HomeMy WebLinkAbout0072 STONEY POND CIRCLE - Health 72"Ston6y�Pond .C f r C. �-
Ma-rstoris Mills
A= 065 - 026
1
-\ COMMONWEALTH OF NLASSACHUSETTS
x EXECUTIVE OFFICE OF ENVIRONMENTAL.A.FFAIRS.
DEPARTMENT OF.ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL. INSPECTION FORM—NOT F.OR VOLUNTARY ASSESSMENTS
SU-BSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property._Address: l!x/1e,&
o
<r
Owner's Name: zi
C I s A al
Owner's Address:
Date of Inspection:
v/ [r
Name of Inspecto3
Company Name. ( g�rt _r
Mailing Address:
a�
Telephone Number:
CERTIFICATION STATEMENT
.1 certify that I have personally inspected the sewage disposal system at this address and`that the information reported
below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on;site sewage disposal systems. I am a DE.P
-approved system inspector pursuant to Section 15.340 of Title 5(3.10 CMR 15.000). The system:
Passes '
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
• cs
Inspectol'S S1bYlatL3?£: . _`�-�----- Date: 6to
del
5
The system inspector shall submit: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,insper_tion 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
r .
Page 2 of l l .
OFFICIAL INSPECTI.ON;FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM
PART A'
CERTIFICATION (continued)
Property Address: . I �
Owner• . _Q' elf
Date of Inspection: I
Inspection Summary: Check A,B,C;D or E ALWAYS complete all of,Section D
A. System Passes:
VI have not found any information.which indicates that any of the failure.criteria Jdesc rib ed in 310:CMR'
15.303 or.in 310:C1vIR 15 304,.xist. Any failure criteria.not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components.as described in the"Conditional Pass"section.need to be replaced or
repaired.The system,upon completion of the replacement or repair; as approved`by the Board of Health,will pass.
Answer yes,no or not determined(Y,N;ND).in the for the following statements.,If"not determined"please
explain..
The septic tank is metal an&over 20 years old- or the septic tank (whether inetal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or,tank failure is imminent:System will pass inspection if the
existingtank is replaced with a.com 1 in-septic to P p y � p yc, nl..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 our or high static water level in.the distribution box due to broken or:
obstructed pipe(s).or due to.a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board.of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced .
ND explain:
The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will
pass inspection,if(with,approval of the,Board of Health):
brokenpipe(s),are replaced
obstruction is removed
ND explain:
Pave 3 of l 1
OFFICIAL RiSPECTION FORM -.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM'INSPECTION FORM .
PART A
CERTIFICATION(continued)
P roperty:Address: 7N) f�
Owner: 40
Date of`Inspectit n: A
C. Further.Evnlpation 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 failinor to protect public health; safety or the environment.
1. System will pass unless Board of P.ealth determines.in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health,safety and the environment.
Cesspool or privy is within 50 feet of a'surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public,Water Supplier, if any).determines that the
system is'functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is,within 100 feet of
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 l of a-public water supply.
The system has a septic tank and SAS and the SAS is within 50 fe-et of a private water supply well.
The system has aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply.well". Nlethod used to determine distance
"This system passes if the well water analysis;performed at a DEP cerfified 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 most be attached to this.form.
3 Other:
3.
Page 4 of. 11
OFFICIAL INSPECTION FORPvI-.NOT,I+OR VO)LUNTARYASSESSMENTS
SUBSURFACE,.SEWAGE DISPOSAL.SYSTEM INSPECTION:FORM .
PART A.
CERTIFICATION(continued):
Property Address: 4", �J 4.,W J>
-owner: .�
Date-of Ins ection:
P 'zi-
4. :_�CKXIO
D. System Failure Criteria applicable to all systems:.
You must indicate-"yes" or"no"to each of the.fallowing for alf inspections:
Yes Not
— _�✓ Backup of sewage utto.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
cloaRed:SAS or cesspool ,
— Static liquid level in the distribution box above out invert due to an-overloaded,or.clogged SAS or
I cesspool
_ t✓ Liquid.de,pth in cesspool is less.than 6"below invert or available volume is Iess than %z day flow
Required pumping more than 4 times in.the last year NOT due to closed or obstructed pipe(s).Number
[� of times pumped
_ Any portion of.the.SAS',cesspool or privy is below high around 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 ofa cesspool.orprivy is within a.Zone l ofa.public well.
_ —} Any portion of a cesspool oi privy is within 50 feet of a.private water supply well.
t! Any-portion of a cesspool or•privy is:less than 100 feet but grccater than.50 feet.from a private water
supply.well.with no acceptabie,water.quality.analysis..[This system.passes if the well water analysis, .
performed at:.a DEP.certified laboratory, for coliform bacteria and volatile organic' compou,nds
indicates that the.well.is free from pollution from that.facilityand the:presence.of ammonla
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.]
(Yes/No)The system fails. I have determined that one or'more of the above failure criteria.exist as
described in 310 CMR 15.303,therefore the system fails. The.system owner should contact the Board of
Health to determine what will be necessary-to correct*the failure.
E. Large.Systems:
To be considered.a large system the system mustserve a.facility with a design llosv.of 10,000 gpd to.15,000.
gPd
You must indicate either"yes" or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no -
- _ the system is within 400 feet of a.surface drinking water supply
_ the system is within 200.feet.of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead.Protection Area—IWPA)or a mapped. .
Zone Il of a public water supplywell.
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 3.10 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
Pane 5 of 1.1
OFFICIAL INSPECTION FORM—NOT FOR°VOLUNTARY ASSESSMENTS
SUBSURF ACE SEWAGE DISPOSAL SYSTtj M INSPECTION FORM
PART P
CHECKLIST
Property Address:
Owner:
Date of Inspection: f 1—cl)j, Cic 506
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 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 avai]Me'note as IVA)
Was the facility or dwelling inspected for siorns of sewage back up ? '
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 th 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
L_ Existing information. For example, a plan at the Board of Health.
V-11" 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 I I
OFFICIAL-INS FORM.—NOT FOR VOI,Ulti x° ;I2Y:ASSESSMENTS
SUBSURFACE SEWAGE I)ISPOSA.I SYSTEM INSPECTION FORM
PART;O
SYSTEM INFOR.MA.TION
Property Address: s ".Lt
Owner.
Date,of,Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms:(design): .�. . Number of bedrooms(actual).:
DESIGN flow based;on 310'.CMR 15.203 (for example: 11.0 gpd x 4 of bedrooms): .
Number of current residents:._
Does residence have a garbage grinder(yes or no);
Is laundry on.a separate sewage systen)(�Y es or no): (J.[if yes separate inspection required]
Laundry system inspected( es.or
Seasonal use:(yes or no):
Water meter readings; if av ilable (last 2 years usa.ae(gpd)): �® n"�57,Ae0
Sump pump (yes or no): / � �.(� t .
.Last date of occupancy:
COMMERCIAL/IND USTRIAL./NJO
Type of establishment:
Design flow(based on 310 CMR 15..203): gpd
Basis of-design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no);_
Industrial waste holding tank present(yes or no):-
Non-sanitary waste discharged to.the.Title 5'system (yes or_no):
Water meter readings; if available;
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: k ,n
Was system pumped as part of the Inspedion(yes or no): ,
If yes, volume pumped: gallons--How was quart ity pumped determined?
Reason for pumping:
TYP 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 ally)
_Innovative/Alternative technology.Attach a copy of the current:operation and maintenance.contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate ale of all components, date nstalled-(if known)and source of information:
Were sewage odors detected whenarrivin at the-site (yes or no%
Page 7 of I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBS�UP.FACE SEWAGE DISPOSAL'SYSTEM INSPE CTION FORM
PART C
9YSTEM.INFORMATION (continued)
Property Address:
Owner:o/ '
Date of Inspection: �a� A) D./, �C;k` (
I31UILDING SEWER (locate,on site plan) /v d
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: l (locate on site plan)
Depth below wade:
Material of construction: .i."concrete•metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance (yes or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth: 10
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: ]
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to botto of outlet tee or baffle:
How were dimensions determined; PA
Comments (on pumping recommerldationsrinlet and outlet tee or baffle condition,.structural.integrity, liquid levels
related to outlet invert, evid e of le age, etc:):
/ Q �
GREASE TRAP (locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimen"sions:
Scum thickness:
Distance from top of'scum to top of outlet tee or baffle,
:Distance from bottom*of scum to bottom'of outlet tee or baffle:
Date of last.pumping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert, evidence of leakage, etc.):
Page 8 of I
OFFICIAL-INSPECTION FORM—NO:I`.FOR VOLUNTARY ASSESSMENTS•
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date of Inspection: _ �� e�,)C669
TIGHT or HOLDING TANK:,(tank n ust be pumped at time of inspection)(loc.ate on,site plan)
Depthbelow grade:
Material of construction: concrete metal fiberglass polyethylene other(explain);.
Dimensions'.
Capacity: gallons ;
Design Flow: gallons/day
Alarm present.(yes or no):.
Alarm level`. Alarm in working order(yes or no):
Date of last pumping:
Comments(condition.of alarm and float switches,.etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site.plan)
Depth of liquid level above outlet invert �-f`
Comments note if box is level.and distribution to�outletsal,.any evidence of solids carryover, any evidence of.
erakag�into or out o box„etc,: R &
OAel
41 - 7
e
PUMPCHANIBI R:. (.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.):.
Page 9 of I 1
OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAC�,MSPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATI ON-(continued)
Pro ert Address: , w
• Oivner•
Date of Inspection: J z:V, 06OG
SOIL:ABSORPTION SYSTEM (SAS): locate on site plan,excavation not required)
If SAS'not located explain why:
Type F.
leaching pits,number:
-leaching chambers,number:
aeaching. alleries, number:
leaching trenches,"number, length:
leaching fields,number, dimensions:
overflow cesspool,number:
:innovative/alternative system. Type/name of technology:
Comments.(note condition of soil, signs of hydraulic failure, level offpondina, damp soil,condition of vegetation,
rr
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on*site plan)
Number and configuration:
Depth'=top of liquid to inlet invert:
.Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of.groundwater inflow(yes or no): .
Comments (note conditiorrof soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc:):
'PRIVY:. (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure,level of pondina, condition of vegetation, etc.):.
9
Page 10 of l l
OFFICIAL:INSPECTION FORM=.NOS' IFOR VOLUNTARY ASSESSMENTS .
SUBSURFACE SkWAGE DISPOSAL SYSTEM-INSPECTION FORM
PAIN,C.
SYSTEM NFORMATION(continued)
Property Address, ��� !/1
Owner:
Date of Inspection:. r-,D 4 0
_ a
SKETCH OF SEWAGE DISPOSALSYSTEYI
Provide a sketch of the sewaze disposal system including ties to at]east two permanent reference-landmarks,or
benchmarks. Locate all wells within 100 feet:Locate.where public water supply enters the building.
Yve
G-c '
ce)100
V c �
:!Sep
� ya
a c f l l0a+,Of)
0
X Ca
Pagel 1 of l 1
OF,FFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: `7 � �
. W o l q
Owner:
Date of Inspection:
SITE EXAM
Slope
Surface water
Check:cellar
Shallow wells
Estimated depth to:ground water �'• feet t -
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:
Checked with.local excavators, installers- (attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
s Y! 00 ely A ' c
Je
ll
Permit Number: Date:
Completed by: l
HIGH GROUND-WATER LEVEL COMPUTATION
Site Location: �i ��� �✓/�/( ���•� Lot No.
Owner: 1Y-WA0_.J y Address: y
Contractor: Address: � ✓d1 STEP 1 Measure depth to water table -
10491�
tonearest 1%10 ft. :..............................................:..............................: :Date.,.
month/day/year
STEP 2 Using Water=Level`Range Zone
and:Index Well.Map locate
site and determin.e:
"0 Approprlate:index well................:...................................
OWater-level range zone .....................................................
B
STEP 3 Using morithly report "Current
. _....
.. ...:.Water Resources Conditions"
determine current depth to
water level for index well ........................... 7�
month/Year
:..
STEP 4 Using Table:of Water-level Adjustments
for index well (STEP 2A), current depth
to water-level for index well (STEP 3),
and water-level zone (STEP 26)
determine water-level adjustment .......................................................................................... `
STEP. -5 Estimate depth to high water
. ... .
by subtracting the water-
level adjustment (STEP 4)
from measured depth to water
level at'site (STEP 1) ................................::...........................................................................
Figure 13.—Reproducible computation form.
15
i
lap
N _ Fss
. �..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
5E Alipfiration for Ui-npmiai Works Tomitrnrtinn Famit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: _ \
------- ocation`-�\ dress �]:!t No. i.
Own r Address
Installer Address �•- !,
U Type of Building Size Lot...ZE.44 Sq. feet
., Dwelling l No. of Bedrooms_____________3---------------------------- Attic (�� Garbage Grinder
aOther—Type of Building ---------------------------- No. of persons--------------_------------- Showers ( ) — Cafeteria ( )
Q' Other fixtu es ---------------- -------------
W Design Flow................ .................gallons per person per day. Total daily flow.......3-_'�a-___:__--.___-__--__ --gallons.
WSeptic Tank—Liquid capa6ty)-00-0.gallons Length---------------- Width---------------- Diameter....------------ Depth................
x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area........ .......so. ft.
3 Seepage Pit No--------I----------- Diameter-------6...-..... Depth below inlet.................... Total leaching area._?_ ......s . .
Z Other Distribution box ( ) Dosing tank ( )
'" Percolation Test Results Performed b Q �� (�-_ --_- Date...................................
a y----------------- ��--- •------- '-�
Test Pit No. I----- .......minutes per inch Depth of Test Pit.................... Depth to ground water----- G-
Li. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-..___-..___-___---__._.
---•-•--••-------,--------•------ -...........:...
O Description of Soil------... C9 7- -------------
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 TITLE 5 of the State Envi nm tal Code—The undersigned further agrees not to place the
system in operation until a Certificate of Com }' has bee ue he board of health.
Siged --- ------ -- ---- . -------- -------------------------------- ---------------------------------:------
Dace
Application Approved BY < +- -- .... --------------------------------------------------------- 1...•--133,e ^....
Application Disapproved for the following reasons: ............................... . ................ ... . ...............................................
L ------------------------------- -------
---.....-----------------------
--..._C.------------------------------------------------------------------------------------------------------ ------ -------------------------------
Permit No. ------- --L/--- f = Issued ..... e......
f Dare
6 � -
i
THE COMMONWEALTH OF MASSACHUSETTS
(S ��� BOARD OF HEALTH
TOWN OF.BARNSTABLE
t
Appliratiou for Uinpuuttl lVgrkii Tomitrur#tnn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at• 6 _
..............
( ocation<JA< dress or Lot No.
Owner Address
.. ----------------
Installer Address ' 1
Q Type of Buildin�' ,. Size Lot---76 $._?�_.....Sq. feet
aDwelling- No. of Bedrooms.............J.._-_---_--____-__________.Expansion Attic ( ij Garbage Grinder ( ) IVO
QI Other—Type of Building ............................ No. of persons............................ Showers ( ) - Cafeteria ( )
Other fixtures ----------- - -I .---- -
- f
W Design Flow.................5�................gallons per person per day. Total,.daily flow._-._. ,.3' _._.�..................gallons.
W Septic Tank—Liquid capacity).00.0-gallons' , Length________________ Width---------------- Diameter"'-.------------ Depth................
x Disposal Trench—No. _._.... ........... Width.......... Total Length.................:: Total,leaching area____._._.._.__......s . ft.
' Seepage Pit No--------)i.......... Diameter.____.__. ..._. Depth below inlet.................... Total leaching area.60?......s�f
Z Other Distribution box ( ) Dosing tank,(
''" Percolation Test Results Performed b t �_ �!�......_.N.. -P.... Date.____---�_Q... ../___.--E.
W Y ' :�-
Test Pit No. 1------____------minutes per inch Depth of Test Pit_________________ __ Depth to ground water.....
..._.. ��_
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Ix O 4 VV ----...........................................•-----------------•-••-•--------.............
_.. ---
xDescription of Soil.----------�--�-�--'------�................... ��-- - --�1'--.1!?---------��-i--�r--------------------------------------•--------------•----•-----
----------•-------------�r=I. - ' - ` = Z................................................................. .............
c.� --
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 TITLE 5 of the State Envi �in tal Code—The undersigned further agrees not to place the
system in operation until a Certificate of Com iti
s has beeri�usued-�-b'y�the board of health.
Siged ... --------- ---- ^-'' --- ------------------
Dare ,/
Application Approved By .............. ...... ------------------ - �...--- ���6✓
Application Disapproved for the following reasons: .. ......_... ............................. .- ...................................................................
--------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- -------------- ........................................
Permit No. ....... ..� ....'...." --.-----(/ -'�. Issued ........................... ..............................te......
------------------------------------------------------------ --------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Te>r#ifirate of Complianre
THIS IS TO CERTJFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ---------- Z\ ............. ---------------Inare-------------------------------------------_...._...------------------------------------------------------.........
llcr
at ............ '_f� .. ......... r�'lP�.� c � ...`Cyr- ' , 1 - .......... .... ....
has been installed in accordancevw/ith the provisions of TITLE of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..._ --L/_- f.-- ... --------------- dated .-----------.__-_...__..------ ......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...... .,/.............. ..� - /..� .----------------- Inspector-- % - -------
V
--- -------------- --------------------------------------------------------
a�-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
p TOWN OF BARNSTABLE /
19WIT11 tl ` urk �n�tu r r#Uan rrnti
Permission is hereby granted..........i\_\C.- _� �--------------------------------------------•-------..-------..-.---
to Construct O or Repair ( ) an Individual Sew e Disposal System
at No. ... ... -----ram."•`�'"' ----- <.Gi.,._...._(�n 'l_r..`..
Street //
as shown on the application for Disposal Vl orks Construction Permit No.k, -.:l-_.:___.__ Dated...................................._._....
....C)
Board of Health
------------------------------------------
DATE--------------- 2 9 -- ----------•-------------.
FORM 36500 HOBBS&WARREN.INC..PUB 1SHERS
------------
I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE
8 IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL
STANDARDS FOR THE PRACTICE OF LAND SURVEYING
IN THE COMMONWEALTH OF MASSACHUSETTS
----------- ---------
PAUL A. MERITHEW, RLS DATE
LOT
8
tK'
Ti
LOT 160
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PAD
PROJEC T L OCA TION
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Q) 609 GAR. STONEY POND CIRCLE'
300� �� �i / y g 1� °_ o / 212 1 \���_,�� �i� \`. . \ MARSTONS MILLS, MA.
Lj�?L��j?�?, ®R Ii �. ���, gol.41 APPLICANT•
JOHN BRITTON
79-03,58"E
)1A NKEF SUR VE Y CONSUL TAN TS
STONEY <
P. O. SOX 265
PONDw UNIT 5, 40H INDUSTRY ROAD
MARSTONS MILLS, MA. 02648
CIRCLE PH.(508)428—0055 — FAX(508)420-555J
LOT 9 OF A
U L ILUAM I SCALE:- I"=30' IDATE: 12128193 _I
lVIERIAT.
E ' ;EBERMACD H
No. 32098 140. 23 1 I?E-V. RE v-
IST q-
L L JOB NO. .'50421 SHEET I OF 2
TOP OF FOUNDATION
e
,20' MIN.
10 .min 2"LAYER OF '
�nlL ErC �'✓✓EIS'
EL 50
FINAL GRADE 52 ORIGINAL & F r/e"-1/z"
/ , , , , , , , , , , , , , , , , , , , —7-�-7 FINAL GRADE' CONCRETE COVERS WAS ED STONEEL ORIG N5 L &
/ .
4" CAST IRON Iz'iYtAX , FINAL GRAD
OR SCHEDULE 40 EL 49 4" SCHEDULE 40 P. V C. 12»
P. V.C. PIPE
20 MIN. PITCH 118 PER FT. DIST. M N. EL 49.5
7
Box
PITCH 1/4 PER FT. FLOW LINE 10'
INVERT 1 10"
19" ' / PEFCAST
EL.=_4 9. 4 — MIN. INVERT � 2,� g LEA IT OR
INVERT EL.= ' 8t 71 W� J0 EQUIVALENT
EL.= 48. 96 -- LEVEL c _ LIQcc
INVERT INVERT INVER o 6' 3/4" TO 1-1/2"
_I_0_0_0 WASHED STONE
____GALLONS EL.=_4$ EL.=_48.2 EL.=_48—_ oc 0 -
SEPTIC TANK o W c`
EL.= 42
LEACH PIT I -----
3' e' 3'
PROFILE OF 12'DIAM.- —
DISPOSAL SYSTEM
SEWAGE - - - - - - - - - - - - -
NOT TO SCALE BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL= 38' _
R
ALL ELEVATIONS ARE ASSUMED
SOIL LOG
WITNESSED BY: J. DUNNING
P6111
GENERAL NO TES PERCOLATION RATE 2 MIN/ INCH
1. THIS PLAN IS FOR REPAIR OF SEWERAGE DISPOSAL SYSTEM. '
2. PLAN REFERENCE BOOK 432 PAGE 32, LOT , BARN. REG. DEEDS. DATE 10�4187
3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM TEST HOLE I
AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. EL — 50' DESIGN DA TA.-
4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS
FOR THE SUBSURFACE DISPOSAL OF SEWAGE. NUMBER OF BEDROOMS 3
5. ALL CO VER TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 7oS sue
12" OF FINISHED GRADE. SOIL 00 GARBAGE DISPOSAL NONE
6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE o o MED. SAND 330
SAME, UNLESS NOTED BY FINAL CONTOURS. ° TOTAL ESTIMATED FLOW GPD
7ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 00 ( 11 D__GAL./BR./DA Y x _ 3 _ BR.)
j OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER °
OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING °°° SEPTIC TANK CAPACITY _ 1000_
SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING. °8°
UNLESS NOTED. 00o LEACHING AREA REQUIREMENTS
' 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL EL 38 °°° NO WATER. r;�p�A A Oi 44sfq yY 2 5
BE MORTARED IN PLACE. ,� � SIDE ALL AREA _ _ GAL/S.F.
9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH ENCOUNTERED ';: dIL��AR9 sc BOTTOM AREA _ Q GAL/S/F
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO ` 'o liE3ERMaN T
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. No. "3 71 = LEACHING CAPACITY (BOTTOM & SIDEWALL)_6'78 GAL.
9 _ o
10. THE EXCAVATOR�CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UNDERGROUND 9 F Sr s 3 ( 3.14 X 6 X 12 X 2.5 ) f ( 314 X 12 z X 1. 0 = 4 )
UTILITIES PRIOR TO ANY EXCAVATION. THE WATERGATE WAS NOT FOUND, THE GENERAL RESERVE LEACHING CAPACITY 678 — 330 =-348 GAL.
CONTRACTOR SHALL VERIFY LOCATION WITH WATER DEPARTMENT. JOB NUMBER 421 Iy yfl
J 50 SH. 2 OF 2
i