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HomeMy WebLinkAbout0045 HANE ROAD - Health 45 Hane Road, Marstons Mills k = 151 008.i oyL . ti t� COPY COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r . ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE 1 a Z Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTI M INSPECTION FORM PART A CERTIFICATION Property Address:`4S uAh�Rc�,111ArsjonS m,i�S 11�c�.oJGyr Warm®4 omenar it 5 +1 V n Address of Owner:445 Hwe. m�14ru 0Aq? Dace of Inspection.N R E I D C . ELLIS Name of Inspector: nspect :(please Print) I ern a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) cornpminy Dame: E L L I S B R 01 H F R S r n N S T - c.gT_ Maa'Iing Ackkess: 21 ENTERPRISE -R-040-i— 'A R M O U T H PORT , MA Telepfi we Number: 5 9 8 3 6 2 {Z� _ CERTIRCATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signatene: Date: _ The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS Q RECE UEO MA\ 3 1999 W revised 9/2/9 8 Page I of 11 TOWHOFBAWIiISTAg� HEALTH DEPT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIFICATION (continued) Property Address:-t s W 4>1 e A S �n I Q 5;rn A Owner: JAv)'A'S)'"1-1V Y) Date of Inspection: INSPECTION SUMMARY: Checkf A,)B, C, or D: A. SYS PASSES: ��' I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: --- ------- -- ----- B. SYSTEM CONDITIONALLY PASSES: X"4 One or more system components as described in the "Condi Tonal Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, or NO). Describe basis of d atermination in all instances. If "not determined", explain why not. _ The septic tank is metal,unless the owner or ope►ktor has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank we., installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, tructurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspecti In if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water I el observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution I x. The system will pass inspection if (with approval of the Board of Health). broken pipes) are replaced obstruction is removed distribution box is levelled or re, laced _ The system required pumping more than four time 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 revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 45 14nno— R 1• M fir,To n s Y1��11 s�m R Owner- Ds�vl�SU-AIkvAn Date of Inspection: 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 DETERMINES IN ACCORDANCE WITH 310 C%4R 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT E PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vege ated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND F UBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC I EALTH AND SAFEw AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption syi tern(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption sy tern 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 sy tern 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 a revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:'4S I w-c, Q2 MAYSTons -f () ��,mA Owner: Dta�/i�Sv.�l,vtav� Dane of Inspection: D. SYSTEAR FAILS: /✓ You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure con itions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should lie contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage into facility or system component Jue 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 cogged SAS or cesspool. Static liquid level in the distribution box above outlet nvert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert r 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 r privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet f a surface water supply or tributary to a surface.water supply. Any portion of a cesspool or privy is within a Zone I f a public well. Any portion of a cesspool or privy is.within 50 feet o a private water supply well. Any portion of a cesspool or privy is less-than 100 far t but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has be n analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia ni ogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to th I criteria above: The system serves a facility with a design flow of 10,000 gp 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 Nater 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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII G CHECKLIST Property Address:�s��h� R�.rn�{��n s rn i ,mra Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the.following: Ye 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 rxrrmal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage backup. 1� The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. i Al 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. The size and location of the Soil Absorption System on the site has been determined based on: — Existing information. For example, 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) 115.302(3)(b)) _ The facility owner(and occupants,if different from owner) were provided with information on the proper maintenance-of Subsurface Disposal Systems. revised 9/2/98 Page 5ofII f PART C ' SYSTEM INFORMATION property Address:16 Mane R :m rsTom,M'k 1\51 mf\ . Owner: T Avis.S"VrAv, Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:/ g.p.d./bedroom. Number of bedrooms(design): W Number of bedrooms(actual): Total DESIGN flow S--:) _ Number of current residents: Garbage grinder Ryes or no►:;Z/J Laundry(separate system) (yes or no): If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no):­,fj,-�t Water meter readings,if av ill/le (last two year's usage(gpd): Sump Pump (yes Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow 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 occu;parcy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or not If yes, volume pumped:/Z)��o gallonsL — - Reasonforpumping: S;,i �i''J�'f��i4✓!� � 2 ��'!" j�tr2✓ TYPE QF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)/� 1 revised 9;2/98 Page 6of11 PART C SYSTEM INFORMATION(contiraped) Property Address: 5r11rsT�nfa Owner: ��V c���s�1 idrAn Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade Material of construction:_cast iron�, 40 PVC_other (explain) istance from, riva:e water supply well or suction line_to ' - Diameter 1 Comments: (condition of joints, venting, evidence of leakage,etc.) SEPTIC TANK: (locate on site an) N Depth below grade• Material of constru ti n:Lyon rate metal_Fiberglass,.—polyethylene_other(explain) 7� 1/0 4 �)W, If tank is metal, Iis ge_ Is.age confirmeV by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: a Distance from top o`s udge to bottom of outlet tee or baffle; Scum thickness. u Distance from top o- cum to top of outlet tee or baffle: Distance from bottom of scum to bottom..of outl t tee or baffle: How dimensions were determined: Comments- (recommendation fog'pumpin , condition of inlet nd outlet ee .o baffles, depth of liquid level in rel tion o filet invert, strut ral integrity, eviden�e.of leakage,etc.) 7 NS GREASE TRAP: / (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass ._Pol.yet7e. er(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 9/2/98 Page 7of11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIOM FORM PART C I SYSTEM INFORMATION(continued) rty-rope Address: �{�r1nrrocn G.YnRr5TbnS ml I is,rn� Owner: DAVI S 4Yh Date of Inspection: ///� TIGHT OR HOLDING TANK:_ (Tank must be pumped prior to, or time of, inspection) (locate on site plan) Depth below grade:_ Material of construction: concrete metal Fiberglass Polyethy ene other(explainl Dimensions: capach r: gas Design floor: gallons/day Alarm prosent Alvan level: Alarm In worldng order:Yes_ No— Dot©of previous pumping: Comments: icondition of idet.tm corifton of alarm and float switches,.etc.) DISTRIBUTION BOX:_ (locate on site plan) d Depth of liquid level above outlet invert:, :omments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) �� V 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 appurtenance 5, etc.), revised 9/2/98 Page aof11 PART C SYSTEM INFORMATION fcontirwed) -roperty Address: HAyYC. 1.Y1-\Rf! (forjsh11 - Owner: �A�►� $l>`�v rein Date of Impecdon: SOIL ABSORPTION SYSTEM ISAS1: 1a4 (locate on site plan, if possible; exca ation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers,number:_ leaching galleries. number:_ leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition f soil, signs oI hydraulip failure, level of riding, amp soil, co ditlon of vegetation, etc.) C� ulQ CESSPOOLS:_ /} (locate on site plan) n Number and configuration: Depth--top of liquid to inlet invert: Depth of solids layer: Jepth 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, c dition 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 pondrig, "nditi4 n..of-vegetation. etc.) revised 9/2/98 Page 9ofII • I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) �,I� 'ropert Address:�};j 1Y1�f1C •mArST011 S ��1��`� �� Owrw: DAv Si ll�vra�� ) Date of Inspection: I I I 5 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Iw/ i 67 �j Vv I J 1 I J � v G 1 s 1 � Pq f I i revised 9/2%98 Page 0ofII I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirwed) 'roperty Address: 5 Hnne, •(Ylla{5jo(1 'I l l S rn{� Owrw: Date of hrspection: MRCS Report name_ _ ----------- -- — — Soil Type_ --- ------— — —----- — Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow _ Moderate Deep_ __ — SITE EXAM Slope �e�_ Surface water fvw Check Cellar Shallow wells Estimated Depth to Groundwater_Feet Please indicate all the methods used to determine High Groundwater Elevation: 0 tained from Design Nans on record C__ � erved Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Mustbe completed) XW17 revised 9/2/98 Page 11ofIt J TOWN OF BARNSTABLE . . . 1 CATIONAcp.� / d - me", �.x s �'�'I/l,SEWAGE # ��— 6 7 //�Q_ �(ca VILLAG� r. S s+.e o f ASSESSOR'S MAP6r T u NSTALLER'S NAME & PHONE NO. Cbtr v Ca. Zic-. , SEPTIC TANK CAPACITY 160o \LEACHING FACILITY:(type) /e C6 vyL (size) ®0gd NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ® BUILDER OR OWNER p�� /�`" dlldwS' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: t 7- VARIANCE GRANTED: Yes No � � ��, ��� �� � �� a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ® .✓ OF� s } a Apptiratinn for UiipnsFal Works Tonstrnr#inn ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: •-•• ........................................... Locat, n- ress or Lpt�jo. ••. pr Owner �y -----.Address ........................................... Instal er Address � d Type of Building /// Size Lot--- J.__--4 ,_..Sq. feet Dwelling—No. of Bedrooms...............%_3_.....................Expansion ttic - Garbage Grinder ( ) aOthe Other—Type of Building -�_.._.F_9ehk.L . No. of persons......... .( -)-�.............. Showers ( ) — Cafeteria ( ) r fixtur s --•-• ....................... W Design Flow.................. �.�................gallons per person per r day. Total daily flow...��........._. .............................. WSeptic Tank—Liquid capacityl......._�allons Length.....•'.._..__-_ Widt ._..... Diameter................ Depths.... � L x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No._-__---I............ Diameter.._.. Depth below inlet..... Total leaching area... - 4;q. ft. Z Other Distribution box ( Dosing tank_( '-' Percolation Test Results Performed by...... . � Date------.. � .._. aTest Pit No. 1---....zminutes per inch Depth of Test Pit..... .... Depth to ground water.... (s, Test Pit No. 2..._--..2-..mmutes per inch Depth of Test Pit----- -_.. Depth to ground water--_-1.. - --------------•---..... ---•---•-- ----------•_....--••••--•---.....•.............. .. O Description of Soil............. _1.. _C�` � r " �'� ................... V ....---•---•-.....•---•-•----••-----•--••-••--•---••-•---•..............•----------....-••--•----•-•-••••------------------------------•-----•••-••••----••••-•-•----...........••-••.........•---------- W •-•-------------------------••----•-•----••--•-•-•-•---••-----••••--•--•-----...•-•--•-----•...---•-----••--•-•--•--------------•••......--•--•---•••-•-•--•...............-........................... VNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individ al Sewage Disposal System in accordance with the provisions of TI'i U 5 of the State Sanitary Co e Vhloa a further agrees not to place the system in operation until a Certificate of Compliance has bee iss health. g Application Approved By........ ..................................... �........---- Date Application Disapproved for the following reasons-------------•-----------------•-----•-------------------------•-----------------•--------------•---------....._ .....................•----------------•-•----•----••--------•--------------------•---...-----------------'------------.-•-------••---------............................................................ Date PermitNo......;Z.. ...... 5 -•--- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH _j W A.•✓ . -?IV Appliration for Diipoii al Works Tonstrurtion ramit Application is hereby made for a Permit to Construct (L)or Repair ( ) an Individual Sewage Disposal System ,a_t: /j / f(�+�+� " { n> r f (//{f// / .•••-••••-••..-•r.......................................•••...........................•.......... .....................................................................------....................._. / — Location-Address or Lot�No. .....�...... ----------- .�`/ f.............................................. Owner t ----.• Address a -•-••••.. 1 ._. �� /__...[............. ............... %� - Installer Address 24 S dType of Building Size Lot... :.................Sq. feet Dwelling—No. of Bedrooms.............. :...._.....................Expansion Attic.-( )— Garbage Grinder ( ) Other—T e of Building �� r`__.f.___ No. of persons........L............... Showers — Cafeteria Otherfixtures..:.-....................---f------•--•--------•-----------------------------------------------------------•----------------......---......._-..---- ________________gallons per person per day. Total daily flow.._.._ `._r�.. ..___ .......... Ions. W Design Flow.................. g P P P Y Y WSeptic Tank—Liquid'capacityf_b1_,gallons Length___ °.___G.. Widtlf�.._.�.d� Diameter________________ Depth-��__.__.__._... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-.____/.............. Diameter.....1...?-_`.... Depth below inlet...-��.-: .-'. Total leaching area.. �c` __ sq. ft. z Other Distribution box (�)� Dosing tank-(—)� '-' Percolation Test Results Performed by.__.-:.._j_:_.:__..:''?_"•=: ..._...'1._c sr..'...��!. Date.............................. � '�-a�3�; - Test Pit No. 1........... ....minutes per inch Depth of Test Pit....L2......... Depth to ground water........................ w Test Pit No. 2___ ___ ___minutes per inch Depth of Test Pit.... _. ........ Depth to ground water_-__- ----•-•-------------------------------------••••......••.......A Z?-................................... Description of Soil............ = 1 E- �I '-� �� •� ............:.""`-------.....---�---�--��-------------•....................... - x U •••••-••••--•--••••••••-•-•••-••••••••••••-••-••-••-•••••-•................••--....-••-•••-••--•••••••••...-•---•--•----•---•----••••---•-••--••••-••••••••••••••-•••••-•-••-•-••••-••-••••.....--•-•••. W -----------------•-------------------------------------------------------------•----------------------------------------------------------____------•------•----------------------•••-•---•----- UNature of Repairs or Alterations—Answer when applicable............................................................................................... --•••••• ----•--------------------------•-•------•------------------------------------------------------------------------------...............---••--•--- Agreement: C'.. � , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI i- 5 of the State Sanitary C9de)— The un ersi further agrees not to place the system in operation until a Certificate of Compliance has been is i eby th ,b(o -� health. �/ Signed__'. ' J.�.._ . Application Approved BY-- zfa" ..---•• lr�..". - ✓ ...................................... ............ Date Application Disapproved for the following reasons:............................................................................................................... ..............................................................•------------------......----•---------------••••--....-----•••----•--•---•-•••••••••---------------------•••-•---••••••••--••---....••--- Date Permit No.....S._-.(�r...... Issued........................................................ Date l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ .....................OF.....4 -3i C9rdifirat a of TompliFatta THIS IS TO CERZIFY Tat the Indio*al Sewa e is osal System constructed (�-")or Repaired ( ) by----.-------•---------------- �.�- �: ......••-- ,� �� •_ � _ _•• - / -•Installer. w_ at................ ....................................- ----•------------ ---------- --------------------------------------___-._---.---.------•-----------------------------•- has been installed in accordance with the provisions of TIT F 5 of The State Sanitary Code described in the application for Disposal Works Construction Permit No.___ __� -___ ` ..... dated----------' __a��. ...._ v_______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS _y BOARD OF HEALTH _ ....................... , ,`�/ - � ' • ` ` Ia®F..... G Z /,/ r.. r?�._ _. :_., �i��oo�tl >�rk� n,��rion rrn�i� Permission is hereby granted------/7••-//-Z.---- F to Construct or Repair ( �) an Individual Sewage Disposal Sys at No._G' _% -;_, /--" e/cl:`�J Q,c> a''" � c�. _._... ---------------------------•••• . --•-•---•--•. ----- _ ------•--------------------------................. Street as shown on the application for Disposal Works Construction Permit No.....................-ax Dated_____"-;11Es_f��'._____._.__. -_ ----------------•--------------------------Board--o-f-----ea l--t------------------------------------------- Hh DATE•• ....W_t...�.. FORM 1255 A. M. SULKIN, INC., BOSTON BENCH MARK sP11sE iN PoL,� > I I q # � �� Er401/. , 33. 2 N. C,. ✓r0- TEST HOLE RESULTS . P 1 P , Q 1 DATE : WITNESSED BY 7-0 P o /T ecg P,-q y 1^ IZ a Pr,,V d. .ern. V7 J m E N T' 0 F C ` S C.A L.0' ,C3 Y I3 /�./•�n/ 1� V ,U L.� °r' f) t.✓Yi.. 5 /� CGctrr7 TJf T b r_7 . [ / ✓ J / •r 1* �, j ' SAnlT� CLE"�nf . ..... 1 2 0 � - b`;l s2.so ` ' I.�' LJ i rZ C u tl.1.D w� 7'I /IQ /,/` 10 0�a I 11. Pe' l�! rJ 1 e C� `/ 1= 5 lw 121rrE zi' LF0�9c A Ig � ' I :� � ELEV. TOP OF MANHOLES AND COVER TO BE BUILT TO QD _ W ITHIN 12 OF FINISHED GRADE FOUNDATION `o + ` :- �, •• ro FINISHED GRADE MIN, 2% SLOPE •y �(.1< � � L�.qC/-,t ' D i 1�-1 N ^.`- 4" DIA. - " P/T , >30 „ �• ��v _ - - 4 DIA. PIPE �12o FIRS 2M1 --- �� g PIPE _ ^'",w. : MIN. PITCH F'r. 2' LEVE MIN- 2 LAYER OF / _ .. SEpJkG.. �.j i '—�`" 1�8'--y2" P E A ST O N E o r p r.•. MIN. PITCH 1 j • • r GJ ra 1 FT. /000^ R 117.�a 1 )7.0 ``` •• i 11 N t ' :. INVERT :. /4/ GALLON I-{20 IN'VERI� co".rwHa INVERT ®� N0. m•�; Al • CL Y !.� !=h/GGt•tT" 1"< 'I� 32 _ 1 1/ '7, �5 DIST, ,Q m I �2 DIA. • pRoPD, r F04T'iNG, TO AF EPTIC TANK 112.5 m 5 c� �4 . ,a 1-a\ PI N AM .,� INVERT - . _ . _ INVERT EOX �' 3� ©•'•• SHED STONE {� ) �At7 o F l �L;� CE,D "o'n! ,• INVERT �,� W ©0.� ALL AROUND >m 1 s T O E . TR-Er^'l ✓ '7� N DwEG4. r GA12 a. PLACE ON ,. __ I ,• � a te. sAt rnn!. o ! E3 O t- :f ,�o---►-1 FIRM BASE �— Mho -- �4-- 8 v .' BOTTOM AT ELEV. _ - sN � L yr i � r4' \, 11ZG, 1n! 40 CoM ;- �•�10 MIN. , I DF Pott�N -----= , _ - /VD GARBAGE ( 2 0 M IN.) 3 � ~ PAcT17 s ••/� ='��' GRIN DER04 Z� CGA Y l 5 ENGOVNT�°72E'1� ;Bo7- ao=` T, NOz� �' ELEV. / a 4.3; 1N CE-4 L.l1R )-1OL15 TJa of PR O F I• L E OF GROUND WATER TABLE aAw Lqvv 96, _ 4 SANITARY DISPOSAL SYSTEM ( NOT PTO SCALE ) DESIGN DATA sE T- • CONSTRUCTION OF SANITARY DISPOSAL 3 BEDROOMS SYSTEM SHALL CONFORM TO THE MASS. 330 �gl30V'4' 7--h�.1S L Cl 7- �- �' p_. -.92 `�.�a,z� ENVIRON M E NTA'L CO.DE TITLE r DESIGN FLOW L GAL./DAY 0% LEACH RATE - Z MIN. INCH E'L,EV,�- T,0c� lG 24.5 t' s. (T'v .z3.c .�w�n�cT� (REVISED • 7-' I-77� AND T-HE TOWN OF ' HEALTH . REGULATIONS. REQUIRED LEACHING CAPACITY : 3._ 0 SEPTIC. TANK,' DISTRIBUTION BOX AND LEACH— PROPOSED '143 GAL/DAY. ING UNIT TO BE OF REINFORCED CQNCRETE : 2Z5 3.5'lY 1. 07r(c,�� MIN.- CONCRETE STRENGTH s 3000PS.1. �ca� G �• REQUIRED SEPTIC TANK / e9, 73 '1 MIN. STEEL STRENGTH * 20,000. P. S. 1. MIN. DESIGN LOADING : N- PROPOSED SEPTIC TANK ��na � �• Q ,A f • DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM ` UNLESS H2O DESIGN LOADING IS USED - V • ALL PIPES AND ' FITTINGS TO BE WATERTI.GH-T ` AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL- DATE a SITE PLAN HOWING PROPOSED CONSTRUCTION ZONING DATA LEG- END LOCATION : F O R L_ E`Q 4EF-L - Sep L � ����� Df V. C522222, D A T E • ��'�/a 6 ZONE • — — — — TEST HOLE LOCATION REFER, EN CE s,ti �, REVISIONS REQUIRED AREA ' _ s�vj lo,��o �' ' EXISTING SPOT ELEVATION 17.6 �� �c� °F �7 ),�p� 37.5' EXISTING CONTOUR 16 a�j� v' cR,nrG REQUIRED FRONTAGE ; t SH A./ fK 4240 F'(;r 2lz 7 8 2 REQUIRED FRONT SETBACK �C�a1 3O PROPOSED CONTOUR 16 `i"24, ' s y � � • o SCALE REQUIRED SIDE SETBACK 15 '� PROPOSED WATER SERVICE —W-- v ` , NGISTt REQUIRED - REAR SETBAC K : 15 �5 PROPOSED GAS SERVICE --G-- sslMIALEN�°� �� 3�t- 3 rrJ+./!n� � .3 0.�re.� �o T'.�' e�•-✓ �i 4187 PROPOSED ELEC. a T E L E E & T /2 CRAIG R S HORT , P. E . PROFESSIONAL CIVIL ENGINEER BUILDING INSPECTOR APPROVAL 'DATE 131 ` OLD ROUTE 132 •, ' HYANNIS , _AAA. 02601 FILE NO. / -,577 rEL� �' (c�17) 34, - 11 SHEET 2 OF BENCH MARK A) E*40V'. , 3Z. 92 n/• amV.AD TEST HOLE RESULTS . P .5 G38 O DA T E : = ,r WITNESSED BY : 7-�©.+�•��•s m � /-;r��?f.I J3. 0, I'h ENT 0 F Q" ' S CA i-'e a >1 B /•z./.�n/ Z� v p L)�F °� �l-�a�;.-� �'rI cGvZqTw J D � 77,E7 v 8S F4 lIG •3 • j SAN1� CLFwa/� V _ la7, 0 3 ° 52.5 0 q ©o o ► I t. . N o G, ry r .r w T'c TZ ,�,o•� U A f E-_,i- ,. L:� 11� MANHOLES AND COVER TO BE BUILT TO L , �� :! ELEV. TOP OF � QO r1� �-4'n9 �1; s' G' : ..I.$` •• • FOUNDATIO WITHIN 12 OF FINISHED GRADE D c.° w r' 1 �+ ro N FINISHED GRADE MIN, 2% SLOPE / - , • _ / r� I �• �� I A _ ---- 4" D I A. PIPE H 20 FIRS 2~MI P/T t13 -v 4 D - -- --- 3+ 1C3C� 3 . / P! P E «''�`k. MIN.PITCH FT. 2• LEVE , i - , . �8 ?2'LAYER P (�/�/ � 1 � seprac • N�. I r � Y E R O F Gl o ► l O MIN. PITCH �o�%v+w Imo' EAST ONE L 1l8.o I /000May. l 17.E a l7,0 g. . e , %F INVERT :. GALLON ,I�'0 INVERT 6"sc,w�P INVERT .• QW /ti/GCavN 7-ZT:R/T= 32! a 1 / ► I7. I'7 •.®� •► 1 �2 PRvP�D _ FOOTING•+ Tv AE ll7, 7S EPTIC TANK INVERT DIST. IJ2.S ':.� 35�v � • . �4 DIA. PJt� //V �/,EI2 7— - - 0. �o• . 1 FAM• .,! INVERT _ 80X � ©• • WASHED STONE ?L.� c ED one. .9 _ INVERT 41 W Q N pwL Asz PLACE ON :�°" ac �C ©�;`_ ALL- AROUND_ __. S Tp � TL1r4 ✓�-X� - ► G • .5.qsN. ©� / 8•' O f= a' �o F I R M; BASE �o $, . Q7 a ml - / d ' L t �J a`,l 1. `9 S N L v 7 / I O' M IN ) r13 -TTOM AT ELEV. /09.0 ! T" E 0 Ijo P.9c . : •.., .- /VO GARBAGE ( 20_MIN.) 3 L 3 ' /Z E• P i4 C .D v�/•/-rH t T�'� .5.�r,/D �:,1r- • GRINDER 12� 4 _. .__.. ._w� C .. , Z CLAY / S FiV G O V/V 7—t^'!2P1] ,t3oT. c7F T, N01_4T '� ELEV. / o 4.3 g CR-L L c4J )-1 (0L Th+�N' " PR O F I• L E OF GROUND WATER TABLE G,!rz0vv s 7'A 4 ,9 4 , )D /,9 . P.t•/2 - S A N I TA.R Y D I S P O S'A L S Y S T-E M 407— ( NOT :TO SCALE ) DESIGN DATA �� • CONSTRUCTION OF SANITARY DISPOSAL BEDROOMS sro•�/�- `�� r° SYSTEM ' SHALL CONFORM TO THE MASS. 330 DESIGN FLOW GAL DAY "�•`5"" �.8v �.�" r�i.5 � aT I2 a• : ,�c-•c32 �/.�an.� _ ENVIRONMENTA'L CODE TITLE )Z' � 2 �',L F v,�- T�c�/ �7•-v n•E -�n/.Z ri C T- (REVISED . 7- 1`7 7) A N 0 - T-H E T O W N O F . LEACH RATE - MIN.�I N C H ,E-v3y , , . REQU LEACHING CAPACITY ivtr� Y3=EG . • SEPTIC TANK, DISTRIBUTION BOX AND LEACH- PROPOSED � -4 3 " GAL/DAY. ING UNIT TO BE OF REINFORCED CO.NCRETE •, 2.,S(3,5'71' )2) /, Q �c•�� - MIN. CONCRETE STRENGTH = 3000FS.1. ' REQUIRED SEPTIC TANK : /000 G•,�ac, e9,73 MIN. STEEL STRENGTH * 209000PS. 1. MIN. DESIGN LOADING : H20 PROPOSED SEPTIC TANK : )<50® G••�7t . Q • DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN LOADING IS USED �' • ALL PIPES AND_' FITTINGS TO BE WATERTIGHT AND TO BE of CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL, DATE SITE PLAN s . ON . ROWING PROPOSED CONSTRUCTION ZONING DATA LEGEND L.O CAT 10 N : Z3 e�IZIV . FOR z 0 E ; p�'�'N s�.�c� �N �2�' EST HOLE LOCATION , ' , ��' �/• �'� �' �'• DATE . ����s � N — — — — — T z e6 REFERENCE • 1- e� ?- � .. ..� r� � REVISIONS : e�! REQUIRED AREA ' 08 0 EXISTING SPOT ELEVATION 17.6 REQUIRED FRONTAGE 0t50) 37,5 EXISTING CONTOUR 16 R� �, ® � L A ,23 K 4 2 < P� � 4 -� �� �i REQUIRED FRONT SETBACK : ) 3o PROPOSED CONTOUR 16 ��� p +� �s �• PROPOSED �,. : .!� s � SCA LE � / = �' REQUIRED SIDE SETBACK • WATER SERVICE W � a,� ►STE �� PROPOSED GAS SERVICE GPIA REQUIRED - REAR SETBACK f'L �v'rv'�NG� .3o�h'� �oT' e�•w/ 7 PROPOSED ELEC. a TELE E BT CRAI G Re SHORT , P. E . PROFESSIONAL CIVIL ENGINEER L. BUILDING ANSPECTOR APPROVAL DAT E 131 OLD ROUTE I32 -, HYANN IS . _MA, 02601 FILE NO. i-15-77 r_-4_j *(�l 7 3 4o 2- y•g 1 1 SHEET 1 0F 1