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HomeMy WebLinkAbout1366 OLD POST ROAD (CT & MM) - Health 1366 Old Post Road, Marstons Mills j A t 6a. IVWIV Ul- bA1UN31AttLE V LOCATION' / SiA::Ar SEWAGE # V LAGS Zgg !/57 25;1'/�' sVYJ�d�' ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /�V/ 6F (size) NO. OF BEDROOMS_ 5 J BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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-0fgachi ility) Feet Furnished b - C I / \—, 1 �� of 0 D ATE : .12/26/97 PROPERTY ADDRESS : .1366---O-ld Post Road Marstons Mills Mass. L On the above date, I Inspected the septic system at the above aCCre86. This system consists of the following: 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. 3 . 1 -1000 gallon leaching pit. Based on .my Infc� ctlon, I cerllfy the following condltlons: 4 . This is a title five septic system. *-'( 78 Code ) 5 . The septic system is -,in proper working order at the present time. .6 . Pumped septic tank as part of the inspection. • 51GNATUR!- Name : J . P . Macomber -Jr.,. i Company: J • P_Macoa)ber &- Son-_Inc A d d r e s s :_ _bb------ --- --- __Cen � erville �Mass;_02632 Phone :---508_?J l_. j38_------ I THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY ,OSEPH R MACOMBER & SON, INC. ,' T+nk�-CeupoolHLeachllald� Pumprd 4 Initlllyd Town Sower Connoctlont P.O. Box W Centerville, MA 02632.0066 7 7 5-3 3 3-8 715-6412 \ , Ae I G) COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 WILLIAN1 F 'A ELD TRUDY CORE Govcmor Sccrctar ARGEO PAUL CELLLICCI DAVID B STRUIrtS Lt Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION Property Address: 1 366 Old Post Road Marstons Address of Owner: Date of Inspection: 12/2 6/9 7 Mills (If different) Name of Inspector; Joseph P.Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc Mailing Address: BOX Centerville,Mass. 02632 Telephone Number: 508-775-3338 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 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: diti �sses Cononally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: �Q ', Date: The System Inspecto hall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: �Iha e not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 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 conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http://www.magnet.state.ma.us/dep Printed on Recycied Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1366 Old Post Road Marstons Mills,Mass . Owner: Ruth C. Knight Date of Inspection] 2/26/97 B) SYSTEM CONDITIONALLY PASSES (continued) A Sewage backup or breakout or high static water level observed in the distribution box is due to oro'Ken or oos:r_c..ec pipelsl or due to a broken, senled or uneven distribution box. The system will pass inspeoson if (with approval or :ne Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced ,2l The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspeRron if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 faiihng to orotec? me public health. safety and the environment 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING l.\ A MAN. ,ER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: �1a 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 APPROPRIATE) DETER,,,w ES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: IL, The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface wafer s,;. y or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water suppl•. -eh 4Li� The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water suaa -e Z6) The system has a septic tank and soil absorption system and the SAS is less than 100 feet but SO feet or more iro.T, a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compovnos �nacates trna: the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen s ec-a: to of less than 5 ppm. Method used to determine distance /. (approximation not valid) 3) OTHER tr.vl..d 0�/75/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 366 Old Post Road Marstons Mills,Mass . Owner: Ruth C. Knight Date of Inspection: 1 2/2 6/9 7 D) SYSTEM FAILS: You must indicate ei;•.er "Yes" or "No" as to each of the following: A 1 have determined that the system violates one or more of the following failure criteria as defined in 310 CN1R 15.303, The bans 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 th distributionnbo above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in d is less than6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped D 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 I 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. El 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 L11 the system is within 400 feet of a surface drinking water supply lj,/# the system is within 200 feet of a tributary to a surface drinking water supply -/r the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area • IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 1 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST r 1 o r ons Mills Property Add ess. 1 366 old Post Road Ma st Mass Owner: Ruth C. Knight Date of Inspection: 2/2 6/9 7 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. 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•�luding 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 condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. l The size and location of the Soil Absorption System on the site has been determined based on: i✓ _ The facility owner (and occupants, if cUfferent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. 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)) (revis*d 04/25/97) P&g• 4 of 10 i� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1366 Old Post Road Marstons Mills,Mass. Owner: Ruth C. Knight. Date of Inspection: 1 2/26/97 FLOW CONDITIONS RESIDENTIAL: Design flow.`4V R.p../bedroom for S.A.S. Number of bedrooms: Number of current residents: 0 Garbage grinder (yes or no):/D Laundry connected to system (yes or no): *4y Seasonal use (yes or no):A,,$ _ Water meter readings, if available (last two (2) year usage (gpo): /iNz Gq/ tlu1 /Olr�y7� 61Z 11_ Sump Pump (yes or no): j� " fw�iL f ;Cq Last date of occupancy: %e COMMERCIAUINDUSTRIAL: Type of establishment. All Design slow: VrtRallons/day Grease trap present: (yes or no)A& Industrial Waste Holding Tank present: (yes or no)_� ,Non-sanitary waste discharged to the Title 5 system: (yes or no)Afo Water meter readings, if available: 4,�4 dlz t Last date of occupancy: / _ OTHER: (Describe) 14.4 Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS a,�n s rce of information: ZIP / � - System pumped as pan of inspection: (yes or no)_S If yes, volume pumped:�/ gallons / Reason for pumping 12 ;7.Ex TYPE OF SYSTEM Septic tank/distribution box/soil absorption system .et Single cesspool Overflow cesspool e110 Privy ,60 Shared system (yes or no) (if yes, attach previous inspection records, if any) ,(/ I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) l (r.vl..d 04/25/97) P.9. 5 or 10 r SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 366 Old Post Road Marstons Mills,Mass . owner: Ruth C.Knight Date of Inspection: 1 2/26/97 BUILDINC SEWER: ,Locate on site plan) J/ Depth below grade. /6 Material of construction _ cast iron Z0 PVC — other (explain) / Distance irom pjivate water supply well or suction line r Diameter _ Comments (condition of joints, ve ling, evidence of leakag )c.) �. /� s r t X SEPTIC TANK: /GUdfldll�v� +locate on site plan) rr Depth below grade. Material of construction: Zconcrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age V4 Is age confirmed by Certificate of Comphance JL' (Yes/No) Dimensions _ /lYG"J�' ��1� ��/ cJ Slucge depth Distance from top of sludge to bosom of outlet tee or baffle:�_ Scum thickness O Distance irom top of scum to top of outlet tee or baffle: Distance from bonom of scum to bon of outlet a or baffle:_ How dimensions were determined: " Comments trecommendanon for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet nven, su c ra integrity, evidence of leakage, etc.) .4- ipry a ` •� oU��IP� �� A211 34 CREASE TRAP:AI�t,lr, uocate on site plan) Depth below gradeA,W Material of con structron&-4—concrete4 4 metA//*Fiberglass(/0 Polyethylene�L%4other(explain) AIA — D,mens,ons: ,4,W Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bosom of outlet tee or baffle: '14 Date of last pumping: 11 Comments (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inven, 'ntegriry, evidence of leakage, etc.) t A �i-ir"i /L4i2 lr.v�..d 0�/J S/971 P.9. 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 366 Old Post Road Marstons Mills,Mass . i Owner: Ruth C. Knight Date of Inspection: 1 2/2 6/9 7 TIGHT OR HOLDING TAN K:dL,&16(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade:W ' Material of construction:4i4concrete2Ametal�t,fiberglass �+Polyethylene.c. other(explain) XJ/•i''''' Dimensions: dJ/P Capacity: it;� gallons Design flow: 4,'11 gallons/day Alarm level: / / Alarm in working order.Z12 Yes;4/`r Na Date of previous pumping. i40 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: Comments: (not if level nd distribution i$equal, evi ence of solids carryover, evidence of IeakagG into or out of box, etc.) r r JV. PUMP CHAh1BER:-'X1C- (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No)-4 Comments: (note condition of pump chamber, condition of pumps and appunenances, etc.) (r.vis.G 04/25/97) P-90 7 of 10 fr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1366 Old Post Road Marstons Mills,Mass . Owner: Ruth C. Knight Date of Inspection: 1 2/2 6/9 7 e SOIL ABSORPTION SYSTEM (SAS):/eeD1'C'4A :locate on site plan, if possible; excavation not required, but may be approximated by non intrusive methods) If not determined to be present, explain: Type: leaching pits, number leaching chambers, number: leaching galleries, number: leaching trenches, number,length: _ leaching fields, number, dim ions: overflow cesspool, numb r: Alternative system: -�— Name of Technology7YP,• U ' Comments: (note condit of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) i n CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: iJ4 Depth of solids layer: 4"4 Depth of scum layer: xux" Dimensions of cesspool: AW Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PR IVY: pi�'� notate on site plan) Materials of construction: Dimensions: Oepth of solids: comments: mote Condit on of soil, signs pf hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) P.g. 8 of 10 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propene Address: 1 366 Old Post Road Marstons Mills,Mass. o»ner: Ruth C. Knight Date of inspection:1 2/2 6/9 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: n0vcle ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) fG o lt..i..0 .t/73/371 P.y. 9 of 10 t SUBSURFACE SEWAGE DISP.. :. SYSTEM INSPECTION FORM t C SYSTEM INFOI: :ION (continued) Properly Address: 1366 Old Post Road Marstons Mills,Mass. Owner: Ruth C.Knight Date of Inspection: 1 2/26/97 Depth to Groundwater ;�6,Feet Please indicate all the methods used to determine High Groundwa;e+r FIL'.ation: Obtained from Design Plans on record _O/bservanon of Site (Abuning property, observation hole, baseryv-nr -)mp etc.) —z Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records —4z--�eck local excavators, installers Use USGS Data Describe in your own words how you established the High Grounc}.vaur-Elevation. (Must be completed) Used Groundwater contours Based on Gahrety & Miller Model 12/16/94 tr•vlra•C 0�/75/97) Pic, of 10 ra—•r�- T•.r.-lrr.•nts+ra-rrr.atrrrr.r:-.�e-r+rv.r:�+.-s*r..+nr�tt*sa-�nsr.r+•o+ .rnrrr-r---r-. �-•�,-,n-�, Barnstable ' TOWN OF LIOARD OF HEALTH 1 SUIISURFACF SF.WA(;F DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION ` �•.•�•�.T•••...—r. r�.-T.T..�el•R.'fSi TZtr cslrar.1:'I'1•.r5'1�'[utnlarmvr�'R*•'nesar RT'RTRSZw1R7 rs+nn•'mrrtrt:o•-Trr+rr.r.—.rrrr•1. —. -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 1366 Old Post Road Marstons Mills,Mass ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Ruth C. Knight PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Seiq 'Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City State tip COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1 578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the inforiation reported is true , accurate , and complete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : —4Z'system PASSED The inspection which I have conducted has not found any information . which indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* \ The inspection which I have con icted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . 1 Inspector Signature / Date One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF IiEALTII. * If the inspection FAILED, the owner or"operator shall u within one year of the date of the inspection , unless allowed dort required he m otherwise as provided in 310 ChIR 16 . 305 , partd . doc W Ul �7 7 � ti _ S THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF E OMMENTAL PROTECTION BE IT INN O WN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CER + � D TITLE S SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws _ Issued by The Department of Environmental Protection. Junc s. 1995 Acting Dircctor of the ( 1 1011 of W11Cr �PojjjtjjC�'�01) ootrol ASSESSOR'S MAP NO. PARCEL �Q �► '4 3 7.� L0CA'TI0H Gov SEW.AGEqg � PERFAIT !!/��Nt2 `;, VILLAGE. . v.4Ar-es f1HSTALLER'S NAME ADDRESS ®DATE PF: RMIT�ISSUED DATE CAMPLIANCE ISSUED �. .� � i e'` --. . _ �;� O "'f �� a a .-� No. � Fxs.�.�:`........: THE COMMONWEALTH OF MASS/�ACHUSETTS BOAR® OF HEALTH �Q W.K_...................OF.......ax�.C.M..3-T .. c..................................... Appliratinn for Disposal Works Tnnitrurtinn amit Application is hereby made for a Permit to Construct (D() or Repair ( ) an Individual Sewage Disposal System at: .....-----1_.................... --d --f��---*Post... ..�..��,.f----------------- . -----.....------------......-------------- Location-Address or Lot No. ......................-..............................e!k-,ry... .---------------- P, ner a G Address � ._ --------------------- ----------- •------------------•----------------------- Installer Address 'Type of Building Size Lot__���3,t_-S6 O Sq. feet Dwelling—No. of Bedrooms................ 3............•...__.__..Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—Type of Buildiii ............... No. of persons............................ Showers g ---------------------------------•---------P--- ( ) — Cafeteria ( ) P4Other fixtures --•--------------- -•--------••-•-•-••---....••••------••--•--••-••--•--•----•-••••-•••......---•••............•• W Design Flow............................�.....__.gallons per person per day. Total daily flow____._:_.....__.33 .0..........._gallons. WSeptic Tank—Liquid capacity,/OO-Grallons Length.E."_�_�. Width.y_'/_Q..'Diameter................ Depth_r"._7-- x Disposal Trench—No. .................... V�idth.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........./........... Diameter...(.?."__.IL" Depth below inlet...y'_:a Total leaching area..z FP_....sq. ft. Z Other Distribution box (X) Dosing tank ( -P .5-vi-7 Percolation Test ResultZ Performed by_.__ax'�!cs..A _ �/!r_y-<-...__...Z..................... Date.......`!1 iy � ,.a Test Pit No. 1................minutes per inch Depth of Test Pit------ Depth to ground water_-___yP 4i Test Pit No. 2.....Z......minutes per inch Depth of Test Pit...... Depth to ground water...... _ P4 '/----------------------------------------------------------------------------.........--.?-............................................................ o Description of Soil-----••o..................................'0 Ss;``'�`�--- 6 x ....- -- A G--• ....................................................... U / -----•••-• -•-•••-••- ........................ Nature of Re airs or Alterations—Answer when applicable __�_4__�...___.��___`�_V R W rn .. UP -------------------------------------------------- -•••••--•••---------••------•-••-•-•••-•••--•••----•••-••-••••--••••---------••-••••...•-•••••••••--•--••••...-----••-----•••.---••-•••••--•-••----•••••-•----•---------•-•-----------••••-••-••--••••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITHE 5 of the State Sanitary Co —The un igned further agrees not to place the ystem in operation until a Certificate of Compliance- bee, ' sued by th bo rd of health. Si ... D e ............................................... ...... ......... .. ApplicationApproved By--••............. - ••-•-•-• • ..... ...................... •.................... ------------- ---,-- Date Application Disapproved for the following reasons--------------------------------------------------------------<......------------------------------------------. ................................................................••..••-•--•--•-••••-•••--•--•••••...----.............-••••-•-••-•••••-•••••-•••_....._..........................----Date........ 71 PermitNo........ �-•-a---. Issued........................................................ 4. .i �� c ^37 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF.........-..... Appliraation for Disposal Works Tonstratrtion rrmit Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage- Disposal System at: J j ................»........... ...............--»-•------ .............. Location Address or Lot No. ...-•--••--•--- ............................!!! G/ f_J!__'`r ...__.»» .... ............................................. �wne C --• Address a J n..................................... •------------•---• Installer Address Type of Building Size Lot__:!? _�-.. _ _o_Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder aa Other—T e of Building No. of ersons____________________________ Showers YP g --------•------•--••------•• P ( ) — Cafeteria ( ) dOther fixtures;------------......................................................•----•--------•-•----•-------•-•--•-•--••• .;•••••• -•••----••••-•-•-•-- W Design Flow.............................................gallons per person per day. Total daily flow................_:"..�.Q______._.___ Ions. �P Y Y WSeptic Tank—Liquid capacity/0©_�allons Length_a.--`_C_'._ Width.y. /O_.'Diameter................ Depth__s_�__7..�� x Disposal Trench—No_____________________ Width__.___.__;.__.____ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter__j.K.__......_.__ Depth below inlet........ ..... Total leaching area....'_.=�?_.__.sq. ft. z Other Distribution box (�`) Dosing tank ( i� s•'4 t` i%'-%x` -,` N Date a Percolation Test Results Performed by i��, 1___.___�________._.__.. Test Pit No. 1________________minutes per inch Depth of Test Pit._____f _._____. Depth to ground water_.___! �__�_.e___. Test Pit No. 2....... .......minutes per inch Depth of Test Pit______ Depth to ground water---____- U.. . . O Description of Soil........o•-- J lr o 7 5"E, :.`_� __S��s�'-' ' - 3 _ _ ii r •� ---- -- ---- - ��� ---- W -•--------------- -•-` `"`= `� `...`-'.-`--`---------�=-`=--- .............. .............................. 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 TITL2 5 of the State Sanitary Co —The u igned further agrees not to place the ystem in operation until a Certificate of Compliance been sued by the�bo 1-d of health. d. Si 2 •............................................................. A lication A roved B ... -- ---.................. Date Application Disapproved for the following reasons--------------------------------------------------------------------------------------------••--•------........-- ---._._....••-••-•••--••-•-••••-••-•-...••-•----------•--------------.....•1---•------------••----------•--'•-----•-------------------------------------•-----------------•---•-------- — Date--•--------- Permit No..... ,. • =�--•--- » Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD-HEALTH ...........j......1,7. ............OF... ` "y'^ ( C`��................ Trrtifiratr of ToutpliFanre , THIS IS-TO-CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by........................ �. ` ��` - �._.....--•-•-••................... .•---••-•---•••. t j`l�G Installer 1 �/ ' -- c�� L at --------•--•------••••••--••--••-•---•--••----•---•••-••-------•-------•------•--------• ---•- -=--•-•---•-------•--•-------•--....•---- has been installed in accordance with the provisions of TI T IE_ 5 of, e Sanitary Co�efa� described in the application for Disposal Works Construction Permit No---------��'............__ _____________ dat .................. _�_.__L_.._._.__.._______ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' � ` 7'�7........................................0 .OF..........:... ...........c� No...........:............. FEE........................ Disposal Works Tonotratrtion rruti# = �Permission ish reb ranted._. .: ._________.__ to Const uct o epai ) a Individual Sewage-Disposal Syst % ' �- at No.... �• • / \� = 1 •-•-•-•-•.......--.••....."'-•---------•-•------•-----•••--•••---•--•••----•--••----•--•--•-•-•--•...•••----••- Street as shown on the application for Disposal Works Construction Permit NS? -_7_. D ted"q./2�-�" ............. DATE Z Q....................................... • -•---•-- Board of Health ----- --•• ... ••--•- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS SYSTEM w � A 4 TOP FDN. FINISH GRADE EL . f?. o . FINISH GRADE OVER ::.e... FINISH GRADE OVER °' ' °• SEPTIC TANK :,. :;•° LEACHING PIT • ' VARIES r 3 OF 1/8" 12 MAX p ASHED PEA STONE PRECAST CONC. OR BRICK 6 MORTAR •...a•' °' 3" .J 17UT'LEt PIPE LEVEL TO 12" BELOW GRADE o:• ° FOR R FT. MIN. 0••'q:�°; e O O .Qo. .. e.•e.. a:.o' . .e::.e• e..•..o:e••e aq 0: :'0 • e a •.•'�; •o• .-_ .> a . . - -• ° .-r•.-r.•r*.. C. I. OR PVC TEES -.� � ,28 0 0•'' :O.D .D. •o •. a esMr. FLR. GALLON e : `' S TRIBUTION BOX .. ° • A' ' STALL ON LEVEL BASE " " PRECAST °. ....e..0: o... 4b PRECAST CONCRETE: w SHE O 1-1/2 H— ,0 REINFORCED CRUSHED CONCRETE o. ► STONE ° 's.o:e. .°;o-q•:n.•'e:o:•:a:d.e•,o.e:a..•p•.:o•. :e. .b::o.•o. 0.•0.a?.o:o°•.o•o,o..•°••o••,o.o� 'a :. • H— /0 REINF. :e d SEPTr ' 40 INSTALL EVEL BAa, ,;; . -'v,-AVA !'f V. OIR ° ° ° a ,t ASWW Ai-! . PER VIOUS — - s _-� ,� ✓ - MA TERM MWA FN INC L EACHING AREA s � Ole-PC .A/ /y CEEX�A VA TEO AW TEAL 1� rI T" �y EFFECTI VE DID AMETER PIT gyp/ v sX I"}TA'G a, SHOWN ARE BASED f.,W A. ALL wrt �t !> . l 0 + 9L'A4L TH MUS I rat MV . I W IS COMPLETE PRIOR PERCOL A TION RATE.' - MIN./IN. � ro -Y► r } .;� H.�N MUST E APPRp VED WITNESSED B Y.' 7= �+EAL T AND CA E 6 I SL AI NOS . eft • L L A TION SHALL BE I/w 4ffI41f THE STATE SANITARY BRD. OF HEALTH DESIGN DA TA z r, ._• 'F.F , - AND LOCAL APPLICABLE DATE. !TIONS , 1000 GALLON OM RECORD PL ANS AND o 5a.0 6 T` ' NUMBER OF BEDROOMS ' \� PRECAST CONCRETE l ? FOR SOLAR PURPOSES L o Q M t Loa .., t GARBAGE DISPOSAL A SEPTIC TANK ` i fE C 4p^c(y 5 �1 DAILY FLOW s SEPTIC TANK REO 'D. ►� a SEPTIC TANK PROVIDED f dy4 ?i —=—_. ss, LEACHING REQUIRED b PRECAST CONCRETE LEACHING PIT +� y� to #-s-,.e 1" c c » S%p �n 4, C' 4. SIDEI✓ALL AREA S. F. S. F.X G/S. F. = GPO �r R_ --._.• :> ;„� BOTTOM AREA = S. F. i S. F.X G/S. F. = GPD LEACHING PROVIDED GPD s' 4LPOSED ELEVA TION N o "NA f« ; so — 'FISTING CONTOUR SINGLE FA MIL Y RESIDENCE Ob.,+F•RVA TION PIT _ DIStRIBUTION BOX PROPOSED SENA GE DISPOSAL S YS TEM �F C V:d i JM/4tCS LEACHING PIT =' WTUND y) PREPARED FOR No. 29894 710 r o o SEP, C TANK ' h� Q L o-r _` fk r , MC SHA NE CONSTRUCTION CO . . ,. . LOT 1 OLD POST ROAD (R?I 9c' WE � t� of DAVID BA PVS TA BL E — MA SS . PIA.- INVERT ELEVATION , SA CKI 28085DA 'PLOT PLAN �� c�SrE o�, CAPE 6 ISLANDS SURVEYING, INC. r �,o G y, SCALE A S NOTED P. O. BOX 334 SCALE: 1 = `ti F �St. :;,,.�``� z si q MAP SEC PCL LOT HSE A.p PLAN NO.,S'1;-;4R TEA TICKET, MASS.