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Home My WebLink About0329 OAKMONT ROAD - Health (2) F329 OAKMONT RD. (BARNSTABLE) A= I f r COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 041 d d DEPARTMENT OF ENVIRONMENTAL PROTECTION ��o'co �Tyo� O tis � Darren Meyer,R.S.,Certified Title V Inspector,508-362-2922 �OT��6Z TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 329 Oakmont Road Cummaquid Heights,MA Qt Owner's Name: Edward Molans Owner's Address: 329 Oakmont Road DARRM Cummaquid Heights,MA Id. Date of Inspection: April 4,2001 JE 4ER = Name of Inspector: (please print) Darren MeverFiQF Company Name: n/a D SAS Mailing Address: 43 Vine Street Duxburv,MA 02332 Telephone Number: 508-362-2922 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fa g Inspector's Signature: Date: The system inspector shall submit a copy of this inspection Oport to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. r Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 329 Oakmont Road Cummaquid Heights,MA Owner: Edward Molans Date of Inspection: April 4,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _Yes_ 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: Septic Tank did not show any signs of hydraulic failure, liquid levels in the distribution box were equal but appears to have settled a bit the 6 x 6 leach pit was full. B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the ' for the following statements. If"not determined"please explain. The septic tank is metal 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 1 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 329 Oakmont Road Cummaquid Heights,MA Owner: Edward Molans Date of Inspection: April 4,2001 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: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of 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. 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 and volatile organic compounds`indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 329 Oakmont Road Cummaquid Heights, MA Owner: Edward Molans Date of Inspection: April 4,2001 D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no".to each of the following for all inspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due town overloaded or clogged SAS or cesspool N/A Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow N/A Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone 1 of a public well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 329 Oakmont Road Cummaquid Heights,MA Owner: Edward Molans Date of Inspection: April 4,2001 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health X_ Were any of the system components pumped out in the previous two weeks'? _X_ _ Has the system received normal flows in the previous two week period _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up'? Was the site inspected for signs of break out? Were all system components, including the SAS,located on site? _X_ _ 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? _ _X_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X_ _ 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(3)(b)] Title 5 Inspection Form 6/15/2000 5 r Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE IDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 329 Oakmont Road Cummaquid Heights,MA Owner: Edward Molans Date of Inspection: April 4,2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_5_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CUR 15.203 (for example: 110 gpd x#of bedrooms):_550_ Number of current residents: Does residence have a garbage grinder(yes or no):_YES_ Is laundry on a separate sewage system(yes or no):_no_ [if yes separate inspection required] Laundry system inspected(yes or no):_no_ Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): 1999-2000: 280 gpd, 1998-1999: 288 gpd Sump pump(yes or no):NO Last date of occupancy:_current_ COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): od Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title_ 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Barnstable Septage Treatment Plant(NO VOLUME AVAILABLE) Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other.(describe): Approximate age of all components,date installed(if known)and source of information: AS BUILT INDICATES SYSTEM INSTALLED DECEMBER 2 1988 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 329 Oakmont Road Cummaquid Heights,MA Owner: Edward Molans Date of Inspection: April4,2001 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: X_(locate on site plan) Depth below grade:_24"_ Material of construction:_X_concrete ._ metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1,000 gallon tank, 8' L x 5.5' W x 5.5' D Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle:_15" Scum thickness: 12" Distance from top of scum to top of outlet tee or baffle: .. 12" Distance from bottom of scum to bottom of outlet tee or baffle: 0" - How were dimensions determined: standard 1,000-gallon tank,field measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Recommend immediate pumping of septic tank,tank is in good condition,no signs of leakage,concrete tees on both inlet and outlet in good condition, liquid level below bottom of outlet pipe,no signs of hydraulic failure 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(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 inspection Form 6/15/2000 7 r - Page 8 of l l , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 329 Oakmont Road Cummaquid Heights, MA Owner: Edward Molans Date of Inspection: April 4,2001 TIGHT or HOLDING TANK: (tank must be pumped 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 present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_X_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 1/2" 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.): D-box appears to have settled a bit Water level in D-box is equal with one outlet pipe and appears to be functioning correctly,D-Box is in good condition No signs of solids carry over,No signs of leakage. 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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 329 Oakmont Road Cummaquid Heights,MA Owner: Edward Molans Date of Inspection: April 4,2001 SOIL ABSORPTION SYSTEM(SAS): X_(locate on site plan,excavation not required) If SAS not located explain why: Type _X leaching pits,number:_1 —6' x 6'_ 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.): Leach Pit is approximately 10' below grade Located Leach Pit with underground camera,Leach Pit is approx. 1/e full PVC tee is in good condition no signs of hydraulic failure no ponding of effluent or damp soil,vegetation near leach pit is normal . CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note 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.): Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 329 Oakmont Road Cummaquid Heights,MA Owner: Edward Molans Date of Inspection: April 4,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters'the building. I i 6 i se,Q -Ti ES A-I 221 fir, a Z A - 3 +16 b - ( ZS1 g_ Z 30 3 ' 67, �, 0 Title 5.Inspection Form 6/15/2000 10 f Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 329 Oakmont Road Cummaquid Heights, MA Owner: Edward Molans Date of Inspection: April 4,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+feet below grade above leach pit. Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators;installers-(attach documentation) _X_Accessed USGS database-explain: You must describe how you established the high ground water elevation: Observed Site Conditions and Elevations,USGS Maps and Charts Title 5 Inspection Form 6/15/2000 11 0 TOWN OF BARNSTAI3-LE LOCATION SEWAGE # dry' 7a G `VILLAGE III Oj+**K^A R�- ASSESSOR'S MAP.. LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY Z000 LEACHING FACILITY:(type) 10--Ir (size) G NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER -BUj62E OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: f .. VARIANCE GRANTED: `_'es No Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address:—_329 Oakmont Road _Cnmmaquid Heights,MA_ Owner. Edward Molnns_ i Date of Inspection:_April 4,2001_ t SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet Locate where public water supply enters the building. �— O��oNr fro I ' I i f • 1 � ge�(lc�M �WI✓u-I rJ� A q-1 A z A 3 : qq,�„ Z56 g-z• 3� 3 Title 5 Inspection Farm 6/152000 10 No...22.......70i� Fmic.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .. ......I.......................0 F .................................... Appliration for Uh4poiial Marks Tantitrurtion Prrutit Application is hereby made for a Permit to Construct or Repair ( an Individual Sewage Disposal System at: .......a2._�..... ..........a....... ...................................................... ation-,e,_ss kll� or Lot No ........ ..... .. ............................................ ................................................................................................. wn............. Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms----------- ..........................Expansion .................-------Expansion Attic Garbage Grinder - ---Other—Type of Building ............................ No. of persons.....................______. Showers Cafeteria 04 Other fixtures ..................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width.........._..___ Diameter__.____......... Depth_._..__.._...__. W . Disposal Trench—No..................... Widt'h.................... Total Length......._......._.... Total leaching area-------_----------sq. ft. Seepage Pit No..................... Diameter.___................ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 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-.__________--__----__-. �+ ---------------------------------------------------•----•------------.....----------•-•...---------•......................................................... 0 Description of Soil-----..............................................................................................................................................I................... x ........................................................................................................................................................................................................ ............................................................................................................................ --------------------;6� on A wapplicable_____ ......r----------------------- Nature of Repairs or Alteration when applicable-----Ir?.--e. --_------ .. ... ...... . ......... ......; ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'iT'!Eo 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......... .................... �� to Application Approved BY. . .. .. . ... ..... ............... . . .................... Application Disapproved for the following reasog:...................4........4..r........................................................................ ......................................................................... ---------------------------- -------------------------------------*---------------------------------- IVOI Date . ..... ................. Permit No....33..... Issued...................................................... No..�:'..(�O......... Fim................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...... OF..................................------------------------...•----.._....-----------•--_. Appliration for Dispoii al Workii Towitrurtiun rrranit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: _ 2„ ," In r.' . ( /!" .........a... '_._.......... .: � :' '��=: •-- ../i...................` ° . : .............. - -•f ------------------ Location-LAddress A or Lot No. ______________________ ......................................... .........._•..................................................................................... Owner Address f JCtic a�_� / — fps" — _ .�_::.__ =' I`•=--•------ ...................1.-•---------•------------_........._ .....--••• ••----•• .. ..... ..... - - � Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..........---_'?_..........................Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------------------•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter________________ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet..............:..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 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------_................. a ............................................................._............................................................................................... ODescription of Soil......................................................................................................................................................................... x U •-•••-•-----------------•-••-•-••••••••-•••••--•--••---...----•••••-•••-•------•--•••-•-•---•--•-••-•--•--••••-••-•--••••••----•--------------•---•-----•-•-••-•••-•-•--•--•----•-----••....--•••••••- W -•••---------------•-------------•--•-••----------•------•---•----•-•----•-•-••---------•---••••--•---•---••••---------- J-----------•------- -- ---------•------------------- U Nature of Repairs or Alterations—A��}�swer when applicable_____ ` _ r__:-,-?'- �_._.____ _. -' —: Agreement: r QJ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TILE LE ;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------uq=- - r a.---- ................. ..::.....•••--•-•--•-_•••-- .... Into Application Approved By. ___ __. i.....___f..:._.___ T Application Disapproved for the following reaso ---------------------•------------.._.__......-:••••-----•-•------•-•-•-•-•••••••---•---....-••---------•----------••--•--•------• --- ------•------------------------ ----------- �} Date PermitNo.... �...---- --------------- Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS OARD F HEAIjH i .� � �.... . epprtif lrFatr of TnntpliFanrr THi I .TO E T Y Tha t In K al Sewage Disposal System constructed ( ) or Repaired ( L/ bY �..��1�- ___- _�` --------•••----•..--•-----------•.-•-----•...•--.--•-.---.- Insta 1 at •-- •R1 has been installed in accordance with the provisions of iIii, �of T Sa.nitar o e s� es be' n the application for Disposal Works Construction Permit No.___ " � d �jc _____._.._ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE---------------•-- 1.21"--.-----�. .. .................... Inspector-----------1 �J ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEAL H NO................��...J YVO, �(__ - FEE._ , ..O......... ......_- 'Dispos l k otudr ion rrntit Permission is hereby grantq/__ J T ..................................................... to Construct„( r Re air an Indi i al e gage Dis osal S st c i at No............-��-�`-�-----. T'. � � V l �S J_!!_.d ��--t1-j -- _C as shown on the application for Disposal Works Construction -F it No.__.......� ; d-III . ••--' L-•-----••-- [_. ___ _ __ Board of Health DATE- ----- •---•-••• • ---------------•-----•---- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS -3 9 ASSESSORS MAP NO: e t. A ; i O N PARCEL NO.: 5 Vt A C E P E R M I T N Q. Lit �� ,�.�f-��-__..__..:..�__ _�_..�__ � � ► �._...�.. VVLLAGfir. I H S T A LLER'S 11AME ADDRESS c UILVER v OR OWN ER HATE PCRMIT ISSUED 12 6 DA 'fi E C0MPL � ANr- i 15SUED � �� I 0 eb� � o A,pp-oy. ,o s , s s &h -}OP arr Fim THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF.........................----..........------------....---•-----......................_._ A:pPliration fu I r, t",Iial Workii Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 6 .4 7 4k�tt44 U% /_ ................. .. ' k.................................... .. 6 ........ I 111� ........................ .. Adft ... .. ..... No ............................................ . . owner " ... Y � .................... ...........5 ...... ..4. Addiz. ..................................Installer Address Type of ll iding _;2; Size Lot............................Sq. feet Awing—No. of Bedrooms,------4!&............................... Expansion Attic Garbage Grinder (e a4 Other—Type of Building kAr0A.-A?------- No. of persons___.... ................... Showers Cafeteria Otherfixtures -------------------------------------------------------------------------------------------------------*'*"**-----------....*-------------------- Design Flow----- .........................gallons per person per day. Total daily flow.........VYP........................gallons. .......... 1:4 Septic Tank—Liquid capacityZ gallons Length................ Width.....__..__.._.. Diameter--__-___-______- Depth..............-_ Disposal Trench—No..................... Width.............__.._.. Total Length:__............_.... Total leaching area....................sq. f t. Seepage Pit No.. _-.... Diameter.-�...K A........ Depth below inlet.................... Total leaching area...Y��.....sq. ft. Z Other Distribution box (Y� Dosing ta?, ( ) �11 1.111.Z g%_ Percolation Test Results Performed by-_........... .......................................... Date_.....-........... ............... 1.4 ,.-I Test Pit No. per inch Depth of Test Pit..... ............. Depth to ground water.................._..__. 0-4 �14 Test Pit No. 2................minutes per inch Depth of Test Pit.___........_..._._. Depth to ground water____...____............. ....... ........... . .................. ......... .......... ----------------:��--------------- q 0 Description of .,oil----------....... ...... .......................................I................................ .................................... U ........................................................................................................................................................................................................ ................ ....................................................................................................................................................................................... U Nature of Repairs'or Alterations—Answer when applicable.............................................................................................. ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemin accordance with the provisions of TLIT=4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b i y the rd of health. CIO— ...........C...... ...... .......................... Signed .. .................... Date Application Approved By ...........2........................................................ 1g _ .......... Date Application Disapproved for the following reasons:.............................................................................................................. .......................................................................................................................................................................................................... Date c3 PermitNo..... ..................N-7.......I.................... Issued........................................................ Date ......—---—----------—-----------------------—---------------------------------------------------- FRis THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................-----•-•-.---.....O F..............................................................---•........................ 1p irttiiun for Disp aiitt1 Works Tonoirnriion Prrmii °Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S tem at• e �- .._.. ......... ....... ......•-••-•-••--•• ... ..----•• --...._.. •uS � '( e•+.. dry( /�4f `/' �blr+e W 8 Nq. .+ / M W _ _..._ ...... __...._-^. ......................... ............................................... .................._. . }fie • r� s W P`� J>�f '9R c�11 ,� +VL. ..i[,S Addc�.� ........ ........... e .. ----.L.................. ... ... - Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......., X --- Expansio Attic ( ) Garbage Grinder Other—T e of Building `.... No. of persons______ .._.......-_.._.. Showers — Cafeteria Otoe�Wi ures ..................... ................ d --- •--•••-•••--••-•-•---------• . Design Flow............................................gallons per person per day. Total daily flow_.._._. t��..._.............................gal Ions. WSeptic Tank—Liquid capacity! ..gallons Length________________ Width...:............ Diameter................ Depth................ x Disposal Trench No. .................... Width....................: Total Length.................... Total leaching area.-_ ....__..sq. ft. 3 Seepage Pit No...................... Diameter 6 ........ Depth below inlet................... Total leaching area. .....sq. ft. Z Other Distribution box (1110 DosingLanjk ( .-- Percolation Test-Results rerformed by.,'."'...~ '.I .. Date...............................g` Test Pit No. 1 ..sSS ;nutes 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........................ a •. 0 Description of Soil...,.- Wt.Ym CRe >L , 0_ '` + l e. I,,•� s u fir... . ..................... • ••................. ...... .... U ......•-• , ........ ..................•--... . ..--•---••-••----•••--•••---•----•••••-••-- .........-•••--•-•-•-... .....•-----......•--•••...............-•----.._._... 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 TITI `5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be Issued by the bo rd of health. cf •--- /'r - elk— Signed-'`:.---.......-•-•-•-------•-`v--=-•-----��-•--•------------------•--.....-•- ................................ Application Approved By.......................................................... .......Ay" ..--- ...__.._.. .. { .... ..... ... ... .... Date Application Disapproved for the f ollowing.reasons:c -................ .............. .............. --------- �' .. .....................----........................... ..._w �" Date Permit No....... �.�.. .. -- Issued........_..•... ................................_ 'rf' .. Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH I .......... . ........... .rOFf .............................. (Irr#if uttir of 09-nmolittnrr THIS 15 TO CERTIFY, That the-Individual Sewage Disposal System constructed ( ) or Repaired ( ) :.......... = _. + Installer at•---•----•----:....... ......_..:............._ ..�r m..+_ ................ ;.e +rr '` ` -••--------------------------------------••-----... --- •--------._ has been installed in accordance with the provisions of TI 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..__...::: = .'�:�._._._..... dated.......... ...............:... THE ISSUANCE OF-THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL�F NCTION SATISFACTORY. DATE............. -��-k �- Inspector..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF........................... ig o No. ........ F ........... .......--........... P.;. iu�roottl orku Tonsiruriion VarAft F ��r C'• -f ��tt ermisslon Is hereby granted........fP_,-•-•--•.:........:..s.._----•--._....-•--•-�-�` -------•-•-•----••-•-----.....................-•-•-----.................___.. �t to Constr`,u or Repair ( ) an Individual Sewage Dispo.�sal System atNo. •.. ..... - ...�...i...... ... ?_..._ � l�.f y :........ f' �'"" !" =-�-'-•� ........................................................... Street as shown on the application for Disposal Works.Construction Permit --` Dated.... e l.......................... j ��f^ Board of Health FORM 1255 M. SULKIN, INC., BOSTON ' _ r. s s SECTION SEWAGE" • t SEPTIC TANK- 2p - D BOX - ZZ -LEACH pl`�. �w TOP F FON s ;!' -.IMSL)* /12"OFIISTOlk" WASHED STONE Ipt > - �.z qs1 /�/� EXIST.. 3 rn i n:J6 b. ,a 77 OUT• , QU IN J l� ,.,,,..SEPTIC - Ilk ELEV. „:. ELEV. ELEV. .,.::.ELEV:. • ,01. qg a WIN, ELEV. : J fi. 1 , OFi4^-:14e R.>. .o`: i .,.,. . WASHEDSTtlNE_ - - e TEST HOLE LOG - t) . TEST BY J E.L e• -T. MO Y r-AKI • WITNESS _ � TEST DATE BEDROOM HOUSE T.Hi .1 T.H. 2 DESIGN l _ ELEV.gZ� �n .�. ELEI/Qj Z NO / s�S 9(n�2 . PEFtE RATE. L Z .MIN/IN.,. Ot$POSER DISPO ( _ '" y ' P FLOW RATE 1f0)('1 z q {1I c -1 Q•..Z (GAL./DAY) co p � -T . C>2i ot_ SEPTIC TANK 'bejD (��Sd= u N11q.1 �Tt�(e~S REO'DSEPTIC TANK SIZE / I 1 \\ ` yr M t:V 1 M LN map tut FACILITY 'LEACH A �i 1 C C !- 1 rzW.�r 8S.2 SIDE WAL _- 1�2 QtPL�(2:5D) - Z1 .cro. 1 1 1 7 - BorroM' .�zh�> :!^op) a '�. lLG�/D. �. TOTAL 2�319 i o I / 1 / l kq utt..,C7tN(r pt v � l 1 ti USE: LEACHING IT - 12 � �I A►� x � t�.71 XF n+ � l N / �/ /�p-r 2 / / (�((� / q 'FM IT 3 / WATER ENCOUNTERED + ` I (d 61 DE .4'5 • � / �oRr�D C,o►.liTc�U� . NOTES (UNLESS'.OTHERWISE NOTED) / / 1.DATUM(MSL)!.TAKEN FROM i:�YP�rJ t S QUADRANGLE MAP . �K OF 2.'MUNICIPAL WATER -------AVAILABLE 3.PIPE PITCH:W"PER FOOT 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO I C[._-44 ARNE H. S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. � OJALA � •/ / / � �`�/ 6.PIPE JOINTS SHALL BE MADE WATERTIGHT q 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. CIVIL. ti \ /, _.. .. / STATE ENVIRONMENTAL CODE TITLE S. _. N0:3t)79?. - -� - ,Z q _ 1 � /r_ o�-, \ SITE PL�N _ (._ ,\ \: . � \�.\`- tP``H bqf�` :LOCUS .. T OFt�MUNT AD 8. T%-�.Ab 'Pt-Ad�J FQL. Y'?p'7L'Y.+c.� I,��dCl� Cw�``C t+.�JD �+-�aJa.� / _ - - - \ Z G C(t A< U►.ISU't Aicat ::MA'C t �6'CWi✓Er.t GiLEV• `Is" E A HNg A UM MA U I�� P�A2.r�ST � (� T R G:PROFESSIONAL ENGINEER 2C� P LaC. OJ A LA .- H _ PLAN V Ey.� f /�,- "T i�i I _ �_ _ _ REF: Y�/A N 1�. 3��' 1 l7 1 0�) H fcN CO Er M�DII�M -•PAID Off- t0 - --- _ Q. UND lCk t.11.1(r \ mm o 826348.-- `� 171V�✓�N �own Qp engineering ��s �y PREPARED FOR:..-p , \ CIVIL ENGINEERS BOARD OF HEALTH y O".mon LAND SURVEYORS -REG. R (EXISTING)............. R SC AL n ! f2 - RVEYO I L I D CONTOURS (PROPOSED)-O-O-O-O- APPROVED DATE �A'C- I'I�A%NIA Y t ALES.. D E •j �S ASSESSORS MAP NO: I. UCATION PARCEL NO.: SEWAGE PERMIT N0.• VILLAGE --- IIISTA LLLR'S IIAME ADDRESS R U I L 0 E R OR Q1fYKER DATE IsEiRMIT IS.5UED IZ D A T E C0. hiPLIANCL ISSUEDky- t � L x ' .� �. ko 1