Loading...
HomeMy WebLinkAbout0075 BRALEY JENKINS ROAD - Health 75 Braley Jenkins Centerville A= 171 141 S M E A D No. H163OR UPC 10259 smead.com • Made in USA 2J 'i me � I A %jUMMUNWEALTH OF MASSACHUSETTS 'S. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTE CTION OFFICIAL INSPECTION FO 'TITLE S / 7 / RM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Names 1, i Owner's Address: i Date of Lupecdoas Cs- 1 Name of InspectoU101 we p zrba( Company Names MsMellingng ess. tAddy Telephone Number: �.1 =-•4 `�= '!3 CER1'Ih'ICATION STATEINENT " CD r— I cer*that I have personally inspected the sewage g disposal system at this address and that � M below is true,accurate and complete as of the time of the' information reported �B and experience in the proper tizaction and mnce of on site The inspection was ormed based on my approved system inspector pursuant to Section 1SJ4 o�jye 310 �o��sys�'I am a DEP 1 ( CMR M000). The system; V Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Sfpatu , Date: Q i o The system inspector shall submit a copy of this ' . DEP)s within 30 days of completing this inspection report to the Approving Authority(Board of Health or ,000 gpd or greater, the inspector and the system shall submit the repn.If the system is a ort two tsystem e appropriate pro has a design flow of f the DEP.The original should be sent to the system owner and copies sent to the buyer,,if applicable,and thorw e a approvin authority. - B Notes and,Comments �r' �� C q`1 l�o� S e l o plj v S Q.., . ""This report only describes conditions at the time of Inspection and under the conditions of use at the time.This Hon does not address how the s of use conditions of use. ystem will perform In the future under the same or different i Title 5 Inspection Form 6/15/2000 page 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address ('c, Owners ti0A k Date of Inspmdons Inspection Summary: Cheek AAC,D or E/AiM eomplets all of Seetlon D A. ss System Paes t I have not found any mfornatioa which indicates that any of the 15.303 or is 310 C11 R 15.304 exist Any dilure criteria not evabuted are l.a�w. m 310 CMR Co to: e�rSe� �. B. System Conditionally Passes: One or more system components as described in the"Conditional Pas"section need to be replaced or Th0"M upon completion of the replacement or repay,asVPOvcdby the Board of li4esitb6 win , iAnswer yes,no not determined(Y.N.ND)in the for the following saftmenta.If"ao explain. not The septic unsound.exhibits tank tal and over 20 years old*or the septic tank( tal or not)is structurallyinfiltration or Wiltration or tank faih n is existing tank is replaced wi complying septic tank as approved the and of��will pass inspection if the A metal septic tank will pass ' on if it is s indicating that the tank is less than years old is available sound,noslang and if a Certificab of Compliance ND explain: Observation of sewage backup or bre high static water level in obstructed.p#*s)-of due-to a brok the distribution box due to broken or eq settled- approval en diatributioa box.System will pass approval of Board of Health): inspection if(with br en pipes)are laced struction is remov distribution box is level or replaced ND explain: The Sys equired pumping more than 4 times a year due to bro or obstructed pipe(s).The system will Pass inspectio (with approval of the Board of Health): broken pipes)are replaced obstruction is removed ND explain: Till. i inanartinn 97—v" </1,cP7nnn 2 L OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS •� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A cc CERTIFICATION(condmud) Property Address: t''c•-\ `C iS c Owner: ., � �. l Date of Inspection: C. Further Evaluation it Required by the Board of Health: Conditions add which require Anther evaluation by the Board of Health in order to determine if the system is to protect public health,safety or the environment. 1. WM pass unless Board of Health determines in accordance with 310 CMS 1 03(i)(b)that the system tbnedoulng In a manner which wW protect public health,safety and envttonmentr — cesspoo privy is within 50 fed of a swam water _ Cesspool Or is within 50 feet of a bordering vegetated wetland or a marsh 3. System will fail unless the Bo Health(and Public ter system is functioning in a manner that tects the public alp ' any)determines that the _ P tut,safety and environment: _ The system has a septic tank and soil system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface supply. _ The system has a septic tank and SAS the is within a Zone 1 of a public water supply. _ The system has a septic tank and and the SAS within 50 feet of a private water supply we& The system has a septic and SAS and the SAS is I 100 feet but 50 feet or more floor a private water supply well**. ethod used to determine distance +'rt'his system passes if well water analysis,performed at a DEP c ed laboratory,for coliform bacteria and volatile o . compounds indicates that the well is free - -pollution from that-facility and- the—presence—of aia nitrogen and nitrate nitrogen is equal to or less 3 ppm,provided that no other failure criteria ggered A copy of the analysis must be attached to this fo 3. Othe . Ti►1a C rnono.-►inn '74—Aj1,(m nun 3 .-am-TWa as ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Addresa: 'A Owner: Date of Inspection; 1L System Failure Criteria applicable to all systems You Ma indicate or"no"to each of the following for jLinspccdonL Yes o Backup of sewage into facility or system componeid due>n overloaded or clogged — or p�of effluent to the surface of the ground ar sm*ce adu to i m de clogged SAS or cesspool waters dun to an overloaded or ctatic liquid level in the distribution box above oudet invert due to an overloaded or clogged SAS or Zz Ijquid depth in cesspool is less than 6"below invest or available vohume is leas than%day now equit s ped I more than 4 times in the last year==du@ to clogged or obstructed P�(a).Number Any p�of Any pord=of the� cesspool spool Of p*vy is below high�water elevation, _ cesspool or privy is within 100 beet of a sar&ce water supply or tributary to a siaSce Any portion of a cesspool or Privy is within a Zone 1 of a public well. Any patios of a or— cesspool privy is within SO fed of a private wad Any partian of a cesspool or privy is leas than 100 tbd butsuppt ten' supply well with no greater than SO feet f3om a acceptable water private wager performed at a DEp eertlAed labors ors bacteria p�u the well water analysis, Indicates that the well to flk+ee from pollution from that retells and vol Presence ce of&compounds nitrogen and nitrate nitrogen Is equal to or hue than.S f�ti sad true presence of ammonia are triggered.A copy of the d Provided that no other failure criteria analysis meat be attached to th4 lorm.J (Yes/No)The system fib I have determined that one or more of the above described is 310 C1bIIt 15.303,therefore the a �e criteria exist as Health to determine what will be system�'The system owner should contact the Board of necessary b correct the failure, E. Large-Systems: - To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 13,000 gpd- Yon must either"yes"or"no"to each of the following; (The following crite ' ly to large systems in addition to the criteria above) yes no — the system is within 400 feet o cc drinking water suppl — the system is within 200 feet of a tributary to e drinking water supply _ the system is located in a nitrogen ttive area(Interim ead Protection Area—1"WPA)or a mapped Zone lI of a public water su well If you have answered"yes" any question in Section E the system is considered a si "yes"is Section D a e the large system has failed.The owner or operge system co k or d a ered rator of any la significant thre der Section E or failed under Section D shall upgrade the system in accordance with 31 15.304.'Ih Mom owner should contact the appropriate regional office of the Department. Tot^ fnanaef�nw cn.,,,Ail c,innn 4 OFFICIAL INSPECTION FORM-NOT FOR_V_OLUNTARY- ASSESSMENTS- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addraa e j��J� ,S Owner. Date of Ina*doat Check if the following have been done.You must indicate`fires"a"be as to each of the following: Yf No �L. ._ Pumping information was provided by the owner,occupaA oc Board of Healhh _ Were any of the system c:amponenb pumped out in the previous two weeks? _ Has the system received normal flows in the p wibw two week period? _ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected faz signs of sewage back up? � Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? J _ Were the septic tank manholes uncovemd,opened,and the interior of the talk of the baffies or tees,material of construction,dimensions, of for the condition / depth liquid,depth of sludge and depth of scum? V Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subswrilm sewage disposal systems? The size and location of the SOB Absorption System(SAS)on the site has been determined based on: Ye# no V _ Existing information.For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CUR 15.302(3)(b)] TWA i ln.nsr►inn Fn.rn ICli gi,)nn I 5 f , �moo..v� •• OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Cc. e- t-hV-om Owner: Date of Inspeedon: FLOW CONDITIONS RIISID>P1�1'1'IAL Number of bedrooms(design): 3 Number of bedroomm(a bWa DBSMN Bow based on 310 15.203(for example. 110 gpd x*of bedrooms):3 J�j Number of ctereent residents: U Does residence love a garbage grinder(yes or no):V\p L laundry on a separate sewage system(yes or no):M[if yes separate inspection required] Laundry system inspected(ya or no):V,0 Seasonal=a:(yes or no): Water meter readinga6 if avlblable(last 2 yeses usage(gpd)): SUMP PAP Use of no):� � Last date of occupancy: 4&j tNtC (DG CONMOMCUL4NDUSTRIAL Type off Design Bow(cased on 310 CUR 15.203): and Haab of dedgn Bow(aes+trfpeeaona/sgR,etc.): tlresse trap Peesent(yes Of no): 1 Industrial waste holding twk present(yes or no): Ndu� _ fary waste discharged to die Title 5 system(yea or no): Water meter readhgM if available: Last date of occupancy&&. O N=(describe): Pumping Records GENERAL INFORMATION Source of information: Was system pumped as part of the inspection(yes or n-0-jW7 If yes,volume pumped:_gallons-Ii w was quantity pumped 4ete d? Reason for pumping: T\Q (A`,� T)lPE OF SYSTEM %J Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool —Privy _,Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contra obtained from system owner) ct(to be _Ti&tank _Attach a copy of the DEP approval Other(describe): Approximate age of all co orren ,date installed(if kno )and source f information: Were sewage odors detected when arriving at the site(yes or no):110 ThIs 9 Tnenaafinn An.w,4n gr7nnn 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addresm c, " K-cam S Date of Inspecdow "1 BUILDING SEWER(locate on site plan) u Deem below grade: Materials ofconsum tod�—cast iron ✓ Q PVC_other(eaplaia): Distance fMm private water supply wen or section has:_+aU_ y Comments(on c9ndition of joints,veadng. T o leaka�etc.r �� 1tev� SEPTIC TAM,_(locate on sits plan) Dep&below xmde 'Zt, Material of constnucticoncrete metal_fiberglass_polyemylene If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of catificaftD ).: 11 Distane 8rom by of ha_to be}ttom of outlet tee or baffle: Scumthiclmesr tt1Zlo DLtance 8rom of scum to of outlet tee or top baffle: ,� Distance 8rom bottom of scum do bottom of etee or bafIle.1('� 7 r\ O rWo-1 (e\8S How were dimensions&ft rmined; Comments(on pumping secommemanons,tniet and outlet tee or baffle condition,structural integrity,liquid levels as related too inv evide p of leakage.ate.)• t GREASE_11W:___(locate-on site-plan)- Depth de:_ Material of cons concrete_metal fiberglass_,polyethylene_other (expo): — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or b Distance from bottom of scum to botto et tee or baffle: Date of last pumping: Comments(on pumpin ommendations,inlet and outlet tee or baffle condition,strut as related to o veM evidence of leakage,etc.): ty,liquid levels T41a C rnennr,inn Rn►n,IG/1 q/7nnn 7 rolsv o us i 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 \Se cagy_Ms Owner: i Date of Inspection: TIGHT or HOLDING TANK: (tank must be pumped at time of hupectionXlocate on site plan) Depth below Material of sanction: ncr:te metalfiberglan _po ne oti:er(explain): Dimensions: C+P=uY aallons Dwip mow: aalloadda Alarm presew Alarm level: (yea Crop): ALrm' order(yes or no): DComments(c of alarm and float switches,etc.): DTSTRiBUTTON BOX: (if presew must be openedKlocate on site plan) Depth of liquid level above outlet invert d c� Comments(none if boot is level and distribution to outlet equal,an evidence of solids c leakage into or of box,etc.): y carryover,any evidence of �P S .d ® W _Q_Q of PUMP CHAMBER: (locate on site plan) Pumps in working or3ftbv&jxoo); Alarms in working order(yes or no Comments-(note condition ofpnmp chamber,con amps and e . Tide 4 I.+unortinn F nn„ Ali cmnnn $ •osv a Vi i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contimled) Properq Address `e Owner. �M, f-t, Date of Indpation: SOM ABSORPTION SYSTEM(SAS): (loests on site plaa,excavation not required) If SAS not located explain why; �!71eschb*lid.dumber: �1 x 4 kwkbg chambers number: .salleriesnuz6a: leaching troaehea,number,length: leaching&W nuagm,dimension-• Overflow cesspool,number: innovativ ahernative system Type/name of technology: Cow(note condition of soil,sign-of hydraulic thihurq Tavel of Pam&imp soil,condition of vegetatioq e +v -S Yl 0 S CESSPOOLS: (cesspool rant be pumped as part of hupectionXiocate on site plan) N and configuration: Depth- of liquid to inlet invert: Depth of layer; Depth otscun L DimgngiwM5 of Materials of construction: Indication of groundwater Comments-(ante-coalition of so' ��or-no): -_-- of hydraulic failure,level o nding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: comments(no ond'ticn of sor Signs of hydraulic failure,level of ponding,condition o stating etc.): T41a 9 Tnv"A/t;An Form!./1 C/fl1I1A 9 a • Page 10 of 11 OFFICIAL JNSYECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM MFORMATION(continued) Prop M Address: e -TfnrO \ w Owner: O Date of Iaspecdon: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide ask**of the sewage disposal system kwhiding tins to at leant two permanent refs ease landmarks or benchmar1o.I.acaoe all wells within 100 feet.locate where public water supply ebters the handing. . DEC. 2Z 6 O 1 ,n OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Propa q Address Owun Dab of lupa doa: SITZ EXAM Slope Surreal wades Check caw Shallow wells Estimated depth to grovad water t feet please iadicade(check)all methods used to determine the high ground wader elevagm Obtained ftom system design plena on record-If checked,date of design plan reviewed: Observed site(abutting property/obsomdon hole within 150 fleet of SAS) Chocked with b W Bond of Healt!"Vlain: Chocked with local eacavatam bu tallow-(a lien) Accessed USGS databaso-eaplaia: S T)W -ZS5Z�O�Q.� J Yo must desWlm how you estpbHshod dp high onnd w e a 1 S O` ©n/1 1 J �J `, no ( Tifla C Tnana,-/inn Rnr.n Ali vinnn l l THE COMMONwEALIM OF MASSACHUSETTS BOARD OF HEALTH � )'-<9 (T � Applira#ion for Disposal Works Tono rnrtion lirrmit Applicatio hereby made for a Permit to Construct �r Repair ( ) an Individual Sewage Disposal System at: - sf ~tea ......... ...._7.'..._.......... 1... . �- ...... ----------........------. ..._........_.... -- ---......... --... .. - or ot No. Loc n-Address eV aW �r Owner , �.._... Address ........._ .. .... ... - -----1.2.:y..... Installer Address dType of Building Size Lot..e�.-c_---`�6--C)....Sq. feet U Dwelling—No. of Bedrooms........................_ _Expansion Attic_(- Garbage Grinder.-e—y— aOther—Type of Building No. of persons........ .............. Showers<(—'j=Cafeteria Otherfixtures . ------------------------------------------------------•------------------------.-.-------..........---------------------------- W Design Flow....................._ ..____gallons per person p day. Total daily flow......... .. ..............gallons` . WSeptic Tank—Liquid capacity/ ®� gallons Length--• y tameter................ Depth _.. .. x Disposal Trench—No..................... Width.................... Total Length..................../Total leaching area................ sq. ft. Seepage Pit No........I_.......... Diameter...... Depth below inlet....! 5..... Total leaching area...2....--•--..sq. ft. . Z Other Distribution box ( Dosing tank,�— — '-' Percolation Test Result Performed b ._. �`?` f _ � _..... Date.... eer aTest Pit No. 1_._.__.-...._.minutes per inch Depth of Test Pit____________________ De th to ground wa ..._ .._. ....... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ •--- ---------------------------- O Description of Soil �•--.....................................jl-----------!mo d�' .............•--- - ----------- x -----------------------------•-------•-------...----•-•--•---------•---......._....----.......--------•-----------------------------•---•-----....----------....------------------------------------••-- 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 pr ' ns of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ope4*tentil a Certificate of Compliance has b en issued by the board of iealth. ...... ` 4_1.......................... S......� D licationApproved BY •• /r............................................... ............_.Z--•- ................. Date Application Disapproved for the following reasons-------------------------------------------------------------••-------------------------•-•----••.....-•---- - ..•-••••-•----•-•-•-•-•-•--•-•-••--•-•..............••------------•---•--••----••--•-----•--•----•--••••-•-•--------•---------••-----•••-•-----•----•--•----......-•--...---•-•-•----•-•--........---- Date PermitNo...... -------.-- Issued_..................................................... Date THE COMMONl EALA OF MASSACHUSETTS BOARD OF HEALTH 7 ...................................O F........ Appliration for Diipnsal Works Toustrnr#iun Famit Applicatio hereby made for a Permit to Construct V_ or Repair ( ) an Individual Sewage Disposal System at: �^ ' "ZV: .................f....... ............................................... Owner in � _•�- ..._`.-���.Lo.��un-Address orLot No c c ` G .._ .............................. ------------ -------.... .. ...... ...._............ ess . - .................•---........................... ..�._-7-..•r_-v-...e..r_.....•`�..�..-�.•....�..IY .�...�. Installer Address � Type of Building 3 Size Lot--------:.................Sq. feet Dwelling—No. of Bedrooms........................ ...................Expansion Attic'(`) Garbage Grinder" _ — a Other—Type of Building �...J_.°'."': `. p ( ) Cafeteria ( ) !: No. of persons............................ Showers Other fixtures W Design Flow--------------------- ---------hod_gallons per person�per. day. Total daily 99w.............................................gallons-•, WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth. ....... xDisposal Trench—No..................... Width........ ......... Total Length__.....e.....__::_,Total leaching area............>_--_sq. ft. Seepage Pit No---------__________ Diameter....__ ... Depth below inlet.......'...`..... Total leaching area................-.sq. ft. Z Other Distribution box Dosing tank---_ �/ �i / W Percolation Test Results Z Performed by..........................................� ................. _.._.. Date.......__.:_/... ...._...L_._.....�. Test Pit No. 1......-.......minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a :... = ............................./--..-----••---...:. O Description of Soil---•-••-----•-•/!'7-P-�--.--�--�-= -�-- •---�---�.��-?•�---•-✓-��. -�v��j' W --------•--•---------••---•-------••-----•--••-----....-•---•..............•--•-..............--•--••-----------------..........-------•----•--•--•'-•--------•-•-•-•--•....._..-•-•-------•-••------•- 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 oils of TITL L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in op o .,until a Certificate of Compliance has been issued by the board.of health. ...... "--•-�„i ✓-`=--------= -.,✓„�,ir� •�•✓� ....--------•------ ... ,.7F---•-�/...... C g AiTplication Approved By ...- a �"` .. ...... ..........•-•............. Date Application Disapproved for the following reasons---- -----------------------•--------------•-----------------•------------------........-••---•----•------..... ----•--•----------••----•----••-•-----••-•••------------•-----------•--•------•-•-----•-------------•--------------•--•--•••-••-•-•--------•----•-••-•-----••--••....•-•---•---------•-•--••----•------- Permit No........ a .......? ...��..._ --. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F..................................................................................... up n ifirab of f omplianrr THIS IS - 0,�CER D,TI Y:That t I dividual Sewage Disposal System constructed ( or Repaired ( ) 1! C ry � l Inst Ilex at.. C i has been installed in accordance with the provisions of tate SanitaryCo s�r' in the application for Disposal Works Construction Permit No' -- .. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... 1!:.1_11�.< Z Inspector....../�.................................................................... THE COMMONWEALTH OF MASSACHUSETTS ��. BOARD /OAF HEALTH l ............. ..........................................OF..................................................................................... FEE............_........... �i���a��t1 nrk� �un��rinn err t# Permission is hereby granted-.....[. .........................:...._._....._........._..._ ..... ................ ....... to Construct ( T-6r Repair ( ) an Individual Sewage Disposal System atNo. ---•.........................................•---.:::......-------------------------------••--.•-•--•---•------•-=........----- p •-----. Street as shown on the application for Disposal Works Construction Per . ......................... --------•-------.. �- DATE. r' / � v Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS H0o5e- # -7,� ASSESSORS MAP NO, LOCATION SEWAGE PERMIT Q. VILLAGE INSTALLER'S NAME i ADDRESS al S UILDER OR OWNER �? I DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 0/,, 5 r ��� ����� is � � ��� �� 7 \� �---^ -�� ���- I, SO1 L LOG 2 lR ' , / - DATE_ Z ." . WITNESSED BY: i "' - - , X " ✓ - - , N1 Cpv! tlW1 .etr f e�' 1 f i A=l r+r S~2 7 2" .4 4.6 C tl / F't 7— t i IYI 'l�f Vrs'7 r3 CN' /v/0 WQ 1,6 7e I 028/ � ELEV. TOP OF MANHOLES AND COVER TO BE BUILT WiTH1N 7T FOUNDATION -•' lP" OF FINISHED GRADE. -,-.., Qj - , ` /�"c�oQ :.4 F d, 2, WISHED S L O P E CRAD £ y jCAST , OR IRO 4.. PvC . :p"•: PVC SCH. 40 ---`•, ' �• PITCH I/q� FT. 2'L£VEL', 0"" MIN. 2�" LAYER i ---,� ,� _ j S I } . 1/8f" 1 2": PEASTONE i Q S PITCH �o0� N J INVERT ,t r'L,'c J<'Jf�Q • y ! I N V E r .`t' D 1 ST. q=Q �' r"GALLON INVERT iNYERT .9 BOX ap dy ©e . • 3 4 - 1 1 2 DEA . SEPTIC TANK q "' ape `g' . ...• ..• INVERT ,Q :y�� �,jd V WASHED STONE 5i, 50 C�7-C u S v INVERT 00 ALL' AROUND . 10 + p G A R B A � ' ELEV. BOTTOM[MIN GRIND: ER " ". " OF P IT „ - ZOO RAIN. 3 - 6-0 DIA- � ' 17 1 PROFILE OF GROUND WATER TABLE AsL 39',Q�} I SANITARY DISPOSAL SYSTEMA I ! NOT TO SCALE DESIGN DATA BEDROOMS CONSTRUCTION OF SANITARY DISPOSAL DESIGN F LOW '"330 _ GAL./DAY SYSTEM SHALL CONFORM TO MASS. � �. ' E NV ( RONME' NTAL CODE TITLE V (REVISED 7- 1 - 77) LEACH RATE MIN. { NCH -T •• s . i .� PROPOSED LEACH CAPACITY : AND THE TOWN O F HEALTH REGULATIONS. a SE-PTIC TANK.,DISTRIBUTION BOX AND LEACHING PITTO BE ' OF- REINFORCED CONCRETE : 443 GAL. DAY MIN. CONC'RETE STRENG1'H _ 3000 PSI MIN. STEEL. STRENGTH 2O00OPSI 'H ,10 DESIGN LOADING f DRIVEWAYS ` NOTTO BE LOCATED OVER SYSTEM UNLESS H - ab DESIGN LOADING IS USED. a ALL PIPES AND .FITTINGSTO BE WATERTIGHTAND I TO BE QF CAST IRON OR SCHE.D 40 P.V. C. SITE PLAN SHOWING - PROPOSED CONST-RtJGTION SH• 10FI—SHS LEGEN D (� �L O G A T'1 O N.• �A J��..�"T°'"` ,�.. ,�' �"EMT-�`r� y'�i.:4',� � FOR ',� . � ,✓ -0 , APPROVCQ f9 i5CLE: of c DATE : - BOARD QF HE<ALTH PER UR --- - REFERENCE: BUILDING SETBACK REGULATIONS EXISTING CONTO I6 �. Q ' BUILDING INSPECTOR OR BUILDUNG 5 PROPOSED CONTOUR DATE AGENT COMM ( SS 1ONER BCD EXISTING STI NG SPOT ELEVATION f�/! { N. FRONT SETBACK X I7. 6 tH 0 . PROPOSED WATER SERVICE W _ A t MIN. SIDE SETBACK, +� _ AT 1 O N - I � REAR SETBACK � TEST HOLE LOC �' MIN EA S a. R N C . .: - ss t;E. PROFESSIONAL' LAND 5U'RVEY,OR.S -a ENGI-VEERS •�1. , • 1586 M A I N' ST"R EET R'TE. 6A) EAST .O N N t S MA. , E SS: 0264t F _ _ , _