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HomeMy WebLinkAbout0132 GOOSE POINT ROAD - Health 132 GOOSE POINT RD.,,..HYANNIS - �' A= SQad, z UPC 12534 No.2 R HAATINOY YN r r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFF RSRECEIVED DEPARTMENT OF ENVIRONMENTAL PROTEC ON ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 N Nk. 19 2000 .,J TOWN OF BARNS DEPTT`.�"�� ,A�tr5Y OXE s tary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A �) , CERTIFICATION Property Address: f 3 � �PINj' Name of Owner tl A-A1 - [144- /—d lrr `+ \ 14 0 0 PIS MA Address of Owner ` (2 601,13�1 yyk/ Date of Inspection: AP?-t L. 8, 2. 90 f1 N �� �etl�i AJI,/ A4 Q Name of Inspector:(Please Print) ✓ " L ,( i 1 am a DEP approved system i pector pursuant to Section 15.340 of Title 51310 CMR 15.000) r'�,, 9 Company.Name: Q� �000 Mailing Address: l ll 12 A4A B 2,33-4 '_FpTT�tr Telephone Number: 7 5— 02,73 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information I is,true;accurate and complete as of the time of inspection. The inspection was performed based on my training and expel ro fiction and maintenance of on-site sewage disposal systems. The system: Passes DARREN _ Conditionally Passes M. Needs Further Evaluation By the Local Approving Authority .o MEYER 2 _ Fails !IIlA,11 Inspector's Signature: ::6�JAILIJIL Date: The System Inspector shall submit a copy of this ins ction report to the Approving Authority(Board of Health WNEPPAI: n 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 to the system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS — 7l�lS /NS P�G�Zb�/ Sffi N9r CON51W 6b A-5 Q gUA'(L,4 f6{A-� 7 E S`f'Sl iv� ►nlcLt� G�ni�N 7D d��i��'T e_-IxL� . %! /�/0 /HIED/zivl,��1 �J iPG/°.2t<S� S Dl3S�i�1/fh-7b nos AO C 0w q /00 '�GLa�✓ %p4v 14--z-ram Di eo-m, / eP Sys revised 9/2/98 Page Iof11 i�Printed on Recycled Paper A r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: J 3 2 (71 0656 Pot NTT pt� 1-y of P15 &W, Owner: D A-N +-Zt jj D 4 P57- Date of Inspection: A-PA-u- L-�-) ?tea INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as descri �d in the "Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as proved by the Board of Health, will pass. Indicate yes, no,or not determined(Y,N, or ND). Desc a basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,unless the o ner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that th tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is racked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass spection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water evel observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution ox. 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 replac d The system required pumping more than four times a ye 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 revised 9/2/95 Page 2of11 f; s i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: oos Oorr Pb . tFY"NtS MA owner: DQr,,,-t- (,tN DDT p65C Date of Inspection: C. FURTHER EVALUATIOww,, IS REQUIRED BY THE BOARD OF HEALTH: ►i Conditions exist whit require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety a the environment. 1) SYSTEM WILL PASS UN L S BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.30311)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is ithin 50 feet of surface water Cesspool or privy is thin 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOA HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PR CTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank an soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply = The system has a septic tank and s 'I absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soi bsorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil a sorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well ater analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facilit and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine dist nce (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: i32 t W56 Pal uT 1KD I MA Owner: VA44 {. L1 N D-A POT Date of Inspection: A-P 4u- ?ti D. SYSTEM FAILS: gO Y qqmust indicate either "Yes" or "No" to each of the following: N 111. 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this . �F " determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes �pl� X�• 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 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. " Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 4k You must indicate either Yes or N 6 to each of the following: The following criteria apply t large systems in addition to the criteria above: The system serves a facility wi 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 enviro ant because one or more of the following conditions exist: Yes No the system is within 400 fe t of a surface drinking water supply the system is within 200 feet f a tributary to a surface drinking water supply the system is located in a nitrog 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 upgra the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B f f CHECKLIST Property Address: (3Z 6kO0500I n/'f r Owner: D" ►- LA N D k 1005T Date of Inspection: Check if the following have been done:You must indicate either "Yes" or"No as to each of the following: Yves No ,cL _ 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. x _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. X _ All system components, 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: VISUAd, 0356"kDoW x l�l�/FSvl2�'Nl�jvTT Existing information. For example, Plan at B.O.H. 6(AS UILT) Determined in the eld(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)) A10,)ej X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 132 4w5ePot N r,P�- "kpms 1�4 Owner: vw�j +u N b A Po- Date of Inspection: � 0 FLOW CONDITIONS RESIDENTIAL: Design flow: /10 g.p.d./bedroom. Number of bedrooms(design): r Number of bedrooms(actual): Total DESIGN flow pd,,� Number of current residents. Garbage grinder(yes or no):V Laundry(separate system) ,(Yes or no): 0 ; If yes,separate inspection required Laundry system inspected (yyes or no)r4 A Seasonal use(yes or no):/�Go Water meter readings,if available(last two year's usage(gpd):I99? 311�i'6 G p1, 1��8'2(164Z '' /III: 3066S Gam-, Sump Pump(yes or no): ao Last date of occupancy:6 A49"? COMMERCIALIINDUSTRIAL: Type of establishment: Design flow: gpd ( Based on 5.203) Basis of design flow Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yes or o)_ Non-sanitary waste discharged to the Title 5 sys em:(yes or no)_ Water meter readings,if available: Last date of occupancy: , OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORD an source of information: � 181 9 y - Al - �iax sus -ate l�✓,9-a� � s ��Nr ��u�cf� System pumped s part of inspection:(yes or no)-66 If yes,volume pumped: gallons Reason for pumping: lJ ArV1& TYPE OF SYSTEM _X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other Q APPROXIMATE AGE of all components, date installed(if known)and source of information: ' Sewage odors detected when arriving at the site:(yes or no) revised 9/2/95 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) erty Prop Address: 132 C1©OtV101 NT RAC tf y/} Pl,N Mil Owner: VA-v N DA �i'T Date of Inspection: �RlL S� ZoaO BUILDING SEWER: (Locate on site plan) Depth below grade: �� Material of construction:_cast iron '`40 PVC other(explain) Distance froV private water supply well or suction line Diameter it Comments: (condition of joints, venting, evidence of leakage,etc.) Goan �m�v�,Tto� _ nCv ylsvA�- prQoec,�+ytS SEPTIC TANK: (locate on site an) �` Depth below grade:22' 1`� Material of construction: X concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) A r t I 1 Dimensions: I?Ox �2 X S X S Sludge depth: to Distance from top of sludge to bottom of outlet tee o baffi q _��/e � O0/� Scum thickness: �,, ,t 6 Distance from top of scum to top of outlet tee or baffle: 2-7 Distance from bottom of scum to bottom of outlet tee or baffle: 3 How dimensions were determined: M, XASUkCL Comments: (recommendation for pumping,condition of inlet and ou let tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) D O GREASE TRAP: (locate on site pla Depth below grade:_ Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to%conditi t tee or baffle: Distance from bottom,of scum of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumpingof inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 132 Gi 80.5E PO I r`r r k, 0 y VIA Owner: (�Orl-t ! ('1 N A' P05T Date of Inspection:y.p TIGHT OR HOLDING TANK: (Tank must be rior to, or at time of, inspection) pumped P P (locate on site plan) Depth below grade:_ Material of construction:_co rate_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm an float switches,etc.) DISTRIBUTION BOXY&J (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.) Ina C../ / V197 PUMP CHAMBER: (locate on site plan) Pumps in working orde •(Yes or No) Alarms in working order Yes or No) Comments: (note condition of pump c amber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) J*Property Address: 132 4eo5EPo rta� R,� f l�A�N Nl5 M4 Owner: p -t'U N1Jft POS G Date of Inspection:"ktL 8 Z SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number: l�I x ,� w/ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) 600b 66ND1i-7,9 ti , Ale 5K� OF Gi9�LU�' /J"644 PiT AeV CESSPOOLS: N (locate on site plan) Number and configurati n: Depth-top of liquid to inl t invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool mus be pumped as part of inspection) Comments: (note condition of soil, signs of hyd ulic failure,level of ponding, condition of vegetation, etc.) PRIVY:_ �,I1p, (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure level of ponding, condition of vegetation, etc.) revised 9/2/95 Page 9of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 32 C�005CP0/NT AD Owner: P" 4- 1-1 Nb A- Pas r Date of Inspection: ff Pot, 8'Y SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) W "1005,Ep /,�.P' ko l O 1 Tl 95 A ( revised 9/2/98 Page 10of11 I R SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION(continued) Property address: 132 C-1ooSE OD t roT R, NYkN 015 M ft Owner: ' ",F LI N P A 1�51 / Date of I pec6on: "Put- NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater'—7P Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record X Observed Site(Abutting property,observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) r revised 9/2/98 Page 11of11 LOCATION L/ i►/ /r—_ SEWAGE PERMIT NO. VILLAGE I TA LLER'S NAIRE ADDRESS /no r f'w 7 f n b G hPlo . UAR UILDE R OR OWNER rl- J'dS coo DATE PERMIT ISSUED .OAT E C0IMPLIANCE ISSUED ��©�� ��D Z/ r it - �� �� 3� � z �� �p ,9 L. FEs../.....�.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................OF.........................................--.--.--.........------.----..................... Appliration for Ui_qposal Marks Tonitrnr#ion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S1ystem at: r iz cation-Address 2 Z / /� or( t N _I,r .... \. . •••.. ... -••....---•• ...........................` ....._(�e�1s,�y�y�s, ..... :..`7./.�... .......... w .....?:1.°. ...__.... . Add! a!✓a.. .................................. Installer Address dType of Building Size Lot.A©; m_ ___......Sq. feet U Dwelling—No. of Bedrooms- _.__ _. Expansion Attic ( ) Garbage Grinder ( i aOther—Type of Building 4hy. No. of persons............................ Showers ( ) — Cafeteria ( ) Q ; Other fixtures ..........•-•-- -'•--•••-•-•••---••-•.................••----•-•---.........•••--...--.........-•--•-•--------------.........-----•••-•.........------ W Design-Flow..... .3.A............................gallons per person per day. Total daily flow------3.�.;-6-..........................gallons. tx Septic Tank—Liquid capacitv.`o m a.galIons Length................ Width................ Diameter----.--......... Depth................ 114 W 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.......................................................................... Date........----------------------.......... aTest 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............... Ix ••-•---•--•••••••-•••••••-•---•"•........-•..................................... --••-----------------.----------------------- 0 Description of Soil..........................................................-----•--••---•----....-------•'•-•-----•---•--•----•--------•-----------------------...............--•-•••--•- x U •-••--•---•---------'--..._.... W ----....-•------------------••---••••-•--•-••-•••••-----------•••-•••-••--•••---•-••--•-----••---••--•••------•--•----•-••••-•--•••--•-•--••••••'-••-------•-----•-----•----•-•--•---•--..............-- UNature of Repairs or Alterations—Answer when applicable................................................................................._.._........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 14ssued by t sof health. KPP ned. `!.. .tion Approve . ....... :...........• --.:.................--------•---•--•--------..._...---------------- �i2 y 7 Date Application Disappro d f o the following reasons:-•-•----------•••-•...................•-•------------------•-•---------•-'•-----•---.........---..............._ -••-•-•'.-•...................•------"••-'•-••••'•--•••-----........_.....---••-------•-•......------•--.................._........-•-•••--•••'----•••••••-•--••-•............"-•-•---•-•---••-•••--•-- Date PermitNo......................................................... Issued....................................................... Date �10r. " / S FE c... �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .................. ................._.OF...............-...........-.......-......... ----.....------------............--------• Appliratiun for Uiiputittl Workii Tunutrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy tern at, -—) �� .. s _ . 5..... --.......,...��.�..��� �as Oon.A�.�5 o :t S:o�....... �...... r ............................:- ............._--_� _. �:' .:Z X .:.. ........... ................... Installer Address d Type of Building Size ........Sq. feet U Dwelling—No. of Bedrooms ..Expansion__________________________Expansion Attic ( ) Garbage Grinder (�� aOther—Type of Building ./_t'�.:.��_��w No. of persons............................ Showers ( ) — Cafeteria ( -) dOther fixtures ------------------ ----..------------------------•---...---------------------------------........_._...............-•------....-•-....--•-••......_..... w Design Flow.......33'D ......5-•ate............................gallons per person per day. Total daily flow ---a__....._._..__._..........gallons. WSeptic Tank—Liquid capacitv.�°� gallons Length................ Width................ Diameter.._......._..._. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------j(------------- Diameter.......P,........ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------•-----....-----...------------•--•----••----------••-••-••••---•••........................................................ 0 Description of Soil........................................................................................................................................................................ x U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•••-••-•-•-.._....••---- w -----------------------------------------------•------------......------------------------------------------------------------....-----------------------------------------------------------._....... 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 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 boar of health. Sined. �- -•............................... Date Application Approved BYothefollowing .............. Z---.......--••-•................................................. 4_ / /` f 'f y' /Date Application Disappr#d' f o reasons-------------•------------------•---------------------------....----------------.....---._....--•-------•------- ••---•-•....-•-•-•---••--•••--•-••--••--•-•-------•---••-•-••---•-•---•------••.............•----•-••••--------•----•--•-••--•--•...-----•••---...••-••-•--------•-•-•-••---••---•---•....-•--••---•--. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..............................................................I...................... .---- Traif iratr of Tompliatta ,,THIS T,OV,CERTIF , T he Individual Sewage Disposale/System constructed ( o�Rep red ( ) y. r b . �. ..... .�.. /�------ -----------•---------•---.-------•---••-•----.-.------ ...._. / InstalleLo at.---Z" ------- � =---... `' '' _ = -�` ----------------_-------------------------------......---•---- ------------- a application for Disposal Works Construction Permit No.__ 5 of e�tate Sanitary Codes de a din the has installed in accordance with the provisions of TIT , V C datedy- Code.,S..de-__ --._-..._-_ e THE ISSIIANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILLl,F�CTION SATISFACTORY. DATE...l°1� •----------------------------------------------•----• Inspector.,........ .....--------•-•------------------------••-------------------........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.....................................................................................Nol_?................... FEE........................ . �tu�ro��l� �rk� on ion rrmi� Permission is hereby�ranted .= --•-••--•....---- ............................................................... to Construct ( or`�R�pair ) a- Individual!! r e D posal System � s"1Y...... f� Street �+ as shown/onthnappli tion for Disposal `��orks Construction Permit No.__...•......-_.�e ed.__ t ____.�"j_...��....... •----•-•............................ --------•••--•----......••--••---•---•and of Health DATE.. 7....................................... ........................ FORM 1255 A. M. SULKIN, INC.. BOSTON - `al►.�G�C FAnAtLY W(D GARBAGE CPjfJDER. D/a►y F%•oW _ IID x 3 = 3306.Po. 1! SEPTiG TAQIC = 33Ox15C>% = -495G.RD U5E• 1000 vsE t000 Gal.. 23• �s � a�; .. o15Po5nL PIT 31. 4 5 t p�r/At.� gRC,ls = 15a•S.F �-\ `t"� • ' - i... - 150 5.>= X 2.5 = 3?5 G.Po - Z7'4 r• a• ' x . ;z. BOTTOM AR-F-Az .. . �o `'`•F• / t'�`, : ' .+� ` 50 5.F x 1• o r. �•p G.P. 'ToTA 1-. DE51GN s ,4.25 G.P D. �3A 33 -TOTAL- "AA I LY FLOW - 33o G.Po, M r , ;;.►.. PE2COLAT►ON RATE; 1"iN 2MIN o�L�55 N Z9. Wig` y i ; } �'• ; 37 x OF =o ALAN LOT/2 a I F W. N w JONES t No. 25190 o -33 i 1000 P16T. INS. gaT�� ,3Z.� ,,. .� ; �:• • is L loop INS BoX 3Z:� MEN LP TN IN y. �� WIiTN 3z o -3 Z G•2A✓E� WAsuco ' 6TvNE I _ CaRTIFICD PLOT PLAN i iz 'von'`? PRoF1 L/.g �! 1.o C 4'�I o N CE���1✓.�G. t_�'� . 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