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HomeMy WebLinkAbout0050 BELDAN LANE - Health r 50 Belden Lane 189-031-013 Centerville No. 4210 1/3 ORA f ° Kok � X 10% �, .r Commonweafth of Massachusetts Executive Office of Environmental Affairs " Mq �fC I� =• Department of k R 1 s Environmental Protection lk -49,96f WIIIIam F.Weld Governor Secret Z EOFJt 19 David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A Al CERTIFICATION Property Address: SO"0mA961J ''t`�—C<'""� r Address of Owner:Date of inspection: -q fp (If different) Name of Inspector.l_�V(S 112_.0e__�5 Company Name, Address and Telephone Number: CERTIFICATION STATEMENT I certify that l 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: v Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Sign ure9`E��vv V Date: �a`r' ��f� The System Inspector shall 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 Department of Environmental Protection. The original should be Sent w.the system owner and copies sent to the buyer, if applicable and the appro�ing authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYS M.PASSES:. . 7I 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. 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 riot determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, 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 8125195) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5.500 `.*Printed on Recycled Psper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: G-t/ ael Date of Inspection: B)SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled 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 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 saltmarsh. 1) 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 ANDJHE ENVIRONMENT: _ I he system has a septic tanK anu Soil absorption SySlem anti is willliil I ICCI to 8 Su'-E: 'rr-,Ei Suaj,i') or tribuiai 1' to a surface water supply. _ The system hay a septic tank and soil absorption system and is within a Zone I of a public water supply 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 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 a free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• D) SYSTEM FAILS: 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. 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. (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D)SYSTEM FAILS(continued): 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). 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. 44 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. L 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: / The following criteria apply to large systems in addition to the criteria above: 1 't The design flow of system is 10,000 gpd or greater (large System) and the system is a significant threat to public health and safety and the epvironment because one or more of the following conditions exist: 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 LI of a public water suppiv 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. ,(revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: t:a v,--( Date of Inspection: —Cl Check if the following have been done: ✓Pumping information was requested of the owner, occupant, and Board of Health. one of the system components have been pumped for at least two weeks and4 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. -fThe facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow -f-The site was inspected for signs of breakout. A system components, excluding 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. he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. ,--Ihe faci:i;y c...,cr ;and occupants, if differ(^t fror owner} were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Sd��«c��✓ Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: .gallons Number of bedrooms: - Number of current residents:_ Garbage grinder(yes or no): Laundry connected.to system (yes or no)-.1-1 Seasonal use (yes or no): 1-4 Water.meter readings, if available: R r I Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design'.flow: aallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, .if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION , PUMPING RECORDS and source of information: r A- System pumped as pan of inspection: (yes or o)_ If yes, volume pornped: gallons Reason for pumping: TYPE.O� SYSTEM - �/ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known)and source of information: y�� SewageAffors detected when arriving at the site: (yes or no)L14 (revised 6/1S/9S) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: '�(� � �`.t� Ce Owner: CCAfti�l Date of Inspection: �S-4t(0 SEPTIC TANK: (locate on site plan) Depth below grader, Material of construction: V"/concrete _,metal _FRP —other(explain) Dimensions: SY Sludge depth:_ Distance from top of sludge to bottom.of outlet tee or baffle: Scum thickness:- t� �c Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: lit Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth o�quid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 50uv-1�> T� GREASE TRAP:I` (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom no crv—J- hottnm at OUtiet tee or banie- 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.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: -� Date of Inspection• TIGHT,OR HOLDING TANK: / ( (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition.of inlet.tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: at'tt`LL— Comments: mote n ievei and distribu►iw. eyu4 e�.'dence of sued: ca;ryu�er, evidence of leakage into or out of box, etc.) PUMP CHAMBER:" (locate on site plan)' Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 6/15/95), 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Iry Date of Inspection: SOIL ABSORPTION SYSTEM (SAS�)`:'V (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: leaching chambers, number:_ leaching galleries, number: leach ing.trenches, number,length: leaching fields, number, dimensions: overflow.cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: (locate on site plan) Number':and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: . Depth of scum layer: Dimensions of cesspool: Materials of construction: r Indication of ground+ate=. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on-site plan) l Materials of construction: Dimensions: j Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) r' i B (revised 8/15195) t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) r^- t Property Address: ,J b-i ele Owner: Ctcv�e.f Date of Inspection: 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �e,� DEPTH TO.GROUNDWATER ' c,.,A=tic•-- Depth to groundr.�wate _feet method of determination or approximation: Ltl 7Z �3�'c—c,w. C,✓_ (J t► 1 S �' to cv e._ �i^ A 0 ,5�M eKr- (revised 8/15/95) 9 mr, �QIIJ vv F� k ,�- 1 0 ,T llk U � \� 2 W 30 W ti.► N gj LOCATION a SEWAGE PERMIT NO. VILLAGE INSTTA LLER'S NAME i ADDRESS CzQrL1 /el- n 1 o0 max GUILDER OR OWNER DATE PERMIT ISSUED ��/�� DAT E COMPLIANCE ISSUED r 1�� 1041z 17 r, '— .. � ,+' ,+ •� � fir,i'c,.. y �'t �.r�5 d s 3 1 r J .� 3 � 4 .. - •`� -.t, . t'J '� , AI 2—"3 S � 't ca & � �w�t .�• D + 1 y l� �'i.�/uz�"�4•`�:".i i. ''« / 000" � - t .�.t # f� K,t.t• i�s`j*''�.` .+ tiy';y,.. c.'.. fir f ^a "f� ,5. - "' S, ,;• h- 'ter... },+ F 'a ,'" h�ti." r„ cv'114 � r Y {q �.'Fi,a�'� i� ♦:, 24 tF IT gi \ a f q.t 9r � �t`'� �`,/,'m. k'tl�• t '��� �7L /�/W� _ All 14 s '3 x` e . ZZ w. 27 ei b fi .. ; �,}• ! ',' �_,,.Al U[ t� O. "2 /• �✓ / .. t e . - �.� a,. `• ^"''-,•"ea t G U sV• U. ,R�•^ "�.k juts\�y�"r.r 2' �. +2' Xri `"vat kx-�x - .. - i - - �•� v f. ROBER7P. . - $ 1 f 0 i� lax k°i o BUNIKISR, c ! it No.22162 0 _ Y_s 1 0� GISTE� pIA ph [ .•#y`et RJ rJ.wS + •t, .. .. . _ a t4 t . = LEGEND ,. ISTING � SPOT , ELEVATION 0�0 CERTIFIED . P.LQT;>, PLAN ,$ EXISTING. CONTOUR - --- p � — - —/ �> Fil4lSHE1) : SPOT 'ELEVATION T 3 fsc-_.D�9w FIIp:ISHED;*,CONTOUR - pIN sAPPROVED C BOARD OF HEALTH ..\\ f A a <fi �ry .0.ice pl A S � $3 DATE AGENT: SCALE U DATESA_'.` &0 .131 LDREDGE ENGINEERING CO ING'� ,. CLIENT _.�._ _. , - I . -CERTIFY THAT tTH£ PROPOSEO� ' r EGISTERE� REGISTERED1 JpB NO.�y_G 6� BUIL'DING SHOWN. ON THIS 'PLAN ; CIVIL LAND I CONFORMS .TO THE ZONING LAWS ;f Y� ENGINEER SURVEYOR DR.BY ! _A d :c. r OF BARNST LE MASS12 gg 33 NC' MAIN ST 712 MAIN ST. CH'. BYE _J /G �,._. � t; °SO;jYARMOUTH, MASS. ,' HYANNIS,: MASS. Z r SHEETS OF %� DA E REG. LAND SURVEYOR: s T . r— -*r '::°'� ti?.ar i.' �.« y.a r'i�'.i •„ti 1a' ,,. ....��. - ✓.. � .st .ir - - .,,y,. .�. ,4- , ...y, , - - ��" � :. y� %Y b. _ _ -# ` •-^~ :iY07F ,i:' /F EITHER TNE,SEP7'/G T�N�k OR . 20 FT. M/N iEACNliYG P,/T'ARE MORE ' TNA.N /2 BELOW �$ ..� .e ,. /RAOls;;f1 24"O/AA9 ETER CoNGR7' COVE. y"�_...—.r � `: < SNALL �.E 1®ROC/GHT TO wI�AOAE.�AN EXTRA c` = ¢Opvc 0/PE hrEAYY. CAST IRON COf/ER Sh/.4LL 8,= • ;`CONCRETE M/N. PITCH /F/N ,DR/VEl�✓A y, ' �`L 9 S s.z CODERS �B a _ p M/N. CONCRLrTE COVER CLEAN SAND BAcxF/LL -"- _ '_ L/QU/O LEVEL .r•• .t•� .. +. :. 2 LAYER 4"CA57- ;' � P �� OF IRON PIPE c 5: �D d 0 (AL. ° •." 1 • • • • • • • 1 / o •40 M/N-P/TGN - ,DIST. • • • • 1 1 a WASHED S70NE SEPTIC TA/VK BOX ° " i • 8 • • • • • 1 .°o �° ° a•.. •: , v °D 1 1 •EFFECT/VE 1 : � T/f r • • DFP • • 1 � o WASHED .STaNE aO: is Y• :.� •` .O 11 • • • • • • 11 6p oc ': =o r s a 1 • • e o • • •.1 / o PRECAS T SEEPAG E ? o v• u • PI7 OR EQUIV. /NV CA-r e'LE✓ATIONS CL q c�, p p o `x I/VYERT AT BUlLDlNG 5-6+ 5 'FT. S 576.0 _�D FT. O/AM. EE TABULATION, INLET SEPT/C TANKFT- OUTLET SEPTIC TANK SS•8 FT. ` INIIET DlSTi4/1�UT/ON BOX '-S'S F7. SECT/ON OF GROuNo 1�X►TEh TABLE OC/TLETD/STR/B[lT/UN BOX S`S'4 FT. INLET LE.acN//VG ofT 5 S� FT; .TEN/AISE O/.5'POSA L SYSTEM . TABIJLATIDIV LEACH//VG P/T, A- 3 FT SCALE %4,1 _ /1- O DIMEIV5101VD/fyIENS/ON $ 6 FT DES/GN CR/TER/A _f�L FT. IV`� . NUMBER OF BEDROOMS 3 Gi4ReAGED/SPOSAL UN/r. SOIL LOG So%L. TEST_ TOTAL EJTlAlAT'ED FLOW 3 3 d' G.4L.1DAY ' SO/L 7-E5T A/ SOIL TES r*2 (' /� /8 v NUMBER OF LEACHING PITS__ �_ �'ELEY. S7.o �^-ELF1! ,DATE OF SOIL TEST Fr/ S/OE(j-.4CHING PER P/T /S-S— SQ, RESULTS WITNESSED BY TZ P. .!3!T Al/ BOTTOM LEtI CN/NG PE/Z PfT -7 $Q. '�T f'L`R COLAT/0.fV RATE,*/ L `''S MI",1 f NCH Lo yoE,pCOLAT/ON RATE 02 TOTAL LEACH/NG AREA,. Z(7 �' SQ. FT. Sv/3 S�3/L RESERVE LEA�'NlN6 AREA SQ F T At/�L- /—lj T Sr SA�✓Y� k 'OBERT, $ — F P r r+ y U BUNIKIS v1~i 5,4�✓v� ' ° �m 0 5� ELORCDGEEIVG/N6ER/JVGCO,PVC, 12 is2 NO. e '..ya +' 1' ,fi,{' 'A� �Gl ^.. � �4�4 "�"'' , s, .— •S.().•'.. w�9 r - .i. `'° A3 712.•'MA/N S.T 33 NO;MAIN ST. .. �n s ` �`" a� ,5: ;• UR ST �\� E "�:�� ."�: �L. � + - HYIiNN/.�, .'.MASS � DSO YA:RMO/JTH�,MAS•s•' "iVOGROUNt7"yyY,4TC'R ENCOU NT ERED„ • :'� ' s <' GROUIS/O. 1n%4TER,AT ELEI/ ' JO8 N0. .7 O SHEET ZOF_� S i yr r. I Y J _h. ' j�^ .k^t a4 ✓ `�= �w $ - ,..i ,::s e. 'y.,.,Si'�t^;-. : '-.� .,f'' . ,. r a- .'iw..`a.-ye'.`rlot r"b i.,. ' L• y e de' �Sr. lk F'rle I4 s ,x L"p �.. r`d 11 t , �, *� : th s S +-«s+ b �'A t e., LJ' (/ L""J - .�',V •L-- .—�� - f a �, yy��r'� rkyx;,�:Y>r N A 't't f'{ $^b�a•+��r' hy r t r z,^ � � sw;� ?.CSt(S t,ip JS`' tl�4d p, ,j,.,�ikfi Ylx �� r S• �' 3' t r a ,r; 000 c" ek :S�r��, ,;s A 3 .. ... (�. a y.t ,r -i Z ,t,,, •"Src.... ��j� H��`k4 vF�p" 5' FE. A Tyr .,e .,. �..26,^• � " A t 4 *�''rJ" �� .,��*'' t.u. Y 3 ,fn k L a t 3 1 s :* u . ��. ��� �r'/— _ 1 F t i 't's •�t o n 4 -� 4 t J�3 r t o- r it .7.�` ° ..;� - t Xlv �QV /U 14) • U 00 AL EAT/C . 3 ., � +�L 'F .Q - i � � W �'i=•`1 y t11' Af+n. r� ,? 0. I + s p a p�,yCM r. ROBER7 �t 4 P. n � a !� BUNKS 4 , No 22162 40 r" ONA1. LEGEND CERTIFIED , PLQT ' PLAN , EXISTING SPOT ELEVATION Ox0 EXISTING CONTOUR - - - 0 - - - LoT / 3 dcLD/+,/ 4,q ffic- FlNISHED '.,SPOT -ELEVATION 1670 _ FINISHED, CONTOUR ----- 0 - - — f tee APPROVED ►BOARD ' OF HEALTH 9 All kl S TA 2 JA "a ASS*' DATE r AGENT SCALE- �v DATE LDREDGE' ENGINEERING CO. CLIENT__ __. - I .CERTIFY THAT THE, PROPOSED r EGISTERE REGISTERED �Og N0 ?� '_6.�_ BUILDING SHOWN ON THIS PLAN $�� a CIVli. LAND CONFORMS TO THE ZONING' LAWS DR.BY �4: ... — � � EN.GNEER SURVEYOR OF BARNST-A LE MASS. - It- - r ' 33NO,MAIN ST : 712 MAIN ST. CH. BYE �/DXEII '.YAR_,OUTH, MASS. HYANNIS, MAS;;. _SHEETZ OF .-_ REG. ' LAND SURVEYOR �. •. .-...,, r r�t�..., .�.�.. , I -, x; y .. .. .. . = i-.... a .r:�.:r-'?• .. , F� N.�sY,� ` Y ,.. .r'� t .' r- �.� i.r. y t ,`: "¢t� .. x _ '� , _ •2-�' �t 3' •,� 20 FT. M/N ^ . . `7 a /�(07E /� E/TNER TN'E.SEPT/C-T.ANk OR fC:HING P/T AigE, /►%JORE.. THA.,1/:/2'�BELON/ �r��./0 �`M/N.r ',;` ,��'� �'`.„� 4"' c ,�.<: :f,.t"'RAOE� A 2¢•�/AMET,�'R 'CO/yC�FFT� cowE,P �.=n. � ,�,.�: �. �. ,.. fP _ ,� �, � T' 'SJ,IALL 9� �,gRdUGHT TO 6RAOE.�.�4N.EX7•RA �'PYC P/PF Y f-iE.4y c^s-r /RO/Y COi/E'R SOYA DE USE.[ K rCANCRETE ., N. P/TGN �A O L. J'�.,5 co M/�6"PEiQ FT /F/N .GR/VEy1/A Y a _ CO/VCRET� 2 M/N. CU ✓ER CLEAN SAND - - L/QV/D LEVEL ._ .,:.• z -' ,.,.• 2 LAYER f 4, 4••CAST J OF q M1N.P/TCN /ON �.� GAL. a l • o • , p o WASHFO SMIYe D/ST, • • • 1 1 n d SEPTIC TANK 6aX o ° " r • 8 • • . • • 1 e Q. : � 0 1 1 • 4 B O • a ° EFFECT/VE 1 ` , °v • ° 1 • • DEPTN • ° 1 ' ° o , WASHED STONE PRECA5-e• 7-SEEPAG E o u. a 1 • • . . o o • •-1 1 p�.a• 0/7 OR EQLIIV- fl ` o I I o s ' •. • • • 1 1 ' e a /NVeKT EL EVAT/DN S YE/eT AT BU/LD/NG S(9� S FT. �6.0 — D/AM• C SEE TABULATION, /N /NLET SEPT/C TANK FT OUTLET SEPTIC 7-ANK •�' FT GieOUNo ril,�►TER TABLE /NLET DISTi4/BUT/ON BOX �s"S FT SECT/O/V OF O d -LET D/S-rR/,s&-r1ON BOX FT . SEWAGE O/SPOSA L .SYSTEM /NLET•LEACH/N4 Ic'IT 52 fl FT`' T/IIeULAT/ON LEACH!/VG • r DIMENS/ON A SCALE �14 = / " O D/M.ENS/ON 8 6 FT. DES/GN Cft/TER/A FT. �l Al'.NUMBER OF BEDROOMS 3 _ D/HENS/ON C_� , GAReAGED/SPOSAL UNIT_ SOIL LOG SO/G TEST TOTAL EST/M.ATED FLotw 30 G.4L.1DAY ` SOIL. TEST At-1 SOIL 7:=-S7',•2 NUMBER,OF LFACHINls P/TS_. L_ f`ELEY. S7.O /"'ELEY, j ,DATE OF SO/L TEST S/DE LEACHING PEst P/T / SQ• FT. f RESULTS N!/TNESSED BY R �• a�N/ /S o _ l �, PL`RCOL N A7-/O RATE# Ny/IN / L �55 M/ CH <p BOTTOM L+Fi4 CN/NG PER P/T 7 C SQ. FT', L v�}tl :C FERCOLAT/CN RATE�k2 M1N. INCH TOTAL LEAGN/NG AREA, �� SQ. FT. Sv/3 S�/C- o RESERVE LE,4CNl N6 AREA SQ. - 13 §^ �o ROBERTi 1 ' BUNIKIS' No:22162 O 1��FG:�:gTEP4; 4k- 712 MAIN ST. -,. 33 MO:MA/N ST 9YA/�/1V/3�, MAS5. SO rARMOUTNI MASS Ss%ONAI EN : a . NO GROUND `;;I a R ErNCOlJNTERED 4 r;: X. IIs, - `` ., b�• 'r"`r•;'R GRO U11/L7 kV.4 TER\A7',AFL- ``�§ A �'3 .,,,:9;'a, � � m. �;. l...r' ���y y�5 `j � r�f� �.: � r e. �i 7,.�,7� .iF ., 5 �`-'•1 � .A 4��'-�Y�Imo, ... .i«v. s:l; .. .wtl , 7^ .. ""+'•. "� .+� No...........JP_..... Fps.. ,.................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �i✓-/..........OF....... 0-..................................... Allp iraatiun for Bigm.4 al Workii Ti n i rurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -13 Locat' n-Addres or Lot No. OOwner , Address a �� 1 .__Y.__._.X!!_S.�dSC f .�....�_........... .-•------------------•-----.........._..__. Installer Address yy d Type of Building Size Lot__L__4// y Jy_!2__-Sq. feet Dwelling—No. of Bedrooms_____._.__________________-----------Expansion Attic ( ) Garbage Grinder (,J°) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ __ W Design Flow............................................gallons per person per day. Total daily flow------ .........................gallons. WSeptic Tank—Liquid capacity OO.Q_gallons Length_._.`�_.____ Width_____'____. Diameter________________ Depth................ 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 (a() Dosing tank ( ) G Percolation Test Results,tesTiY�rI Performed by........ .............. /;f—,f .!t'1.� _______ Date... --- ---?--------•-------- Test Pit No. 12. minutes per inch Depth of Test Pit_________,_________ Depth to ground water---,11�6N :------- fz Test Pit No. 2_______ _____minutes per inch Depth of Test Pit---/1_........... Depth to ground water....e6 qL.1.l ec •-•-- O Description of Soil---.--C>. f�� 6��n' ��5�•' ........ - --. ----- - - J �iQ.[�e. - f .v ------------ v ------------ `� --------cuc r_ _..3 ------------------------------------------------.................................................... W VNature of Repairs or Alterations—Answer when applicable.-______________________________________________________________________________________________ - -----•-•-----•--------- ------- --------•.._.....-••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'i T p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been •ssued by the oar of health. Sig ate Application Approved By...... �e . -•-•-•-•••• -h � ............................................... •Le • �-'.--�-o_-- Date Application Disapproved for the following reasons--------------------------- - - ---• ••-----•------•-----•-•--•-•-----•-•----••--•-----.._....----••-- ----•-------•-----------•----•---•---------------•-------------••------•-•----------•--•-----------•----------•----•-------••----------•---•----•-----------•-----•-•-• -----------------------•--- -- �j Date Permit No. Issued (..--! tT Date Date No .....z`1l ...... F>�$... © �_Br_......... s.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................ . ......._.....O F......% Lry J� --------------------------------------- Appliration for Dhipati al Workii Tonotrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Loca' n-Add re or Lot No. /. E ' ! / - Ct_::e_T:c.L_J_!*//.c...................•-•----- / Owner Address a .......... r'�'t�Y �'......At.t �t ----........ fit.'-�? ...... -•----------------------------------------- Installer Address Type of Building Size Lot__ZR I U....Sq. feet Dwelling—No. of Bedrooms............ _________________________Expansion Attic ( ) Garbage Grinder (NO) Other—T e of Building No. of persons____________________________ Showers — Cafeteria dOther fixtures --------------------------•----•---•-----•-•-•----•---.•••••••--•••---••---••-••---••••---------------•••----••••••••••••............•-•-----••••--••- W Design Flow.............................................gallons per person per day. Total daily flow...... ..........................gallons. WSeptic Tank—Liquid capacityeQ4.0__gallons Length----- Width___.!,�........_ Diameter________________ Depth................ x Disposal Trench—No. _---••-----_______ Width__ ______________ Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No................... Diameter...'�..____...... Depth below inlet.................... Total leaching area... ....sq. ft. z Other Distribution box (.'k,) Dosing tank ( ) r 1-4 Percolation Test Results Performed by........ �tfi7P ?�••_•4!�r�'.10! ....... 1/` 0............. Date___._, .,_ aTest Pit No. hrs�r'�'�minutes per inch Depth of Test Pit..... Depth to ground water._No►�c�__ 44 Test Pit No. 2?_ ......minutes per inch Depth of Test Pit._Ik--_______-- Depth to ground water....5 N' .L ato[1C.!� P4 ----------------------------------------•---------------_........•••• -------------------------------------- j' D Description of Soil----- �. I� 'GGs�ner r� sr't / f ..e f /, k! G X. --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- V 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 TITLE p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t``hee�bo of health. 1 Q p- � ! ate Application Approved By..... .� . . . .....h----- .U44 ................... ................. .......Q-'--- Date Application Disapproved for the following reasons:.......................... ----•-----------•----------•----------------•------•------------------------- ...................--•-••-•-••••••-••--...••---•-•••---••••••-•-••••••••••••••-••-------••---•••••••••••------•---••-••••••-••-••••---••••••---•••••---••••••••••••-•-•••--•••-•-------------••••••••-- Date PermitNo......................................................... Issued `................. Date THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..OF......r~ .{ / /.'0: .: ................................ Tntif iratr of TomViiana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (-k") or Repaired ( ) f Installer ----�•-•" / at -•- � _/._.. .._ -r i m x C ,n.2/n/v.1:44 ------------------------------------------------------------------- has been installed in accordance with the provisions of T r `" of The State Sanitary Code as described in the Y , application for Disposal Works Construction Permit No._. _:_ ____________________ ' •'__1 .__.___._______-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UN�TION TISFACTORY. DATE............... ... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No Dispoiia1 Workii TM rnrtion rranit -V L Permission Is hereby granted A ' . ................................................•---•--- r..._.. to Construct"'('V') or Repair ,( ) an Individual Sewage Disposal System at No......--•-•-•••- f'rQ�o: P-----Li%�': -------------------------- -------------------------------------••-•-••------- Street ... ��s1 -------------------------------- ������6'oard of Healt DATE................................................................................ . FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS