HomeMy WebLinkAbout0030 CROOKED CARTWAY - Health L30 CROOKED CARTWAY, MARSTON MILLS
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CO MNWEALTH OF MASSACHUSETTS
EX CU'TIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617)292-5500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property.Address: 30 Crooked Carlway, Marslons Mills, MA Name of Owner: Tom Ellis
Address of Owner: Same
Date of Inspection: June 15, 1999
Name of inspector: (Please Print) James M. Ford
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: .lames M. Ford
Mailing Address: P.a'Box 49, Osten le, MA 02655-0049
Telephone Number: (508)862-9400 Map: 064
-CERTIFICATION STATEMENT Parcel: 002
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:
✓ Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
ails
Inspector's Signature: Date: June 20, 1999
The System Inspector shall sub a copy of this inspection report to the Approving Auth
ority(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
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revised 9/2/98 Page Iof11
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 30 Crooked Canway, Marston Mills, MA
Owner: Tom Ellis
Date of Inspection: June 15, 1999
c
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon
completion of the replacement or repair,as approved by the Board of Health, will pass.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not.
The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank, whether or not metal,is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health)
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
revised 9/2/98 Page 2ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 30 Crooked Cartway, Marston Mills, MA
Owner: Tom Ellis
Date of Inspection: June 15, 1999
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 IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a 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 to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
® The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3 OTHER
revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 30 Crooked Carlway, Marstons Mills, MA
Owner: Tom Ellis
Date of Inspection: June 15, 1999
D. SYSTEM FAILS:
You must indicate either "Yes" or "No" as 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
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_.
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 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. 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" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public
water supply well
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page 4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 30 Crooked Cartway, Marston Mills, MA
Owner: Tom Ellis
Date of Inspection: June 15, 1999
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health.
✓ e 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.
✓ As built plans have been obtained and examined. Note if they are not available with N/A.
✓ — The facility or dwelling was inspected for signs of sewage back-up.
✓ _ The system does not receive non-sanitary or industrial waste flow.
✓ — The site was inspected for signs of breakout.
✓ All system components,excluding the Soil Absorption System,have been located on the site.
✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles
or tees,material of construction, dimensions,depth of liquid, depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
✓ _ Existing information. For example, Plan at B.O.H.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
(15.302(3)(b)].
✓ _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2/98 Page 5ofit
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 30 Crooked Cartway, Marston Mills, MA
Owner: Tom Ellis
Date of Inspection: June 15, 1999
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom.
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
Total DESIGN flow n/a
Number of current residents: 2
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 yearga usage(gpd): 1998-50,000 1997-42,000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: gpd(Based on 15.203)
Basis of design flow
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:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Never pumped-per owner
System pumped as part of inspection(yes or no): Yes
If yes, volume pumped: gallons
Reason for pumping: Maintenance
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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed(if known)and source of information: 6187-as built card
Sewage odors detected when arriving at the site: (yes or no) No
revised 9/2/98 Page 6ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 30 Crooked Cartway, Marston Mills, MA
Owner: Tom Ellis
Date of Inspection: June IS, 1999
BUILDING SEWER: _
(Locate on site plan)
Depth below grade:
Material of construction: _cast iron _40 PVC _other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting,evidence of leakage,etc.)
SEPTIC TANK: ✓
(locate on site plan)
Depth below grade: 21"
Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: 8'6" x 4'10" x S' (1000 gal.)
Sludge depth: S"
Distance from top of sludge to bottom of outlet tee or baffle: 27'
Scum thickness: 8"
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: 10"
How dimensions were determined: Measuring stick
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 baffles were present. The liquid level was even with the outlet invert. There were no signs of leakage.
Recommend risers be installed to bring covers within 6"of grade.
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:
(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.)
revised 9/2/98 Page 7ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 30 Crooked Cartway, Marston Mills, MA
Owner: Tom Ellis
Date of Inspection: .tune 15, 1999
TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or 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:
Alarm level: Alarm in working order: Yes_ No_
Date of previous purging:
Comments:
(condition of inlet tee,condition of alarm and float switches, etc.)
DISTRIBUTION BOX: ✓
(locate on site plan)
Depth of liquid level above outlet invert: 0"
Corns cents:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
The D-box was level. There were no signs of solids.
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.)
revised 9/2/98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 30 Crooked Cartway, Marston Mills, MA
Owner: Tom Ellis
Date of Inspection: June 15, 1999
SOIL ABSORPTION SYSTEM(SAS): ✓
(locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods)
If not located,explain:
Type:
leaching pits,number: I -6'x 6'
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
Alternative system:
Name of Technology:
i
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.)
The pit was Y2 full. There were no si1!ns of failure. The bottom of the pit to grade was 9'6'.
CESSPOOLS: None
(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(cesspool must be pumped as part of inspection)
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.)
revised 9/2/98 Page 9ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 30 Crooked Cartw+ay, Marstons Mills, MA
Owner: Tom Ellis
Date of Inspection June 15, 1999 Map;064
Pbrrel:002
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)
13
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revised 9/2/98 Page 10of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
T' PART C
SYSTEM INFORMATION (continued)
Property Address: 30 Crooked Cartway, Marston Mills, MA
Owner: Tom Ellis
Date of Inspection: June 15, 1999
NRCS Report name
Soil Type
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 60+/- 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
Check local excavators, installers
✓ Used USGS Data
Describe how you established the High Groundwater Elevation. (must be completed)
Using Barnstable Water Table Contours map and Topographic map, the maps were showing approximately 60' +/-
at this site.
This report has been prepared and the system inspected and passed as 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.
revised 9/2/98 Page 11 of 11
TOWN OF BARNSTABLE
LOCATION SO Crook .0 ('1 A SEWAGE # S-)- 3(o'7
V MLAGE n ASSESSOR'S MAP & LOT 0614 100X
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /Q Q
LEACHING FACILITY: (type) 1T (size) 6 X?+
NO.OF BEDROOMS 3
BUILDER OR OWNER otv% £111.5
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
• 1 I
33
A-3
f33-
ALI- yy"
TOWN OF BARNSTABLE
LOCATION ��� � —SEWAGE
#
VILLAGE /`��j zs--� 6/0P� A'SSESSOR'S MAP & LOT �—
INSTALLER'S NAME & PHONE NO. - e!( _�/� ��
SEPTIC TANK CAPACITY `40 ems'
LEACHING FACILITY:(type) 1 (size) -
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER � a-, S
DATE PERMIT ISSUED: (J
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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N....'1 -3b6? .. 1 ......` a�
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...Tto.w.tii.............oi....... 3 R.tJ.STPt.FI,.. .
- 20 ApplirFation for Elhipas al Works Tonstrnrtion ramit
Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage Disposal
System at:
...... . LOT 2_.)_LlTrLE-: Po m o ESTA7ms
......... ..•• .......
- Location-Address or Lot No.
................. ��SCE..... ANE..........................................................
Ow er
W Address
Installer /> e���;�X� "7V—a Address
U Type of uilding �`%"'�'" Size Lot4 }3®It.Sq. feet
0-4 Dwelling—No. of Bedrooms___--_---__- .........................Expansion Attic (No) Garbage Grinder (Alo)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures -----•----------•-------
w Design Flow._......6...-5..............................gallons per person per day. Total daily flow------- ----_----•----__-___..gallons.
WSeptic Tank—Liquid*capacity 4.000.gallons Length_$._..... Width4__1Q..._ Diameter---------------- Depth.S_.Aff....
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No......I------------- Diameter.....1_Q......_. Depth below inlet...�.(Pl... Total leaching area..257...sq. ft.
Z Other Distribution box (?C) Dosing tank ( )
'-' Percolation Test Results Performed by.�PE.5;;D...Zt{kAIVE___CO!�15uGTAMSDate.... _-'7 �._..
,.a Test Pit No. I-___........minutes per inch Depth of Test Pit__-144-....... Depth to ground wate r* � ' �!4
� 5td�4, q
f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa v'-----------_._'
.............................................................-••------•--.......
O Description of S oil TP t. -f?T..................a -TOPSOIL. w 'Y -
x Z a_721r 5t t_T' `GI„q,t ltJ!f,P. 7Z"-1 " STief1 F(Ep--..... ------------ �1 v
c.� `�
wFi�E__C� ✓E . '`..SAn-o--------------------------------------•----------------------------------- ------------------- ---•-
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 provisions of TIT TIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Comp ance h een is ed b the boai3W health.
Sig c
Application Approved By....... .... ........... � ,�a-'�
Date
Application Disapproved for the f oll ing reasons:------••--•-----•••------ ..................---------•-------......................... ......................
..................................................••--••-••---•--------•...--•-••...._........••---...•-...................----•---••--•...---•••---•--••--••--•----•---•--••-•-•-•-•-•-••--•-•-••----
�n p -••-------•-----_Date
Permit No.. -- �i'+-�`` -- Issued ®-Sf
Date
No: ......>�.b .. `j S
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.-r4.............OF.......i.�p�A.RW.5 rABL_G...........................
Appliration for Dispao al Works Tonstratrtivit ramit
Application is hereby made for a Permit to Construct (7>(,) or Repair ( ) an Individual Sewage Disposal
System at:
-- Location-Address or Lot No
' P►J I.OQ s'.til. E*tal�T'i t t�z .................. KAC,. LAN O ---
wner ..........................................................
- ---
Address
. ' s �eri:��� Sr . na ..t �.� 1A�a
� Address
U Type of uildmg C ��� --� Size Lot 4p5�7=__Sq. feet
Dwelling—No. of Bedrooms_____________3......................... Attic (4 p) Garbage Grinder (Jo)
Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
- ............................... j d f• tl 3.3.elr_______________________ ' to
W Design Flow----Other fixtures ................g�---------P----P•---------P-----•--y.-------------•----y---------------------.....---------------...--------�gallons.
� Mons per person per day. Total daily flow-------
WSeptic Tank—Liquid capacitylt400gallons Length.��._ :__._ Widths__.#:Q_._. Diameter________________ Depth-6__8{`_.
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
� pSeepage Pit No____________________ Diameter Depth below inlet_6x_ ' s . ft.
._ �Z.�...__ Total leaching area_.e��__�.__ q
Z Other Distribution box (A Dosing tank ( )
aPercolation Test Results Performed byC PIPCaL�"__ �t�1j _ � 4!�•7°� Date_______ ___. ...
a Test Pit No. I.... .........minutes per inch Depth of Test Pit---144__----- Depth to ground wat f
04 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w (��
. __.._r.�.__.___ dt 19
W ............................................' _..�.............................................................................
D Description of Soil TF 1•-0-T._Z. �.... �" 'YbP 1L. "` _S�.P�QI�............................ .......AU_YN
U ��"/t- t!"''4""7 �ee rl � lYlt .+ �.�Z lI ,1', p_ T!.t� � �i�-••-•...-- ...... C. W ILS 0',1
S .....
IN 0-
U Nature of Repairs or Alterations—Answer when applicable................................................................. f.
-------------------------•--•-----.......------------------•---._...--------....-------••-•--•-------........------------------------...............................
Agreement:
Gcr/iG
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT L,u, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed..................... -=---�07'w
- -------•----...---- .....
Date
Application Approved By....._________ _ _ ;.r
Date
Application Disapproved for the f of ing reasons-----------------••...-- -•••••
...----•-•-••-...•••-•....................••-------•--••-•....--•---•--••-...--•••••-•-------•--•--•••••-•••--•••-•--.•••-•---•-••-•-•---•---------•••----•--•-•••-•-•--••--•--•-----•-•......•--•--...
Date
Permit No....��... � ............................ Issued...... - --•--
Date
THE COMMONWEALTH OF MASSACHUSETTS
OARD OF HEALTH
�. �w ..............................................
O F.....................................:
Trrtifiratr of (IumpliFaatrr
THIS IS TO CERT FY, hat the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-------••------------ r�' ....... L�C ------- -
// / Installer
dLAWAM
has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the
application fo- Disposal Works Construction Permit No...... ___.....1�--7............ dated_-6._- 1__�::_X-]_.....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................... •. u. ................................. Inspector................... 1-•�-......--------..........--•--•--------•-------
t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
J ,T OF.. �;. .................................................
T .??..J..� ?. ... FEE........................
�i��r�a��al �rk� ��att��rttr#ia�n �ermi�
Permissionis hereby granted...............................................................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewag Disposal System
at No._L-bT-...-n...... ,
7.:.. '1.�� .. .------•----------------------------------------------------------------------------------------
Street
as shown on the application for Disposal Works Construction Per Nog_7=:�6 __ Dated.... __._ �................
..............
DATE................................................................................ Board of Health
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
REVISIONS.
MCI INDICATES
SOIL TEST PIT DATA INDICATES SEPTIC TANK DETAIL: 1 0 0 0 c�j A L_ DISTRIBUTION BOX DETAIL-. LEACHING PIT DETAIL:
N0 DAT F
PE PC. OBSERVED NOT TO SCALE NOT TO SCALE NOT TO SCALE
P- 5538 TEST GROUNDWATER
NOTES: L SEPTIC TANK SHALL BE STEEL 4� INLET AND OUTLET TEES TO BE CAST IRON, NO. OF OUTLETS: MANHOLE COVER LOAM 8 SE ED
REINFORCED CONCRETE. SCHED, 40 PVC OR CAST-IN-PLACE CONCRETE. TEES BROUGHT10 FINISH GRAOEi OR PAVEMENT
TP Lo-r TP TP TP TO BE CENTERED UNDER MANHOLE COVER. _T NOTESt
94�.o GRD. EL.___ GR D. E L G R D. E L. 2. SEPTIC TANK TO WITHSTAND H-10 LOADING _j-_�_——
GRD. EL UNLESS UNDER PAVEMENT, DRIVES OR 1. DIST BOX TO WITHSTAND H-10 LOADING 2"MIN,OF 1/8"
GW. EL. UNLESS UNDER PAVEMENT, DRIVES OR TO 1/2"
GW. E L. GW. EL. GW. EL._____ RAVELED WAYS,WHEREIN H-20 LOADING ED 12"MIN. FILL,�
T TRAVELED WAYS WHEREIN H-20 LOADING W 'tH 41,1
SHALL APPLY, �j PRECAST SHALL APPLY. St6ME —
DIST. I
b
MANHOLECOVER Qz.
0 3� ALL PIPE CONNECTIONS AND CONCRETE BROUGHT TO FINISH GRADE BOX 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF Aur
CONSTRUCTION TO BE WATERTIGHT. a = C=
:S U B L_ INLET PIPE EXCEEDS 0.08 FT./FT OR IN PVC INLET P I�E;-� C= r= C= 93
z4- PUMPED SYSTEM. cy, 1.
GENERAL NOTES:
3- FIRST TWO FEET OF PIPE OUT OF DIST C3 t= cc V,
SILT �f' C-LAI COVER 3 -
BOX TO BE LAID LEVEL. 0�.., -,, NOTE, I THIS PLAN IS FOR DESIGN AND
06 . I LEACHING PIT TO
PLAN VIEW r-1 WITHSTAND H-10 LOADING CONSTRUCTION OF THE SEWAGE
DISPOSAL FACILITY ONLY.
RtMOVEABLE--\ La UNLESS UNDER
(MOTTZED) i _A_
PRECAST
C,
—---------- COVER > 3/4"TO 1-1/2" L__j PAVEMENT,DRIVE OR 2. ALL CONSTRUC,rION METHODS AND
WATER LEVEL SHALL CONFORM TO MASS,
r DOUBLE LEACHING PIT TRAVELED WAY WHEREIN MATERIALS
-20 LOADING SHALL
WASHED
H
OROVIDE E= C= C�r C= I= lb APPLY. D.E.O.E. TITLE 5 AND LOCAL ,130AOD
STONE
INLET TEE 1 14- OF HEALTH REGULATIONS.
72 WATERTIGHT (no finesl
JOINTS(typ) Li 3. ALL PIPES LOCATED UNDER PAVEMENT
PE R-c- t3 a C= I= C= C= C3 C3 13
T 4'-0" MIN. OUTLET' I
PRFCAS SEE
OR TRAVELED SHALL BE SCHEDULE
SEPTIC LIOUIO DEPTH TEE NOTE 2
4" INLET EQUAL.
41-10", r 40 OR
TANK 0 C3 C:3 f" r=i
TOUTLET
ST F—P,r, F)E F-)
2
DIA
L
Flt\JE ---BOTTOM ON
BOTTOM ON LEVEL STABLE BASE 0. - �D EVEL STABLE
11Y� BASE
16 01A,
CROSS-SECTION
:S/1�N4 C�
PLAN VIEW CROSS-SECTION VIEW
NJ 0 WATEP, A ------a
144" CONSTRUCTION NOTES:
DATE:' DATE: DATE: DATE: INVERT ELEVATIONS: 1. IF ENCOUNTERED, ALL UNSUITABLE -SOII.�
tHALL 8E REMOVED WITHIN 'A WIDE
Z I ONEIAROUNb THE LEACHtNG,FACILI TY
TEST BY: TEST BY: TEST BY: TEST BY: 4" INVERT AT BUILDING
AND ,$HALL BE REPLACED,WfTH .CLEAN
WI L-Sot4
4" INVERT AT SEPTIC TANK(in) SAN6 AND GRAVEL IN ACC09DANCE WITH
WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: �i. T(T
4" INVERT AT SEPTIC TANK(Out)
PERC,__RA..T-E PERC._.R-A TE: PERC. RATE: PERC. RATE: 4" INVERT AT DIST. BOX(in) 92— /G
MINJINCH MINJINCH MIN.IIINCH MIN./INC H 4" INVERT AT DIST., BOX(Out)
INVERTS AT LEACHING FACILITY:
DATUM:
ZZ
VERTICAL DATUM: ASSUMED \11, i M\lCiCr A Z_r_,tir_/4 I . G-7
LOT 3
BENCH MARK USED: SEE PLAN NIF
r
CAPRICORN REALTY TRUST
tn
cn
LOT 4 OBSERVED GROUNDWATER
N 0 t14;5
ELEVATION
N30*3" ZE
28935
o P
ZONE.- RF
SETBACKS;
DE
DO SIGN CRITERIA
F�rl
FRONT 301
2::)
SIDE 15
DESIGN FLOW:
REAR 15
BEDROOMS ATI10 G.P.B./D _;�,�_G.P.D.
3
cz
__AZ_0
0 7
-441�
3
Group
The BSC
J
LOT 14 - REQUIRED SEPTIC TANK:
P0_<;ED '
38c x 150 4
C_- 0 4— 1 9S GAL. %
L
Ln SEPTIC TANK PROVIDED: /� 000 GAL.
NOTES:
C'X
SiZE OF LEACHING FACILITY REQUIRED: Cape Cod Survey Consultants
PROPERTY LINES SHOWN HEREON WERE COMPILED 4-
CA
FROM A PLAN RECORDED AT THE BARNSTABLE r Ali DESIGN PERC. RATE: MINJINCH
CA
5,0 3261 Main Street
REGISTRY OF DEEDS IN PLAN BOOK 409 PAGE 41
__R 0 1P. Z% Route 6A
4
'D-
AND DOES NOT REPRESENT AN ACTUAL SURVEY ON 94
co Barnstable Village MA
THE GROUND. m m 1�j 02630
/Vil 617 362 8133
THIS TOPOGRAPHIC SURVEY WAS MADE ON
THE GROUND BY TRANSIT AND STADIA METHOD
PROJECT TITLE:
ON MAV� 1570 SIZE OF LEACHING FACILITY PROVIDED:
P/T / ,2 SEWAGE DISPOSAL
SYSTEM DESIGN
kJo
7: <
79 _7r16_rz
.4 C-,.R b
300.00,
FOR
39 32' 43"W LOT 2
LOCUS PLAN' SCALE, 1`-?083 LITTLE POND
90 '
ESTATES
IN
BARNSTABI.E. MA
LOT 13
MARST
ONS MILLS)
NIF
CAPRICORN REALTY TRUST EL.-100.00' - C,B,1D.H, AT N.W.--;,
PREPARED FOR:
6 7 COR.OF LOT 7.
DATE PRG)�-ESSIONAL ENGINEER CIVIL CAPRICORN REALTY
0 G
TRUST
LOCUS ,
4f,
L17TLE POND FESP,LIA F,y .2-7, j 9 8 7
C. DATE
FRANK RACE
ca
WHITING 9� LANE
COMP/DESIGN:
CHECK:
/7
DRAWN-,R
PLAN VIEW
MYSTIC LAKE F I E L D WE.
DATE PROFESSIONAL LAND SURVEYOR SCALE: 1 20'
FILE NO, 3 138GO6 75S . 2 C)
MENU____ 011111 o FEET C.6. ID-H. AT Al-W. DWG. NO,'1 24 7-1 SHEET
0 10 zo 40 6
COR. OF PLISKIN LOT. JOB N&,�?./386,all OF III
T
P)
r
7;:
Cq
U �