papered for every Cityfrovm state zip Code Date of Inspection Pa9e- D. System Information (coat.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water. feet3 Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ® Observed site(abutting property/observation hole within"150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Hand auger 4'below bottom of dry pit with no water encountered. Before filing this Inspection Report,please see Report Completeness Checklist on next page. 15ins.3M3 Title 5 Official Inspection Form:Subadaoe Sewage Disposal System•Page 16 of 17 Commonwealth of Uassachusetls Tine 5 Official Onspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 112 Black Oak Rd. Property Address Marilyn Santia Owner Owner's Name infOrnrtatiO°is Marston Mills MA 02648 51 2017 required for every Pam- Cityrrown State zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 1Suis•3f13 Title 5 Official Inspection Form:Sut�tace Sewage Disposal System•Page 17 of 17 L o CATION � SEWAGE PEaM o 110. VILLAGE IaSTMIL} ER'S aACIE ra PDRESS 3S/ d BUILDER DR OV13ER DATE PERMIT 19SVE0 3 -�L• �X DATE COZIPLIAH.CE ISSUED zZ 3 r f �S .�3 /0/�(/-/ ?c/'- /9 3 LOCATION / SEWAGE PERMIT NO. i etc oAk1 PtQ VILLAGE I f /9 P' }�S�o" / 1,W s InST-A L�ER'S NAME b„ 0 D A E S S vi E c7 Z 74'51;e'e. B U I L D E R OR 0%10 ER r1f pr t DATE PERMIT ISSUED D,AflE COMPLIANCE ISSUED �L QL ^ L 21� /22 gz\ No.W.1.. Fas....u`..©.............. THE COMMONWEALTH-OF MAgrSACH,"OSETTS BOARD OF HEALTH Town arnstabl e ................... .....................O F.......................................-----.............. .-........................... Aplifiration 'fur Elhipas ai- orks Tiltu arnrtiun thrnti# Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: Lot #41 - Black Oak Rd. , Wla1'rtons Mills I. IVIA ................_- _..........--•--••-----------------•--------•••-•-•-•......-•----..---- Capricorn R6A.I.'ty`TrOust 7b� F'a�mou Fi is #No ;yannis ..- • ..................._ - ---- ... ....... ----------------------- ..........--...................................................................................... W Steve L e b e l Owner Address f Installer Address U -Type of Building 3 Size Lot............................Sq. feet a Dwelling—No. of Bedroom sanCh Expansion Attic ( ) garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........................--.. Showers ( ) — Cafeteria ( ) Oth�Sfixtures ........................................-••--•------......-•-•-••-----•-•-------------------•••..._... 330---------------- W Design Flow............................... �,,,Tgallons per persgv& day. Tot ,dilbr'!flow-------•-----•--•-----•------••-•••-----5.g�lons. WSeptic Tank—Liquid-capacity............gallons Length................ Width................ Diameter--.-----........ Depth................ x Disposal Trench-No. .................... Widt _,_._-------.-.----- Total Length......6A..........Total leaching area....2jjEj.......sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box n��a ( ) �Dosi #&dge engineering 11-25-81 a Percolation Test Resy�lts0 Performed by................................•........12_1......................... Date...........,...npne....eneounter ,.a Test Pit No. minutes per inch Depth of Test Pitid- A..._........ Depth to ground watenq.. A............--. es f4 Test Pit No. .........minutes per inch Depth of Test Pit..f.............. Depth to ground water...-�................ a _ _: Cto n 1--------------------------------........................................................ W rZoeIl0 Description of Soil....----- � 9 83c ---------------------------------- _........•--------•-----•----•-----......1-0-.•-••_..12,......med- Vqrite---sand/t-rae es--•of---gr-ave-1/nG,---wator---at-- 12 ' ------------------------------------------------------•---•-----------•---------•••••----•-•••--••-----•••-•--------•---•--•-----•---------•-•------•---••-----•----------..._--•------......--•--_.... 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 TITU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the boar f health. ed '.�` . . _ ..._.._ I'z.es 3 12� ! Application Approved Date Application Disapproved for 'e f wing reasons---------------•--------------------------------•---------------------------------......•--••-------..._._------ •......-•--------•-•••--.....----•••-•--•......•---•------•--•-•------------------------•--•------••------------•---•---•-----•••--------•--•--•------•-•----•-------•-•--•-----•---------------•--•.... Date PermitNo......................................................... Issued....................................................... Date ^ w. No. W._.1..�f 5 .........r ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ...-----..................................OF........................................------.................-----•--•------•--------- Appliration-fur EkopasFal Works Tilustrnrtiola 1hrmit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: Lot #41 - Black Oak "Ed. , Ma'rstons Mills ;, 111A ................ .......................................................... ............----•-•-••--..........._......•-••-••••-••----•-•--....-•-•--_.._...._..............._. Capricorn RLW&It� �dust 765 Falmouth R?5 Ri;0-Hyannis ......................-..... - -- ---------------••--•-- •----•---••-•-------._......---._....-•---------•----••...._..•--•-------•-••..........._.._..... W Steve L e b el Owner Address ..................... .......... Installer Address QType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms._. Expansion Attic ( ) �arbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Oth xtures ............................................................---•-•---•------•------•-------------------W Design Flow............................... gallons per pers Ip a;�day. Tota (}1 gow............................................ Rns. W Septic Tank—Li—Liquid*capacity��0�gallons Length ._�_... ... Width......`�.._. Diameter-------------_- Depth................. P q P Y-----------=g - x Disposal Trench No..................... Widt .................... Total Length....... .f._..___. Total leaching area___-_ sq. ft. 1- 0 Seepage Pit No..................... Diameter--------- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) DosinVfWi-6dke Engineering 11-25-81 ~' Percolation Test Res is Performed by.................. .................... Date........................................ ►.4 0 17 none encounte�- ,� Test Pit No. 1 .`A_....._..minutes per Inch Depth of Test PitI� ----•------_ Depth to ground water._ _____________ e Test Pit No. .................minutes per inch Depth of Test Pit.................... Depth to ground water..._._.................. O Description of Soil........._2............— 20*---_.loam"& -topsoil -------------•--------------------------------------••------------------ x 2 I-O- Ivie 3iuin---yeTT o_w__.s anii----•---•--------------------------•------------.............--•---•---•---- v ------------------------- ---- _______________1II".... ...12.........iriea:...wYi.ite.._sariaftraces---i....'---gravelJ`rio-..w `�e�:_.at: 12' 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 TITIS 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. Pres. .t ned--•----•---•-----------------------------------------------••-••-------.---•- �'�_ ...... Application Approved $3�_..ZZ " _ � Date Application Disapproved for g reasons-....................................................................................._......................... ....................•--------•-----------•--------........_....--•--•---"-•---------------------------------------•••••----•-----•-•-------••---....._•-••••-•--•-----•-------•---•----••-•---••----•••- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS 64 BOARD OF HEALTH Town Barnstable ..........................................OF........I.....I...................................................................... Tntifiratr of TnntpliFntrr THIS IS TO CERTIFY That the In�ividual Sewage Disposal System constructed (X ) or Repaired ( ) by Steve Lebel ------------------------------------ Lot ;# 41 - Black Oak Rd. , InstallerMarstons Mills , f,'A at................. ••------•••-••-•---•---••-•---•-•---------•-----------------•-- has been installed in accordance with the provisions of TI 1 p ]�fe State Sanitary Code as described in the application for Disposal Works Construction Permit No..........'................................ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................L.:. - '- .......................... Inspector..........k"r..-............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TownBarnstable................._...................................................................0 F..................................... No......................... FEE........................ Disposal igork,5 Tnnstrnrtion rrmit Steve Permission is hereby granted Lebel------------- to Construct (X or ftpair l eaR lditdVa Sev�age Disposal System at No. Lot ' '..T.._Marstons Mill . MIA •-••---•----•.....---• . • . -- ....•-••••---- -•-•-----•- .. ......... Street as shown on the a licat' n for Disposal Works Constru '0l3 -P r 't N - ---------------- Dated.' _.' ................ / G� •...................• ---•.............Board-------------.......................................... 2! -•--- Board of Health DATE----- --•--•••• -----•--------------•-----•-----•--•-•••--•---•---•-•-.... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 Oo l ` f 41 NbrE JL o T ' ExisriniG opn_c2APN/ KEP2ODuGEn Pao"- PLAN, Z.0l l35 Sf 1 DRIED Dra. B. /978 8Y QA)rrE R 4- N YE vf7w / IIdhTPOA/Fll_ SPOT CIEV. BY EL-OKEDC7E EkArvNEEI_uuG %s' ,\ M 8= 10 + " STA .�4. � PHI'terc�LIP r I No. 366 .0 NAL ENS' '�= S ROBERT $ BIRUCE CApAIG i� L �G K 4 ers � o •. J� �ovIt LEGEND CERTIFIED PLOT PLAN SPOT ELEVATION 6x0_ EXISTING CONTOUR--- O --- y� «ck c�ia FINISHED SPOT ELEVATION A�TpNS ,�! ILLS FINISHED CONTOUR ZonlF f2,F Ia APPROVED OAR OF HEALTH IC2E J So'Fie6m A � ATE AGENT : 30 SCALES/ , DATE+ 3 LDREDGE ENGINEERIAW CQ /N �2/ait cc CLIENTS I CERTIFY THAT THE POP0 0 EGISTERE REGISTERED J08 NO. 83 2S'6 BUILDING SHOWN ON THIS PLC C1VIl LAND DR.BY CONFORMS TO THE ZORIINS LAWS ENGI -rEm SURVE R OF BARNSTABLE,, (SASS. 7112 MAIN STREET CH. BY: ' HYANN I S, MASS. �, � 3 g .. SHEET— OF 7 TE RED. LA D SURVEYOR E/TNER THE SEPT/C TANk OR , 20. FT. M/N• 1-EAClV1.,VCt P/T ARE MODE TNA/V /a"SELOW- /p f'T M/N. GRAOar, ?4'O/AM ETER CONG'RET.� COi�ER} ha SMALL eE BROIJ4R7- 7 GTADE.CAN X-,rRA � 9'PVC P/PF NERVY CA ST IRON CO{��R Sh+.4 L L DE USED COVERS M/N. P/TCN /F/N DR/V4WA Y /g PEiP FT �- A GO VER CLEAN ,SANG - L/Ql//D LEVEL. . •: . 4"CAST Z LAYFR /RON P/PE 1000 v e M/JV.P/TC/V GAG. 1 . • • • • •• t s •e WASHED 57VNE SEPT/C TANK BOX r i , . . . t t , 4 . 64 BOX n • � �e • e ►. • .•e it e,D" / 1 •EJ�fECT/Vr ' ' : •; - 3144 `z,�a • o e' ' t • DEPrN • • t • ,• WASNE0 STONE •-�, t r' a •-. . os• 1 • ee • + • t t • e e • • t t i e, . • • e e e • • • t o •o,•, PRECA5r SEAVWCrE V7/ CPO 018,0 t . • • • • t t o o P/7 DR ZVVIV- lAfVZAT E'LEYAT/aMX J sty /�a = 78 INYERT AT BL//LD/NG q3,7. FT. 01AM- /NLE7 SEPTIC Ti4NJC 43.S FT, p/T �AJ6A`�Y �- f'T PIAJW. C(-WE'TA&VA Ay'JO/4� OUTLET SEPTJC TANK 63.3 FT. INLET D/STR/BNTJON BOX 43.1 �cr GROVND WATER T.46{LE O�lT1ETDJSTR/BI/TJON BQX�FT. SECT/O/V OF' _ INLET' LEACH/Nlr "l T 6�FT, SEyL/AGE G/SPI,�SA L SYSTFrM L&ACJ�/M& PIT TA8l�LATlD/V 3'CALE : %4' a /=0� DJMEN3'10/V A 2 -3 XT. DES/6N CRITERIA pJAlEyvs/aN B�FT• /VUMBER OF 6EDROOJyS 3 D/MENS/ON C 4'y FT. h9► - Cw4R6A4GED/5dPO5AL UNIT POPE SOIL LOG SD/L TE$T TOTAL E.3T//►SATED FLGH/ 330 0.4L.1DAv SOIL TEST A/ SOIL 7ArS7-02 NUMBER QF L�'AC/!/NG iojTs 1 �ELEKGµ_7 ELEY, DATE OX SOJL TEST --SRN J`- 198l SIDE LEACH/NG PERP/T S59 PT. RESULTS IYITNESSED. 8Y RRE -1-—95013) BOTTOM l.Z4CN/NG PER P/T S$Q. FT. -- a-2 ` PERCOLATION /eA7-&#/ --2 M/NJI/NCN TOTAL LEACH//VG AREA —ZSQ, FT. Susso"' PIERCOLAT/oN RATE A2 '; RESERVELEACNINCrAREA SQ. FT. _ OF N 2 M EDrurn �HS•_ `Z!1 OF ?� ROBERT y4,p /0 12 ��ARSTJAIS ILLS � BRUCE c� EIDRE WE lR6ca - f No. e ELORED�sEENG/N6ER/IVG CG,/NC. 7/2 MAlN 9T.� /-/YANN/9, MASS. POST O ��Fs' ONAI E �� rTJlr✓ SZ"k] p,Ai LGO D, 7-W-'f ,9v. �J l9 d n/o G/�ovnFo yY�4TEitP E�NCOUNT1�Eo CL/ENT F Q GMO[JNO yvslTER AT IaLEj! JQB ND: S3 257-6 4H,efTs2..0i* 2-