HomeMy WebLinkAbout0078 BAY LANE - Health 78 I3AY LANE, CENTERVILLE
A= 078 031
UPC 12534
No.2-153 LO R
HASTINGS.MN
TO OF BARNSTABLE
Lam.,.... _N SEWAGE #
ryJILLAGE �- ASSESSOR'S MAP Sc L
INSTALLER'S NAME& PHONE NO.
7SEPTIC TANK CAPACITY :
LEACHING FACILITY: (type) 4;1�14/ (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet.
Edge of Wetland and Le ching Facility (1f any w-Hands exist
within 300 feet le chi acility) Feet
Furnished by `�
Apr
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DATE : 5L22/98 - --_.
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PROPERTY ADDRESS: 78 Bay_ Lane------------
Centerville Mass *V � \
02632 �I4 �'�'FO
to �8
---- ool�1998
r ze
On the above date, I inspected the septic system at the � ove address.
This system consists of the following: Ot , �.
fa
1 . 1 -1500 gallon septic tank.
2 . 1 -Distribution box.
3 . 2-600 gallon precast leaching pits.
Based on my inspection, I certify the following conditions:
4 . This is a title five septic system. ( 78 Code )
5 . The septic system is in proper working order ,
at the present time.
SIGNATURPI
-- -
Name :- J .- P . -Macomber-jr .
-- -- ------- -------
Company:_josegh _p__ M�comf�2r Son, Inc .
Address :__BQ: _EzFL___—______-_
—_G.Pn-�-eLYiUR,_Ba--n632-0066
Phone --508- 775- 3338
-------------------
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
mom
JOSEPH P. MACOMBER & SON, INC.
Tanks-Cesspools-Leachflelds
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775-3338 775.6412
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE HINTER STREET. BOSTON. MA 02108 617-292.5500
WILLIAM F WELD TRUDY CO\T
Govcmor Sc:roar?
ARGEO PAUL CELLUCCI DAVID B STRU• LS
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commrssionc!
PART A
CERTIFICATION
Property Address: 78 Bay Lane Centerville,Mass. Address of Owner:
Date of Inspection:5/22/98 (If diHerent)
Name of Inspector:Jr)gpp h P_Macamber Jr.
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: J.P.Macomber & Son Inc.
Mailing Address: BOX 66 Centerville,Mass . 02632
Telephone Number: c08—_7 7 S_3-318
CERTIFICATION STATEMENT
I cenify that I have personally inspected the sewage disposal system at this address and that the information reposed 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:
asses
Conditionally Passes
Needs Funher Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date:
The System Inspector s all submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Depanment of Environmental Protection. The original should be sent to tt,e system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, Or D:
AI SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303
Any failure criteria not evaluated are indicated below.
COMMENTS:
81 SYSTEM CONDITIONALLY PASSES:
Vv_ 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 determination in all instances. If "not determined", explain why not
4yJ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(anached) 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 exfiltratron, 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.
(r.vi..d 04/25/97) Page 1 o1 10
DEP on the World Wide Web: http:Nwww.magnet.state.me usioep
Printed on Recycled Paper
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• 1
SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FOR•%+
PART A
CERTIFICATION (continued)
P+operl, ACCreW 78 Bay Lane Centerville,Mass.
o.,her: Peter P.Long
p.lr of lnsprc:ion5/22/98
BI SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is cue c'•z-
pipets) or due to a broken• sealed or uneven distribution box. The system will pass
Board of Health). Describe observations:
broken pipes) are replaced
obstrvAion is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed p.;e s "e �•s:e" ^
.nspecj.on if (with approval of'the Board of Healthy
broken pipe(s) are replaced
obstruction is removed
Cj .FURTHER E-VALUATION IS REQUIRED BY THE BOARD OF HEALTH:
N� Cond.t.ons exist which require further evaluation by the Board of Health in order to determ ne J -C'
D,ohc health. wiery and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNC? O-'!-'C
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or prNy 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 AP?ROFR:AT:'
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAF '1 .;-,:)
ENVIRONMENT:
W6 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 :re. C ; s_-, - .
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone 1 o' :.o -:e
, ',e) The system has a septic lank and soil absorption system and the SAS rs -ithin 50 fee: of : .
,� The system has a septic tank and soil absorption system and the SAS s less than 100 e-
private water supply well. unless a well water analysis for coldorm bacsena and ola:.Ie
the well is free from pollution from that facility and the pies�eQjce of ammonia nitrogen an - ;:e Cse
less than 5 ppm Melhpd used to determine distance �// (approximation not va'
1) OTHER
Pay• 2 of )'0
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 78 Bay Lane Centerville,Mass.
Owner: Peter P.Long
Date of Inspection: 5/2 2/9 8
DJ SYSTEM FAILS:
You must indicate ei; .er "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 Ch1R 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 into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distr'b ution box above outlet invert due to an overloaded or clogged SAS or cesspool.
t v-�
Liquid depth in coupsel 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($).
Number of times pumped d.
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.
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.
El 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 above:
�fZ . 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)
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.
L
evised 04/35/27) Pa9. 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 78 Bay Lane Centerville,Mass.
Owner: Peter P.Long
Date of Inspection: 5/2 2/9 8
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 components have been pumped for at least two weeks 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.
As 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,Acluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
—The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
/ Sub-Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b))
(revised 04/25/97) Pago 4 of 10
SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Properly address: 78 Bay Lane Centerville,Mass.
Owner: Peter P.Long
Date of Inspection: 5/22/98
FLOW CONDITIONS
RESIDENTIAL:
Design floN.b 40 $.p.d'/bedroom for S.A.S.
Number of bedrooms:S A
Number of current residents: cC
Caroage gander (yes or no) :R1
Laundry connected to system (yes or no).4
Seasonal use (yes or no).AJD
Later meter readings, if available (last two (2) year usage (gpcl: /9? rlit.(_� � •ltiS 7_
Svrnp Pump (yes or no):— LO �qv� , &.P.��
:asl Cate of occupancy
COMMERCIAUINDUSTRIAL:
Type of establish m nt. iL/17�
Design (IOC: Ns >tallons/day
Crease trap p(esent: lye$ or no)&14
rndvstrial Waste Holding Tank present: (yes or no)Za
Non•sanrlars ..ante discharged to the Title S system: (yes or no)-V,*
Water meter readings, if available.
AM
Las: dale of occupancy:—AA—
OTHER: ;Describer AM
Last date 01 Occupancy' A114
GENERAL INFORMATION
PUMPING RECORDS and source o .information.
�-ee-
System pumped as pan of inspection: (yes or now
e✓
If yes, volume pumped: / O gallon
Reason for pumping
l "H'+_
TYPE OF EM
Septic tank/distribution box/soil absorption system
Y Single cesspool
Overflow cesspool
Pnvy
Shared system lye, or no) (if yes, anach previous inspection records, if any,
I/A Technology etc. Copy of up to date contract(
Other W4
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Se..age odors detected when arriving at the site: (yes or not
D.9. 5 of 10
Customer Data Entry Screen C/
5/27/9$
Name: Peter Long 778-2498 Customer Code:
idress: 78 Bay Lane pion
Town: Centerville State: Ma zip: 02632
Mailing
address:
78 Bay Ln Centerville MA 02632
Notes: 10/29/91 pump T 135.00 loc 25.00 10/30/91
1/94 letter ,
7/3/96 pump T 175.00 7/26/96
5/19/98 sew insp 250.00 pump T&P 260.00 3-riser speed leveler
broken cov 207.20
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Properis Address: 78 Bay Lane Centerville,Mass.
O»ner: Peter P.Long
Date of inspection:5/22/98
BUILDING SEWER:
.ocate on site plan)
r�
Depth below grade. 149,
~material of construction: _ cast iron 40 PVC _ other (explain)
Distance from private water supply well or suction line L/l r S`
Diameter #'
Comments: (condition of)oints, venting, evidence of leakage, etc.(
SEPTIC TANK:/—rem 9►4A41V
,locate on site plan)
Deptn below grade.
material of construction: Zoncrete _metal _Fiberglass _Polyethylene _other(explain)
u tank Is metal. I1st age Is age confirmed by
Cennif,cate of Compliance��(Yes/No)
Dimensions' /b"�II11e AO O) 911 4),Lik U 1/ 21a
Sludge depth 1 21 1 1�
Distance from top ofsludge to bonom of outlet tee or baffle.
Scum thicknes:
Distance irom top of scum to top of outlet tee or baffle:_:
Distance from bonom of scum to bond of outlet ee or bffle:4a"- .
mow dimensions were determine8'. r
Comments
trecommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integriry, evidence of leakage, etc.) Pump the septic tank annually. There is a garbage
disposal_ present Tnlet & outlet tees are in place The tank is
structural 1 y czniinri The tank shAWS no signs of leakage
GREASE TRAP:Ahf-Q,
(ioute on site plan)
Deptn below grade'4111
atenal of construct ionXAconcrete / metalV1?Fiberglass41,4 PolyethylenewAother(explain)
Alrl
Dimensions: A1.4
Scum thickness. A/A
Distance from top of scum to top of outlet tee or baffle: V-4
Distance from bonom of scum to bonom of outlet tee or baffle:AJ —
Date of last pumping: AU/}
Comments:
trecommendahon for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structurai
,ntegrlry, evidence of leakage, etc.)
Grease trap is not present
(r.vi..d 04/25/97) P.g. 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
- PART C
SYSTEM INFORMATION (continued)
Property Address: 78 Bay Lane Centerville,Mass .
Owner: Peter P.Long
Date of Inspection:5/2 2/9 8
TIGHT OR HOLDING TANK:eQ&JC,(Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grader
Material of construct ionwA concrete-vAmetal,VAFiberglass&,4 Polyethylene.Vlother(explain)
Dimensions:
Capacity: AA gallons
Design flow: NA gallons/day
Alarm level:-A-Alarm in working order Yes;,{ , No
Date of previous pumping: , h
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
Tight or holding tanks are not prpcanf-
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
Distribution box was not level installed on gpee1i 1pweler This
maclee—tne Mow equal to the two pits No vi denr-e of Gnl ; do tarry
over, No evidence of 1 Pakagi- ; nt-n nr—rout Of the haX-
PUMP CHAMBER:aAa
(locate on site plan)
Pumps in working order: (Yes or No) V,4
Alarms in working order (Yes or No) IV
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
Pump chamber is not present
(revised 04/25/97) Peg- 7. of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 78 Bay Lane Centerville,Mass.
Owner: Peter P.Long
Date of Inspection: 5/22/98
SOIL ABSORPTION SYSTEM (SAS):�4'po 9AAL."
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number: 16-1
leaching chambers, number:
leaching galleries, number:_0
leaching trenches, number,length:—�---
leaching fields, number, dimensions: y
overflow cesspool, number: d
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Loamy sand to medium fine sand Nn s; c,ns of by ramie fallur_e
or ponding All yeaetation is nnrmal
CESSPOOLS:&AVC
(locate on site plan)
Number and configuration: 0
Depth-top of liquid to inlet invert: A14
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection)
Cesspools are not present
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Cesspools are not present
PRIVY:&Afl�'j
(locate on site plan)
Materials of construction: Dimensions: A14
Depth of solids:�i
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Privy is not present
(zevimod 04/25/97) Page 8 of 10
SUBSURFACE SE`VAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propeny Address: 78 Bay Lane Centerville,Mass.
Owner: Peter P.Long
Date of Inspection: 5/2 2/9 8
SKETCH Of SEWAGE DISPOSAL SYSTEM:
,nclude'ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
7"
0
�:716 �•5 i
3'1
1 y
6 0 o c,'o c.
O '
(,ot) �k �
(revised 04/25/97) Page 9 of 10
SUBSURFACE SENVAGE DISP• t. SYSTEM INSPECTION FORM
) C
SYSTEM INFOI. 'ION (continued)
Pro ert Address: 7
P Y 8 Bay Ic-m 0etjtErvi_1_l,et-
NhSs.
Owner: Peter P.1-ig
Date of Inspection: 5/22/98
P
Depth to Groundwater % Feet
Please indicate all the methods used to determine High Groundwater Fle.ation:
Obtained from Design Plans on record
�Icondit.ons
observation hole, basemtry simp etc.)
Determin
Check with local Board of health
Check FEMA Maps
Check pumping records
Ycheck local excavators, installers
Use USGS Data.
Describe n your own words how you established the High Groundw.aier E levalion. (Must be completed)
Wed Water Qaltoirs tip
Gkn:et & Miller
12/16/94
(revi..d 04/25/97) P.r. ]Da( 10
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TOWN OF Barnstable BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I
�- �-•rn-T••._.. .—r..r.-.-rn.•.sr.+n-rr+rri rname+rrn�rr-s�*-ume�snmr--rn.nswrnr+mmrsmrsrs r+m.n�+.rrnrx.•+rrn.r.�.•.T.rr•T-•r-- —..A
-TYPL OR PRINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRES$ _78 Bay Lane Centerville.Mass _
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Peter P.Lcfnq
PART D - CERTIFICATION r
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & Sd11f Inc. /tFtlo
COMPANY ADDRESS Box 66 Centerville,Mass. 02632
Street Town or City State LIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1578
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
complete 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 :
_k4/Systeai PASSED
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*
The inspection which I have con ttted has found that the system fails to
Protect the jiublic health and the environment in accordance with Title
5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspecteo form .
Inspector Signatur Date �-- '�
'i��i^iT3�..i f;iii�.iT.•Jf �r One copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the DOARD OF HEALTH.
* If the inspection FAILED, the owner or operator shall upgrade ' the aystem.
within o'ne year of the date of the inspection, unless allowed or required
otherwise as provided in 3.10 CMR 16 . 306 .
partd .doc
-
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THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE S SYSTEM INSPECTOR
as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
)MIC
Acting Director of the L Mutt Of Water Pollution Control
1
L CA VMN SEWAGE PERMIT NO.
.r CIS ��✓ . � ,� Lat
VILLA
I N S T A LLER'S N ME i ADDRESS
�e
e UILOER OR OWN R
DATE PERMIT ISSUED 3d7—Y\Y�
DATE COMPLIANCE ISSUED
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THE COMMONWEALTH OF MArACHUS TS
BOAR® OF HEALTH -
F,
...------ .... .................OF...............................1-......-----
Appliration for Uhipoii tl Workii Tonstrndiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) 'an Individual Sewage Disposal
System
....... `4._. : •. --
............. .....................•-•----•-------..---... ..---.............---•--..--.......•--•..
Loc tion- ress or Lot No.
..tea.-_ .......
•........
---------------------•-------------
p qqwn Address
a �lok�..r1A.A�w......... �. . ................................ ............................•-----••-•----.......------•-••--.............................------..
InstaSler Address
Q Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms.__......�_____________ Expansion AttiF ( ) Garbage Grinder ( )
p, Other—Type of Building L il....._ No. of persons..(...F1&LLH_._ Showers ( ) — Cafeteria ( )
Aa Other fixtures ------------------------------------•------•-- -----------------------------------------------
•-----------------
---------------------
.._..........
W Design Flow.... '_.. �a-----__gallons per person per day. Total daily flow.......6.a 0.......................gallons.
Septic Tank—Liquid capacity..[. .gallons Length................ Width................ Diameter--------_------- Depth................
ZW Disposal Trench—No. 'V............... Width.................... Total Length.................... Total leaching area....................sq. ft.
I
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (t,� - , Dosing tank ( )
a" Percolation Test Results Performed._by.......................................................................... Date.............................. ----
al Test Pit No. l...... :minutes per inch Depth of Test Pit-------1__._.____... Depth to ground water.._ Q2...........
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil.........
s_
-•--------------------•------•-------•-•-----•----•-•---------------------------•------•-----•----••-----------------.....------------------.........----------•----------.............--...._......--
W
U Nature 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 TITL IE 5 of the State S n' ary Code— The undersigned further agrees not to place the system in
6Aoperation until a Certificate of Compliance s e b t board of health.
Sign ��.
.tact
Application Approved By........... ..........��=
Date
Application Disapproved for the following reasons:---------•--------------------------------------------•--------------- -------•----------------•------•---•---
.............................................................Z-Z•�--------.....-•--------•....•----•-............••----••-----•••---•-----------•-•---• �-------•----Da......------•---
Permit No...... ............................................. ( Issued...----- ` D
Nc. .1.................. Fics....... •:...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................... .---------------.OF...............--.-..--.-...-........-
Appiiration for Diipusal Works Toustrnrtinn rrnti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System t:
.................................................
------------
Lo at' - dress or Lot No. .............•
ttKr AddrAo
ess
Inst'eller Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms--- Expansion Attic, ( ) Garbage Grinder
Pk
Other—Type of Building �_......... No. of persons-1... �.... Showers .(J ) — Cafeteria ( )
Otherfixtures -----------------------------------------------------------------------------------------------------------------------------•----------•-•••-----
Design Flow_--:"' ..5 G________gallons per person per day. Total daily flow.....{:� _� ________________________gallons.
Septic Tank—Liquid capacity__:.-I.U__.gallons Length................ Width................ Diameter__._____________ Depth................
w Disposal p Trench—No. ._.___.._____. Width.................... Total Length.................... Total leaching area....................sq. ft.
x
> Seepage Pit No--------------------- Diameter.................... Depth below inlet..._................ Total leaching area.__...............sq. ft.
Z Other Distribution box (t-'r Dosing tank ( )
'~ Percolation Test Results Performed by..................................................... ____ Date...................
Test Pit No. 1.....___________minutes per inch Depth of Test Pit......_______::..... Depth to ground water______-._____.____.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----- -- -
O Description of Soil__Ch )'---•---------------------�--------- -------•----------
U ...---••----••---------•----
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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 TITHE 5 of the State S- tar Co e— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance, el Igft e board of health. +y
_... J `%S
,' Sign ---- .1 -' ' ``�""
.c.,;•,,,,___ '' r 5"' .�' �.,. "----------------- ............ --,, Bate:.._ �r.----
Application Approved By..... ` ,� r c `'`
- •-- -- - -- ........ --•--..................................
Date
Application Disapproved for the following reasons---------------•-----------•---------------------------------------------------•-----------.._..-----......_.._
..................................•-•-----•--•-----------•--•----•---•-•--------=-•-----...---•-----...--I---------...--••------------•----•---------------------------------------•------------•••--•---
Date
PermitNo.......................................................- Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Tatifirab of Toutplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal Syste constructed ( ) or Repaired ( )
by_..N ?C..tY.l .�..... .''�?I. ..................................: J0 .........._..
...............
]ler
at---------7 9'---------- A .4: ---------�` - "�- ;
has been installed in accordance with the provisions of TITLE 50 e State Sanitary Code as described in the
application for Disposal Works Construction Permit ______.____ dated....=.��:_ '}
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E® A nUANTEE THAT THE
SYSTEM WILL FUNCTIONSATISFACTORY.
DATE....... Inspector
THE COMMONWEALTH OF MASSACH ETTS
BOARD OF HEALTH
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No............ :........ FEE...::: ....
�nn�#rnr�ua-t rrnti�
Permission is hereby granted . -............. - Orr� ----•--........................................................
to Construct k,-)-or\Repair ( ) an Individual Stwage Di-s: osal System
at No.----... ....... ......k-- ----• '"
Street as shown on the application for Disposal Works Construction Permit,No..��.......' _____ Dated__��__. __._�_.. ...._ .
Board of Health
DATE.............
-�--- ---�-: :----�-•�
FORM 1255 A. M. SULKIN, Nc., BOSTON
The VOGT
RESIDENCE
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Ww RC-X I TE L 508-)630904
FAX.505-343-0903
sW� I ® I j agngdesign@comcast.net
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NEW RECESSED CEILING MOUNTED LIGHT FIXTURE P. -'I
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(D NEW RECESSED BUILT-IN CABINET LIGHT FIXTURE I (�
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NEW SURFACqp
B IZ7_ (HEIGHTS TO BE DETERMINED IN THE FIELD)E WALL MOUNTED LIGHT FIXTURE gW�
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RW-O= NEW RECESSED WALL MOUNT LIGHT FIXTURE IZB-m
NEW DIMMING WALL SWITCH WORK NOTES:
3*e NEW DIMMING WALL SWITCH(THREE WAY)
1.) RECEPTACLES INDICATED ARE SPECIAL CONDITIONS.
NEW DUPLEX WALL OUTLET ALL OTHER RECEPTACLES SHALL BE INSTALLED TO CODE.
VERIFY LOCATIONS WITH GNG PRIOR TO INSTALLATION OF BOXES.
WALL OUTLET SWITCHED
2,) WALL SCONCE HEIGHTS SHALL BE PROVIDED BY THE OWNER ,
AND GNG DESIGN DURING REGULAR JOB
WP NEW DUPLEX WATERPROOF EXTERIOR OUTLET sn••f rin.
MEETING WALKTHROUGH. PROVIDE WHIPS UNTIL FINAL
LOCATIONS HAVE BEEN DETERMINED.
LIGHTING PLAN
zt SPECEL REQUIREMENT
3.) LOCATE EXTERIOR OUTLETS AS CLOSE TO LANDSCAPE
® NEW DUPLEX FLOOR OUTLET RECESSED W/ GRADE AS ALLOWED BY CODE.
FLUSH HARD WD COVER PLATE CONFIRM SWITCH AND RECEPTACLE LOCATIONS WITH DRAWING KEY
OMNER AND GNG PRIOR TO WARD WIRING. NEW CONSTRUCTION
NEW CABLE TV JACK
TV® 4.) COORDINATE ALL AUDIO-VIDIO REQUIREMENTS 0 EXISTING CONSTRUCTION
WffH OWNER WHILE ROUGH FRAMING 4S EXPOSED TO REMAIN y A.
DATA® NEW COMPUTER DATA JACK E---� TOISBE DEMOLISHED ON 1
5.) REPLACE EXTERIOR LIGHT FIXTURES LOCATED AT JA-2 MARM 15.2001
pH® NEW PHONE JACK EXISTING FRONT DOOR AND BETWEEN GARAGE DOORS. A-3 an.e wme..
PROVIDE 2 NEW GRADE LEVEL FIXTURES AT FRONT
ENTRY BRICK WALK WAY,SWITCHED AT ENTRY. �
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LIGHTING/LANDSCAPE FLOOR PLAN SCALE: 1/4'
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