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HomeMy WebLinkAbout0011 WHITE MOOR - Health 11 WHITMOOR WAY,BARNSTABLE A = 317 065 I A G O t i A 4 a 59an'Stl; -eiL-Barnstable 'i� Commonwealth of Massachusetts Executive Office of Envirolunental Affairs Dept. of Environmental Protection • One winter Street,Boston,Ma. 02108 John Grad D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 508 56 4-6813 WILLIAM F.WELD Governor ARGEO PAUL CELLUCCI 12 f Lt.Governor � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION p Property Address: 11 Whitmoor Way Samstable Map 3i7 Lot 65 Address of Owner: 5,c Date of Inspection: 3/5l98 (If different) c9 Name of Inspector: John Graci Kathy McAbee I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) �c9� Company Name,Address and Telephone Number: `+ C 91 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 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: X Passes This Inspection Is based on criteria donned In Title V _ Conditional) Passes code Vo CMR 16.303.My findings are ofhow the system Is performing atthe time of the Inspection.My Inspection does _ Needs ur er Evaluation By the Local Approving Authority not Imply any warranty or guarantee ofthe longevKyofthe Fails septic system and any of its components useful life. Inspector's Signature: Date: x5re8 The System Inspector sh I submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/27)97) One Winter Street • Boston,Massachusetts 02108 is FAX(617)556-1049 a Telephone(617)292-5500 a s i i• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) , Property Address: 11 Whltrnoor Way Bamstable Map 317 Lot 55 Owner: Kathy McAbee Date of Inspection:31519E _ Sew.ane backup or,breakout or high.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system.will pass inspection if (with approval of the Board of Health). Describe observations: :. broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed t 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 THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption'system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — . The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: F . You must indicate either"Yes"or"No"as to each of the following:' I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ — Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. n Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is In hydraulic failure. H (revised 04rt7l97) SYSTEM INSPECTION FORM SUBSURFACE SEWAGE DISPOSAL . PART A CERTIFICATION (continued) Property Address: 11 Whitrnoor Way Bamstable Map 317 Lot 65 Owner: Kathy McAbee Date of Inspection:315198 D]SYSTEM FAILS(continued) n Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy,is within a Zone 1 of a public well. k Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: , The following criteria apply to large systems in addition to the criteria: y. t , The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) r The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. A t _ d (revlae004RT1971 - - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 11 Whitrnoor Way Samstabie Map 3l7 Lot 85 Owner: KathyKath McAbee Date of Inspection:31519E Check if the following have been done:YOu must indicate either"Yes"or"No"as to each of the following: _t_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x — All system components,excluding the Soil Absorption System, have been located on the site. x 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. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to,Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)J (revised 0412T)87) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 11 Whibnoor Way Bamstabie Map 317 Lot 85 Owner: Kathy McAbee Date of Inspection:3151118 t FLOW CONDITIONS RESIDENTIAL: Design flow: 3M g•p•d./bedroom for S.A.S. Number of bedrooms: , rc Number of current residents: o r Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: oneyearaso COMMERCIAL/INDUSTRIAL: Type of establishment: nia Design flow:0 gallons/day Grease trap present: (yes or no) No : Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no)'No Water meter readings,if available: rda Last date of occupancy: nra OTHER:(Describe) rds Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System Is geftlng pumped:imo gallons System pumped as part of inspection:(yes or no S If yes,volume pumped: allons Reason for pumping:_ n flC1"(1C 5� TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes on no) ( if yes,attach previous inspection records,if any)" I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source Information: 79r8 Sewage odors detected when arriving at the site: (yes or no) No trsvlsed 04rttl9T) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Il Whhmoor Way Bamstable Map 317 Lot 8S Owner: Kathy McAbee - Date of Inspection:315198 SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction:x concreate metal FRP Polyethylene—other(explain) If tank is metal, list age nla . Is age confirmed by Certificate of Compliance Ho (Yes/No) Dimensions: L8V'H6T•w4•10^ L Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:24" Scum thickness:2" Distance from top of scum to lop of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: measured ` 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.) Septic tank and ell components are structurally sound and functioning properly.Recommend pumping every two years GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Scum thickness:nra Distance from top of scum to top of outlet tee or baffle:rda ` Distance from bottom of scum to bottom of outlet tee or baffle: nre s 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.) rda BUILDING SEWER: (Locate on sae plan) Depth below grade: 26 Material of construction:_cast iron,x 40 PVC_other(explain) Distance from private water supply well or suction linet— F Diameter: e Qmments: (conditions of joints,venting,evidence of leakage,etc.) i (revleed 04n7187) t e ' r 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM,,.- PART C ` SYSTEM INFORMATION(continued) F. Property Address: 11 Whitrnoor Way 8ametable Map 317 Lot 65 Owner: Kathy McAbee M Date of Inspection:315199 , TIGHT OR HOLDING TANK: N (locate on site plan) ` Depth below grade: rya Material of construction:_concrete_metal_FRP_Polyethylene :5-6ther(explain)' Dimensions: ara Capacity: ria gallons 1 Design flow: rda ggallons/day Alarm levei:_nla Alarm in working order? Yes=No y r Date of previous pumping: r x °. Comments: (condition of inlet tee,condition of alarm and float switches,eic.) �' + Ma e� .9 DISTRIBUTION BOX: p u (locate on site plan) Depth of liquid level above outlet invert: rda Comments: A (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into`or out of box etc.) f a. PUMP CHAMBER: Y (locate on site plan) Pumps in working order:(yes,or no)A_ r Alarms in working order(yes or no) _Ye: a Comments: (note condition of pump chamber,condition of.pumps and appurtenances etc._) 'Y rda yT- T • (revieed0411118T) 6 • ;«° � ', i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 Whitrnoor Way Bamstable Map 317 Lot OS Owner: Kathy McAbee Date of Inspection:315198 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: roa Type: leaching pits,number: two:1,0W gallon leach pit - leaching chambers,number:roe leaching galleries,number: rda leaching trenches,number,length: nta leaching fields,number,dimensions:roa overflow cesspool,number:We Alternate system: roa Name of Technology: We Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Leach ptis and all components are structurally sound and functioning properly.Old pit Is empty.New pit never had more than than 4'of water In It CESSPOOLS:_ (locate on site plan) Number and configuration: roa Depth-top of liquid to inlet invert: roa g Depth of solids layer: n�a Depth of scum layer: roa Dimensions of cesspool: roa Materials of construction: nla Indication of groundwater: roa inflow(cesspool must be pumped as part of inspection) roa Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) We PRIVY (locate on site plan) °r Materials of construction: roe Dimensions: Na Depth of solids: roa Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) roa (revleed 04r171871 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C -SYSTEM INFORMATION(continued) 4 11 Whltmoor Way Barnstable MapA317 Lot 65 III Kathy McAbee 315198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) III AA �n : r • , a (nvio•doam�si) Page ! e! 3o w= SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 11 Whitmoor Way Barnstable Map 317 Lot 65 Kathy McAbee 315198 Depth of groundwater 12 .f . Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts. (revlud0A)27197) Faye 10 of 19 TOWN OF BARNSTABLE q, LOCATION // IfemDj)' yVa SEWAGE # 92 `1/ VILLAGE� l ASSESSORS MAP 6� LOT INSTALLER'S NAME & PHONE NO. 1 1^ G 4 L Dh e, SEPTIC TANK CAPACITY LEACHING FACILITY:(type) X L s` i ! (size) NO. OF BEDROOMS PRIVATE WELL OR,PUBLIC WATEg BUILDER OR OWNER ) O� in A a,z-� Dui h cr DATE PERMIT ISSUED: zl 3 c= DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r/ C l �all lotB t $- I 18 . 5 �N► rm,K ;3=2 33, S �I B-3 '4q- a .02 �. v � m�YgL A~�' o (F)4 A-,Y 33. A-L Z 7•0 1 J3 6� 1 - 03 No... AL.^..1 c.. Fxs....3..C. ..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE App iration for Disposal Works Tonstrutiun Prrutit Application is hereby made for a Permit to Construct ( or Repair individual Sewage Disposal System at: / ?,Q 02 A S 7.4 t or 3 ET Locaf ddress or Lot No. .......... ...... __...._:_........... -------•-•--------------................_•-•-• Owner / 5Address Wa .............................. �� .`4...•-------------•--..................-----•--••----........ -..._.... � _ ....----------•--•--•-•--....----•---------.... Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aP4 Other—T e of Building No. of persons............................ Showers YP g -------•-•------------------ P ( ) -- Cafeteria ( ) POther fixtures -•--•••---•-----•-------•-----•--•----------•----•-•-••-•---:------------------------•--------•----•----•--•-----. ------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—'Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ W 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. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... �Z, Test Pit No. 2................minutes per inch Depth of Test,Pit.................... Depth to ground water........................ a -•••------•-•-•••-------•---•-------------•-----------•--•-•---------.....--------------------............................................................. 0 Description of Soil...............................................................................----------------------------------•---------------------------•-------•---••.......---•- x W VNature of Repairs or Alterations—Answer when applicable_--.---�-_�.'-_____._-__-.!'.�. ©..__ _!¢...........OvS.... /DCj ----------------------------•--•----------......•-------.....-----•--------------------••----..--....----•--------••------------•-----------•--•-----................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance-Ras been issued bV the bpard Signe G - ---------------------------- Date cy Application Approved By ............c� .. .�..a ------ �� =1 `I............................................................. Dale Application Disapproved for the following reasons• ..................................................................... ---------------------- ------------------.................. .................................................... ----------------------- Date Permit No. --------- .- / 7 ....................... ------ ------------ Issued ................. ..................... Da[e � S Fxs....t. ._�-�_....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dispooal Workii Tonstrurr#iion tirrutit Application is hereby made for a Permit to Construct ( or Repair ('" ) an Individual Sewage Disposal System at: ����Z/r/5-7A/3/e N/ 7- /vl D D 0L ............................................................... .....................................;;;! ..................................... , D `� /&LLocat��}�d?s,s or Iot No. ...... ,-1 — /._.,..'......./.__.._.... ..................... ..............•-••----------•---•.....•-------•---•-••------•----••-------------._.........--•---. W J� Owner // Address a ............................................ ----------------------------------------- /f�..x...... / s Installer� Address d Type of Building Size Lot............................Sq. feet V DwellingNo. of Bedrooms............................................Ex anion Attic a — p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.............................Showers ( ) — Cafeteria ( ) Otherfixtures ........................................----------•---------•--•--•-------------•-------••-•-•---------- W Design Flow............................................gallons per person per day. Total daily flow.............r..........._...._...._.....__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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....---_________.____--- (4 Test Pit No. 2................minutes per inch Depth.of Test Pit.................... Depth to ground water........................ r4 -------------•-•-•----------••-•--....._....•••------••--------:....-----------...........•••-•...._..........................'............................. 0 Description of Soil................................................................................ x , V .....--•-----•----•----------------•-----------••---.....-------•-•----••••-••------------......-•-------•-•-•----•-----------------••---••----------•.................................................. UW •-•----------------------------------•------•-----•-----••-------••---•-----•------•-•--------••-------• ---• ----- Nature of Repairs or Alterations—Answer when applicable___-...R Z- O o G h► / D!/E2•F�Cv -------------------------------------•-----•----......-------------------------•---•--•------------•--------....••••----••------•-•--------•••--•-•------•--......--•--•---------•=-•---•---••---•------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance lias been issued b,he board of1health Signed��/%� / �D 9� r/ ......... - ate Application Approved BY - �. � .. '� ��....3 -..p2 , Date Application Disapproved for the following reasons: ------- -----------------------------------------1--------------....--..--..--------..--..--................................. ...............................................................................................------..-------- --- ..---- ....----.---..----..---- ---. ...------- -------------------.............. ------.--.........--------------------- Date PermitNo. .......... . ` - f ............ Issued --------------- ----............................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fer#tf ra e of Complianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( by............................ .G2.-�`'. ::.....---.....----..--....---...--...-------- ................................... / Instal L at - // l�l%f// , /vi D o 2 .A. :'.�.S7A..,.?.....'---------------------------1�----------------------------....---.............................................................................. ... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........5... ..-.../.7...L{........ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE.SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ .I.......-��--s� ....................................... Inspector ..........r� .... ............•.................... ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � TOWN OF BARNSTABLE Permission is hereby granted�-1o_-ul./.. orks TInstr inn urmi Yg to Construct ( ) or Repair (��n Individual Sewage Disposal System at No.......................1. lil/f�/? �?? O D 2..................j5.91.W-S-7 q 0 Street g IZL as shown on the application for Disposal Works Construction Permit No. - __- .. .. Dated.......................................... `1-..----••------------------ --------------------------------------------------- DATE........... ..-. .°`...r;.2 ....................................-•--•.• Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS U LUC T•ION SEWAGE PERMIT 5 4446 �- VILLAGE INSTALLER'S NAME i ;ADDRESS BUILDER OR OWNER a DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 7_,23_ 7� L � \. �� 1 ~ f��av�r�. G',r�e.+s� �. �'� � ��`� � �' %-` No........... .... Fps..`.-.... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEWLT... ......OF........ .. ....... Appliration for Uiipuiial Works Tnnitrurtiun ramit Application is hereby made for a Permit to Construct (po<or Repair ( ) an Individual Sewage Disposal System fat: a a .................................................................................................. Locatioq-Address = or Lot.No. � ..f__......� G, .............................................. .f�.1 ...... �--• -----., � Own/er- y Address _ 1bs� ..... .......Ae_✓ I� ................ �� Installer ddress Q Type of Building Size Lot;�4&A.,!....... Sq. f t V Dwelling No. of Bedrooms___-__: .................Ex Expansion Attic Garba e'Grinder PL4 Other—Type of Building ............................ No. of persons........... ............. Showers ( ) — Cafeteria-,( ) Q' Other fixtures ...................................................... W Design Flow....................... allons per person per day. Total daily flow__....... ....d....................gallons. WSeptic Tank/—Liquid capacity-/ allons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No.-•------------------ Width_.`................ Total Length............. Total leaching area....................sq. ft. 3 Seepage Pit No*------- ___________ Diameter_......1.�_..... De t belo4iinle �iJ....... Total leaching area.....gno..6..sq. ft. Z Other Distribution box ( ) Dosing to )~' Percolation Test Results. Performed b . _.._.. ..._y. ....................... Date... :ZZ7.YTest Pit No. 1.....e�-_-__minutes per inch Depth o Test .................... Depth to ground water-___•___-__-____•---__-. li Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Descripti n of Soil- -�e � y �' t- 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 iII'LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasz been ssued by the board�iealth. n X ` Date Application Approved BY �-- r d -- -----•--•----••-•------ �� '2 c9 Z p- Date Application Disapproved for the following reasons-----------------------------------•-----------------------------------------------------------------.......----- -•----------•-----••-•--•••....••------•--••----•-•---••--••....---•••-•---••-••................•--•-•••.------•••--•-•-••--•-•••-•-•--••••••---••••••---•-••---•----•---------------•--••••-•--------•- Permit No......................................................... Issued_,;; ^7 -./-•-------Date..... Date " I ............... .._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEEE T z , . ---......OF....... ------------P-1441 . ............................ �#pt#affvu to i r. Di"os ai Works Tomitxnrtinn permit Application is hereby made"for.;a kPermit to Construct (V'<or Repair ( ) an Individual Sewage Disposal system at 'Locati Address or Lot No. - - ...... �f—f7 �.-14_.. Owner Address Installer A dress Type of Building 4 Size Lot............................Sq. f t Dwelling—No. of Bedrooms..___, ................ . .•Expansion Attic ( ) Garbage Grinder ) aOther,;.=Type of Building .............4r r_,_,-.-:._ No. of,,per sons------------- ............ Showers ( ) — Cafeteria ( ) Otherfixtures •••• ----•-••--•••--••.. ----------------------------------------•- --••••-•••••............-••...----•-•-- W Design Flow................ ''"' I' ____` allons per person per day. Total daily flow........ .. gallons. WSeptic Tank—Liquid capacity/p`, allons Length.......... w Width................ Diameter.............._. Depth................ x Disposal Trench—No: Wldth*_____________ _ Total Leng _ Total leaching area....................sq. ft. Seepage Pit No......�:_._ Diameter ....{�_.4th below nl t.. ... ........ Total leaching area...: .&.sq. ft. Z Other Distribution box ( ) Doing aPercolation Test Results Performed by_ .._ ,. . Date (.:Test Pit No. 1:... ?,.._,.minutes per inch Test Pit ._ .: Depth to'ground water . ................ (s, Test Pit No 2��iutes per inch Depthlof Test P>t ... Depth to ground water........................ _ r .. .... O �g ��/ x Descriptio�I of Soil' - _fit "' .-- ---• -- - POW .0• Nature of.Repairs or Alterations—Answer when applicable............................................................................................... r' Agreement The undersigned agrees_to install the aforedescribed Individual Sewage Disposal System an accordance with the provisions of TITL4: 5 of the State Sanitary Code..— The=undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board o4.health.. 11 �,...., ignrt ----------------•---- `ram... D ate Application'Approved By.._... ... �= . a Date Application Disapproved for the f gllowing reasons , ..----------•-•.............•-••-----••......••---•• . .. ,+'" ........................ •-•- Date PermitNo..... ••--•--- =--------•------_. Issiied--------------------------------•-•--•---- ......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F EA TH /fP Tr , ' iratr era$ Ter mpliFanrr s T IS IS TO C TIFY Th t;'th tlividual Sewage Disposal System constructed ( �r Repaired ( ) by ---------------------- .......--_--••• -- . ... ' ristaller 444' at. .... " �� Jl� d has been installed in accordance with the provisions Of T T 5 ofx The §tate Sanitary Code as described in the "application for Disposal Works Construction Permit No._--___ -----_ ............. dated__.'"_! —�_ ____._.__..__... THE ISSUANCE OF THIS 6156.IFI6TE•SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE ' SYSTEM'WILL FUNCTION SATISFACTORY. , DATE`---•----• Inspector f . 2 THE COMMONWEALTH OF MASSACHUSETTS BOARD OX HEALT q f No......... v.. FEE. ......... isp0SatP IV arks. n. n rrmif Permission'i hereby granted=`* j ;q,. ......_.._ -> ' to Constr ( o air ( dividual Se ge is System at No... .._ 1`f..... dt' »---••---- tr et as shown on the application for Disposal Works Construction Per No....�/. ..�.._. f ated......!::..,�.J...._7.1....... ......••.. ..... -r'. ---.•.........-•-•--....._ DATE_ 7.- oard of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS f 1 i--.r..yb Sr'7 C G� r• /�"��L Z ✓�G Gr / ...� f � . f W1417r Mao P�e�v. Nu Xi I h C4 v P1 7- 0.I 3110 � �'s ,, ELlbl/, 75p • ill n $'X of V% f �R�Sn�dCc� � o ,,, � Fo✓.uD,c J�sp I 3a,Lo Az- ��7Z-'Ait=` �' i P�posC=v Dzv�w�•y Qt��'�pl� � Lo T // 01 7#6 Z: 30. a' A= 4 73 titi.3 , All CERTIFIED PLOT PLAN LOCATION Rnr�•t:;�I� • ,�.� � :£.' SCALE . ./. �-' . . DATE 79 PLAN REFERENCE .BE?^!G. . L. . . . . _ 5,410 wn/ on/ A pLAA-., �0,2 Zo3d'ZT F, J'• -� r•'� ,i'r Ihl.�i7`"F A-�t/D. Jolfi./.,5, BETNEZ� ,Ti�r. . .G.LrG;-PZ>E—iC> /N / —,46A , ZZ4 I CERTIFY THAT THE ESC�ST7!�/G . !vv�vDR -t SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF . . . . . . WHEN CONSTRUCTED. DATE PETITIONER: REGISTERED LAND SURVfi4OR N59345 fi 3o Zo TOP OF FOUNDATION CONCRETE COVER ° CONCRETE COVERS 0 4"CAST IRON 12"MAX. �h • I MAX. " • PIPE (OR 4 ORANGEBURG(OR EQUIV.) .' EQUIV.)— MIN. PIPE- MIN. LEACH PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT PRECAST ° J LEACHING IN.UT . e EL.. r`�.�.. INVE T INVERT p . ere, PIT OR SEPTIC TANK EL. 07. . DIST. EL - , _ EQUIV. INVERT BOX /ooa GAL. INVERT e; EL. r . .. ,B INVERT v w w 0 �:�. 3/4"TO I I& EL?�`... EL ¢O e' �0 WASHED w • STONE W DIA. --•� /o' DIA.:—A n�a.it PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE ^����LlVII�LFV�IIV� SOIL LOG WITNESSED BY : DATE Testy. i7 7,9. TIME.V.30 1qr P�4i!G �!u/2,k:' . . . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ! iy<1S. •G,,. %� P�.ENGINEER ELEV. . Z9,00. . . ELEV. .a-.4r .. (.o oai e 021, 2.,+,, /s,,g-5o)L s��-50-� DESIGN DATA : �►ND�uy/ \\ NUMBER OF BEDROOMS QMteE' PE'XC. S,gT.D TOTAL ESTIMATED FLOW . .330 GALLONS/DAY 7Z FiniE s .D �1iXT� BOTTOM LEACHING AREA SO.FT. /PIT SIDE LEACHING AREA . .�8!4 `S . . SQ.FT./ PIT HGsD��M GARBAGE DISPOSAL !?Y4M47 .(50% AREA INCREASE) 5'a"�� GlL4VEZ,' TOTAL LEACHING AREA . SQ.FT Cew2 144,i PERCOLATION RATE �?^!E. MIN/INCH LEACHING AREA PER PERCOLATION RATE SQ.FT. .!!P.WATER ENCOUNTERED NUMBER OF LEACHING PITS .1.l�!T.W/TN• TL✓o,��T' APPROVED . . . . . . BOARD OF HEALTH OF �N6'oN A44.S/DES, /✓�L 70�vs �"oF srAve ne P,7- THOMAS'E:KEL'LTY'CO: DATE . . . . . . . . ' ' ' ' ' ENGINEERS—SURVEYORS AGENT OR INSPECTOR 346 LONG POND DRIVE SOUTH YARMOUTH, SS. �'M OFM,ISS OF 02664 THOMAS o 'EY 0.2stoc�0 9 E`GIST£a��� S7ti {�� �`�pNALE�6� PETITIONER �M0 5U�V