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HomeMy WebLinkAbout0126 JOE THOMPSON ROAD - Health 126 J6e Thompsim-T I Hyannis': r.: W= 174-001 004 1 1 COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION OW / y o,,M Sao TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: #126 Joe Thomason Drive West Barnstable,MA ✓ 7 U r Owner's Name: Nancy Titus s `� Owner's Address: #126 Joe Thompson Road -10 West Barnstable,MA ` Date of Inspection: 03/27/06 I -�- Name of Inspector: (please print) Mr.Carmen E.Shayf Company Name: CAPEWIDE ENTERPRISES,LLC cn Mailing Address: P.O.Box 763 Centerville,MA 0632 -- Telephone Number: (508)-428-4028 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: XX Passes �H�F Conditionally Passes LSs9 Needs Further Evaluation by the Local Approving Authority _ oy Fails o �1RfUfEN N Inspector's Signature: `^ Date: 3/27/06 " �,SHAY 10, HAY10, J� RTVF FS INSPEV The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of He 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 1' Liquid observed in Leach Pit. ****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 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: #126 Joe Thompson Road West Barnstable,MA Owner: Nancy Titus Date of Inspection: 03/27/06 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 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #126 Joe Thomason Road West Barnstable,MA Owner: Nancy Titus Date of Inspection: 03/27/06 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 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,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,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 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. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION continued Property Address: #126 Joe Thomason Road West Barnstable,MA Owner: Nancy.Titus Date of Inspection: 03/27/06 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool XX Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped XX Any portion of the SAS,cesspool or privy is below high ground water elevation. XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. XX Any portion of a cesspool or privy is within a Zone 1 of a public well. XX Any portion of a cesspool or privy is within 50 feet of a private water supply well. XX 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.] NO (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 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. 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: #126 Joe Thomason Road West Barnstable,MA Owner.: Nancv Titus Date of Inspection: 03/27106 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No XX Pumping information was provided by the owner,occupant,or Board of Health XX Were any of the system components pumped out in the previous two weeks XX _ Has the system received normal flows in the previous two week period'? XX Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up'? XX _ Was the site inspected for signs of break out? XX _ Were all system components,excluding the SAS, located on site XX _ 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 ? XX _ 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 XX _ Existing information. For example,a plan at the Board of Health. XX _ 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)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: #126 Joe Thompson Road West Barnstable,MA Owner: Nancy Titus Date of Inspection: 03/27/06 FLO W CONDITIONS RESIDENTIAL 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): 330 Number of current residents: Unk. 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): Seasonal use: (yes or no): Yes Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL 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: None Available Was system pumped as part of the inspection(yes or no): If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM XX 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: January 1993-original,- per Owner&BOH Records Were sewage odors detected when arriving at the site(yes or no): No 6 I_ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9126 Joe Thomason Road West Barnstable,MA Owner: Nancy Titus Date of Inspection: 03/27/06 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction: cast iron _40 PVC XX other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 24"to Top of Tank Material of construction: XX 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: 5' deep x 5'wide by 8' long (1,000 gallons) Sludge depth: 4.0' Distance from top of sludge to bottom of outlet tee or baffle: 2' Scum thickness: 'A inch scum laver noted Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Structural integrity of tank was ok. No evidence of cracks, leaks or water infiltration/exfiltration 4" PVC Tee present at inlet end. Outlet Tee present and in good condition. Liquid level equal with outlet invert GREASE TRAP:_(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.): -I 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: #126 Joe Thompson Road West Barnstable,MA Owner: Nancy Titus Date of Inspection: 03/27/06 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: 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: XX (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_ 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.): D-Box Present—one outlet,no evidence of significant carryover. PUMP CHAMBER: (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.): ,1 f Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #126 Joe Thompson Road West Barnstable,MA Owner: Nancy Titus Date of Inspection: 03/27/06 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type XX leaching pits,number: I 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.): No evidence of hydraulic failure of septic tank or of leach either leach pit. F Liquid observed in leach pit. Cover located and removed as part of inspection. Riser present. Top of leach pit is 48" below ground. 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 or no): 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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #126 Joe Thomason Road West Barnstable,MA Owner: Nancy Titus Date of Inspection: 03/27/06 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. Swing Ties: Joe Thompson Road A- Tank In— 14' B- Tank In—45.5' A—D-Box—27' B—D-Box—52.5' Water Line A—Leach Pit —36' B—Leach Pit —64' Exist House B Deck Septic Tank O (1000 Gal.) O D-Box Leach Pit O 10 Page 1 I of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #126 Joe Thompson Road West Barnstable,MA Owner: Nancy Titus Date of Inspection: 03/27/06 SITE EXAM Slope Surface water - %: mile+/- Check cellar -Yes Shallow wells—None Estimated depth to ground water 82.5' 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: XX 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) XX :Accessed USGS database-explain: You muse describe how you established the high ground water elevation: Checked with Quadrangle of USGS Map. Per USGS MAP PLATE 2: Elev.of Ground=Elev.-130 Elev.Of Groundwater=Elev.-40 Feet Elev.Of Bottom of Leach Pit 10 Feet below grade or Elev124 Therefore: 126-40=86 feet separation between Bottom of Leach Pit and Groundwater. Groundwater Adjustment using Index Well SDW-253(Zone C): 3.5 feet Adjusted Groundwater Separation= 126'—43.5 =82.50 feet between bottom of pit and ad*.groundwater Grade=Elev. 130 feet Pit#1 Septic Tank Bottom of Pit=Elev.= 1266 feet Adj. Groundwater=Elev.43.5 TOWN OF BARNSTABLE LOCP�T ON �(p ��� -j'� P�� SEWAGE# -(g VILLAY S ASSESSOR'S MAP&PARCEL - I y�-oa► 004 INSTALLERS NAME&PHONE NO. -T.-'E �5Co p SEPTIC TANK CAPACITY LEACHING FACILITY:(type) j-e . i� �� (size) l ©®og NO.OF BEDROOMS 3 OWNER PERMIT DATE: COMPLIANCE DATE: 2 "ZZ-9 3 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) wP, Feet Edge of Wetland and Leaching Facility(If any we ds exist _I within 300 feet of leac n facility) Feet FURNISHED BY Swine Ties: /� �. Joe Thompson Road A- Tank In-14' ! B- Tank In-45.5' x A-D-Box-27' B-D-Box-52.5' Water Line A-Leach Pit-76' B-Leach Pit-64' Exist House B =Deck s Septic Tank O (1000 Gal.) e D.Box Leach Pit r TOWN OF BARNSTABLE •�"' LOCATION LGt 10I 1&z " SEWAGE # �3 `66 VILLAGE 24 AI _5 k,,s i nWs ASSESSOR'S MAP & LOT P� •�© INSTALLER'S NAME & PHONE NO. Tl 771- tog6 SEPTIC TANK CAPACITY I,UCD �� (loin j LEACHING FACILITY:(type) CerleA. (size) 1, NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER (u, 771--G 9� DATE PERMIT ISSUED: MI 17/ g3 DATE COMPLIANCE ISSUED: ^2 03 VARIANCE GRANTED: Yes No ;J Lof (0 jl � No. Fps..... _ THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH T�Q..�^� .o F...33�nS T6-�- �r3 G• ....... Appliratiou for Uhipasal Workii Tomot.rnrtion Famit Application is hereby made for a Permit to Construct ( ✓<or Repair ( ) an Individual Sewage Disposal System at: � J o,E Two �s v- " i2 /'�f.F rt 'l °. �s i✓1 . c c. ...... _--_ -...................................................... ........_.........-•-•..-•---- S L.S Z �ati��dT� /Zc/ST- .._�.3.�.....OLD T,d !32 l-f YA .✓r✓is Owner Address -� �JrS.................... . .......�.•`..s..!E..........✓...... ..LA;- ................................................ -•----•---................ Installer Address Type of Building 3 Size Lot....2.-_J_.._.1 feet Dwelling—No. of Bedrooms___.. ............:....................Expansion Attic�(�f' Garbage Grinder:-(--j- p, Other—Type of Building No. of persons........!�!................ Showers Cafeteria-t-"� Q' Other fixtures ------------------•-•__-----------. W Design Flow..................•._......SS._..gallons per person per day. Total daily flow............ 3 .................gallons. WSeptic Tank—Liquid capacity PPPP.gallons Length.0 4_... Width.¢_ Diameter................ Depth..�`..�.."._.8.'0' x Disposal Trench—No. .................... Width.............._..... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No----------I......... Diameter-----1.0'..... Depth below inlet._...!'.......... Total leaching area.... _G 7.sq. ft. Z Other Distribution box ( pIr Dosing tank (_ f Percolation Test Results Performed by..... q_�.9.___.. `5 .fir.. ........ Date........ �`f g7 aTest Pit No. 1....-�"_2-.minutes per inch Depth of Test Pit..... L. .� . Depth to ground water..... .. ...�!. - GZ Test Pit No. 2.... Zr minutes per inch Depth of Test Pit.... .`.�'.._.. Depth to ground water.... ................'{' a ................................................y ----- --------------------------------------------P.... .4... O Description of Soil............. ....... _ 11' ........-'S---496 1�...................... ----------------------------------------------•-------------------------•--------------•-•---------------------------------•------------•---.•...-----------•----------------•------------•......--..... 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 TITLi; 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued b th a of health. SignedA. _- . ............................................. ..40,1 . Date/ Application Approved BY .: .............. 16:'- = kk Date Application Disapproved for the following reasons:--•---•-------••-----••-----•--•-------------------------------•------•------•-•----------......•---•-••.------ ..............• --••-•-•--••---•---•---....._...-•-•-•---------•----- -•--........_....._........------•--•--------.._..--------------------.....----•-•----...-•--•--••-----...Date----••---..._ GG Permit No.... `9............ .......... Issued....................................................... Date No.._U�.��.:. �l_ ! Fics....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Marks Tons#.rurtion rrrmi# Application is hereby made for a Permit to Construct ( 1"or Repair ( ) an Individual Sewage Disposal System at: _ .•Location•Address or Lot-IQ,o. _ r-i ;s.... 7`" v l Q L. J I ! . l /f�!✓�1/�,a OOw�ner�1 Address � ..................................... ..Installer - •-•-•..... -... .... Address - ... .. ..................... U Type of Building Size Lot. -f �Sq. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic 4•-°") - Garbage Grinder-t—r ` Other—Type T e of Building j �'" `�' '' No. of persons '............... Showers Ga YP g .............•-•---•---••-• P { )-= Cafeteria-('-T P4Other fixtures --------------!_..............----------•-•----•..............••-•.......-------•---...... ...._.... W Design Flow........................:...�-' '" ._.gallons per person per day. Total daily flow.._......._.�"�::............................................gallons. WSeptic Tank—Liquid capacity.'�:...``..gallons Length.--':'-..:.G.... Width.-_.! ....`.. Diameter................ Depth., ........ ' Disposal Trench—No..................... Width.................... Total Length Total leaching area...........-........sq. ft. Seepage Pit No...........:........ Diameter.... Depth below inlet.......°........... Total leaching area....?.�.7.sq. ft. Z Other Distribution box ( vr Dosing tank ~' Percolation Test Results Performed by......`:-r...`'._'... ... :.:...........:.............:'__._.... Date.............,_.......�1..., _!7 ,tea Test Pit No. L.....�.. .minutes per inch Depth of Test Pit.....fi..` _.�..... Depth to ground water......�..��°..�.._.."�" ,., ,. (s, Test Pit No. 2......::... :.minutes per inch Depth of Test Pit....!...`.°..`... Depth to ground water.....`...:......-- 0 ................................................�...-�.......... .......................... F1J. ..........�...............�...... Descriptionof Soil.-•............. ..... .....•----••-----?2.......�..............................................................P.......................................... W UNature of Repairs or Alterations—Answer when applicable.......................................___......_._..__.__:______..__..._...................._.. ......•........................••----••---..............----..•...............-•----....--------------•---•--.......-----.....-•--•-----•-•-•-••--••------•--•-•--...............•---•...........0...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Date_ Application Approved By....... 1 �" ^'4 '" --•---••--------------_ ........� -S•-...... `.. Date Application Disapproved for the following reasons:............................................................. •...................................•---•---•---•--..........-----•------•-----........._---•--...-•-._.--.......•............-•--------•--'--------....--------•---•----•----'--••-----........-•---- C/ - Date PermitNo.....Q.Z.........................•-----•--..... Issued.................................................... -- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................ OF f7� 1' _ .. .............................................................. Tntif irat a of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by.........`.�:..!.. ..r - .: :.': -`�................ -----....................................._....................................... ._...._ Installer._._, at-•--.... = `� .._�i_.EF' - "r---.r Q�e ) --�---Z - -J -.0: .'�'...........�2.� ...... --- has been installed in accordance with the provisions of TIT.� 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......_ -.. Z........ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATJSFACTORY. DATE......................... .... .....- ................ Inspector........... r. .................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .:'i.....".....OF................................. ............................................... No........................ i Fs$....................... . Disposal Vorks Tono#r u#ion Prrmit- f: Permission is reby granted....... `t f `'= t . . �. .......................................... •-•-•-•--•-•....................----•---............_. . ___.. to Construct ( or Repair ( ) an Individual_ Sewage Disposal System _ at No......... _.Q..... -�--•--.✓_... Q,,*).-)i�__s IQ ✓.....��..:�................F)�/�_7 Street ". as shown on the application for Disposal Works Construction Permit No.�-9,2a... Dated................................:....:.... . ..................... -••---..............----:......--•--..... "Board of Health + DATE................................................................................ FORM 1255 A. M. SULKIN. INC.. BOSTON BENCH MARK TEST HOLE RESULTS P#G47(o DATE : WITNESSED BY TE2.T2. L�y�//./ / •�/ ,, ©. /�.. % ° ' TEST HOLE2EG TEST HOLES E-L )23,o r=l? 2� s �13sgr ..._ E� 12i. o 30 MEZ:) UM / a 72 O F L/N 7, o O /OC% / 7-p \ S NJ] A'T �G • l EAc N • / y/r• , / O_1 / IZia 3 N—� A/OGROUND WATER A/dGROUND WATER, N ENCOUNTERED ENCOUNTERED 6H 1 DECKS '� ELEV. TOP OF MANHOLES AND COVER TO BE BUILT TO FOUNDATION WITHIN 12 OF FINISHED GRADE / }�TZOPoserD 1. 12� ., iGA2 �� ;••� °Q FINISHED GRADE MIN, 2 % SLOPE DW45'4L. ••+ 4 D IA. ` ,f �•:. - 4" DIA. PIPE FIRS 2M1 / /�S`'/ I �•r•' \�'�' -Pl P E _ ,^^„'^,;;,• �- MIN. PITCH I FT, 2� LEVE MIN. 2 LAYER OF_ —`br- 1- P E A S T 0 N E: /q I MIN. PITCH i.-v,�+ 2r i � I , / 2/, 00 FT. / Jl 2a•2 g . • Q 'f' 1/4/ —� I N�VE R T b«dwNP INVERT •-' a �• 0. m•- • Y , INVERT 12c�.7S GALLON 20 q2 ® Wes. •� i E P T I C Ta,NK INVERT DIST. / 20,0 ':,� �� V ©•••• WASHED DSTONE FOOTING TO BE PLACED INVERT = 80X I 8^ ON INVERT W p '•� i ON A MINIMUM OF I OF •• � w ALL . AROUND ' 9 PLACE � q •- , :, a • VIRGIN OR ,COMPACT.ED ai ,/2---a-I FI RM BASE �--- - �- /`f ' ... A • -ELEV. Al s • SAND in mlN )V 20O GARBAGE MIN.) GRINDER- � C �f �/� r-•---�Q C �/ i �! ,C3 T, ELEV. / O 9.Z_ / ��rw✓ PR Oc i L E OF GROUND WATER TABLE L3E'4 \tip �--- SANITARY DISPOSAL SYSTE M ( NOT To SCALE ) D E S I G N D ATA / • CONSTRUCTION OF SANITARY DISPOSAL 3 BEDROOMS SYSTEM SHALL CONFORM TO THE MASS. DESIGN FLOW 33o GAL./DAY ENVIRONMENTAL CODE TITLE r (REVISED 7- 1-77 ) AND THE TOWN LEACH RATE -- MIN./INCH HEALTH DEPARTMENT REGULATIONS REQUIRED LEACHING CAPACITY : -4'27GPD • SEPTIC TANK, DISTRIBUTION BOX AND LEACH- PROPOSED " SSo GAL//DAY ING UNIT TO BE OF REINFORCED CONCRETE : 2.5( 6 ,0 ;I /0)+- �. a!y'(S)Z MIN. CONCRETE STRENGTH • 3000PS.I. REQUIRED SEPTIC TANK : /000 (GAL. MIN. STEEL STRENGTH • 200000 P. S. I. MIN. DESIGN LOADING : H10 PROPOSED SEPTIC TANK : /000 ,GAL. • DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN LOADING IS USED • ALL PIPES AND FITTINGS TO BE WATERTIGHT AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DATE SITE PLAN SHOWING PROPOSED CONSTRUCTION. ZONING DATA L E G EN D . LOCATION : B A R N S T A B L E Crn��s ToNs � � c s� r�►f� FOR : LEBEL- SOLLOWS DEV. CORP. — DATE : s sP•�c�• ini �' zow DATE • ZONE : 0P N 1? E 25.E TEST HOLE LOCATION � : LOT s o•t AS SHOWN ON - REVISI ONS '* ONS REQUIRED AREA _ �43,SGo,� ♦0,8�4, EXISTING SPOT ELEVATION 17.6 ���� o PLAN BOOK 439 PAGE REQUIRED FRONTAGE C/5o) 37.5 EXISTING CONTOUR _ _ 16 0 REQUIRED FRONT SETBACK (3©) 3001. PROPOSED CONTOUR 16 ZZ av� SCALE REQUIRED SIDE SETBACK : (!s) ' PROPOSED WATER SERVICE - W- No•274M _ REQUIRED . REAR SETBACK : ,(�S� PROPOSED GAS SERVICE -G FSS/p�AL ��G��' . Z3 v r9r2p 0900-;;=�J2a Jg.4- PROPOSED ELEC. 8t T E L E E 81 T c.�/��g g CRAIG R . SHORE , P. E . PRO FESSIONAL CIVIL EN 01 N E E R BUILDING INSPECTOR APPROVAL DAT E 131 OLD ROUTE 132 , HYANN IS , MA. 02601 FILE NO. �57 ( TELE . (617 ) 362 - 9411 ) SHEET / OF / I� II