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HomeMy WebLinkAbout0011 COLONIAL FARM CIRCLE - Health 11 COLONIAL FARM CIR.-,C-L OP,' -� A = 043 064 I{ I II r i > Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms the computer, r,use 1. Inspector: (y/) only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name VIRr�A P.O.Box 763 Company Address Centerville Ma. 02632 n City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑jwFalls ❑ Needs Further Evaluation by the Local Approving Authority ; ca vi ri t�a 01/13/2010 _ ,I Ins ctor's siigri—Apr Date 71 L� 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. i ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. � d t5ins•09/08 Title 5 Official Inspection Form:Subsurface Se age Disposal System•Page 1 of 17 v r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: i 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I °M 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is Marstons Mills required for I Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if'(with approval of Board of Health): ❑ broken pipe(s)are replaced ® Y ❑ N FIND (Explain below): i ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I ❑ distribution box is leveled or replaced ElY ❑ N ElND (Explain below): Observed broken pipe;from D-Box going to one of the leaching pits.Pipe must be replaced. i ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipes)are replaced El El El ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: I Eli 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 11 Colonial Farm Circlei Property Address Thomas P.Fitzgerald Owner Owner's Name information is Marstons Mills I Ma. 02648 01/13/2010 required for every page. City/Town I State Zip Code Date of Inspection B. Certification (cont.) 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 fe4of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. 'I ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. j 3. Other: I i I D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•09/08 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 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 water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. .For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No. ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. s t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I � 11,M Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills j Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of El ® this inspection? ® El Were as built plans of the system obtained and examined? (If they were not j available note as N/A) I ® ❑ Was the facility or dwelling inspected for signs of sewage back up? i ® ❑ Was the site inspected for signs of break out? i ® ❑ Were all system components, excluding the SAS, located on site? i ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? I ® ❑ 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: I ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] I I , I D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 I I I, t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of,Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald j Owner Owner's Name information is Marstons Mills required for I Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1500 gallon septic tank,B-Box and two leaching pits. i I i I i Unknown Number of current residents: Does residence have la garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No I Laundry system inspected? ® Yes ❑ No I Seasonal use? ❑ Yes ® No Water meter readings,�if available (last 2 years usage (gpd)): 2002,000 2009:12:122,000 Detail: 2008:342 gpd 2009:334 gpd 1 i I Sump pump? ❑ Yes ® No Last date of occupancy. 01/13/2010 I Date Commercial/Industrial Flow Conditions: I I Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) I Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding I tank present? ElYes ElNo Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No i Water meter readings, if!available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Offi'l,cial Inspection Form Subsurface Sewage Di I sposal System Form - Not for Voluntary Assessments M 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is Marstons Mills required for I Ma. 02648 01/13/2010 i every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupanlcy/use: Date Other(describe below): i I I �I I it General Information Pumping Records: Source of information:% i Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons I How was quantity pumped determined? I Reason for pumping: i i Type of System: I� ® Septic Itank, distribution box, soil absorption system El Single cesspool ❑ Overflolw cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any ❑ innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight taIl k. Attach a copy of the DEP approval. ❑ Other(describe): II t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is Marstons Mills Ma. 02648 01/13/2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10'+feet Comments (on condition of joints, venting, evidence of leakage, etc.): c Joints appear tight.No evidence of Ieakage.System vented throught the house vents. Septic Tank (locate on site plan): Depth below grade: 2.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 4" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills I Ma. 02648 01/13/2010 every page. City/Town I State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) 'I Distance from top of sludge to bottom of outlet tee or baffle 28 I Scum thickness 3" 5„ Distance from top of scum to top of outlet tee or baffle i Distance from bottom',of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Measured I Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. I I i j Grease Trap (locate on site plan): I Depth below grade: I feet Material of construction: I i ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): I Dimensions: Scum thickness I I Distance from top of scu i m to top of outlet tee or baffle Distance from bottom of,scum to bottom of outlet tee or baffle Date of last pumping: i i Date t5ins-09/08 II Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I I i � � I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i °wM 11 Colonial Farm Circle Property Address Thomas.P.Fitzgerald Owner Owner's Name information is required for Marstons Mills Ma. 02648 01/13/2010 every page. City/Town i State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i i i I i Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: . I I ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): i Dimensions: I Capacity: gallons Design Flow: gallons per day Alarm present: I ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: I Date Comments (condition of alarm and float switches, etc.): i I "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I I t5ins•0111, I Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills Ma. 02648 01/13/2010 every page. City/Town State t Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has two outlet Iaterals.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.Pit#1 was dry.Stain line is up to invert.Pit#2 was dry Stain line 50" below invert.Pipe is broken from D-Box to this pit and needs to be replaced. 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 ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts u u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ITT M- .. • a ' r , r} ' R wo Gp s } a* � cur � J ARM IZ 1 f f 1'JRS Xd LITl e7 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 55'feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments III °M 11 Colonial Farm Circle Property Address Thomas P.Fitzgerald Owner Owner's Name information is required for Marstons Mills Ma. 02648 01/13/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness.Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. 6 D / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pphtation for Misposaf *pstem Construction jhrmit Application for a Permit to Construct( ) Repair K Up ade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t( C v l o^.txL i,►even Owner's Name,Address,and Tel.No. A w'Icy ni�VkG P'W YL Vr Assessor's Map/Parcel /11&1Vy Installer's Name,Address,and Tel.No. 64tu,:,,,4 Designer's Name,Address,and Tel.No. Type of Building: + Dwelling No.of Bedrooms Lot Size sq. L Garbage Grinder( ) Other Type of Building , ,�,,�, � �� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets rX ta4 Revision Date Title _ Size of Septic Tank d� Type of S.A.S.� � ��C(, `e��„�,�, (�,r f Description of Soil Nature of Repairs or Alterations(Answer when applicable) �CD1C� ni rest L e_4ww,mac, O (Cipl o eh Date last inspected: 1 3 20(o 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 Certificate of Compliance has been issued by this Board of Heal Sign Date Application Approved by Date l / 016 Application Disapproved by Date for the following reasons Permit No. ac)/C) ' Date Issued LL- 0/0 No. Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN QFTBARNSTABLE, MASSACHUSETTS + Yes 01pprication for Misposai Epstein i-onstruction Jermit V Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. 11 C u I o^.k+c asM Owner's,Name,Address,and Tel.No. Assessor's Map/Parcel � Installer's Name,Address,and Tel.No. �,q� ,, .(z, «. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 16,(A ') — sq.ft. Garbage Grinder( ) Other Type of Building ,., , �,�y. E No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date !— Z_! —7ul s, Number of sheets r��t! Revision Date Title _ Size of Septic Tank h oo Type of S.A.S. b1C( , (, �,„ P,.i f Description of Soil Y Nature of Repairs or Alterations(Answer when applicable) �j(r�k t7r(LQ 4jt c,vt�,"� T) — 3 ` p K Date last inspected: 3 2ofO 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 Certificate of Compliance has been issued by this Board of Heal Sign Date d Z 1 u r Application Approved by Date / ,',/ O/6 Application Disapproved by Date for the following reasons Permit No. G/ �"`� Date Issued 0,/0 THE COMMONWEALTH OF MASSACHUSETTS ` ` �� BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(1<) Upgraded( ) Abandoned( )by La tLzw,J,_ 01!-" at I l (t)ron.lam l t o�r� 2o/a� has been constructed in accordance l with the provisions of Title 5 and the //for Disposal System Construction Permit N ✓G /a`dated Installer 6©4&w.�G �'ZJ�L✓ ��1 ei L c Designer (l►9 #bedrooms Approved design flow �/} gpd The issuance of this permit shall not be construed as a guarantee that the system wil cti as desi ed. p Date /o Inspector e, i` r ------------------------------------------------------------------------------------------------------------------------------------------ No. no I l GTE Fee 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS misposal 6pStem Consfrurtion 3pPrmit Permission is hereby granted to Construct( ) Repair(,,Z) Upgrade( ) Abandon( ) System located at r U l u►'►e✓_7 Ay;,I-m �,.,,7r-/ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction m A st be c pleted within three years of the date ofCedby mit. Date j//0 Appr I TOWN OF BARNSTABLE SEWAGE # _ 'i'L-'.AGE t�AR0iONS Mil k& ASSESSOR'S MAP& LOT Q ®b 114S T ALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY S cSO� LEACHING FACILITY: (type) (size) 1 NO.OF BEDROOMS BUILDER OR OWNER1 PERMIT DATE: �1+�� _COMPLIANCE DATE: Separation,Distance Between the: Maximum Adjusted Groundwater Table and �3 6 Feet Private Water Supply Well and Leacbing Facility (If any wells exist on site or within 200 feet of leaching facility) N A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ,OLq �tiD �Z � i w r - 43 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL.AFFAIRS Jl DEPARTMENT OF ENVIRONMENTAL PROTECTION l° ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 F.WELD T$UDY COXE ernor /Secretary EO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner ate^ ��� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM rl C PART A L01— 061A CERTIFICATION rty Address: 1\ Lo�ow�+>,lr �+�Q-w� C t t, �hQ-STa �ttlb Address of Owner of Inspection: �'�,�:t->L\-\w �5 (If different) of Inspector: I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) any Name: T L ng Address: hone Number: n ;— "►1 l ����� M �Z�~ IFICATION STATEMENT ify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and lete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails tor's Signature: Date: ystem Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30)'days of completing this inspection. 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 priate regional office of the Department of Environinemal Protection. The original should be sent to the system owner and copies sent to thr if applicable, and the approving authority. ECTION SUMMARY: Check A, B, C, or D: STEM PASSES: 1 have 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. NTS: STEM 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. to 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. d 04125/97) Page 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a 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 levelled 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: 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 DETER.MpiES THAT THE SYSTEM IS NOT FUNCTIONL'�G IN A . MANNER WIVCH "ILL PROTECT THE PUBLIC HEALTH AND SAFETY AIN'D THE ENVIRONNIEN7: _ 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 "-ILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETEILNIINES THAT THE SYSTEM IS FUNCTIONING IN A b1ANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply 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 supply well. _ The system has a septic tank and soil absorption system and the SAS 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (raised 04125197) Page 2 of 10 w - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DI 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 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 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 to clogged or obstructed pipe(s). Number 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 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 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public water supply well) 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 4412519 ) Page 3 of 10 " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: L w i�AIR�1rv� Owner: Date of Inspection: 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 pan 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. excluding 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. j —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 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)] (revised 04/25/4'n Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: \� Owner: &t,,,\yp —\�. Date of Inspection: `1 FLOW CONDITIONS RESIDENTIAL: Design flow: 4-1 Q p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: y Z, Garbage grinder (yes or no):_±:i,N Laundry connected to system (yes or no): i Seasonal use (yes or no):� Water meter readings, if available (last two (2) year usage (gpd): N Sump Pump (yes or no):_t-J Last date of occupancy:-3 ,Q N ` COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day 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: OTHER: (Describe) Last date of occupancy: GEINERAL IN'FORMATION, PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_ , If yes, volume pumped: Gallons Reason for pumping: TYPtr OF SYSTEM_ N� Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: r� C1L %AQ S _ (Z,r,1�j uL� Sewage odors detected when arriving at the site: (yes or no) (revised 04/15197) Page 5 of 10 � w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner:Ck�w yQ a\ Date of Inspection: BUII,DING SEWER: �V (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) 'SEPTIC TANK: (locate on site plan) Depth below grade: a` Material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: 600 Ci& Sludge depth:'_ 11 Distant from top of sludge to bottom of outlet tee or baffle:_ Scum thickness: rl tt Distance from top of scum to top of outlet tee or baffle:_ 1 Distance from bottom of scum to bottom of outlet to or baffle:_ How dimensions were determined: Comments: (recommendation for pumping. condition of pinlet and outlet tries or baffles, depth of liquid level in relation to outlet -invert,, structural in grity, evidence of leakage. etc.) i���2 i t'f-2" Mp N- SS t� 4—"'T� � GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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.) - (revised 04/25/97) Page b of 10 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: v- Owner: Date of Inspection: G z"k�G TIGHT OR HOLDING TANK: ( �7 (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in workinc order _ Yes: _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches. etc.) )ISTRIBUTION BOX: S (locate on site plan) Depth of liquid level above outlet invert: c Comments: �T� (note if level and distribution is equal. evidence of solids carryover, evidence of leakage into or out of box, etc.) �'�U� l.U�—�C_� OItGTQ-\Viuild � Lc PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) II� (revised 04/2S/97) P2ge 7 of 10 �I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I l C&\oo.,i s- Owner: Co%.v n e tN'e�k t Date of Inspection: ji,1 Z L\ SOIL ABSORPTION SYSTEM (SAS):—W—S (locate on site plan, if possible. excavation not required, but may be approximated by non-intrusive methods) If not determined to be present. explain: V Type: leaching pits, number: UK(O leaching chambers, number:_ leaching galleries, number: leaching trenches. number.length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (not condition of soil. signs of hydraulic failure, level f ponding, conditio of vege ion, ) Ci S B � p van CESSPOOLS:. (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: _ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (rerLsed 04/25/97) Page 8 or to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ( � �-�it ' t"N L— r►�Q—`r'�G\vZ Owner: Date of Inspection: , 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) 3 O 1A A5 (revised O4125/97) P2ge 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: l (o t one Lc TA',Lv\,-1 Ck V-- Owner: �A N„e Date of Inspection: ,2 L`�S Depth to Groundwater (3Feet 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 Use USGS Data Describe in your own words how you established the High Groundwater Elevation. 1ltust be completed) i (revised 04/25/97) P2ge 10 of 10 c5V � �d LI� i1 TOWN Or BARNSTABLE -f-�. G e Lc3CaTION eolon;a: FP SE1WAGE F'6 -762— VILLAGE/I7 4 L("5.`�l�f /I�� �,SSESSOR'S MAP &.LOT C)lr ^ dG l INSTALLER'S NAME & PHONE NO. S� DXf S 60 e Sd l? SEPTIC TANK CAPACITY! LEACHING R&CILITY:(type) �e�c�, Pi r5 (size) 0° NO. OF BEDROOMS ✓ PRIVATE WELL O ?UBLIC WATER2J _ BUILDER OR OWNER iht oetil D DATE PERMIT ISSUED: ©G �'o DATE CObiPLLkNCE ISSUED: VARIANCE GRANTED: Yes No �a � � 1 _. �' � ,. r � ' r ® � � �. r ASSESSORS MBAR NO: a PARCEL NO.: 04-�_6 � - N . _...... I Fims.....7.5.ao....... THE COMMONWEALTH OF MASSACHUSETTS / BOAR® OF HEALTH T�fj.(J12-.-----------------OF........ . ......................................... Allp iration for Db5posa1 Works Tonstrn.tinn ramit Application is hereby made for a Permit to Construct ()0) or Repair ( ) an Individual Sewage Disposal System aK. .. ..._ "]X/....JV.en...l'�►L. .......... �----------------------------------•-•-----•- Location-Addre M� /� �,n sNo. ... - - A.4!I!/!4JQr ... ^f-- .ALA/J.----•--•----•............................... owner Address ..................... � r�.ot� -$�. Installer `- Address Type of Building Size Lot...15j.#k__7_......Sq. feet U Dwelling—No. of Bedroo .. .Expansion Attic ( ) Garbage Grinder ( )- a _ ,., a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) . a' Other fixtures ___________________ _ _ W Design Flow........... 5............ -oftgallons per person per day. Total daily flow......._330........................gallons. WSeptic Tank—Liquid capacity./. M.gallons Length.......S_.._.. Width..... .._...._ Diameter________________ Depth................ x Disposal Trench—No. .................... Width.................... Total Length............... Total leaching area....................sq. ft. Seepage Pit No......J------------ Diameter..........$ Depth below inlet........fa......... Total leaching area._ QQ......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by.....Wft....I.taQAU)..'LC..k............................. Date......V/- /$.'(............. 1.4 Test Pit No. 1..... __....minutes per inch Depth of,Test Pit.................... Depth to ground water--_________-_-___----_-. G%, Test Pit No. 2................minutes per inch Depth of'Test Pit.................... Depth to ground water........................ (4 ..............---------•--------••-•-••-------•-----•- ------------------•---...... O Description of Soil-------------.0.:3... ._....� ...4.•_?JA.46fl[!i- ------------------------------------------......--- ........................................... ------------------------------------------ --.....Addis M---�Y •-------------------•-----•-•----.....-----------•------•------------------------•--•-----...---- ----------------------------------------------- - Q•-4A. ...-=--------------------------------------------------------------•---------------------------•--------------- U Nature of Repairs or Alter to s—Answer whe plica ---------------------- ----------------------------------------------------------- - - - --------- --- --- ........... --- ..... ------------ Agreement: The underVsd agre t install the or esc ' ed Individual' wage Disposal System in accordance with the provisions of TITTLE of he State Sanitary C e he under n further agrees not to place the yste in operation until a Certificate o Compliance has bee is d by f health. Signed---- •. -• . --• •• -- ••-----•...... ....... ...................... Application Approved B Date Application Disapproved for the following r asons:-••---•-•---•-•---•-------•-----•----------------•---•-••-----••------------•-••--•-----•---•-•---._....._------ ......................................................-.....................................................................----••-•------•-----••••--••••--•----••--•--•----•-•----•--................ 11) Date Permit No......... ?J77 Issued....................................................... Date IL No<:Ere_—n�22— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....Te)Zj_4! ------------.....OF...... Appliratiou for Bi_qposal Works Tontitrudivit rantit Application is hereby made for a Permit to Construct (k, ) or Repair an Individual Sewage Disposal System at: -----J&fta-)---- ............. ....... ............................................. Location-Address t No. ................................................... .........816---------------------------------------------- Owner Address 8AA.K1,Q.hd.&6................................................................. Address Type of Building Size Lot_J_.5,o.41v.7--------Sq. feet U Dwelling—No. of Bedrooms ...........Expansion Attic Garbage Grinder P_� P4 Other—Type of Building ............................ No. of persons......_._........._.._...... Showers Cafeteria P4Other fixtures .......................... ........................................................................................................................... Design Flow..........ff.5........................gallons per person per day. Total daily flow......J3C)..........................gallons. 04 Septic Tank—Liquid capacity/6Lb..gallons Length......(f........ Width._. ....... Diameter................. Depth.............__. Disposal Trench—No..................... Wid1th.................... Total Length............. Total leaching area--------------------sq. ft. Seepage Pit No-----I-------------- Dia"meter.........!9........ Depth below inlet......&.......... Total leaching area.o?0.6.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by__.LjM.t--- .............................. Date___-'./id._5/8`(0.............. Test Pit No. I... __......minutes per inch Depth of Test Pit.................... Depth to ground.water------------------------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......____..__....._._._ P4 ......................................................................................................................................................... 0 Description of Soil.............0-::3...........7-41 .................................................................................................. ....................................... .................................................................................................. U -------------------------------------------------- --------Ai0_kJa7tZ4................................................................................................................ U Nature of Repairs or,,Alter,6ti s—Answer whe - ppli .............................. . ............................................................. .............I--------------­------------ ----------------- ............. ..... ..............I-------------- .. ................. ......................................... Agreement: crj i The„u' er- gned agre install the desc ' e Individual ewage Disposal System in accordance with the provisions of T-T L'_ of i'ie State Sanitary 5ode,4 the unde, ig d further agrees not to place th syste in operation until a Certificate o Compliance has be i ed by' b r of health. Signed.. ... .............................................. ......... te ................. ,Va ..............,_ 6 . Application Approved By_=_. C�;_ .. ...................................................... .... ....17) Date Application Disapproved for the following easons:................................................................................................................ ......................................................................................................................................................................................................... Date Permit No. C. ........................... IssuedL....................................................... Date THE COMMONWEALTH OF-MASSACHUSETTS BOARD OF HEALTH ........ .................OF...... ........................................... wAT rrfifiratt of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed k0 or Repaired by.....A k_Lq. .......... ....................................................................................................... A I------------------------------------ 11, at..... . (.,a..L.....Ij 4A.al au,(..L.......... aknla.......M-05--------------------------------------- has been instilled in accordance with the provisions of_TAIIIE' of The State Sanitary Code as dewribed in the 0 .7 a ...... application for Disposal Works Construction Permit N ..... dated__--- - -----------_-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... X,----- --P . ..... Inspector... 4-e -, . - THE ...... COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................._OF..... 7jA.1-6........................................... Disposal Dodo 01MInstrurtion "prrutit Permission is hereby granted...Kitey.f I..........fft.r. ------------------------------ ............... ----------------- to Construct ()C,) or Repair an I -e DZP� Os stem Individual Sewag atNo.. • L-------------------- S Street e i it lee................ t.eet as shown on the application for Disposal Works Construction Permit N kE .........2_1 ......................................... ................................. d of Health Boar;;9L DA . . ... .................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS A SHEET i OF 2 k N `SPA �' . N76'20 51f OPE 97.gg N72,32 07 8 r 14.00 1546Z25 S.F 21.0• 6. !0 N A T EXISTING FOU .�, 0 5 0 • V 1 s h o` l�e 'top: of wdll e ,moo 2 •o• N ,j4,o' .48 9, c /i PROPOSED 1500 GAL. .h 0 SEPTIC 'TANK Z I 0 46 J N` PROPOSED 1000 GAL. LEACH PIT (2 P?rS REO'D.) WITH 2' STONE AROUND RES. / { I AREA1 / TP.48 r� / 44 P=5564 ` AREA D/ST. BOX (OUTLET PIRL �. . . LEVEL FOR 2) / ej FND. 46 ', 0 T� ,a p0 , R-55. catch bos, el. 41.37 ' 44 / _.B- '�I_. dgv me G.. p a. . Y COLONIAL FARM CIRCLE " SEWER PLAN SITE & " FOR ° may BA YSIDE BUILDERS o _WI"CAM LOT 8 COLONIAL FARM CIRCLE U ARWICK H o ,sn, �a MARSTONS MILLS BARNSTABLE, MASS. Ka PROFES 0 LAND:,SUR ZONE: RF Scale: 1 '= 20 Date: 11127189 { ASSESSORS MAP..': .OUT OF MAP 44 PCL 9 BENCHMARK.DATUM 'ASSUMED FLOOD ZONE: NON-HAZARD "C" Wm. M. Warwick & Assoc. Inc. 213 Old Main Road Box 801 North Falnw-uth, Mass 02556 WATER SOURCE. TOWN WATER (fog) 563 - 2638 DIM 85 JOIN 10. DYIG LO MHOM BY, 8H lyr�, SYSTEM. PROFILE SHEET 2 OF 2 TYPICAL,,,? L 1 t d r t tFw +'t11' i ti,.T 21''CONa MANHOLE COVER WATERTIGHT OR at. FRAME&COVER IF PAVED F.G OR BRICK&MORTAR BY TANK RISER(S) Q O � ) -'' COURSES AS ROD.'_.TO BRING TO GRADE. SIB.D /.+.'. I t.i.lt'A '✓ l,I;T •t� �i S• •I� 1( 1! fl.. �'. I J 1 i ',! '•Ir• � , .r'<• d ��t�r�.,,?t-`('j ` ". .+A I-: �. ..1� ..�. ti'�,5,i' r _ FlNISH.< ptAOf!.' ,7/'. J krf. .'1,•� �� tt�'}.'�fs'S��y-�.,�i Jd ii �nGi � ''r� ] 'C t� 5 � ''ice 'A' W k4 VCrach _ . y 4 40 IF I ri p. I,s I i d J s6 r sit % c t ROW'LINE f 1 �,r oL�!'d!5t(rf� k tF-. ! ,!E'C + ', S. f - a-.. .Il, seh.40 4 PVC ---- il�xC iy i x1 Y 44r F R � ^ `' Jv ROW LINE ,I.1',nIQ11. 1 ,. / + • •• ............• •.• , �LS?AorNc , a ,.: J+D—BOx" 5.22 .. � , r r ,#.; , r, + aK ♦}}t t ( .r q5,v��..... ... �'�� 15 'GAL: 1 5• LOADING 7'ANK' - .......... :::'....... �tl l'S'',r'r�!•,f7'yty� 't ......•... •...........• • CFI,? ° _ �`�' alr� 7V'Mw•. `Yhr rah C ,, .......... loco GAL. ........ t 1t j NOTE fOWVDA ITQN ID,`Bfdl1 y pi ••••.••••• ••••••.. 4 7. , - X rt,+F DE9CNEDrBY DINCRS,�r t iT 4t+ ry f S SEPAL TANK&D-BOX 1D BE •••••••••• LEACH BASIN •...•..•. r '•i+ a � � 'INSTALLED,OVV A LEVFL, STABLE BASC p�'GONG•MANHOLE COVER WAIERT)CH1 •••••••• •��•••••• tq E :^Y{.J',tTt'�'t• {+t''n�Yr -4 iirtF"t�ir+ l 14 ` t�.r,yr}4 A i:�l-� =' i1:v ,1.�•i -yAr s,, y,S+ OR C.I..FRAMC.&COVER JF PAVED FQ J a sly /'�..•.•• •:::::.••:: TANK R15CR S OR BRICK TAR � . f��r�./,.i�r d o a rl :COURSES.AS ROD.`TO BRING:TD GRADE •••""•' it ;r ry rJ�/lJ"1Z'CHBAtSIN� ►SEC TI01 V'g ,r i{'; ' NOIE: MUST BE 10 GRADE IF DESIGN 1 .:. •• V BAS ••••..... •" I EFRUENT IS > THAN 1000 C.P.D. `V 5t., r zIK'rs t 1 ,V 14'47 �ti {tiiTj; ut�+ij„�a,+-, y4-�M"�- if ,�i•�' t;�. t -+ 4 i 1 L r �l t�' i r Nsts b 7 Sw 1, 1 J y ad�f�rl119SN nr.V.CRADEir Pr a� f r F �F`r{' � �h7a Ji 4;f� �9•v +f d"�".,k,I. Z �' rfy rsJ a +Ati FF uY tc S ROW ��" OF''I/8,r TO 112" \ �1 17, tt i17 rj.f' J'l�yi bx �i••:1•ioi i •..a.• • f�1 s� dt ........... ........ WASHED PEA STONE, . FREE: OF.IRONS, FINES, & f y�i- Ilf I rl A, �i17'7� by�tldt ! Yf lj•�.F� .•..•.••••• .c , tI.S ,J •.......... . .•..... • ..• .... { v tl+"+ r'rr ...::::: . DUST IN PLACE., ih/1 illy +lt l.Pl� rf1 �lriMl" � 1''` f III, •.... ...• ? f 1 ,1 •.....• ++ r r r1 + ,} 1 , r''•I� tr 1%J. r'' 7I. •• /I.,�• 1. •.•...•..• ........... ,.SPECIAL NOTES,. r y IF w E�k{.t �,� I,f ri`; ••.• •.• s .} u, w:we �•.i••.• • 'j A/ dy �` rp)j � 4. of rA i`�;� � t( "`rJ k�-11: ����1 :�•:::•:::: 7t �'�jJ/1�, � f f �' .:.1. .. .ti tiJ/4 ::}TO ..CLEAN IT 1 �(�i t �. fn� f5 Y1 d 7 r )7 YiW ..•• •�.•�......• �1. r 4 ,ion ••...•.• r . .-,WASHED.CRUSHED'.STONE,. 1} 1 }d '1..1'�) r �'f•4 d",rr'+�il k tity�i '�Ft _ � t r�U1 •..•�.••..., �, `ryi {k�if� � f ��. •..•.••.. �i€ 1..� S'y,` ,< ?." :aP7 or�r r y�t,rlyJ ,v .i 'i- ' ..... .... s� VJ 4)^ 1 ...•.... . ;. FREE;DF IRONS FINES & µt ✓ t 1 �'f a 't{4'��?.t A 'tn 1 11r >�fl ••.••.•..• ', kl 'wt nYr. .: ••••.....• ° i tYJ':s "DUST"IN,PLACE':`. '. rr �srp �� t ✓, Y, ! -ti r �'I�+t,' t y,.5j �ilf�1 li R c rh �rnt Yr ♦ _ ,�I _._ T ri �r'�1 't�r�j h at 1 r��. ' 1 71 kf7 SL' (�J. i q I1��2 ' t—•r .:�. �'L' FT± ,. � I +¢� 5.t `°Tn�il �rlF'� ' V, f r .sf •, F E FECI}VF DIAMETER 4 rJ,6 1 P 1 } y l f > Ir (NOT TD CXCCED J TIMES EFFEC77W DEPTH) }a-a�lt ,{y4 c�ir}: r, t• '�t.�nt, x,� `l 4,14� k�';i �,trv.:. � �7 •y . •,„ ._ ,. GENE'RA1 J` .yCO1VSTR UCTION `NOTES !•, I �;u�'? ; 'SEPTIC y�TA`NKDISTRIBU7IONBOX,+, &.-LEACH BASIN 'TO.BE "ACME" STD. PRECAST REINFORCED CONCRETE UNITS L wy ,7 t Gtif tid .i•.� ' ',r,ORf EQUAL �'x'CONGRE,TE000i28' DAYS, STEEL ASTM—A-615-68 GRADE 60. H-10 LOADING UNLESS NO "�BEY�4" P'V C 4'�SCH ` 40�PIPES, :GLUED:'JOINTS,:,INVERTS . TO CONCRETE .TO BE PARGED '& ,J ` WATER ,TIGH,TI; M/N/MUM `P/PE:PIrTCHr,TO BLEACH/NG ;UNIT- : •1/4 /FT•; UNLESS IND/CA TED. OTHERWISE., }' ALJL" S'YS+TEM';GOMPONEN;TSI-"SHAL'L" BE•'�INSTALLED IN-.ACCORDANCE TO'' THE STATE ENVIRONMENTAL CODE, TITLE V, 2 ``+THEuMINlMUti1;fREQUIREMENTS:-''FOR: ME:SUBSURFACE; DISPOSAL OF SANITARY SEWAGE EFFECTIVE ON DULY 1, 1977. �ATr:COMPLETION"`OF ,CONS.TRUCT/ON, PRIOR TO BACKFILL/NG, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR AN WARWICK, &`,ASSOC., -INC. '' TO',BE. NOTIFIED /N SOME TOWNS.) INSPECTION ,•,( t ` �QN,;,Y, CHA'I�IGES TD�.�;THIS-:PLAN�:MUST BE APPROVED 'BY THE BOARD' OF HEALTH & WM. M. WARW/CK & ASSOC. INC. T T T T TEST �' T 2 _,Ep 'CLA.TI01� LEA T.4 TEST PIT 1 _ �- # , EL ¢7.�j�' 0, EL. - iHi$ Z � �4 Sol I,MIN ��i'H� 1�t7•CL , .P;.�ii+ 7i�'}T(YJi�',}A�,°,yt;tt{(�t tip 6d')<'�«a�! 1 �'�'I/ }y�$i: � + � P r ! t $ ��' / f r'l l f'$rt tyi Jq yY! f t �'���t „ y*ti(,l)r f"�I�b'ista 1 K} '-4 N 15 .•f I �., ; ,' ta1TESryPIITjECEV n Q= "rJ�ERC DEPTH ; !fir � r�r4' ` ;`;rr-5 ?:�i�',j.` ,'�ra,k•� ?,4,rrstb�'' '+.�,3 ., ., ,w.G. .r :.. •.I � ---�'il.�l���!._?.----_ _. ._._-.. _. r1tpATTETkY�Sl _-_...._ r.t - S6�►_iJ. R,ti IiZ Yti,LJ Y ... ' TNESSED� BY �'• ' s ' HEALTH AGENT, B.0•H. 12 EL. 35:5 EL. DESIGN :DATA`• GROUND WATER WAS SrENCOUNTERED AT A DEPTH OFAFT. NUMBER OF BEDROOMS.' '—�f GARBAGE.'DISP6SAL BEST; TO TAL DA'IL Y EFFL UEN T 4-� GPO. Ja S��°� S�il W1 R P ,� ISoc GAL. FOR SEPTIC TANK REQUIRED 4}, r {,r;'i�• V ,I lyr,t,'ril b - cp r ,. SEPTIC aTANKy PROVIDED r - -----'-- - ------' -__.._ _._ ---__..-- --------- ' _-__ ------- . SIDE.WALL,,AREA S'r 4'^l r JI • r GAL. SQ.FT.GA LISQ,FT. M, dt:o►J� /�i. �/� CI12Gl.� / -' a h ,t ,, , J•'%D�Tu"c's�1LL�'��'7�a�7SF+icZ+���l/S.;f r�.'Z P�'�' =. �"¢ �a_� J�1`.-I���`�J�--- .. .. . 5 .,.- _. -_._ .._._._ ._...._._.... ..- *.... ;k irr S.CS:-r lr�,i. -t{�b,J"�i4.�-8"+�.�•' .r a` , y. •„ � J .- Ij . 11 �'"'0 own Da"te' r �, • Scale' As Shown - � �-� �-Z7.. �`�- ' .r i •4 IIF, ,_lr 7 ° r .�y��j���A.O.��� I OF Wm. M. Warwtick & Assoc. Inc. 213 Old Main Road Box 801 r t North Falmouth, Mass 02556 � . (508) 563 — 2638 �' !,,.'­,:PROFESSIONAL! ANITARIAN �E 7 a �_ i �, � j � -,k,, .. ._.-_ . ....._ ..�.._.__ - .-� �! •t' ,; �� F, wur.�y �.- ..- � r- �[..t.cy,1...� �Y ^k...- - - - � -^+-�e-�wlewr�i`.;�`�^"rti�i' .+ew•r�^-+.^.+r.1.-.,err+rr<:. i�►rc..r.�-T v.....e.�.�r .�+ram _ • r r� ._.i•�r ...�.�..�..w - • --.`U:. l� •,r .., ,_ a