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Home My WebLink About0086 JONES ROAD - Health 86 Jones Road.(Marstons Mills) A=046-066 . } II i i i oltyQo UP CI2934 I N COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 86 Jones Road Marstons Mills. MA 02648 Owner's Name: Robert Breidenbach Owner's Address: Same Date of Inspection: April 11, 2001 Map: 046 Parcel: 066 Name of Inspector: (Please Print) James M. Ford IQA Company Name: James M. Ford cC Mailing,Address: P.O. B&49 Osterville MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT tiO�'i's OO7 I certify that I have personally inspected the sewage disposal system at thi and at the information reported below is true,accurate and complete as of the time of the inspection. The ins as performed based on my training and experience in the proper function and maintenance of on site sewag sposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes N urther Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: April 12, 2001 The system inspector shall su t 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. Notes and Comments ****-This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use: Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION; (continued) Address: 86 Jones Road Property Addre ,. Marstons Mills, MA - -- ___ Owner: Robert Breidenbach _. Date of Inspection: April 11 2001 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. Ariswer"„yes,no of riot 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 _ . .. _. 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: 86 Jones Road Marstons Mills. MA Owner: Robert Breidenbach-Date of Inspection: April 11, 2001 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 systeni'h'as 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 86 Jones Road Marstons Mills. AM Owner: Robert Breidenbach Date of Inspection: April 11 2001 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within'a Zone U of a public.4ell. ✓ 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:bagreater,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 System: To be considered a large stem the stem must serve a facility with a design flow of 10,000 gpd to 15,000 � s3' system d You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 86 Jones Road Marstons Mills. MA Owner: Robert Breidenbach Date of Inspection: April 11, 2001 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of.sewage-backup,? ' r '%✓ Was the site inspected'for•signs of break-out _✓ " Were all system components;.excluding,the.SAS,located on site? - ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 86 Jones Road _. .....';`.__._.. Marston Mills. AM Owner: Robert Breidenbach Date of Inspection: April 11, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 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: 2 Does residence have a garbage grinder(yes or no): No _ Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] - Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2000-47.000 gals.; 1999-86,000 gals. 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):.-__- .--..._. pd.._,.__ _..._....... _. 'Basis of design flow(seats/persons/sgftetc.): - _ . 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: Pumped 2 years ago-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: Qallons--how was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach-previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank. Attach.a copy of the DEP approval Other(describe): ' r ---."-..-'Approximate age of all components,date installed(if known)and source of information: Mar. 27 1986-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' - SYSTEM:INFORMATION (continued) Property Address: 86 Jones Road Marston Mills, MA Owner: Robert Breidenbach _ Date of Inspection: April 11, 2001 BUILDING SEWER(locate on site plan)' Depth below grade: Materials of construction: _cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 36" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes,or no): (attach a copyrof certificate) Dimensions: 1000 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle,` 31" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tees were present The liquid level was even with the outlet invert. There were no sign ofleakage. Recommend intalling risers to bring covers within 6"ofgrade - 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: -—- . :........Gill Date of last pumping: r Comments(on pumping recommendations;inlet and outlet tee or baffle condition,structural integrity,liquid levels _ dl as related to outlet invert,evidence of leakage,.etc. : - 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 4 s.. SYSTEM INFORMATION (continued) Property Address: 86 Jones Road Marston Mills. M4 r Owner: Robert Breidenbach { , •, Date of Inspection: April 11 2001 ; TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of.construction: _concrete metal fiberglass _polyethylene other(explain): Dimensions: 4 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.): t . ' = •=' "DISTRIBUTION .BOX:_f ..✓_`' .(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.):' The D-box was located but not dug up There were no signs of failure from the leach pit PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C €. : = SYSTEM INFORMATION (continued) Property Address: 86 Jones Road _ y, Marston Mills. MA Owner: Robert Breidenbach Date of Inspection: April 11, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 4'x 6'w/3'stone(per design plans) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: --- . -- Innovativetalternative system__ Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation; etc.): The pit had 2'6"of water on the b'ottoin. -The scum-line mas at the.same level. The cover.was 24"below grade: Recommend installing risers to bring cover with 6"of grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: i Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 .OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C =' `SYSTEM INFORMATION (continued) Property Address: 86 Jones Road Marston Mills. MA Owner: Robert Breidenbacl: Date of Inspection: April 11, 2001 Map: 046 Parcel. 066 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. U`k �3 . , . s . •a ,yl t O Aa- sa a &a- 3 A3- (33- SF 3 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM;INFORMATION (continued) Property Address: 86 Jones Road - MarstonsMills. MA Owner: Robert Breidenbach Date of Inspection: April 11, 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: ✓ Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: i You most describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 6'6': A test hole was done when the system was installed, and no water was observed at 14' Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 48'+/-to groundwater 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 andlor this report. 11 TOWN OF BARNSTABLE LOCATION g(-o �QVI S Rd- SEWAGE # V ASSESSOR'S MAP & LOT ` .LAGS M. r11% INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /OW LEACHING FACILITY: (type) P iT (size) NO.OF BEDROOMS 3 BUILDER OR OWNER I�obeT� &t 1 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 a3 3 ASSESSOR'S MAP NO. 6 PARCEL LU C A T 10 S WAGE PERMIT NO. � INSTA LLER'S NAME i ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i r: HCUS�5- � Q c3fo' �1 ,W Nocm2, j' Fus... .. - THE COMMONWEALTH OF MASSACHUSETTS v BOARD OF HEALTH - .w�(.....----.OF.....45A N T,9-�3t�AE--------------------------- Ap ira tiun for Disposal Warks 11untrnrtiun rumit Application is hereby made for a Permit to Construct (V� or Repair ( ) an Individual Sewage Disposal System at: LAC T�1® f J�� ............................,�- -----------�.----.... ..._...... ........................... C �Locatio Address Lo°t - .... . - ......... ----- ^�--- -----------•---._......._._._......._.... � --- ...............--••- �-�-' . ner res/ Installer Address �U TypeSize Lot.... Dwelling—No. of Bedrooms......__.vim.............................Expansion Attic ( Garbage q feet Grinder ( ) Other—T e'of Building No. of persons____________________________ Showers — Cafeteria WDesign Flow_Other 1�0 s .........................allons per person per day. Total daily flow _______._�3®___________________gallons. � Disposal Trench 9 Septic Tank—LiquidNocapacityl®�-�adl�h ns' "Length-&aLength ldth_�..!�:-ToDtal leaching area,__Depth_q..f�: •`� Seepage Pit No......../---------- Diameter-_._�P-_O___._. Depth below inlet___, _..___. Total leaching arew&5 l..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 4 10 0, '—' Percolation Test Results Performed by....4 _____________ Date_./-/ Test Pit No. 1......?,......minutes per inch Depth of Test Pit....../F........ Depth to ground water________________________ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •- ---•----------••-----•--••. •- -••-•-•••....... ..........•--•••-_----- ............................ ----- -- -- 0 Description of Soil....a--f i......4,O'nz14••••--/�� v� `SO/'G,------Z�- - .f�Nd?_..r !/ L x w UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ------------•----------------------•••--•••-••-----..._-•--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIITL YLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in op,Qfation until a Certificate of Compliance has b ,J issued by the board of health. Sign fp�plication Approved By___.._ __.�c L� '�` f P -A to •------------------- - -..._......----------._....__.._...._......_...-'---------•- --._.__...------ Date - --..._.._. Application Disapproved for the following reasons:----•-------•------------------------------------------------------------------•----------------...-•-••--.._... -•-------------------------------------------------•-----•--•--------------------•----•---•--•---------•--••--•-•------•-----•---•--•--••--•----...•-------•-•--•--•----••-----•----•-•••-•••---....._.. Date Permit No........... ..... l.l - Issued = - Date -,3 -,� dj No................I.... ...........3....).......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ..........7"V_W-Y..........OF......46?4 ?74040........................... ....... .... Appliration for Dispaiial Worka Tonstrurtion ramit Application is hereby made for a Permit to Construct (� or Repair an Individual Sewage Disposal System at: aso 6_ -(.ACjKr"09A) 40 .1114 ....................................................................... ...................................... -------------.. ----------- ----------- Location-Add r o. 7 C EAIN I..... . .......................................... Jva ..... .. .................... .......... .................. ..... ...............W----- --- Addres........ .......... r..................................................................................Wa . ... . ................................. ....................................................... Installer Address 7 U Type of Building Size Lot.._..,oms......... .4.400-0......Sq. feet Dwelling—No. of Bedro ...................................Expansion Attic Garbage Grinder P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures ................................................. tl� ----------------------------------------------------------*---------- -------------*............ W Design Flow...............&42...................gallons per person per day. Total daily flow..............9 ...................gallons. P4 Septic Tank—Liquid capacity/ gallons Length..& 4!".. Width..+*'! - Diameter................ Depth S-'-+." Disposal Trench—No..................... Width.0.................. Total Length................$0.. Total leaching area....................sq. ft. Seepage Pit No--------/......... Diameter.....&V...... Depth below inlet..-so...... Total leaching areaA&5_'f..sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by....4�2AE.AW<,Pa4PF C .............. Date...��W.A-S'i---1W.V Test Pit No. 1------Zw------minutes per inch Depth of Test Pit......kK....... Depth to ground water------------------------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..__._.............._... --------------------------------------------- ------------- ----------------------**----------------------------- 0 Description of Soil...... ....Wj .............................................................................. -----------------------------------------------------------------------------------------"-------------------------------- ....................................................................................................................................................................................................... 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 TAITIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in op t. until a Certificate of Compliance has been issued by the board of health. ff a ion Signed.................... ----------------------------------------------- .... f�A�5pplication A roved By.................................c) , q)�, ......... toe ................................................................. .............. Date Application Disapproved for the following reasons:................................................................................................................ .........................................................................................................................................................................................................Dat Permit No............ �......____._...__. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOA OF HEALTH ....OF.. ................................ .......... ................................................... %TWrtifiratr of Tantlifianu THIS'-�,SJO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by............. ..KA ... ?�)or ----------- r'..N Installer at..................... ........ --------- ------------*---------------------------------------------------*---------------*--------------------------------*----------------------- has been instilled in accordance with the provisions of. TITLE 5of The State Sanitary Code as described in the application for Disposal Works Construction Permit --- d-ated_...10-Ao-/an- ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL SON SATISFACTORY. ZZ / DATE........................ . ............................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF...................................................................................... No......................... FEE ............ %VVS!$! Touptrurtion ramit . z-,,( Permission is hereby granted--------- ............................................................... ... .................................... to Construct or. epai. an In&vidual Sewage Disposal System at No. . ge ........................s3C. .................. ZWA.............. ......... ................................................................................................. Street as shown on the application for Disposal Works Construction Permit 75 Dated."E)/V.�A . ............. - ---------- ----------------------------------------------- ......&�-- ----------- Boa d )ERealth ftq W 'F DATE.....................I..........IN 14 ........................................... F-ORM 1255 HOE WAV"N. INC.. PUBLISHERS' .a SOIL LOG NO. 1 NO. 1 SITE PLAN vi 2 3 4 5 - TOP OF FOUNDATION EL 6 7 eo / 10 Y ai ° ► are • a `i --r —Y' s'_. . .f_. il ' I 2 t.!/ , , • a 1 a._a r tf�� IN El !t1 �t. J C' 'C. -- 2 COVER 1/8 3/8 WASHED STONE 12 IN f l '%� > a l I N E t •� ar ) ! e fie NO ��r�,e ,� o 3 1��i IN. ,-'.� C s 3i4 1 1,'2 WASHED STONE _ �• 0/B W/ 6 SUMS • ' ,��.��,� E� •.' 4' LIQUID LEVEL15� '. �� r' `. � �, .. �o .n A it 6 A 14 _.'EFF. VEP1 • Air � t i -- t ..• - PERC TEST RESULTS a :... •__�_S_ I ad <, `' PERC RATE -, z '`.„ /,Ne,`�' PRECAST SEPTIC TANK WITH °a� ; '� °� PRECAST LEACHING PITS •� ~- -- ,, NO.: SIZE : WHITNESSED CAST IN PLACE INLET ANDti .. _ r"•n e . __.__ `' ° ° BOARD OF NEJ}LTH OUTLET T "S PER TITLE V �- .. O I ASIZE : /000 .r c jf t . 1 1 t` t PROFILE OF PROPOSED SEWAGE SYSTEM1 SY STEM DESIGNED BY THE TOWN OF REGULATIONS AND STATE TITLE V FOR SUBSURFACE DISPOSAL uF SEWAGE . SCALE 1l44 - 1 ' O N . B . 1 . All PIPE, SHALL BE SCHED ULE 40 P.V.C . SEWER PIPE - � ' � ,a, ,�,� .. � A ; 2. ALL PIPES SHALL BE SLOPED 114 " PER FOOT EXCEPT FOR THE FIRST 2 FrFT OUT OF THE D ' B WHICH SHALL BE LEVEL = 3 DESIGN FLOW BEDROOMSAT 110 GAIDAY PER BR . GAl DAY �. ,"� .4\� , s r � ,�. -�r• r, .y, ;`- _ SEPTIC TANK SIZE X ':s- _ GAL . 11 X(f� USE % o(� GAL. W1 �<�?- GARBAGE DISPOSAL� s ,.mil/ �.aF:'/ ... y. r. �{,�-. r . � * ` r-�� LEACHING SYSTEM : USE _ - o. 00 ' �p ti /a.s G l(41�Z , o ,A c1Or< EFFECTIVE AREA . SIDE _ B O T T O M r'?r-�L 7r - rt TOTAL FLOWc � 2�, �� —GARBAGE DISPOSAL . TOTAL REQ 'D FLOW �� x �. o = W/ *. :; � -�►. ;�- ,� RESERVE FLOW. .---,-- _ 6AL10AY1�_ _ REFERENCE PLANS Y APPROVED BY : - -- - - - __- _ BOARD O F HEALTH DATE : SITE AND SEWAGE PLAN PROPERTY OWNER . FOR . % w mi BEDROOM SINGLE FAMILY DWELLING s 6 OAT E DOYLE & ASSOCtATES FAL MOUTH , MASS .