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HomeMy WebLinkAbout0096 DROMOLAND LANE - Health 96 Dromoland lane Barnstable �- A= 234 —037 FJ e o r I r r 1 L b TOWN OF BARNSTABLE ° G - Lea--ION j i$1v�c�H v! 41k-e SEWAGE# `0 ASSESSOR'S MAP&LOT' 03 INSTALLER'S NAME&PHONE NO. T04,17 Aar SEPTIC TANK CAPACITY LEACHING FACILITY: (type) `g'goo clew/, r-4.~iye; (size) 32`x// `X 2 NO.OF BEDROOMS BUILDER OR OWNER /�oI'll lei e.? s$o PERMITDATE: COMPLIANCE DATE: `1= Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility. Feet Private Water Supply Well and Leaching Facility (If any wells exist _ on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by COr 31`� fi 6 7i'oP 7i s. ®` .1 TOWN OF BARNSTABLE 1 LOCATION 96 p�'°�'+ L e4 a o/ 1114, t SEWAGE# VII#AGE .�.e, ASSESSOR'S MAP& LOT Q C INSTALLER'S NAME&PHONE NO. TO/,4-, SEPTIC TANK CAPACITY /S y o k a I t /o cy �,v 4 'o"w; LEACHING FACILITY: (type) yul c4 a wiy t (size) 32`x// 'x 2 ' NO OF BEDROOMS 3 BUII.DEIz OR OWNER 1u yr s s o -. PERMITDATE: COMPLIANCE DATE: q ' �•- —J Separation Distance Between the: 1 Maxtmiim Adjusted Groundwater Table and Bottom of Leaching Facility Feet Privatd:*ater Supply Well and Leaching Facility (If any weals exist :op,:site or within 200 feet of leaching facility) Feet Edge:"of Wetland and Leaching Facility(If any wetlands exist wfthi'300 feet of leaching facility) Feet `. Furnished by r L r lal '. • I - .. ` 4- ly o s O O 0 No. Fee 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Mizpoar *pgtem Construction permit Application for a Permit to Construct( )Repair(✓Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S6 �vo•+-n 4rK�(� Owner's Name,Address and Tel.No. { r Gu0-"Art4 �., Ap&7 J 'N sfGa� Assessor's Map/Parcel Installer's N e,Address,and Tel.No. Designer's Name,Address and Tel.No. cum Zw, Type of Building: Dwelling No.of Bedrooms '3 LotSize,2/ /Og sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures k Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations ns er when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi jarVof Health. Signed Date '�— Application Approved by Date Application Disapproved for the YllowiYg reasons Permit No. / g - 7 Date Issued r' a ,..w. No. Fee Sd THE COMMONWEALTH.OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Digp0$a1 *patent QCok5tructiOTY ,xmit Application for a Permit to Construct( )Repair(V/ Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. �,,/ �rp. ,v 4c+o<��� Owner's Name,Address and Tel.No. G Assessor's Map/Parcel !/ 9G 1�r06r+(✓G.GVM�L�AHf CbM rv.a u Installer's Name,Address,and Tel N�o—. Designer's Name,Address and Tel.No. cum w Type of Building: r Dwelling No. of Bedrooms Lot Size/2/ /019 sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic_Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterat!Pns Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance,with the provisions of Title 5 of the Environmental Code and not to place;the system in' operation until a Certifi- cate of Compliance has been issued by this ar of Health. Signed Date 2-.2 Application Approved by Date ;L- �. (' Application Disapproved for the MllowiRg reasons Permit No. q !-� � 7 A Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewa-a Disposal System Constructed( )Repaired (Upgraded( ) Abandoned( )by •-+ ry! Gv f at q4 9*6'a 4f.4" N. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit o. dated Installer �y�s+ /9, J� Designer K The issuance of this permit shall not be construed as a guarantee that the system willi ction as designed. Date / Inspector No.� -------------Fee� G - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS WiOP05al *pftem Congtructiou i9ermit Permission is hereby granted to Construct( Repair(Upgrade( )Abandon( ) System located at 1,*A-e Cuter r-► v!F c. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: - q Approved by� > EDWARD E. KELLEY REG. LAND SURVEYOR U CUMMAQ 10, MASS. 02637 TEL (617) 362-2266 January 8 , 1986 Town of Barnstable' Board of Health Hyannis , Mass. T REF: Lot #26 Dromoland Lane ,Curnmaquid , #85-267 The system was finally installed according to the approved ' leach it was plan with the exception of .the leach pit. The p installed in the reserve area. The system conforms to the Town of Barnstable Health Regulations and Title V. "'. Reg. Profe, � Qrial--Ij rid Surveyor ASSESSORS MAP NO: g • -� PARCEL NO: (� LOCA ION 1 5EWAGE PER A1 tT NQ• VILLAGI O I,H_51 A L L E R'SIN A ME A D p R E S Sv a U.1 L D IE R 0R 0W14 ER�1 DATE PERMIT ISSUED c, "Z -- D AT E COMPLIANCE ISSUED f: 1 bvc� 4'a CC AS1 Tw w K v c p ,i ell a 10 /97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CER TIFICATION FICATION OF SK ETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) e application for disposal works the. P J� , hereby certify that pp signed b me dated z — conceming the 1 ' construction pelmet s g y . property located at a ti Ck •rip �, meets all of the 9 �ry 0 1 N �' y following criteria: There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase in now and/or change in use proposed • There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will W be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) 7�. B)Observed Groundwater Table Elevation(according to Health Division well map) 2y SIGNED: DATE: �2 ' LICENSE PTIC SYSTEM INSTALLER 1N THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also If the licensed al/Installer posesses a certified plot plan, this plan should be submitted]. 5e C /V 7� Lti q:health folder:cert f . �Aw 0-CA I.0N•, `` SEWAGE PERMIT NO. PILLAGE III ?v-o IV\ ICI TA LLER'S NAME 6 ADDRESS D U.I L D E R OR 0 W N ER-:A -- it :I DATE PI` RMIT ISSUED DATE COMPLIANCE ISSUED ECOsr i Ooo pp VOC c` *27 r Me No... Fxs. :� . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............./O 1�t/ .......OF........ lG4�".......... ApplirFa#iun for Disposal Works Tonstrurtiun truth Application is hereby made for a Permit to Construct (tom'or Repair ( ) an Individual Sewage Disposal r System at: 4 - ............................=.......................... Location-Address or Lot No. ----=--------------- ---------------------------------------------. ---------...----------------:................--- Owner Address W Installer Address Type of Building 3 Size Lot.�Z�Z�8 Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showers Other—Type g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures -----•---------------------------------••--•----------.••••----•---•-•----••----••••-------------••-••--•............................................ W Design Flow.................-`_3...-................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityZ��!a.gallons LengthA ........ Width._5?�_e"�_ Diameter................ Depth.. �8 x Disposal Trench--No..................... Width.................... Total Length..................... Total leaching area....................Sq. ft. Seepage Pit No......./----------- Diameter.....14-------- Depth below inlet......._........ Total leaching area_.��Z_4Lq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by._.__.�_ _�-_ems..... �. �' -............... Date...:G'6�19�............. W Test Pit No. 1..G_. ....minutes per inch Depth of Test Pit-__?- `....._ Depth to ground water........................ fT, Test Pit No. 2...G_.6...minutes per inch Depth of Test Pit...Z ... Depth to ground water........................ a --------•-.•-------------------•-------------•---••--•....---------.......---•--•-------.................-•-••---............----•••-••-...._...--•---•-----. O Description of Soil...a-�=3��r f Sum=Sor L--------------- ................./68��---- � 1.....f U ....SAID.-•-•--r'`��T `S�'7 ---•-• cn/ ...-----•--••---•------•-----------••-•-----•---------•----•------------------------------------••-•----------.. W VNature of Repairs or Alterations—Answer when applicable............................................................................................... . . ---------••-••-----------••-----•-•----•--•--.....---••-.._....--•--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLLI 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed............................. . . . . ..... -------- •• ......... {ra. App�ication Approved B ---••••. .------ •-•-•-. . . . • .• --------------- -•---•. •-- ----•- I 1 g.� D y e Application Disapproved for t ollowing reasons:................................................................................................................ ------•---••••••-•-••-••......••-•--••••••••-•--------------••••-----------•---•----•--------...---------.....--•----•--------••-••-•-••-•--------------••----------------•---•---------••-•-------•--•- �r Date Permit No........ .................. Issued.-•----. Date No. ............_....:.. +. F�a... �"3+- THE COMMONWEALTH OF MASSACHUSETTS �.. J7 BOARD OF HEALTH ............. .a-)ti. ........OF......d�! ',�? f . .�°3 � .............. ApVtiration for Uh3posa1 Works Toustrurtinn Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. Owner Address W Installer Address Q Type of Building Size ----Sq. feet v Dwelling—No. of Bedrooms...........3.............................Expansion Attic ( ) Gar' age Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q .tunes ........... ... • -----------•--•-•-•-----•..•-••--------•••••••••--•--•---------••--••-•-••----� ••--••-•--•-•....-•--•............•--- W Design Flow.Other fixtures -- ••'•gallons per person per day. Total daily flow- ___-_---•. .�3sa.................gallons. WSeptic Tank—Liquid capacity!S�.gallons Length.�.�_.._..... Width._.-,<.••._ Diameter---------------- Depth.,a-Ze-9 x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-----...............sq. ft. Seepage Pit No-------/_._:-___•.- Diameter...../*.*..... Depth below inlet.....(............ Total leaching area.' /7 .8..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed ......A i .;��................ Date...j,.. �j�._............ Test Pit No. L,/_k.....minutes per inch Depth of Test Pit__..l.SZ........ Depth to ground water------....m.......... 44 Test Pit No. 2... ....minutes per inch Depth of Test Pit.../o•'Z".___ Depth to ground water........................ t4 .......••-•-•••-••-•••••-•••---------•-•----•-•---•-••--•----......•------•--•-•-•••----••---•--••-•••-•----•-•-••.....................•---•.._........---•- D Description of Soil....0.. 4-i.{..... � £�._ S�t.�-���.. �sS"_.,f_�.t�.........t��?7/.Earl�� U .�.._rr�T3-..._.....k .ra-1 - �!?C......-f �n,£S`--�----••--•---•--------------- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•------------•-------•--------•----------------•-•-----•--•--------------------------............-----------•---------------------------------------------------•-----------------------.....•---.----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in open t- until a Certificate of Compliance has been~issued by4he board of health. r 5 ! _ i ?Signed.. �\�.} .. 1 " .� : Date Application Approved BY'`'. -•-- ......•. = / ,d l '�................ }------. -------- Application Disapproved f or,tl2e following reasons:------•------------••------•----------------------------••••----••......•-•--•--••-•. ... .... .... -•--------------•-------------Q . -•-..... --•--••'-..........----------•-......------'------------•-------••---•-•-•••••-•-• ...................................... Date Permit No................................j11... Issued_.-•-.. .._.. •.D- A'------------------------ THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a'. OF.... G /..5..?'��� .� `rr. (Irrtifiratr of Toutplianrr THIS IS TO CERTIFY, Thoe �><iclN ual Sgve`I&8osaj System constructed (p,, _or Repaired ( ) by--.------Or 1.5•••••.. • . • • --------•---_''.........------•------------------ �- -- -•-------------------•----.............-----•---......----••-•-- + C'vvN N-A Installer has been installed in accordance with the provisions ofj�I C;of The State Sanitary de as escribed in the application for Disposal Works Construction Permit N ........................................ dated-._.. __�_1 .��...__......._.•...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST USED AS A G AR EE THAT THE SYSTEM WILL -111INCJION SATISFACTORY. r� yl DATE..... t. fS_ IF-6._.........•••••....................................... Inspector................ ....---------------•-••----------- ...................... A) J THE COMMONWEALTH OF MASSACHUSETTS -E No,Ajei t2 T,^,Cj:'p T r� SjGty BOARD OF HEALTH ......................... F ............... j ��'., - i �ai nrk �untrnrtuan rrntit ✓ . Permission is hereby.granted----•--•----�''©GE`i2-..........P.L.P.-.-C--��---1-�---•----•-------._._....--------.......-•-----._......_......••-•----------- _. to Corftimct (' @3e � iQ (tC� "tr,�,Jndividual Sewage Disposal System atNo......................':...............................................s:.............---•---•-•.--••- ----------••-••-•-......---•-•----•••••-•-•- r Street , �y as shown.on the application for Disposal Works Construction Perini o......... D ted`�......: ......A_.._.................. . Board of Health _~ DATE..... _ FORM 1255 A. M. SULKIN, INC.. BOSTON - EDWARD E. KELLEY REG. LAND SURVEYOR CUMMAQUID, MASS. 02637 TEL : (617) 362-2266 January 8 , 1986 Town of Barnstable Board of Health Hyannis , Mass. REF: Lot #26 Dromoland Lane ,Cirfomaquid #-85-267 The.- system was finally installed according to the approved plan with the exception of the leach pit. The leach pit was installed in the reserve area. The system conforms to the Town of Barnstable Health Regulations and Title V. .�.�� - Reg. Profe, : 0-na`l- a!( Surveyor @;, t A _Y iQ,!- irauv' f _ Town of Barnstable P# Department of Health,Safety,and Environmental Services ( / �tHE Public Health Division Date v , � Q 367 Main Street,Hyannis MA 02601 BAMMBIZ " MAS& ✓ E1639- Date Scheduled ® Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By:�Q�,n 1`, AIAS'kt Witnessed By:DOA M to?-c,A I ZS LOCATION & so p GENE L INFORMATION Location Address � Qn/ 0 Owner's Name x[, / �IG� Address Assessor's Map/Parcel r—zA- Engineer's Name ' NEW CONSTRUCTION _1i REPAIR Telephone# Land Use Surfa es(%) ce Stones I } Distances from: Open Water Body tt ,'Possible Wet Area 4 t .n Drinking Water Well ft Drainage Way R k 'Property Line (t Other ft SKETCH: (Street rame,dimensions of lot,exact locations of lest holes&perc tests,locate wetlands in proximity to holes) MA ®Peve Parent material(geologic) Depth to Bedrock l Zo rr Depth to Groundwater: Standing Water in Hole: PVD/1Q Weeping from Pit Pace A�2yVCL Estimated Seasonal High Groundwater DETERMtNATtON FORSEASONAL HIGH ,VATERTABLE Method Used 1 � Depth Observed standing in obs.hole.e + in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: iii. Groundwater Adjustment It. Index Well# _ .-_ Reading Date: _ _ Index Well level _ Adj.factor Adj.Groundwater Level PERCOLA`I"ION,>TEST Date 0 ime/ 11 Observation Hole# ( Time at 9" Depth of Perc .° Time at 6" Start Presoak Time a _� Z: Time(9"-6") wmm End Pre-soak it , 6 Rate Min./Inch _ Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant y µR -� rt �V <;DEEP OBSERVATION HOLE LO.,G hole:#. Depth frail Soil 111orizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) •� c 1" r t DEEP OBSERVATION HOLE LOG IIofe #. Depth from Soil Flonzon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel G X,9 3 Z IOAOL - 3Z C.4 16 YK 7 .6 2-- 20 C Su lL j -7 s DEEP OBSERVATION HOLE LOG Dole #: Z Depth from Soil Horizon Soil texture. Soil Color _ Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel /- /2 va L'-4"L I o ye32 12- 31 l 6yiCO 7 6 - zd C Z 0 xe z 134 __ _ _ DEEP: OBSERVATION HOLE LOG I-Iile Depth from Soil Ilorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel I � ► Flood Insurance Rate Man: Above 500 year flood boundary No Yes ly Within 500 year boundary No JC Yes Within 100 year flood boundary No X Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? wV j. Certification *f I certify that on (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tr Wing, pertise and exper' �c cribed in 310 CM 15.017. Signature Date ��, 10/06/1999 11:51 15084203819 JK HOLMGREN & ASSOC. PAGE 02 d FORM 11 = SOIL EVALUATOR FORM Page 1 Commonwealth of Massachusetts Date..................................... Massachusetts Soil Suitabilitv Assessment for On-site SewaZ�Uisosol lafanned B J,0 D Xu�h.snsk.a �t Witness By: p—Qnn¢.... .k. :.....t l.. awl o .�....w�%5 w...._ ..xw._....v._... �..�toa La f 80j DraMo" La4w- • . And 334- t of-�8 83 New Construction ® Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Year Published ..19.9.3- Publication Scale Soil Map Unit :Pv.G--- Drainage Class ............... Soil Limitations ............................................................................... .....:.............-:........._............... Surficial Geologic Report Available: No ❑ Yes Year Published ................... Publication Scale .................. GeologicMaterial (Map Unit) .......................................................................................................................... Landform ....... . ... .......................................... Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Within 500 year flood.boundary No Yes ❑ Within 100 year flood boundary No ® Yes Wetland Area: National Wetland Inventory Map (map unit) ..................................................................................................... ....... ... Wetlands Conservancy Program Map (map unit)...:............................................................................................... Current Water Resource Conditions (USGS): Month .0. Range: Above Normal ❑ Normal ❑ Below Normal , Other References Reviewed: 10/06i1999 11:51 15084203819 JK HOLMGREN & ASSOC. PAGE 03 FORM 11 - SOIL EVALUATOR FORM Page 2 On� ie Review Deep Hole Number .......... Date:. �5 Time:. _ADD Weather ..aool 60..'_.. fir......... . Location (identify on site plant ................................................................... .....:............................................................................................................. Land Use ........VOLI.a..m-f..................... Slope (%) 0:7.3.....: Surface Stones ..ft...........................................................:........... Vegetation ..W.D..O.As..............................................................................................................................:................. ... . Lendform _.:f 1.Q.rtw►n:e....................... Position on landscape (sketch on the back) .............................................................. ......................................................................................... Distances from: Open Water Body ...................: feet Drainage way.I................. feet Possible Wet Area ................... feet Property Line ................... feet Drinking Water Well ................... feet Other ......:................:...:............. DEEP OBSERTMON 11OLL Eau Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsom (Strucpue.Stones.SouWars. Consistency,%Gravel) 0- 1 0 A 10 W Ih I Z, -3Z. 6 .mod,tCA rn ;o YR 716, C.45'' 7.C 16 3 z - !z0 L S�r�y 1 10 YR 718 i � f h Parent Material (geologic) ..........J 4.1:t.................................. ... ... ................................ .. ..... Depth to Bedrock: 7.....'.?Q.. . . Depth to Groundwater: Standing Water in the Hole: ,.N...D....... Weeping from Pit Face: ...Yv.o,... Estimated Seasonal High Ground Water: . 10/06/1999 11:51 15084203819 JK HOLMGREN & ASSOC. PAGE 04 FORM 11 - SOIL. EVALUATOR FORM Page 2 A-site Review Deep Hole Number ..... ..-.... Date:..10/5... Time:.��...�DA Weather C�lQ. djo.......J40Y Location (identify on site plan) ................................................................................................ ............. -...............,........................ Land Use .......Ajr—A.0 r.4.................... Slope (%). Q..'3..... Surface Stones ....... p........................................................... ...... Vegetation ....W.�Od-+LS.................................................................. ................................................................................................................................ Landform ......."j!GNi.I.'.1.¢............................ Position on landscape (sketch on the back) ..................................................................................................... .................................................... Distances from: Open Water Body ................... feet Drainage way...............:.. feet Possible Wet Area .................. feet Property Line ................... feet Drinking Water Well .................... feet Other ........................................ DEEP OBSERVATIUNHOLE LOU Depth from Surface Soil Horizon Soil Texture Soil.color Soil Mottling Other (Inches) (USDA) IMunam) (Structure.Stairs.Boulders. t Consistency, %Gravel) 0 �( Q - 12. A 6 a r+atyo, �oY1� 3/Z 12. - 3 Z wo►"^r ate 714 e b �8_ r CZQ�y oyX �/3 ,syasf� Parent Material (geologic) ........i�t..L....... .................................................................. . Depth to Bedrock: 7�z� Depth to-Groundwater: - Standing Water in the Hole: ...N..pQ Weeping from Pit Face: Nd,nQ Estimated Seasonal High Ground Water: . ' 10r06/1999 11:51 15084203819 JK HOLMGREN ASSOC. PAGE 05 - FORM 11 - SOEL (EVALUATOR FORM Page 3 �Deter�nination for Seasonal Nigh Water Table Method Used- a Depth observed standing gin observation hole................... inches ❑ Depth weeping from side of observation hole................... inches Depth to soil mottles ...45.... :inches ❑ Ground water adjustment................... feet Index Well Number ................... Reading Date ................... Index well level................... .Adjustment factor .............:.... Adjusted ground water level ........................................................ Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious:material exist in all areas t observed throughout the area proposed for the soil absorption system? Y,f If not, what is the depth of naturally occurring pervious material? Certification I certify that on 'ar zil (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Di Lol& Date 10/06/1999 11:51 15084203819 JK HOLMGREN ASSOC. PAGE 06 FORM 12-PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test Date: Time: ...::..J.._.�.�. o.A�'' Observation Hole # Depth of Perc Start Pre-soak WZ6 End Pre-soak 114 Time at 12 Time at 9" r _Q Time at 6" 1Z:,' Oo . Time (9"-6") j� Min Rate Min./inch Site Passed Site failed ❑ .......................... ............................................................................................................................ Performed By: Ark, t" - rJtC t•!ol vhs csC Witnessed By: j2�d1yr. �, f' ') c. Q - X+S�a�Ii lhft Comments: ........................................................................................ 10/06/1999 11:51 15084203819 JK HOLMGREN & ASSOC. PAGE 67 o - z TPZ pf CA" � TPr '►OLi4 rJD L ACIF Loco-Lon S kti" IV L 78. So J TOP OF FOUNDATION CONCRETE C( CONCRETE COVERS 4"CAST IRON II MAX . B OR SCHEDULE 402 . 12"MAX. P.V.C. PIPE HEDULE 40 PVC.(ONLY) PIPE n PITCH 1/4"PER. PITCH I/4"PER.FT LEACH PIT INVERT PINVERT LE SEPTIC TANK INVERT : PI / �'• EL.. 7&'.'/'¢ 01ST. INVERT BOX EL.74 w \ / .,� >_ .•. •; EL .7/"/9 /Soc' GAL. INVERT ' �-►- O / EL7o.73 INVERT G wu 0. .•. 3/4 • . Q n. ! EL.7o, Z.3 O'DIA. --+� 14-' DIA.---•-� PROFI LE OF GROUND WATER TA SEWAGE DISPOSAL SYSTEM NO SCALE V V SOI L LOG WITNESSED BY DATE 4111'94- TIME BOARD OF HEALTH t TEST HOLE I TEST HOLE 2 ELEV. G7,. zo ELEV. /� !� y ENGINEER DESIGN DATA �! �3 A �o„ jam/ ¢ �LAy CC. 70.�4C LZ.Zo NUMBER OF BEDROOMS -� ��•Z �l. w, s �-s TOTAL ESTIMATED FLOW ' ' � lYBUFi�/c . GALLONS/DtiY n4 rrta BOTTOM LEACHING AREA SO.FT /PI T �2. 6' 70 t vs StaMt / /�� SIDE LEACHING AREA ��3.9 i �/.� FirvEz SO.FT./ PIT/43 u 7<�' y �/' ���,•' GARBAGE DISPOSAL NvN� (50 /o AREA INCREASE) TOTAL LEACHING AREA `//7 S0.FT C2 { GL l�.L t; •« �'� _ ¢_ Isic G-Z'Go./o PERCOLATION RATE Lis "Yl/Hn! =�lX MIN/INCH C3. - EZ S ,Zo — LEACHING AREA PER PERCOLATION RATE 7 . SO.F' �q 0 WATER ENCOUNTERED NUMBER OF LEACHING PITS n!%E f'/T G✓i�:*,/ APPROVED . . . . BOARD OF HEALTH Jrcc,r '� '� S"'4/6^ o'v -� -Z Aj G'Z ^t,.J 1 i 7�17 /t�GF_• a� �5T f+�aGc` `yG- 6� LC 7 �� 0. ,{fie '4'•c.� �"L � � �4'��4 7C _'r, ___ ,�_�:1"_ 3[=� i�':� LAB �+=.r _� Af 9 EL _ l o � ��� j 4 � W�`�/ES I-A[-Trc_:. q,✓n ez GZ. BO �, _� -•off I �c Q Q J �?":! f�ot=G �'3 Tf_-'�:` j�•>!�E �4 ���p�SH OF �fgss� �4 71 ('Z .j.✓(J p ST N tt 527 N i.. EZ 70.7.� 3 2 ./.. -1 o p -7 e / --�_ ..J4 SA MIT AP.�P 70 ram. (J� roc {: U/zv�yo�_ 1 I i TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS i °e a 4„CAST IRON II'2„ M►-i"''nr �r�nnr�r 12"MAX OR SCHEDULE 40 PVC PIPE PIPE- MINE 40 PVC (ONLY) LEACH Y PITCH I/4"PER FT PITCH 1/4•PER.FT PIT PRECAST J » c LEACHING o . INVERT a • � OR EL. . 7/.. -4- INVERT INVERT PIT EQUIV. SEPTIC TANK EL . 71?'.9¢ DIST. EL.70-`t �= EQUIV. INVERT BOX - ` /= GAL . INVERT a 0 EL.. 7! /� EL7.4r73 INVERT w W Q �. 3/4"TO I I/2 EL lo. ;. f WASHED I w STONE n, 0' taz 4., _ S'DIA -+�• DIA I PROFI LE OF GROUND WATER TABLE I SEWAGE DISPOSAL SYSTEM I r� NO SCALE i SOIL LOG WITNESSED BY : IV T /� ¢ TIME . r�,30 .qry /Zon/ .%f.f; %=li. S . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ENGINEER ELEV 7. 'Za ELEV. A DESIGN DATA ¢ y,Lgy 70 NUMBER OF BEDROOMS 3 e�Z L2.Zo TOTAL ESTIMATED FLOW 33o GALLONS/DAY I �`_ 'J3• w�7}/ syw�,�•-s /'1d'T� Fi�/E c�. ,,c� S. snip 114 BOTTOM LEACHING AREA �S-3./ SQ FT / PIT 1 9 Ir6'T7c) f-� 5 f SIDE BEACHING AREA SC iT i PIT/¢3 b GARBAGE DISPOSAL No.V'C (500% AREA INCREASE) TOTAL LEACHING AREA . SQ FT q PERCOLATION RATE Z-''� �/�'^ -��X MIN/INCH i' LEACHING AREA PER PERCOLATION RATE SQ.FT-/(.,pD, WATER ENCOUNTERED NUMBER OF LEACHING PITS aNE C'i7- 1,V17,OV p` ^ APPROVED BOARD OF HEALTH DATE o C 1 7" {j\� AGENT OR INSPECTOR SI 13- / ez. 74.3 0 _ 1 gL 34" osr �Tp'/ ry, Leu cLV �q�.CE�v ,CLy i H/rink' 41C4Ay 1 Ei. 47.30 ,y ea -PEUGALt . G'Z. Lt• .,l ' : tiry 3si,v0 4� x 3s L I /G8" 15L 72; /,4ax4 *3 1 Tom" 7' /k�l.,c•' 'YQ y i Z 70,7o i �-; �✓� .SvB-So�G.. "�.I,°r`%� OF M4 7 7-9 ` EZ.70-17 Z5�gA Al-5; SON G� I T 527 N � �` � ��� �$•I Sao � 9 o � 4E'Z.GB.7n srF. iJ 5° o . t�wflrr-G E- .��ZG G-•y � Lr.�F=s V/ P /32' ✓ I 47. Gi.70 / G-1. La.Sp " ){FILL GiaTir � `e