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HomeMy WebLinkAbout0016 ELLAS LANE - Health 16 ELLA'S LANE, CENTERVILLE A= I I UPC 12534 S No.2_ 153LOR HASSTINGS,MN CB/DH 165 0p, _Fnd S o9= Kes SF3ESto tutisB/Biu dnikps LOT 22 kode Fence ,07 SIF REFERENCES: -- Assessors Map: • 189 35.92•CB/oH _ Parcel: 162 — — Fnd -- - Lot 27 LCC 35548D I / of LOT 28 ' �l 19,340f SF z o ZONE:RC o Setbacks: Fron t: 20' - Side: .10' . , I 3 Rear: 10' - � I I Stone Wolk \ I o, 17.3' / Wood Deck \ ❑ sty W/F I °' O LOT 29 f I of 0 19 o Iin to °#j 6 i Legend:o 19.5 ® Roilrood Spike Found o 19 ^ Q PK Noil Found C6 CB/DH t wok it N 0 Guy ` ° W Utility Pole 4.4' 9Ss�� `�\ ° N Light .Post 12.3' 'n 10- OHW— Overhead Wires F SaP�. I n ❑ Stockade Fence loa` 2 o Post & Roil Fence � I LOT 27 1 I I 1 I 1 j 1 I oHw 1 NIF Charles W./ & Janet 1 Haggerty 1 0 j 1 j 1 I to C5 1 O 1 1 0 v O 1 a M 1 I Pove Drive 00' 0" E PK RRSPK rI 79• �n Fnd _ Of. CB/DH\• 0.0 'I Fnd 0 1 LOT 30 j LNG o r— m 38259'17'E m �� 110.66' LOT 26 _ PLOT PLAN At 16 Ella's Lane In BARNSTABLE NOTES: (Centerville) 1.) The 'structures shown were located on the ground MASS. by conventional survey methods on April 8,' 2008. DATE:23/APRI08 SCALE:. 1"--30' 0 15 30 45 60 FEET 2.) The property line information shown hereon was compiled from avar,l k J:lltetcord n:,formation. PREPARED FOR: 3. This Ian is not for recording and is not to be Charles A. Wry p g 16 Ella's Lane used for construction laxout or: deed description Centerville MA 02632 purposes. C, :6 9V 1 Al $ 1iJ? PREPARED BY: CapeSury 318 `t , 3 f 7 Parker Road Osterville MA 02655 DWG #: C716gl L FIELD BY. MLL/DWB (508) 420-3994 / 420-3995fdx � 75 66' 12' Bath Proposed Bedroom Dkvwtte Kitchen Art 15' studio Bath Garage ' 26' Uvtng Room Bedroom Bedroom NEAL A. PRATT CHUCK WRY RESIDENCE DATE: 11,10.08 PAGE 1 of 1 BUILDER/DESIGNER I -16 ELLA'S LANE SCALE: None 42 CHASE ROADAl E. SANDWICH MA. 02537 BY: NAP PHONE: (508) 888-3206 Existing House Floor Plan ATLANTIC ENVIRONMENTAL P.O.BOX 2384 MASBPEE,MA 02649 Attn: Commonwealth of Massachusetts Date: 06/21/96 Town of Barnstable Board of Health 367 Main Street a ,� Barnstable, MA 02630 SUN 2 5 199 ' From : Mr Michael DeDecko Po Box 2384 F Mashpee MA 02630 kaA Dear Board of Health Official; I certify that I have personnally inspected th�sewag disposal systems at the following address : 124 Megan Rd. Hyannis, Ma. & I6 Ella's-d". Centerville,Ma. . The informations reported are true, accurate and complete as of the time of the inspection. If you have any questions regarding this inspection, please contact me at this number: (508)477-14-20. Thank you. Mficerely, tf Michael DeDecko phone 508 477-1420 I Commonwealth of Massachusetts Executive of Environmental Affairs DEP ' Department of Environmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 16 E lla's Lane. Centerville Ma. Address of Owner: Sarah Kay B. Quelle_ (if different) Date of Inspection: 06/13/96 Name of Inspector: Michael D eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o Box 2384 - M ashpee Ma 02649. Tel : (508) 4771420 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection . The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system - Passes ---- Conditionally Passes ---- Needs further evaluation by the local Approving Authority ---- Fails 1 Inspector ' s S ignatuie: �{J"J ti,\, `Date: 06117196 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 or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer, if ap( able and the approving authority. ` t t .. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 E lla's Lane. Centerville M a. Owners : Kay B. Q uelle Date of Inspection : 06/13/96 INSPECTION SUMMARY: Check A, B, C, or D A) SYSTEM PASSES: - I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 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 not determinate (Y,N, or ND). Describe basis of determination in all instances. If "not determinated", 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. ---- 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 ---- distrkution box is levelled or replaced ---- The system required pub g more than four times a year due to broken or obstructed pipe(s). The system w; ss inspection if (with approval of the Board of Health): ----- broken pipe(s) are replaced ----- obstru6on is removed i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : 16 E Ila's Lane. Centerville M a. Owner : Kay B. Q uelle Date of Inspection : 06/13196 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health , safety and the environ- ment. 11 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 of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING INAMANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has a septic tank and soil absorption system and is within 100 feet to a . surface water supply or tributary to a surface water supply. ---- The system has 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 analy- sis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate notrogen 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 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 E lla's Lane. Centerville, M a Owner: Kay B. Quelle Date of Inspection : 06/13/96 D) SYSTEM FAILS (continued) -- 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 distribution box above outlet invert due to an over- loaded 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 cesspool or privy is within 100 feet of a surface water supply ortributary 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 ana- lysis. 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. I /7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 EIla's Lane. Centerville, Ma. Owner: Kay B. Q uelle Date of Inspection : 06/13/96 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above : 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 environment 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 I I of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16 EIla's Lane. Centerville, Ma. Owner: Kay B. Q uelle Date of Inspection: 06/13/96 Check if the following have been done : -x Pumping information was requested of the owner , occupant and Board of Health. --x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built plans have been obtained and examined. Note if they are not available with N/A. --x The facility or dwelling was inspected for signs of sewage back-up. --x The system does not receive non-sanitary or industrial waste flow. --x The site was inspected for signs of breakout. --x All system components,excluding the Soil Absorption System, have been located on the site. ---x The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees, material of construe- tion, dimensions, depth of liquid, depth of sludge, depth of scum. ---x The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods ---x The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION . Property Address: 16 E lla's Lane. Centerville, Ma. Owner: Kay B. Q uelle Date of Inspection: 00 3/96 RESIDENTIAL: Design flow : 33o gallons Number of bedrooms : a-_-,, Number of current residents: c:> 1 Garbage grinder (yes or no) : N Laundry connected to system (yes or no):u Seasonal use (yes or no) : r�U Water meter readings, if available: rj Last date of occupancy : COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow : gallons/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 PUM^P^I\\N(G(�� RE ORDS and source of information : System pumped as part of inspection(yes or no) :..... ........ if yes, volume pomped: .................... gallons Reasonfor pumping :............................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 EIla's Lane. Centerville, Ma. Owner: Kay B. Q uelle Date of inspection: 00 3/96 TYPE OF 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 ................................................................................................. ................................................................................................................................................ ................................ Sewage odors detected when arriving at the site: (yes or no)......N.Q. SEPTIC TANK : (locate on site plan) r� Depth below grade: ... Z. Material of construction: ..&. concrete ......... metal ........ FRP ........ other (explain) . ................................................................................................................................................ Dimensions:'S.4.�.,'�.?i-.1- x Sludge depth :..7``...... Distance from top of sludge to bottom of outlet tee or baffle:.......... ................ Scum thickness :....A.::............ Distance from top of scum to top of outlet tee or baffle: ..............!.b..................... Distance from bottom of scum to bottom of outlet tee or baffle :.....`.5.`............ 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.)...................... ')......................... ..i.... ..........�......: ..:y.\.'..... ..........................................................0 ..- '� r , t........ ,�. L..... � .tc...................... ... . ....... a ...... SUBSURFACE SELVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 E lla's Lane. Centerville M a. Owner: Kay B. Quelle Date of inspection: 06/13/96 GREASE TRAP : ........ �... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FR P........other(explain).... .......................................................................................................................................... Dimensions:............................... Scum thickness:........................ Distance from top of scum to top of outlet tee or baffle......................................... Distance from bottom scum to bottom of outlet tee or baffle:............................... 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.)........................ ................................................................................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:....... (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FR P..........other (explain).......... ................................................................................................................................... Dimensions:............................ Capacity:....................gallons Design flow:...............gallons/day Alarm level:............................. Comments: (condition of inlet tee, condition of alarm and float switches, etc.) ................................................................................................................................................ ................................................................................................................................................ i 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 EIla's Lane. Centerville Ma. Owner: Kay B. Q uelle Date of inspection: 00 3/96 DISTRIBUTION BOX:_*5 (locate on site plan) Depth of liquid level above outlet invert:... Comment: (note if level and distribution equal evidence of solids carryover,evidence of leakage into or out of box, ekc.).':� : Y ..`"1:. :.. c:: ...:`..: , .. :.::.!:::.................... .r:.'.!..r.................. . ................................................................................................................................................ . PUMP CHAMBER:...... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.).................... ................................................................................................................................................ ................................................................................................................................................ SOILABSORPTION SYSTEM (SAS):.....M5..... (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: ... tom. leaching chambers, number:........ leaching galleries, number:........... leaching trenches, number , length:..................... leaching fields, number, dimensions:................... overflow cesspool,number:.......... Comments: ((note condition of soil , signs ,�^of.h draulic failure, level of ponding, condition of vegetation \\ etc �'.. t�A,�)�::' �a:.. : . *�.... .......... ..�.. t ............`..::r -._k_.... J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) I' Property address: 16 Ella s Lane. Centerville Ma. Owner: Kay B. Q uelle j Date of inspection: 06/13/96 0 CESSPOOLS:....N....... (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: ..................... Indicator of ground water: .................... 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.) ................................................................................................................................................ ................................................................................................................................................ PR IVY : ..... ?. .... (locate on the site) Material of construction: ............:...................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) . ................................................................................................................................................ ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address : 16 E Ila's Lane. Centerville M a Owner: Kay B. Quelle Date of inspection: 06/13/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100'. Ell 1�2 rs� � DEPTH TO GROUNDWATER: Depth to groundwater: :..`. :feet Method of determination;lr approximative: t. _ G . .�c-� ... ......... ........... ... ........:� ... ,.. ......................... .............. 2 - _ l i 'S r No.q. ::.7 K4 F.Rs........��..�............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Ol ±1............O F................. .--•-- ApplirFatinn for Dispoti al Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct (C,-Yor Repair ( ) an Individual Sewage Disposal System. at ......... - --------.�Y-JI/1-�-�--•-------•-W�-----•---- -•--•-•------•--�•--�•------ D. ----------------------------------•------- A- -•-------- . Location- ddress or L__ot� o.� _._.. ....... -•--•-•-- ----••-•-------------------- owner Addre t (1Si �-- a ---•......•--. ........ ---------------- ------------------------------ ..................................... Installer Address Type of Building Size Lotq, �.�-__-�_.__...Sq. feet U Dwelling—No. of Bedrooms..........�............................Expansion Attic WQ Garbage Grinder 00 aOther—Type of Building ------------------_------. No.- of persons---..................------. Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... . . d -------------------......--------------- W Design Flow...........!A.®.....................gallons per person per day. Total daily flow............... �.3-30 ............................ WSeptic Tank—Liquid capacitylQQ ..gallons Length---_----------- Width.......--------- Diameter.------------.-- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by........ -a- �.�.....�....._ ._._!":_ "...... Date..........' ,_� Test Pit No. 1................minutes per inch Depth of Test Pit..--------_0...... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................... P4 •-•••---• --•------- -- -•-----•------•-••---.-------•------ -•---------------------•--•---------------------------------------------------------- �- sue. �, Description of Soil..........0.- -- --------•-••----•...Or.-----•....... 1....................................................... W ----------------------------------- S. -A--�------------:Ml.-A--------------.... -A. 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliani7F d by the board of health. atApplication Approved BY rl Date Application Disapproved r e following reasons--------------------------------•--------------------------------------------•--•---------------------........--- ........................................................ ••-•------------•...•---------•••-•--•---------•-•-•••---••----•-•.----•-------...----•---•-•••••---------------------••-------------•--•----- Date PermitNo......................................................... Issued....................................................... Date T a No..-...•--.-•....r- ' Fins........ ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH J ...----:....OF....................... L -- . .: ................................. .Apure#ion for M-4posal Vorkg Tontitrurtion amit Application is hereby made for a Permit to Construct ( C,),'or Repair ( ) an Individual Sewage Disposal System at ........ --------- :. -------------�An�------------- ----------------`,'`------•------------- -•---------------------------------------- Location-Address "' t( t or Lot Igo. Fj r r,.e_o -- �`-.. �'---- --------------•------ -----•-----_••..`.'�...� .. --•------.... s-.--•--.��........................._.. V e (� Owner Q_S J7 a� n1� �-AdC.`JLU t e_ ....................... .................................................. ...._................._............... ...............-•-•--•..............•--•..........----- Installer Address `� j dType of Building Size Lot.............................Sq. feet Dwelling—No. of Bedrooms.......... .............................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ............................ _ W Design Flow............�...._�.....................gallons per person per day. Total daily flow--------------- ...............gallons. WSeptic Tank—Liquid capacity.kg9 '..gallons Length................ Width................ Diameter................ Depth................ 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 ( ) Dosing tank '-' Percolation Test Results Performed by............ .............` .....::�....��... c..... Date........... .......................... aTest Pit No. I................minutes per inch Depth of Test Pit....__........___...IDepth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------_............... ••--------------------------------------•-•--..........----•---...........-••.......•--•..........-•........................................................ D Description of Soil '----- - ------------------ n_O .....................j >.,.'C 7' .......................................... U ••••-•-•---•-•••-••-•--•-•••....••--......•-- -- -------------------------•. ---- . .....I.....-------------•-.I . ----------------•-----•--------------••-------- ------------------ 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 TITIZ 5 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 the board of health. Signed,-- I 1...........•-- --------------- Application Approved By...... � }� � Date,/ jD = Application Disapproved f or the following reasons---------------•------------------•----------------------------•----------------•-----------•--•---•--..._------ -•-•-----•-------••--•-•----••-•••-........•-•-•.....----•---•---•-•---•••••----•--•......................-••---•-•---••-•-••---- •-•---•••••••-••--••-•-•------•-•------•------•----••-••-•--------•---- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4 i`...Q�0� ' ...� .........�..............................OF.............................:...-............................... ................ Tnrtifiratr of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (L-�or Repaired ( ) by ' --.------------ -------------------------------------•-•-----.............----------..........----•- I.. y , (,I Iynst Iler 1 �1- -, A,L- -__ at -------------•----------------------•---•-----•- -••.......---• -•••--••-•------•---•--••-•••••-•-•••......-•---•--- ......................................... has been installed in accordance with the provisions of TITLE 5 of,The State Sanitary Code as/d"escribed in the application for Disposal Works Construction Permit No........f ......_.�U__`............. dated___.:___..j� .........___.._... i THE ISSU NC OF THIS CERTIFICATE SHALT. NOT BE CONSTRU A GUARANTEE THAT THE SYSTEM V YI CTION SATISFACTORY. DATE... .. ... ----------------------------------------------------- Inspector.... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH __ ` vO No.!.�........`. / .._...... FEE../ ................ 11iipos al Vorkg Tuonotrnrtion, rani Permissionis hereby granted..............------==--•------••�--�----------•--------------------•------------------------==-............---•----.._._._.....-------- to Construct ( L-1or Repai ( ) an Individual Sewage Disposal System - e � 11 cam' ' ` 1. f�= en c. C"':� .-�_t1- k'k :`�.,._ at No. =--..••----••-•----•••---•--------------------•......_.. .... ...........---.---------------- --- -••••••• ••-•-•--....-- Street 11 as shown on the application for Disposal Works Construction Permit No-------------. Dated.......................................... ..i DATE_ Z � ..� .r �'" Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS j • -- w j+ NO GARBAGE �jWND62 i '. 'i DA►l.Y FLOW : 110 A 3 =I a30G.Pp ¢ a3ox o•. = G. 0 � >40� 4G 5EPT1G TP►•IK I S / �19 5 P. ,;; -;; ii o15PoSAL PIT usE loco GAS. 4� � ���% S9z ` « vr�.�. �5o S.F � �•5 r 37�! G.p`p \ � s6� � PST I 1, 130TTo/K AREA] .. �� �F , ' 1 -r.►�rc Z I ._ -� So S.t= K 1• c �•o G.P.oy �- ., I °'_ ► z li `-TcTA%- DS'5164t .4Z5 &-PR -toTAL. PA I I Y FLOWS 330�.Po• �� ,.. PE2c40►.ATI0W 2ATEs I"IN ZMIN 012-t.E55 s 28 42 ; % j 3 r95.F AV% Of WCNAAO AN y'_ / (. A. NESBAXTER V i, Na 24046 25 O 44o i w o TOP FNo= ,v �' TEST � P-�33o FG 4 NoL�• f3I Z.e- INv3•v loco INS. �i 6 D►�►T. INS. 0"' '} I o0o INY, ®vac 4Z•G •TANK Seu�Y Gat.. IL 42.0 Gv-P\1G - �Eacu pl•r INV. INV. i �ToN6' MEv, — 3G.o `j GEtZTIPICsp Pt-c.T PLAN I` PRUFII..� L0CA'T10N GI=�1T�F �► ►-��1 MA55. No SCA.L6 5c� ALE I":Go' T= 9I�9��2 ' IZ' 3Z. vo �• UJATL�. . P►-•A N REF ER.EN GE I LP-raxo11 GOMFU` 6 W TN WHE 5 0�IN ESN H L..v-r 2f j Awo S6'[�.GK R.6Qt)IR->cMEN'T> oF 'tNE' _ ,. !: -1joWN OF PAMAe7TA►SL9 ANv IS War t_e►.rn GaU�T � i 74t37D 1.00p.T�ED •WITH TN�6 F�- OD (P�I.AlP1 �1DATE Z '1"' SAXTE2a NYE INC. REG I ST fczs;D rAw o S u V-V RYoeS � `+ "r411�j P►_QN 1�i Norr gA�j�D pId AN OST�c2VILL�' - S• !u5-TR,uMr--Wl' 6VeV�Y �'TNE 0r-P' ,ETS 4410uo • ►.J - t_c�'r I..INU_ APPLIGA►`IT' TAMS ec LOCATION S E W A G I PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS � E7-Di24l,D &C SUIEDEIt OR OWNER 5m T DATE . , PERMIT ISSUED _� _ v� OAT COM-PLIA,NCE IS-SITED 47///,I/IX J r?y`�ft •l,=q BATH DEN - —Clos. — Clos. �i HALL CIOS. MASTER B/R i BEDROOM 22"x48" top w/ sink and cab. under by owner (contractor to install) appr. 62 — exist. deck to remain A. A exist. deck to q-5 STUDIO ADDITION I ,} A_5 be removed (pine flr.) O exist. fence 3 N to remain 1�®.e+4� Q- RED qRC,4a S. Gp9'y,>,; ea 2 5' wind. ,ill ht. — — — — — f�SQ. O i E ��� Z ► . 3e63e N a BOSTON, N. i MASS. ! 5-O" fram. dim. •��q� 1 OF MP55P�� v DATE: LARRY GORDON ARCHITECTURAL DESIGN r� Residence REV.: . . 17/10/08 EII �'ROPOS. FLOOR PLAN rev. date: SCALE: AMPA y Centerville, MA 02G32 508-790- 1 246 16 a s Lane, Centerville, IVIA 1 4 -1 -0 ® J o.