Loading...
HomeMy WebLinkAbout0606 RIVER ROAD - Health 606 River Road Marstons�Mills A = 061 034 --U-3-�. J THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA TOWN OF-BARNSTABLE SEWAGE # � LOCATION �:_ � ,, �r.,�_ VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE'NO SEPTIC TANK CAPACITY,. LEACHING:FACELn Y: (type) (size) :>•r;3 .z..=.' ' NO. OF BEDROOMS -BUILDER'OK4WNER = PERMITDATE: COMPLIANCE. DATE:. . Separation Distance.Betweenahe: Maximum Adjusted'Groundwater Tabfe'to the Bottom-of Leaching.Facility Feet Private:Water,Supply Well acid Leaching Facility. (If any wells exist on site or witfun 200 feet,bf.leaching facility), Feet s Edge.of Wetland and Leaching Facility(If any wetlands exist within 300 feet of:leaching facility) r_ Feet Furnished by - >� i I s . 1 > 1 a i TOWN OF BARNSTABLE {/ LOCATION SEWAGE # VILLAGE ,,L,'Z Il1r/6- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER,O WNER 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 .�G-�� ��� ., u .. � . ,. ffb� �17, = �,�` ,. rye 0 �, / y� ..�, -� ,�� , . _ ,, 3 — D / °2 Fee J� . o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIPPriratfon for Migpogal *pgtem Congtruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( V Abandon( ) El Complete System QIndividual Components Location Address or Lot No. /©/_ Of!llel Owner's Name,Address and Tel.No. Assessor's Map/Parcel / 13 tiI r l4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. calve �e 7 7j- ��z yY/ Type of Building: Dwelling No.of Bedrooms 3 Lot Size ti,�/.3 sq.ft. Garbage Grinder(Ad Other Type of Building ) No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ® gallons. Plan Date 2 7 ® Number of sheets / Revision Date Title 5j Size of Septic Tank Type of S.A.S. Description of Soil 3©�1Z Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue yth Signed _- Date Application Approved by Date Z a* 07 Application Disapproved for the following reasons Permit No. a Gd 3_ 7 Date Issued a0 o, ) UO3r0 / a Fee . .eta_�CHU,r THE COMMONWEALTH OF MASSSETTS Entered in computer: / Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pprication for 30igpozaY bpoterrt ConZtruction 3permit « h Application for a Permit to Construct( )Repair( )Upgrade( /Abandon( ) ❑Complete System ©Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 6�d o�1r�r r 9 Assessor's Map/Parcel �jJ�/5,�®�g Installer's Name,Address,and/Tel..No. Designer's Name,Address and Tel.No. oOwe cz7 , -7 7/-15WV 1 �� Type of Building: Dwelling No.of Bedrooms 3 '0��.;� i Lot Size 9.1 513—sq.ft. Garbage Grinder Other Type of Building oqe-%,V �' e/' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 3 O gallons. Plan Date Z 7 A,' Number of sheets 4 / Revision Date Title S 51 Ar Size of Septic Tank Type of S.A.S. Description of Soil oti�"4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuedr y this Bo d of,Health. Signed—' Datei!/r3/,v 3 Application Approved by 4 . Date '212 o it T Application Disapproved for the following reasons Permit No. UU 3" U.7 't Date Issued o/u 3 r ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site/Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )byf at / �. �� -�/'/� 5 has been constructed i�J accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?uo 1 0 72 date d�2 {?of 7 Installer Designer 121, The issuance toff tth`(s permit shall not be construed as a guarantee that the syste wi ldu'�c�o atdsigned. Date 31 Y 1 D� Inspector X No. 2-003"o72 Fee J y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi!6pogar 6potem Construction Permit Permission is hereby granted to Construct( )Re air( ),U grade( ✓)Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this-permit. Date._ a i a Approved by e/ 7Rt: &2zy Commonwealth of Massachusetts Executive Office of Enviromnental Affairs Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 .Jolui Gii aci D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket MA 02536 WILLIAM F.WELD 0 6 - 3 Governor Q, ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F PART A "<CI L k CERTIFICATION �� 20 Property Address: 606 River Rd.Marstons Mills yFglry9g2 °1�,9 Address of Owner: OFA�TgB Date of Inspection: 10114/91 (If different) � !F Name of Inspector: John Graci Mr.PeterZayka:133 School St.Acto Ma. 01720 1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: 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: X Passes This Inspection Is based on crlterla defined In Title V — Conditionally Passes code 310CMR16.303.My findings are ofhow the system is — Needs F th r Evaluation By the Local Approving Authority performing y at war�warranty guarame of the ntee�oftelellongevirycfthes - Feils septic system and any of Its components useful life. Inspector's Signature: Date: 10/28197 The System Inspector shall Ibmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. 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 of 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 M7197) One Winter Street 0 Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP ECTION FORM PART A CERTIFICATION(continued) Property Address: 606 River Rd.Marstons Mills Owner: Mr.PeterZayka:133 School St Acton Ma. 01720 Date of Inspection:1af14r97 — Sewage backup or.breakout.or high.static water level observed.in.the distrtution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: e Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance 3)Other (approximation not valid) D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage in 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 cloggedcesspool. SAS is in hydraulic failure. (revised 04127)97) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 606 River Rd.Marstons Mills Owner: Mr.Peter Zayka:133 School St Acton Ma. 01720 Date of Inspection:10114197 D]SYSTEM FAILS(continued) Yes No _ Static liquid leval 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due io clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable Ovate-quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is witl-in 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall 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. I (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 606 River Rd.Marstons Mills Owner: Mr.PeterZayka:133 School St Acton Ma. 01720 Date of Inspection:10114197 Check if the following have been cone:You must indicate either"Yes"or"No"as to each of the following: _X_ — Pumping information was requested of the owner,occupant,and Board of Health. x — None of the system components have been pumped for at least two weeks and the 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. X — As built plans have been obtained and examined. Note if they are not available with N/A. X — The facility or dwelling was inspected for signs of sewage back-up. X — The system does not receive non-sanitary or industrial waste flow. -x— — The site was inspected for signs of breakout. x — All system components, excluding the Soil Absorption System, have been located on the site. X 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. x — The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of x Sub-Surface Disposal Systens. Existing information. Ex. Plan at B.O.H. X Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)(15.302(3)(b)) ireylsed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 606 River Rd.Marstons Mills Owner: Mr.Peter Zayka:133 School tat Acton Ma. 01720 Date of Inspection:10114/97 RESIDENTIAL: FLOW CONDITIONS Design flow: 33o 9.P•d./bedroom for S.A.S. I. Number of bedrooms: 3 Number of current residents: o Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use es or no (Y : No) Water meter readings, if available:(last two(2)year usage(gpd): nla Sump Pump(yes or no): No Last date of occupancy:3 months ago COMMERCIAL/INDUSTRIAL Type of establishment: nla Design flow.o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: rda Last date of occupancy: nra OTHER:(Describe) nra Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped In the last year. System pumped as part of inspection: (yes or no)Yes If yes,volume pumped: 1000 gallons Reason for pumping: Maintenance. TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy 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 Information: 19a7 .Sewage odors detected when arriving at the site:(yes or no) No (revised Od127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 606 River Rd.Marstons Mills Owner: Mr.PeterZayka:133 School St Acton Ma. 01720 Date of Inspection:10114197 SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction:x concreate metal FRP Polyethylene—other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No Dimensions: Le'6^H5'7";4•to� (Yes/No) Sludge depth:4" Distance from top of sludge to bottom of outlet tee or baffle: 23" Scum thickness:t" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: Measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are atnuturally sound.Recommend pumping system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle:rda Date of last pumping, Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 2'6" Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction lineS— Diameter: 4••_ gvirnments:(conditions of joints,venting,evidence of leakage, etc.) {revised 0427)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 006 River Rd.Mar§tons Mills Owner: Mr.PeterZayka:133 School St Acton Ma. 01720 Date of Inspection:10114197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_m eta l_FRP_Polyethylene—other(explain) Dimensions: nra Capacity: ria gallons Design flow: !Ua galionslday Alarm level:_nra Alarm in working order?_Yes No Date of previous pumping: — Comments: (condition of inlet tee,condition of alarm and float switches, etc.) we DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: tiquidleveivvithbottomorpipe. Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) The D-box Is structurally sound. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)ver Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Na (revised 04127)97) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: BOB River Rd.Marsions Mills Owner: Mr.Peter Za yka:133 School St Acton Ma 01720 Date of Inspection:10114197 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: nfa Type: leaching pits,number: 1AO0 gallon octagon leach pit leaching chambers, number:Na leaching galleries, number: nM leaching trenches, number,length: rv__ leaching fields, number, dimensions:rda overflow cesspool,number:nia Alternate system: nra� Name of Technolo gy- Comments:(note condition of soil, signs of hydraulic failure,level of po_nd---, condition of vegetation, etc.) The leech pit is structurally sound and functioning properly.it was emp ty at the time of the Inspection it has not he more than T of water In it. CESSPOOLS:_ (locate on site plan) Number and configuration: nra Depth-top of liquid to inlet invert: nla Depth of solids layer: rda Depth of scum layer: We Dimensions of cesspool: rda Materials of construction: nra Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) nfa Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) We PRIVY: (locate on site plan) Materials of construction: nla Depth of solids: rda Dimensions: rda Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na (revlsed 0427)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 606 River Rd.Marstons Mills Mr.Peter Zayka:133 School St Acton Ma. 01720 10114197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 0R Q� �3 pevlsedOW271eT Pape 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 606 River Rd.Marstons Mllls Mr.Peter Zayka:133 School SL Acton Ma. 01720 10114197 Depth of groundwater 12, Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revised0027197) Page 10 of 10 ASES'k'-S MAP NO. r D 'z" PARCEL tt —AU L'O C. A T ION jive-r S E A G E PE RMIT N0. VILLAGE i`r/G� - rec 0 � INSTA LLER'S NAME i ADDRESS i ,S7--, sZ A.I U I L D E R OR OWN ER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �4 /A ll V J N .o.�51tJ..:��. Fps����.�.................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �k pliration for Disposal Works Tonstrurtion Frrmit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System at: Location-Addres o or Lot N . ---------•_:. _t'' . . .: `t� ----------------------------------- --�:. ©:..�'�_9s....9. ...._. .1._.7..1.h..n.'� .....,............ Owner y S1. ' Address j ------ �ect �.!'1�. .....................................^........ , ......L7....1_1. .PR [..4............ -.- Installer Address Type of Building ze Lot....11K, t ...Sq. feet Dwelling—No. of Bedrooms.... Expansion Attic ( Garbage Grinder (i✓0 aOther—Type of Building V9. ; r. No. of persons............................ Showers ( ,�� Cafeteria ( ) Other fixtures .__... --------•---•----------------------------------------------- d ---• -• Q < W Design Flow__._ ._.._.._..�,tC�.gallons perer day. Total daivy.flow.........................gallons. WSeptic Tank—Liquid capacity/0-0 S1.galloris Length_ ___�_`_._ Width.. ..._-.... Diameter................ Dept h.-.._If---- x Disposal Trench—No..................... Width........_........... Total Length................_... Total leaching area....................sq. ft. � Seepage Pit No......../--------- Diameter....... _4..... Depth below inlet........5........ Total leaching are , za.sq. ft. z Other Distribution box ( io-l� Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1..42,..minutes per inch Depth of Test Pit..../__#9......_.. Depth to ground water..Yns./,!lti __.s�N(. fs, Test Pit No. 2................minutes per inch Depth of Test Pit......IV...... Depth to ground Phi --- -----•. ---. Description of S il...�..�_i-- -•.1Qlz.......-- Q ��� �� � _.a� C ��lam._^ '_. -•• . r, VNature of Repairs or Alterations—Answer when applicable............................................................................................... -------•.-•-----------------------------------••---•-.....-•-•-•--•-------------•--••---•-----...-••----•-------------------------------••--•-----------------•--.•••--.---•--_....-------•-•-••-•-•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 5 of the StatPhen The undersigned further agrees not to place the system in operation until a Certificate of Compliad by the and health. -- . �'_--------------- ---- ------------------•--...Date ApplicationApproved By----•- - ------------------------------•-----------•-- .................... Date i Application Disapproved for the following reasons:•-------•-----••----•----•-•-----------•----•--------------•------•-•-•---._....----------...---------•--•-•••-- ---------•-•--•--------------•---•-••----....._....--------....-•--------....--•---------....---•--•-----.......--•--•------•----•-------•-•............................................................ Date PermitNo................................................... Issued-....................................................... Date • I I� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ...........OF.. 7�"�4!'1-S"%'/ � !�-..................................... Applira#ion for Disposal Works Tvustrnr#iun rnmit Application is hereby made for a Permit to Construct "NI" or Repair ( ) an Individual Sewage Disposal System at: y Location•Add or Lo No. any .f' . �. s' �---------------------------------- a, k....-' r :..t..� z.q. .�l.�s..--- --• ---•----•--- �-y Owner Addres7� rr / ••-_._V_........� .'a l�f:!�t..`.'......................•-••-•-••-....__....------ -..........._.17 :�iH_r-r_�.....��'._I..:.......:_ -7a............................... Installer Address Q Type of Building $ize Lot.... ----Sq. feet Dwelling—No. of Bedrooms___..._..._...............................Expansion Attic (� Garbage Grinder ?V/0 aOther—Type of Building k&t?�__I�_I'�"""�_ No, o persons____________________________ Showers (, ) Cafeteria ( ) Other fixtures ------------------------•---•--_ —� a•------------- < r :r r Design Tank—Lim .........../.A, --gallons pe>'` n1per day. Total daily flow.___._._.__��._+.��.__-�1�..............gallons. t"' .•- i p —Liquid capac>tyfDt�agallons Length._____�.____. Width________________ Diameter................ Depth........... W Disposal Trench—No ____________________ Width______..____._______ Total Length.____._.____.__.____ Total leaching area....................sq. ft. x , Seepage Pit No......./---------- Diameter...... 4__.... Depth below inlet____SS7: .._. Total leaching are' %.-.?d_.sq. ft. z Other Distribution box ( V11" Dosing tank ( ) aPercolation Test Results Performed by--•-•••---•-••••-••••--•-•-•-••--....••-•••••••••••---•-•--••. --••_._. Date........................................ Test Pit No. I..-<__?-____minutes per inch Depth of Test Pit..-./ ......... Depth to ground water__ UE___ n►C- 44 Test Pit No. 2.................minutes per inch Depth of Test Pit_____/,?........ Depth to ground waterzV. 0� __AMC. P4 ----------. .DescriptionofS il__ _.'�_ � _ r��4 q_ /4 -- ---/ � � / r_ - --- 0-- ..- 7 ��� :.-�3-- U i ! 0 _ � ' `3 . 0 � � _ t1 . � -� ---------------------------------------------------------------------------------------------------------------•-------•--•----•-----------•-•--•------.... 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 TIT1Z- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h ed by the oard of health. i Si ned_. __ _.__ . _ . g ,tom..::: ! _____________ Application Approved By.._r_- `r_��s_••-•_ ` �- Date -------------------•--•-------•-•-•--•-••----••--•••••-- { 1 -•••••--•----- Date Application Disapproved for the following reasons-----------------------------•-••----------------------•--------------------•--•-----------•-••••-•--------•-•-- _.._._..--•---•--------------•-------....-•--------------.....---•------------•---....__...--•---------....--•----------------------------------------------------------------------------------...••---- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntifiratr of Toutph anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed,( ) or Repaired ( ) 1:� 1G+N --•--•------------••---•---•--._....-•-------------- (/ V Installers at. --------------------•• -r•--------_- 1 -••-- ----•------•---••-............................................... ti has been installed in accordance with the provisions of TITLE j of The State'Sanitary Code as described in the application for Disposal Works Construction Permit No.........................'"_ dated-_..____�.�" _________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL ION SATISFACTORY. DATE.................... .............. Inspector.�----------------------------------•------------•--...-----••---•---•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C> k,rrJ OF . ' I c ... NO.__._ ?.:.:....e a FEE.: c............... Disposal Works Talansirnrtion amii Permission is hereby granted.... ������^ to Construct ( ter Re air ( / ,) an In ividu4 Sewage--Disposal System at No.---• •�__45(•- ......................jc2�-1i'-. =.................................... JStreet " as shown on the application for Disposal Works Construction Permit No .% ------- Dated_._.l 'r` � -•••------•••--_•-•-••=-_ .................................. DATE...............•... ..................................... Board of Health FORM 1255 A. M. SULKIN, INC.,-BOSTON - I { TOP FNDN. AT EL. SYSTEM PROFILE TEST HOLE LOGS 71 .1 ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO ENGINEER: STETSON HALL, RS �p MINIMUM .75' OF COVER OVER PRECAST /` WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 71 .1 WITNESS: JOHN JACOBI 2" DOUBLE WASHED PEASTONE DATE: _ 8/15/83 I 1' RUN PIPE LEVEL j FOR FIRST 2' PERC. RATE _ < 2 MIN/INCH EXISTING 1QQQ GALLON SEPTIC 67.7'±* 68.1 CLAS'S I SOILS p# 2279 1 TANK (H- 10 ) GAS BAFFLE o000 4 E� E� 0 ED 0 E1 E� E� 67.58 0 67.27 aoocl o aclaa FRRo 6" CRUSHED STONE OR MECHANICAL �, , 0 0 o a ca o o ` „ 4 ELEV., ELEV. COMPACTION. (15.221 [2]) off$ 2 M M r 0 65.27 70.0 ' 0 Q 69.7 j DEPTH OF FLOW 4 ( 1 9 SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE TEE SIZES: TOP AND TOP AND INLET DEPTH 10" SUBSOIL SUBSOIL OUTLET DEPTH 14" i 1 3' 67.0' 3' 66.7' LOCATION MAP NT5 LEACHING ASSESSORS MAP 61 PARCEL 34 FOUNDATION EXIST. SEPTIC TANK 12' D' BOX 16' FACILITY 7.57 *CONFIRM SEPTIC TANK INVERT PRIOR TO INSTALLATION OF ANY PORTION MED OF SEPTIC SYSTEM MED SAND SAND PROVIDE 1% PITCH THROUGH SYSTEM 57.7' h I i I . 1 _ �o 12' 58.0' 12' 57.7' _i NO WATER ENCOUNTERED NOTES: 1 . DATUM IS ASSUMED SL'PTIC DESIGN. (GARBAGE DISPOSER Is NOT ALLQWEp ) DESIGN FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD - -"wi�r�E �i vv,11 try .; ,vy 2.3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. LOT 2 USE A 330 GPD DESIGN FLOW 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 46.513f SQ. FT. 1.07t ACRES S'7_PTIC TANK:' 330 GPD ( 2 ) = 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. + 67s USE A 000 GALLON SEPTIC TANK (RE-USE EXISTING) ENVIRONMENTAL CODE TITLE V. °' ,5 LEACHING: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT �,j�► EXIST. DWELL. ,�� 2(30 + 9.83) 2 (.74) - 118 TO BE USED FOR ANY OTHER PURPOSE. 9.7 TH1 67 SIDES: TH2 °' 30 x 9.83 (.74) _ 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. TOP FNDN = 4.4 BOTTOM: 71.1' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT *67.4 TOTAL: 454 S F 336 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 6S DRIVEL 70'0 � s USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. 70s - 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PIT 7oe EQUAL) WITH 2.5 STONE AT SIDES, 4 AT ENDS AND 5 „ * 66.5 x becK } ' BETWEEN UNITS +- 67.0 70.4 ^ �Z. cv ` '0 69.9 9 rn \\ // i \ / �72.o LP 1.7 / +69.3 LEGEND TITLE 5 SITE PLAN m\ 3.0 ��,� 0 ^ x x-�71 �0 100.0 PROPOSED SPOT ELEVATION OF \ 6 .3 + 69. �P 4 71.5 ENE x 606 RIVER ROAD 100x0 EXISTING SPOT ELEVATION WP + 7 .5 IN THE TOWN OF; 6'°.0 o BENCH MARK - NAIL SET + 75 ;I MO PROPOSED CONTOUR ( MARSTONS MILLS) BAR N STAB LE rn 0, ELEV 73.5 ^� + 71.$ IN 7" OAK. = 1 s s 1p0 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI "p \\ .15 ---73 ^ 71.0 CONSTRUCTION/HAMIL.TON-MILNE �d \\ + 73.3 I 30 0 30 60 90 70.0 BOARD OF HEALTH In 6 $ + 727 MA SCALE: 1 " = 30' DATE: FEBRUARY 7, 2003 r APPROVED DATE s � 69. off - _ ^ fox 508362-9880 71.3 .2 down cape engineering, Inc, k\� OF MgS�c ��tN of , �r A H.E SRN!H. CIVIL ENGINEERS �r to r VIL LAND SURVEYORS �o Ao.2 _ 1710 3 939 vain st, yarmouth, ma 02675 AR OJA AE.N S. DATE r_.-. 7,- 1,5- 1-:'e6 71 -19 30 0�1 7�1 7 19 -E L TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 4c 4—' 47-7777 CAST IRON " OR SCHEDULE 482 MAX. 2 MAX. P.V.C. PIPE PITCH 1/4"PER. PIPE - MIN. LEACH PITCH 1/4"PER FT PIT PRECAST LEACHING NVERT PIT OR E L INVERT INVERT SEPTIC TANK DIST w EOUIIV. BOX INVERT I . . v GAL. INVERT - u a. r- -� 3/4"TO I VZ EL.%.57 -7., INVERT *,�'# U.13 E WASHED ww Oisr N w /Oz STONE WDIA. DIA. (6�T—UN WATER TABLE PROF1 LE OF f` r \ a� SEWAGE DISPOSAL SYSTEM NO SCALE e e-49 SOIL LOG WITNESSED BY : DATE TIME. —7411V1 BOARD OF HEALTH A TEST HOLE I TEST HOLE 2 ENGINEER d- 7777,77 - DESIGN DATA : NUMBER OF BEDROOMS TOTAL ESTIMATED FLOW GALLONS/DAY BOTTOM LEACHING AREA SO.FT. /PIT SIDE LEACHING AREA SO,FT.j` PIT GARBAGE DISPOSAL .(50% AREA INCREASE) TOTAL LEACHING AREA . SQ.FT K. PERCOLATION RATE . MIN/INCH LEACHING AREA PER PERCOLATION RATE-Z� 9�? SO.F (YZ' WATER ENCOUNTERED NUMBER OF LEACHING PITS APPROVED BOARD OF HEALTH . . . . . . . . . 4/ . 4 DATE . AGENT OR INSPECTOR S I TE PLA ,1�1 MA PS TONS V1 LL V/ A vi "'N FOP AE -EY ST SO .H AS 5 No. 23100 pro ?-V L ED VA TTSCN 1"24 PiVrrW PETITIONER PRECAST a A NG p 7 L P T OR I EOUIV_ I V, 3/4 To WAS HED STONE 2,