Loading...
HomeMy WebLinkAbout0009 ANSEL HOWLAND ROAD - Health F ` ANSEL HOWLAND ROA' terville I j IF — 172 — 219 k s M E A D No.2-153LOR UPC 12M smssdoan • Yob In USA a mIaL ssssmn 10A ��11 l 6S TOWN OF BARNSTABLE Date: �( TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF'BUSINESS: owt PAW—LO BUSINESS LOCATION: W v 4 �v �eL� tN�ed�33� INVENTORY MAILING ADDRESS: A&4m to ` iRove TOTAL AMOUNT: TELEPHONE NUMBER: . -338(, CONTACT PERSON: tM (moo-c.to EMERGENCY CONTACT TELEPHONENUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ap icant's ure Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: ZI �j I✓ Fill in please: 5f:;;;1ff� j, :^F"� APPLICANT'S YOUR NAME /S: �1ic,In�a � `�'. L+�.wtL� r BUSINESS � �-^' YOUR HOME ADDRESS: da►, .lam L (AgL,- b 1;�,4��;t;�7,,3;�'�/•i�Si�i�,���n ,,' ,i�t�°F� Lk 5LO ttrvrv19 41 t"yyrtY "r> _TELEPHONE # Home Telephone Number iif� NAME OF CORPORATION: �S o�- /��l NAME OF NEW BUSINESS ec. o TYPE OF BUSINESS �Tcrl� IS THIS A HOME OCCUPATION. YES NO Z ADDRESS OF BUSINESS W�1 �e� �� a �����`�° MAP/PARCEL NUMBER / (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you-may need. You MUST GO TO 200 Main St. - (corner of Yarmouth. RBI. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SIO ER'S OFFICE This individ al h e n errfor d a y p rmit re irements that pertain to this type of business. Au oriz i n MMENT I 2. BOARD I HE TH This individual has been informed o rpZerihat pertain to this type of business. MUST COMP WITH ALL Authorized Signat re HAZARDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) 1 0, ti.. . :. This individual has been informed of the licensing requirements that pertain to this type d bus ness. Authorized Signature** COMMENTS; - a7O'ViSN 4` r:,'4 i.i. •a 3e.c 4g, t72' M Ti-G 9J' W LINE OF O H. c NEW ABOVE A6 STEP --------- Q CD ___ ———————— —— U Q N q U1 Q ANDERSEN C O LL] FWG 80(18 R cc:5< TUB/ i Q,E•"'" CO I I D W SHOWS H Do V)LL)-. I b z 5 Lo v I I NEW NEW I c7 1-LLI === ====3= L'DRY 1 II NEW BATH m UTILITY e v) �m o0 I L--- ---- --- it PKT.DOD Q co LINE OF DORMER �I --- O (" I ABOVE I I t a'S O 3•,tt• S.'a• u 1 W A6 1� ° NEW ABOVE e G��:IN��'""v ` D S.F. I,a STUDY I \ m (FIAT CEILING) H —— CL I O O I �• v I I NEW © UP , I I II 1tLjo'7 CR W q Q FAMILY EXIST. II ROOM q KITCHEN II I Q I I (VAULTED CEILING) Q II I PARTIAL FIRST FLOOR PLAN NEW FIRST FLOOR =1200 S.F. E-�I � O I NEW SECOND FLOOR = 13 S.F. NEW GARAGE =676 S.F. w T I = EXISTING WALLS Q EXIST. I SHED DORMER NEW IS CONSTRUCTION TO BE REMOVED ¢ W DINING oM AID'* GARAGE NEW CONSTRUCTION (/a .......... ________ (4•coNaSLAB � Z ZZ4 II _ ____ SLOPE 7 TOWARDS ©NEW SMOKE DETECTOR Z ZI I LL_F____�____3__� DOOR) I w I GENERAL NOTES: REUSE �j DOOR A 1.) CONTRACTOR IS TO VERIFY EXISTING CONDITIONS AND DIMENSION ¢ d IN THE FIELD PRIOR TO THE START OF WORK SCALE: 2.) CONTRACTOR TO REMOVE EXISTING DOORS,WINDOWS, NEW I 6 WALLS,&ROOFING AS REQUIRED FOR NEW CONSTRUCTION. 1/4"= F-0" Exlsr. 4 q q - COVER D A A 3.) ALL NEW CONSTRUCTION TO MATCH EXISTING IN MATERIAL, DATE PORCH A6 O.H DOOR AS DETAIL,AND FINISH. 10/19/2005 t8V'a N . NEW td'DIA T-8, JOB NO.: COLUMNS Tr r1 CONC.rofiTl __ APRON —— LAMB C THE Ste_ G ER S BEN FIE IF A6 ERRORSIOR OMI SIGNS ARE FOUNDOAN� DRAWING NO.: 3'd' THESE DRAWINGS PRIORT 9TARi Of 1 t'S 30' III.D. UC CONSTRTION THE BUILDING CONT TOA WILL BE RESPONSIBLE FOR THE CONTENT L- N WINGS IF CONSTRUCTION At 7C'P I� WITHOUT NOTIFYING THE F ANY ERRORS OR MISSIONSE DRAWINGS ARESOIELYTHE USE OF THE NOTED RECIPIENT& FOR OTHER W SEUNLESS WR TTTEt IS GRANTED BY THE DESIGNER z•.r z.IP zr 'a's Pz Ia.S '— C>7 C A6 Z•pv b J J V rd N Q who b 1A m cn uJ c) NEW STORAGE Q ti B B A6 A6 J NEW > FAMILY m a a ROOM ON, M W BELOW QS J JW V NEW EXIST. MEDIA BEDROOM ROOM b (�, 0 Q � � Q J ACCESS O PANEL ��xx W O Qwz EXIST. BEDROOM REPLACE EXIST. WINDOW WI NEW Z ANDERSEN AW MI y �j (VERIFY IN FIELD) E E 7w Z-7 7.10- zs' -- --- p SC,4 , NOTE:CONTRACTOR TO VERIFY ALL WINDOWS WITH OWNER AND ROUGH OPENINGS EXIST. BELOW W ALL OW 1/4" - 1l_0f, WITH WINDOW MANUFACTURER PRIOR TO ORDERING OF WINDOWS - WINDOW SCHEDULE A A DA`` As I 70/19/2005 TYPE MANUFACTURER'S UNIT ROUGH OPENING REMARKS b - F e A ANDERSEN TW 2446 2'-6 1/8"x 4'-9 1/4" DOUBLEHUNG I JOB NO.: C B AW 251 2'-4 7/8"x 2'-4 7/8" AWNING A6 © ABOVE LA NIf3 C A 21 2'-0 5/8"x 2'-0 5/8" AWNING IaP ztP D TW 2446-2 7-11 15/16"x 4'-9 1/4" D.H.NARROW MULLION rs e•-o' T-T DRAWING NO.: E AN 251 27-0 518"x 2'-4 7/8" AWNING Iz•.P z'-a z+'a r'P F TW 2442-2 4'-11 15/16"x 4'-5 1/4" D.H.NARROW MULLION G AFFW 501 4'-11 314"x 1'-7 13/16" ARCH H CIR20 2'-0 5/8"x2'-0 5B" CIRCLE PARTIAL SECOND FLOOR PLAN A2 J TW 24310 2'-6 1/8"x 4'-5 1/4" DOUBLEHUNG r m NEW RAKE d TRIM BOARDS TO MATCH EAST. 3 C� Q 12 (� UJ O o Q }��ID 2 W �F- E TOPOF PLAT U)LLJ— ❑❑ �C, W O CD W Ca Uv<.�3 S.F. SUBFLOO IRI TOP Of PLATE w 110 a FIRST FLOOR I-J SUBFLOOR F-y W U FRONT E L E VAT I O N °DIA D°`LIMNS 12 CONT.RIDGE VENT NEW ASPHAIi SHINGLES � (1�l O TO MATCH EASTING Q NEW FASOIA d BOARDG TO MATCH TCH Ex151. TOP OF PLATE V�1 W Ll Q F S.F. SCALE: SUBFLOOR A 0 TOP OF PLATE 1/4 - 1-`�" _ 2._0. DATE: ❑ ❑ ❑ ❑ ❑ ^io mnm„ExIsoARDs 10/19/2005 JOB NO.: IS I MINGLE SIDING LAMB M CASTING LOOR FLOOR DRAWING NO.: RIGHT SIDE ELEVATION A3 (MATCH E=TING) I IMATCHE STING) --iIIO ICm 10 lOn �O`O2 IO A9 S DO m IMATCH FASTING) (MATCH EAS ING) iCL 191Cm Ip O n IO Ip0 I Ip0 � p s om om m a m ❑ �N ❑ rv l" am of O❑ ❑ � o rYZ Ell I D o� mTmTFm --n—� m - - o < m ❑ ❑ D m m D ® p� a op o � =p ❑ z `m ❑ aN °=m yp= �J / ZF y0 a � 0 3 0 D d ol� NEW ADDITION FOR: DESIGNED/DRAWN BY: �Io mAY DESIGN " h ANN MARIE & MIKE LAMB 43OTUIT BREWBTER ROAD ti M ASHPEE,MA. 02649 cli 49 ANSEL HOWLAND ROAD CENTERVILLE, MA (508)274-1166 20 R 6 7 6'7Q//a z C NEW 17 DIA.BONOTUBES TO Q C A6 a'a'BELOW GRADE 2.P.T.2.la- Q V N NOTE:DROP TOP OF NEW FOUNDATION v)C)CD TO MATCH NEW SUBFLOOR W/THE_ [;.] NEW P.T.2.6s 16'01 EXISTING SUBFLOORIVERIFY IN FILD [] Q b IF REQUIRED). Q LL] 10 ——— —————— —— — F �aa NEW N n b BASEMEN♦I I REAM PK a BASEMENT WINDOW WINDOW 1 IInI U v I A6 a a I L L J b I ST EL LALLY COLUMNS INEW 31 x 3P%17' �—� CONCRETE FOOTING$ I I ISASEMENT BASEMEN 1 WINDOW L'~ WINDOW I _ b DRILI 8 PIN NEW FOUNDATION -- c I TOP 6 BOTTOM T I I7.r .I Q REMOVE EXIST.FOUND.WALLS 1z-D b I FOOTINGS.B CONIC.SLAB EXIST.FOUND. e DOUBLE �_ WALLS B FTGS, NA CR TO REMAIN TO r 1 DOUBLE CRAWL I .. . �---NEW 8"CONC. ww 1I I FOUND.WALLS r---————————————————————— W Z I I I——NEW 8"x18" I I I CONC.FOOTINGS NEW e CRAWLSPACE I E"' od 0 (7'GONG,SLAB) I Q W = I NEW I I Q GARAGE W I LJ je CONc.BLAB EXIST. I I 'LOPE z TOWARDS I Y I ZI BASEMENT — r I DOOR, i I Z Q I I w 2, ((��REMOVE EXIST.FOUDN.WALLS I I / FOOTINGS,BCONC.SLAB I I SCALE: --------------t I 1/4"= 1'-0" -- —.-- ----- i I i DATE: A 10/19/2005 4 NEW P T.2 x B's 16"oc. I^ I DROP FOUND.WALL I I A6 b A AT 0 H.DOOR A6 _ __ __ LAMB NEW 1701A.SONOTUBES TO -T'.a TA' ------------------- da'BELOW GRADE CONC. NEW I7 DIA.SONOTUBES TO APRON DRAWING NO.: OV BELOW GRADE C 1'S 7.Y IB'6 2.3 l >.5 FOUNDATION PLAN A CONT,RIOGEVENT NEW ROOF CONST. NEW ROOF CONST. WI BAFFLES 2 x 10 ROOF RAFTERS o c. 1?CO%PLYW000 ROOFOF SHEATHING 12 \ ASPHALT ROOF SHINGLES 10 15LB FELTPAPER \ \ 2a B's®tB'o.c. -S'HI.R BATT INSULATION SLOPED CEILINGS(R•30) \ \ 9•GATT INSULATION - -'- Z, ®FLAT CEILINGS(R•3D) 2x B'a 216'o.c. \ \ TOP OF PLATE 2x 12RIOGEBOARD -$IMPSON H 2.5 HURRICANE CLIPS \\ N 12 9 AT ALL RAFTER ENDS \\ ., _ ICE I WATER SHIELD AT BOTTOM \ F (n O PROP AR VENT BETWEEN RAFTERS \\\ OF NEW 1l2"GYP.BOARD eh,r \\\ w ON 1 x 3 STRAPPING y.Lo G Lp ®,B•¢c NEW ` MEDIA NEW \\ �^^ U)W 34 TI GPLYW000 ROOM s STORAGE \ SECOND FLOOR I(�SUBfLOOR-GLUED&NAILED b I SUBFLOOR =N ,d"ENGINEERED JOIST4�16'oc. QmO 14`ENGINEERED JOISTS®16'o.c. \ TOP OF PLATE TOP OF PLATE W —CONT.ALUMINUM SOFFIT VENTS `J"(R•30)BATi.INSULATION N`FI GYP B0 O . .; ON t x 3 STRAPPING�1G to 4.4 IN GARAGE NEW NEW ` TYP.WALL CONST. — NEW WALL ,.2 e 4 STUDS%1`H o4T STUDY GARAGE 2,3. PLYWOODSHEATHING 4.1111Y(R=13)GATT INSULATION CONST. g 4.1?GYPSUM BOARD 5,W C SHINGLE SIDING 6.tYVEK VAPOR BARRIER FIRST FLOOR l SUBFLOOR �1 4•CONC.SLAB TOP OF PITCH 7 TO O.H.DOOR$ FOUNDATION PUN9 1?'ENGINEERED JOISTS®t6'o c. 1 NEW I= TYP 11 Y CIA ANCHOR �-TYPICAL31lS DIA. CRAWLSPACE 41 ® BOLTS 'a"o,c. R STEEL ILLY COLUMN b NEW 8'CONC. FOUND.WALLS FOUND.-S L_J-TYPICAL 30•x W x 1Y !.1 NEW t8•n B" CONCRETE FOOTING (ZBUILDING SECTION @ NEW GARAGE CONC.FOOTINGS W12x6 KEY OO BUILDING SECTION @NEW STUDY Q m Q � � O NEW ROOF CONST. Q 2 2 // •tOc 1Goc. MUIRM--,4 t6•o.c. TOP OF PLATE L-- \ PARALLAM BEAM TO / / SUPPORT CEILING \ JOISTS 12 '�7 OP OF PLATE -� TOP OF PLATE �-r NEW —2.2.8. w Z FAMILY Z 'Q � NEW ROOM h WALL COVERED' SCALE: CONST. PORCH 1/4"= 1'-0" FIRST FLOOR FIRST FLOOR SUBFLOOR SUBFLOOR _ U%l fE 91/ ENGINEERED JOISTS®16'o.c. PT2a8'a@1B'o.c. 10/19/20U5 1.10 FASCIA W' NEW CRAWLSPACE SIMPSON POST BASE _ JOB NO.: F LAMB 17-1 pBAWING NO.: [BUILDING SECTION @ NEW F.R. I r CIA SONOTUBESTO 4V BELOW GRADE NOTE: P T.2 x 10 LEDGER SOAAO BOLTED TO VERIFY ALL ENGINEERED LUMBER� H 56'LaDcBLOCKING ED.USE PLASTIC SPACERS SUPPLIER&IF NECESSARY CONSUL __(( 11 JOIST HANGERS ON BOTH ENDS OF JOISTS A STRUCTURAL ENGINEER I .ea I I w w � I' mD _J mm L J 'I a NEW STEEL BEAM(FLUSH FRAM D)SIZED BY OTHERS 1 — I a�Ili I R I oll s p ,II CI ail I, ,I .NEW 11 ENGINEERED JOISTS®tE o c VJ m l ) L> ae-a O Z 0 r— O x D z G) r D Z z co NEW ADDITION FOR: DESIGNED/DRAWN BY: > �I° til m ANN MARIE & MIKE LAMB 43OTUIT BRE'BTER ROAD �] ° 49 ANSEL HOWLAND ROAD CENTERVILLE, MA (508,274-1166 02649 I �m�O zD m OA Dm mr ZK rN mg NO .TIC T�0°T V I,m O I,AZ mT xcom�m m m oN mE Nmzo O D C o pm Z 1a r z-P m n r i N P )I N P W 4'-P 4 1 I rnn � mn <� I 0 I zd m D I i D, I I I I � I OI I 1 T1 Imo/ 9 2.12 RIDGE BOPAG a D q Z G) r D Z G o rnD rnW Z_P 44'd 7.P za ae'a 2'-P oh A_> NEW ADDITION FOR: DESIGNED/DRAWN BY: I*, �pr COTUIT BAY DESIGN ° `� ° ," ANN MARIE & MIKE LAMB 43 BREWSTER ROAD 00 ° 49 ANSEL HOWLAND ROAD CENTERVILLE, MA (508)274EEIs A 02649 �w ���1 ���L�,.� ��. � ��� \ �� % � �� i� / I ��� \� �� l ��, � � i I% � x 3�� I , � � � � � � �� � � i ��, , \, i� i . � I 30� �,)� i l 3. Jim Morrissey 49 Ansel Howland Road Centerville,Mass. 02b32 System consists of; mik 1 -1500 gallon septic tank. 1 -Distribution box. 2-1000 gallon precast leaching pits. f DATE: 4/22/00 PROPERTY ADDRESS: 49 .Ansel Howland Road__ ---UL32---------------- On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -1500 gallon septic tank. 2. 1 -Distribution box. 3 . 2-1000 gallon precast leaching pits. Based on my Inspection, I certify the.following condltlons: 4 . This is a title five septic system. ( 78 Code 5. The septic system is in proper working order at the present time. 6 . Pumped septic tank at time of inspection. 7. A speed leveler should be installed in the distribution. This will equalize flow to each pit.Does not at this t ' e. SIGNATURE:.,Company' Joae�h_P_ Macomber_& Son , Inc . Address'_ Box-66 _ __Centerville r_ Na__02632-0066 Phone:___S08 775_3338_______ THIS CERTIFICATION ooES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P, MACOMBER & SON, INC. Tsnks•CAs pool:•Lo3chflslds Pumped L Installed Town Sower Connootlon: P.O. Box 66 ContorAlls, MA 026312.0066 775.3338 775.6412 s COMMONWEALTH OF MASSACHUSETI'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-6500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVM B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION PropeityAddress: 49 Ansel Howland Road Nemeoto. Jim Morrissey Centerville,7ass. Address of Addre of Owner: Data of hupecdort: 4 22 0 0 Name of Inspector: (Please Prim Joseph P.Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Thle 5(310 CUR 15.000) company Name: J.P.Macomber & Son Inc_ MaangAddrass: BOX 66 Cent r 1 Mass_ 02632 alep++«»T Number: SUS=7'T�33 3 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-she sewage disposal systems. The system: AY Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails 4upector's Signature: ] • Data: _ The System Inspecto shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEPlwttNn thirty 130) days of completing this Inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department oA£nvironmenttd Protection. The original should'be sent toVm system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page IorII �,Printed on R"Ied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART CERTUWAT1ON Aoontin A000 Property Ache;.: 49 Ansel Howland Road Centerville,Mass. Owner. Jim Morrissey f}sv of t►sp.ctlon. 4/2 2/0 0 NSPECTION SUMMARY: Chock A. B, C, of D. A. SYSTEM PASSES: I have not found any Information which Indicates that any of the failure condWom described In 310 CMR 1E.303 exist. Any tatkur criteria not evaluated are Indicated below. COIaLIFNTS: B. SYSTEM CONDmONALLY PASSES: to 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. indicate yes, no, or not determined(Y. N,or ND). Describe basis of detarmination In all Instances. If'not determined',explain why not. The septic tank Is metal,unless the owner or oparator 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: , the septic tank, whether or not metal, Is creaked,structurally unsound, show•substantial(nfUtration a exflrustion, or tar failure Is Imminent. The system will pass Inapectlon If the existing septic tank Is replaced with a complying septic tank u approved by the Board of Health. 1 Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obsuucud pipet or due to a broken, settled or uneven distribution box. The system will pass Inspection If(wldt approval of the Board of Health). broken pips(s)are replaced obswction Is removed distribution box Is levelled or replaced Nb The synsm fequked pumping-rnm than'fotrrtirnes-o"ardue to broltenw ob.0 cted pipe(s). the-yet*,- wig" Inspection If(with approvel of the Board of Health): ' broken pipets) we replaced obstruction Is removed revised 9/2/98 Pate2of11 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prope►tyAddress: 49 Ansel Howland Road Centerville,Mass. Ownw: Jim Morrissey Date of Inspection: 4 22 00 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 falling to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CUR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICKWILL.PRO.TECT THE PUBLIC HEALTILAND SAFETY AND THE EIVOIBONMENT: a Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE ENVIRONMENT: �[D 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 soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 60 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds Indicates that the well is free from pollution from that facility and the presence of tammonle nitrogen and nitrate nitrogen Is equal to or less than 5 ppm. Method used to determine distance •4,14 (approximation not valid).- 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 49 Ansel Howland Road Centerville,Mass. owner: Jim Morrissey Date of tnspecbon:4/2 2/0 0 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described 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-towage into4ecility-er""tern component due1to an overloaded or-clogged-SAS orcesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid le el in he distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool. ifp Liquid depthth ptf in oessbTis less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped�. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for •►coliform bacteria, volatile organic.compounds, ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No , y/ the system is within 400 feet of a surface drinking water supply _ k/ the system is•witWn 200 feet of­e-NilauterY-to a auvfa0a4ti*ir►g-w+ter•auPPIY - the system is located in a nitrogen sensitive area(interim Wellhead Protection Area=IWPA) or a mapped Zone it of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4orii r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM PART B CHECKLIST Property Address: 49 Ansel HowlaND Road Centerville,Mass. owner: Jim Morrissey Date of Inspection:4/2 2/0 0 Check if the following have been done: You must Indicate either "Yes" or"No" as to each of the following: Yes No / Pumping information was provided by the owner, occupant, or Board of Health. None of the system ecompoasnts.ka►r:bwn pwnped4opstJeast.,two.-%voWw*ndgha,systsm hasJbaeoascs;aiwgwsrstal flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this Inspection. zAs built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. _ The site was inspected for signs of breakout. _ All system components;4WC[uding the Soil Absorption System, ave been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was Inspected for condition of baffles or Was, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orr the site has been determined based on:- Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C I$at issue,approximation of distance is unacceptable) > (15.302(3)(b)) The facility owner.(and.orr,1pants if diffwatat lafncmasioacn tw+;rn ma;ntajULQCA.Qf SubSurface Disposal Systems. revised 9/2/98 Page 5ofII r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 49 Ansel Howland Road Centerville,Mass. owner: Jim Morrissey Data of k`speCdon:4/2 2/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow:_a6l g.p.d./bedroom. Number of bedrooms d�esii�� Number of bedrooms(actual):4 Total DESIGN flow—it Number of current residents: Garbage grinder(yes or no):ff Laundry(separate system) s or o :_ If yes, sepacatolnapactlon•roqulrod Laundry system Inspected a or no Seasonal use(yes or Not available Water motor readings,If available (last two year's useg s(gpd): Sump Pump(yes or no): AAA Last date of occupancy: `0'0 COMMERCIAL/INDUSTRIAL Ty­poof establishment: d1A Design flow: .VA ttpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)A Industrial Waste Holding Tank present: (yes or no)1 Non-sanitary waste discharged to the Title 5 system:Jyes or no),& _ Water meter readings,If available: Last date of occupancy:_ OTHER:(Describe) -4114 Last date of occupancy:_ f GENERAL INFORMATION PUMPING RMS�and 9urc of infgrmati n: , n1 System pumped as pert of in action: (yes or no) if yes, volume pumped: gallons Reason for pumping: �• - f -��/�� y� C./�'V�/ TYPE OF SYSTEM _zSeptic tank/distribution box/soil absorption system _ M Single cesspool Q_ Overflow cesspool —" Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) 1/A Technology etc. Attach copy of up to date operation and maintenance contract Ajb Tight Tank Copy of DEP Approval Other Alp APPROXIMATE AGE of all components, date installed{if known)-and source of-information: -�•�� � �i4g�� Sewage odors detected when,arriving at the site: (yes or no)&Lp 6orn revised 9/2/98 Page SUBSURFACE SEWAGE DISPOSAL SYSTEM IN$PEC''TION FORM PART C SYSTEM INFORMATION(eocrtimbed) PropwtyAddre": 49 Ansel Howland Road Centerville,Mass. Owner; Jim Morrissey Data of In:p'ctj°"` 4/2 2/0 0 BUILDING SEWER: (locate on site plan) Depth below grade:21I/ Materta)of pcon�tructlon:'Y.4ca t Irop.v 40 PVC other(explain) �1Dc Distance frorif private water supply well or suction line A/� Diameter V Comments: (condition of Joints, venting,evidence of leakeg�,•etc.) Joints appear tight. s em is venrea throucina House vent. SEPTIC TANK: �,4 (locate on site plan) d Depth below grade: Material of construction: concrete 4!amet&114lffberglassa0 PolyethyleneAVother(explain) It tank is Instal, list age 0 1s.age.conr4mad by Certificate of Compliance 40 (Yes/No) Dimensions: x lz Sludge depth: Distance from top ofsludge to bottom of outlet tee orbaffle•. Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ Distancs from bottom of scum to bo om of outlet tee or baffle: , How dimensions were determined: &92199d 417 A! OeGr 'o Comments: (recommendation for pumpinQ conditl of inlet and outlet ties or-baffles,depth of liquid level In relation to outlet Invert, structurei-integrity, evidence of leakage,etc.) Yum Llle Se tic tank ever 2-3 years. fInlet and outlet tee o evidence of leakage. The tank is s ruc ura v Sol n GREASE TRAP: (locate on site plan) Depth below grado:.,4/.4 Material of construction:�concrete�metal,!i Fiberglass,✓i4 Polyethyleno;! �•other(explain) Dimensions:_ Scum thickness: Distance from top of scum to top of outlet tee or bsffle:_AfQ Distance from bottom of scum to bottom of outlet tee or baffle:-" Date of last pumping:—A?d 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.) Grease trap is not present revised 9/2/98 Page 7or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 49 Ansel Howland Road Centerville,Mass. own«: Jim Morrissey Date of Irupec"w: 4/2 2/0 0 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grade: Material of construction:ARconcreto metal +i Flberylasa,VAPolyethylene.�Rother(explaln) 414 .dA Dimensions: ,IAA Capacity: " gallons Design flow: IA gallons/day Alarm present A[, Alarm level:_Alarm In working order:Yes414 NoA�w Date of previous pumping:_AIA Comments: (condition of Inlet tee, condition of alarm and float switches,etc.) - Tiaht Or holding tankc ar cc nrlt Pr-"rQ t: DISTRIBUTION BOX:z (locate on site plan) Depth of liquid level above outlet Invert: Comments: (note It level and distribution is equal, evidenoe of solids carryover, evidence of leakage Into or out e1 box, etc.) — laterals. One is higher s ou e , i s r no a distribution Dox. ThiS-WoUldmake an equal flow t-o—each ieaching pit.No evidence of solids carry over.No evidence of--JJ leakage intp or out of the box. PUMP CHAMBER:- el r (locate on site plan) Pumps in working order:(Yes or No) NA- Alarms in working order(Yes or No) 11VVAA Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Pump revised 9/2/98 Page sorII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ProWWAddre": 49 Ansel Howland Road Centerville,Mass. Owner: Jim Morrissey Date of Inspection: 4/2 2/0 0 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible:excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries,number: leaching trenches,number, length: leaching fields, number, dimension overflow cesspool,number: e Alternative system: Il) Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, darpp soil, conditi n of vegetation, etc.) Loamy sand tom dium fine sand No signs of �ydraulic failure or pon ing�olis are ry, ege a ion is normal. One pit is dry and worst-e wat-Pr i s 16" hpl nw the i nvart of the other pit, CESSPOOLS: IV (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: A Depth of solids layer: Depth of scum layer: AJA Dimensions of cesspool: oq Materials of construction: Indication of groundwater: Azi inflow (cesspool must be pumped as part of inspection) Cesspools are not present. Comments: (note condition of soil, signs of hydraulic failure,level of pending,condition of.vegetation, etc.) Cesspools are not orPsent PRIVY:/Ale. (locate on site plan) Materjals of construction: Dimensions: Depth of solids:_ Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) Privy is not present revised 9/2/98 page 9oril SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C , , SYSTEM 1INFOR1dATION(C—druid1 ft.p„tyAdlili,.,,; 49 Ansel Howland Road Centerville,Mass. Ownw: Jim Morrissey D—o+ 2 2/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to at Isast two permanent reference landmarks or benchmarks lots%@ ail wells wltNn 100' (Locate where publlo water supply comes Into house) Z s N 1 91 UV 'aS nod 2�� --a revised 9/2/98 hgt10or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION fcw*xbed) Prop«tyAddraaa:49 Ansel Howland Road Centerville,Mass. Ownw: Jim Morrissey Dote of.Inspectfon: 4/2 2/0 0 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting properly, observation hole, bosemeot sump etc.) Determined from local conditions Chocked with local Board of health Checked FEMA Maps Chocked pumping records _Checked local excavators,Installers Used USGS Data Describe how you established the High Groundwater Elevation. (MM be completed) Used water contours map. Gahrety & Miller Model 12/16/94 revised 9/2/98 Page It of11 • ">.n►.+t�T-nrr►��'+i-:rnrmr•nn+r>r�na�+rmrn:�r'*eT�r►nsR+r•nn'nern�+T�-e+��n� .rn�rr-.t+�r•:..t-.TOWN OF Barnstable BOARD OF IIEALTIi r••} SUDSURFACR SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION •••TT'1�'•. :'f-T.itT.�.T.TT1.TtIn'R.'/T T9Tlfnf7frRT1:T�.51T1r1P1f71.R.�-T�►/R1�IrIt�1R�7 �n .+�I"Pr'Ts'1r•�..� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED Mass. 49 Ansel Howland Road Centerville STREET ADDR1rSS Centerville, Mass. MAP, BLOCK AND PARCEL # OWNER' s NAME Jim Morrissey PART D - CERTIFICATION NAME OF INSPECTOR _Joseph P.Macomber Jr. , COMPANY NAME J.P.Macomber & SCfi' Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 R A• CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: 2 Systeci PASSED j The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* r The inspection which I have con tcted has found that the system fails to protect the j*)ublic health and the environment in accordance with Title 6 , 310 CMR 15 , 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date ne copy of this c tification must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF HEALTH. * If the inspection FAILED, the owner or'""o` erator shall up grade pgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 . 306 . partd .doc N. PV No....... . FE ._.r............ THE COMMONWEALTH OF MASSACHUSETTS k3- -63F BOARD Q HE � Tt-i �i ...--... .�...........OF.........l ...:G2.*............................................................ Appliration for Uiipnsal ITIorkii Tnnitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ._ -- 1 Loca�o �A�d�die�s � or'Lot �To. _. .. =vim• ... '....... .......... ............••............................... 1? � Re�, Address a .............. ... Installer Addddrere �'.. .............. ss Type of Building Size Lot...._ .4'��,_ . Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------•••-- •••••...--••-----•-- ...-----•. ...........-•------------------------•--.........-----------•----.............._........_..... Design Flow........ ....//.....__.gallons per person per day. Total daily flow........... .............gallons. W Septic Tank—Liquid capacity_ ylgallons Length................ Width................ Diameter.............._. Depth_......__....._. x Disposal Trench—N .......e........... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.- .... 440. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•••••••••--•--•-----•-•-•--•.............. ...•••----•----...... .........._....-----------------------•--..........---•-•--------•-.....---..---- 0 Description of Soil.....................................••-------••--------.....----••----•-----...--------•---•-----•-----•------•-----•-----------------------•••••••....._..---....---•- x v 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 TL I'i LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isslwd,by the board of Health. gne _ ... , ................•---. .................................... Application Ap rov B .... .. ... ::.• •_ ,-. ...-....... Date Application Disappro je or the following reasons:----•-•-------••....................................•--••--•--•---------------------------=---•......••---..... 6 ....................................................................................................................--...................................................-..........................._.... Date PermitNo......................................................... Issued ....................................................... Date � j-}-iv �f q + L0CATIO SEWAGE PERMIT NO k VILLAGE INST �Eftls NAME i ��AggDDRE S e U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED `� �� _ � t - / �.� S �� � �{1 .�o s` y No....3-.........� Fss ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ?,IF HEA , c : Appliration for Biipoottl Workii Tomitrnr#ion runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: :........ .. . ::: ..:-......f: ..... ........::......• .................... .. Locat Add ess Y Lot No ............ rteRc !��'.. .. �.: E 7-1 �� ! .............................. � ner Address W Installer Address w Q Type of Building Size Lot_.__., I P..Sq. feet U _, Dwelling— No.10f Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type jof Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) .04 Other fixtures ------------------------------- - - ----------•------------------•---•-•-•-•--..... d Design Flow......'` ;gallons per person per day. Total daily flow.......... -+__ ............gallons. W . 1 � G; Septic Tank—I_iquld capacrty_. .�.___gallons Length................ Width................ Diameter---------------- Depth.— Disposal Trench—N . _ ----------- Width .............. Total Length.................... Total leaching"area . A ?sq. ft. Seepage Pit No-------I s ,. __. Diam ter. --_---___-_-- Depth below inlet....................Total leadl1mg`a'rea _/ .......sq. ft. le z Other Distribution box,:( ) Dosing tank ( ) # t1 0r=,,' k . aDatePercol t n T wt Test } i No. 1................minutes per inch Depth of Test Pit.__._.....____''.__: Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ----•----•--•-----------------------•-----•••-••....-••••--••-•••••--•------.........._----•-------•................................•---- •.... •--••••--...... 0 Description of Soil........................................................................................................................................................................ x W ------------------------------------------------•-------------------------------------------------------------------------------------•--------------------- ............-...-------•----•... —Answer when applicable............................................................................................... U Nature of Repairs or Alterations -----------------------------------•--------------•------------------------------------•-----._.....--•---•.....-•--••------•----•----•----•-•-•-••••--••----•---••-•-••••-••-•••----••••-•••-••----•--- 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 operation until a Certificate of Compliance has been iss d�y the b �rdof�health. � . ........... ApplicationAp ov B.. . ............ .... ..................................................................... -•--- .......:....... Date Application Disappro ,ed, or the following reasons:__...-----•------•-•--•-•-•-•-•••--.......-•----....--••--•-----•-•----•-------------------------------------• ......................................(--..••-.............................................................I-------•-.................--•---•-••--••--••••-----------•--------•.-------••--•---------.-•-•- Date PermitNo......................................................... a Issued...................D .....--.............•---•--•-••- Datee THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... x,,:�,..... ....,: (9rdifiratr of Tompliana THI S O CERTIFY, That the Individual Sewage Dis Mal System constructed ( or_Repaired ( ) by-•---..... ••- -•-----------------•------•--•-•--------...------.....---•--•-••••._.........••---•••. taller at -- ..t. - IA..... ------.... has been installed in accordance with the provisions of TIT F 5 The State Sanitary Code s de a in the application for Disposal Works Construction Permit No.. ._ � PP P = dated-. - 1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS UARANTEE THAT THE SYSTEM WIL FU CTION SATISFACTORY. DATE.., .. --------------------------------•-----.-•------..---- Inspector-----• ..----•• .1...---•-•---••••.......-•-----•-•-._._........----•---.....--- I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ......................OF..................................................................................... No ✓.. FEE.•. . .............. ....... _ Bio�o 1 orko Tonn#rn.rtion rrmit Permission is eby ranted -••- - to Construct 'orir ( ) an?1nivi �ui� ispos stat No.-•••••-- �� ............ Street'",' as shown on/1healicatio for Disposal Works Construction Permit No._.__f_ __.___._ Dated......................ram ... •-----Board of Health DATE . ............................................ /g FORM 1255 A. M. SULKIN. INC.. BOSTON ►.tG`L- FAMILY - 4 gE ORDoM 5E.PT1G TA►vK = 4.40x15o% -- u5�- ISoy GAL. ' o+5Po5nL PIT �sE2- IO oo GAL. SITS/� SToN(g 'Zt I S DcvJAt L A2Ga = t�o S.r c�1tW Arx-A 150 5.p� x 2 5 = 37 5 �.?o 50TTO/vt _L-AC-A II _ - -W O = 5 o G.P o # PANS 1, _ -TO - D 'TAIESIGN = q25 G.PD. )C2= gC1-O �5 ± ZSf i -roTAL DA t L -( F�-DV4 G.PC - — - - r ouo. P S. FL fir, li PP -TIDIJ RATE I" IN 2MIN OP-LE55 ( � - - - - - -}- S � S/G N ��U./CLI�, i ..t�f�Q• Q' ems• vA '( RlCAARD # )W LANIDIUI-AIJ� . BAXTER �, JONES No.24048 No. 2s m STO'� SUii�6 i I• Irj Say TO P P 111 D = 6c) �, NOLF II-¢-$� �• _ .rig -��� �,�, .. I SuPhO�l+ rZ VIST. INS cGn�. SL, , E:PTI(- , 000 INV. TANK -may GAL. i LEAC" L�e�v6L PITS INV. INY. , WITLI jj � V1ASN6D 6TONC- I f' `i L C�szTIFtGD PLoT PLAN � PRaFIL� _ L046,7I0N C-EQTE7—Z—+/IL-L.�� SGALa ��� C 6 IDAT � -1 O I,U vz' P I—A N REF C s G2?t F Y -f N AT T H rc�W►��A`1"t u y 5 N 0 4v N E2EOW GOMPL%( .-c�l NS YJI TN -CNE S I oEL1t-I � �I AND 51=TF�.GK 26Qu1Y2-EMENT� t= -CµE' 12) -To W N O I~ t: NAU5T-4 P A N� I LOGP.TED •WITNItJ T E G ooD PLAIN''" DATED INC. REG 15��Q6D'I A►�D 5 u 7-Y E`(oe5 II --T'►AIS PL&K1 15 NOr' t3c.5c D pId AN d37E2VILLr=-- — MA6S �� IN5-rRuMEt�T Su2vE`( r- -rNE O1=5'SE75 6WOOL�) II I NoT [6� u5EDTo 0ETERr^INS L.oT INES ,4PPLICA�T � ( r