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HomeMy WebLinkAbout0075 HADRADA LANE - Health 75 HADRADA LANE Centerville A = 148 — 105 , SMEAD No.2-153LOR UPC 12534 smaad.eom - Made in USA OIFI OFMSRFWMW AH 1J6®N 1i61Y00UCT USE VE Town of Barnstable P# ' Department of Regulatory Services axnNST"M : Public Health Division Date t � � ►6;9. 200 Main Street,Hyann' MA 02601 AlEU MA'S f Date Scheduled_ ime :' Fee Pd M� ►Soil Suitability Assessment!f or ►Se e,I)is sa a a Performed B Y� Witness( By: LOCATION& GENERAL INFORMATION Location Address'f� ,� � ��y�,�►� r✓ Owner's Name AddressXJ J Assessor's Map/Parcel: ��� /© r�/ Engineer's Name�'d ` T NEW CONSTRUCTION REPAIR Telephone# �V��.��✓1? Land Use Slopes(40) Surface Stones - ' Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 1� C, w CD 7 k V Parent material(geologic) Depth to Redroek Depth to Groundwater. Standing Water in Hole: Weeping from Pit Fade Estimated Seasonal High Groundwater DETERARNATION FOR SEASONAL HIGH WATER TABLE Method Used: Deptii Observed standing in obs.hole: _ _In,In, Depth to soli mottles: In. Depth to weeping from side of obs.hole: In. Groundwater .Adjustment �r�,� e., -fr. Index Well# Reading Date: Index Well level _ Adj.Factor- Adj.Groundwater Level v PERCOLATION TEST Date- Time Observation Hole# Time at 9" Depth of Perc Time at G" Start Pre-soak Time @ 'rime(9"-6") End Pre-soak Rate Min./Iuch Site Suitability Assessment: Site PasseB Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SPIIrIC\PERCFORM.DOC DEL,P.OESERVATION HOLE LOG Dole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, ravel o Ib A17, DEEP OBSERVATION MOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten % ravel If DEEP OBSERVATION HOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION IIOLE LOG Hole# Depth from Soil Horizon, Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes ✓-- Within 500 year boundary No"_ Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviou rial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervi us material? W4 Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with . the required training,ex tise d e er'ence described in 510 CMR 15.017. Signatur Date Q\SEPTIC�PERCFORM.DOC TOWN OF BARNSTABLE LOCATION �Ag /f SEWAGE#—7CP VILLAGE ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. J/mil� �®c�`U/r' 7��— o?o? SEPTIC TANK CAPACITYA-­6`� XrOO 67i4, LEACHING FACILITY.(type) �G'^'���`/T��i4�.d/lI"'is zi e) 3-X A rX, NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: " Separation Distance Between the: J7—0 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility / 9a Feat Private Water Supply Well and Leaching Facility(If any wells exist on` site or within 200 feet of leaching facility) a/ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY _t ®0I- 3�"j COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS " "' DEPARTMENT OF ENVIRONMENTAL PROTECTION G 1 3Q TITLE 5 } OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS a'f SUBSURFACE,SEWAGE DISPOSAL SYSTEM FORM �y<,� PART A CERTIFICATION " . Property Address: 75 HADRADA LN CENTERVILLE MA 02632 1 A% �S g}¢ Owner's Name: REALTY EXECUTIVES C/O DONNNA HUME Owner's Address: 1330 PHINNEY LN HYANNIS 02601 } ' Date of Inspection: 1/24/02 ''¢'` Name of Inspector: (Pleaseprint) JOHN GRACI Company Name: SEPTIC INSPECTIONS Se Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 � 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 the inspection.The inspection.'was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) ;'fhe,,system: _ Passes X Conditionally Passes 3 _ Needs Furth valuation'by the Local Approving Authority Fails ' Date: Inspector's Signature: - - The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP.The original should be : sent to the system owner and copies sent to the buyer, if applicable,and Xt►e approving authorityQz) F Y Notes and Comments SYSTEM CONDITIONALLY PASSES TITLE V INSPECTION.D-BOX IS CURRENTLY ARekfft AND NEEDS TO.BE `y REPLACED TO MEET TITLE V REQUIREMENTS.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG Y THE SYSTEM'S USEFUL LIFE. s: ""This report only describes conditions at the time of inspection and_under the conditions of use at that time This inspection does not address how the system will perform in the future under the same or different conditions of use � h J, Page 2.of 11 OFFICIAL INSPECTION FORM—NOT FORVOLUNTARY ASSESSMENTS A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ;; . CERTIFICATION (continued) ;9 Property Address: 75 HADRADA LN CENTERVILLE,MA 02632 Owner: REALTY EXECUTIVES C/O DONNNA HUME Date of Inspection: 1/24/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all_of Section D A. System Passes: t. I have not found an information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 Y .. CMR 15.304 exist.Any failure criteria not evaluated are indicated below Comments: SYSTEM CONDITIONALLY PASSES TITLE V INSPECTION.D-BOX IS CURRENTLY BROKEN AND NEEDS'. x TO BE REPLACED TO MEET TITLE V REQUIREMENTS.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: X One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The w_ system,upon completion of the replacement or repair,as approved by the,Board of Health,will pass. ;r. Answer yes,no or not determined(Y,N,ND)in the for the follow statements. If"not determined"please explain ` n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits ' substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of HealthAl *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating, that the tank is less than 20 years old is available. [[[ s ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed r i pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced f J ND explain: n/a n/a The system required pumping more than 4 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 J . _obstruction is removed �f ND explain: n/a is k Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR;VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ; PART A Y CERTIFICATION(continued) tf 3 Property Address: 75 HADRADA LN CENTERVILLE,MA 02632' Owner: REALTY EXECUTIVES C/O DONNNA HUME f;Y Date of Inspection: 1/24/02 =. 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 public health,safety or the environment. 1. System will pass unless.Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system.is not functioning in a manner which will protect public healthoysafety and the environment: c e _ 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 salt marsh n 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the.p�ubhc health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water ;i," `s supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than°100 feet but 50 feet or more from a private water supply well".Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds iridicates that the well is free from pollution from that facility and the presence of ammonia t nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. r, 3. Other: ' n/aJ. 7; r Page 14 of 11 OFFICIAL INSPECTION FORM—NOT FORt,VOLUNTARY ASSESSMENTS x= SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). Property Address: 75 HADRADA.LN CENTERVILLE,MA 02632 Owner: REALTY EXECUTIVES C/O DONNNA HUME Date of Inspection: 1/24/02 D. System Failure Criteria applicable to all systems: r You must indicate"yes"or"no"to each of the following for alLinspections: ' Yes No X Backup of sewage into facility or system component due to,.pverloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground*.surface waters due to an overloaded or clogged SAS or cesspool 'a h X Static liquid level in the distribution box above outlet invert.due to an overloaded or clogged SAS or cesspool u. X Liquid depth in cesspool is less than 6"below invert or available.volume is less than day flow u . X Required pumping more than 4 times in the last year IYQlLdue to clogged or obstructed pipe(s).Number of tunes y' pumped Wa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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. [This system passes fl(,the well water analysis,performed at a DEP rw certified laboratory,,for coliform bacteria and volatile{organic compounds in that the well is free } from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal too y less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be : attached to this form.] ,e (Yes/No)The system fails.I;have determined that one or more of the above failure criteria exist as described in 310 a ' CMR 15.303,therefore the system fatly The system owner should contact the Board of Health to determine what will be ' necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve it facility with a design now of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above)' yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply fi _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"'-to any question in Section E the;system,is considered a significant threat,or answered. , " yes in Section D above the large;system has failed,The owner or operator of any large system considered a significant throat under Section E or failed under_Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner 1 should contact the appropriate regional office of the Department. A Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART B CHECKLIST Property Address: 75 HADRADA LN CENTERVILLE,MA 02632 Owner: REALTY EXECUTIVES C/O DONNNA HUMEa{' Date of Inspection: 1/24/02 Check if the following have been done.You must indicate"yes"or"no".as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? _ X Have large volumes of water-.been introduced to the system recently,or as part of this inspection? _ X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwell$ngihspected for signs of sewage backup? x X _ Was the site inspected for signs of break out? F X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of then baffles or tees,material of construction,dimensions,depth of liquid,depth;of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? _ , I The size and location of the Soil Absorption System(SAS)on_ahe:site has been determined based on: .. Yes no X _ Existing information.For example,a plan at the Board of Health „ X _ Determined in the field`(if any of the failure criteria related to Part C is at issue approximation of distance is y unacceptable)[310 CMR 15.302(3)(b)] No fir r 41y Page 6 of 11 ti 1 OFFICIAL INSPECTION.FORM—NOT FOf WOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM°INSPECTION FORM PART C SYSTEM INFORMA', Property Address: 75 HADRADA LN CENTERVILLE,MA 02632 �` r Owner: REALTY EXECUTIVES C/O DONNNA HUME i Gti ' Date of Inspection: 1/24/02 r FLOW CONDITIONS RESIDENTIAL 4 Number of bedrooms(design):4 Number of bedrooms(actual): 4 ° DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):440 Number of current residents: 0 Y " Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no):NO [if yes separateinspection required], Laundry system inspected(yes or no):NO Seasonal use:(yes or no):NO Water meter readings,if available(last 2 years usage(gpd)):0 j Sump pump(yes or no):NO Last date of occupancy: 11/1/01 g5 7 ly'Fy COMMERCIALANDUSTRIAL Type of establishment: n/a " Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO a Industrial waste holding tank present(yes or no):NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO u;. Water meter readings,if available: n/a 4 Last date of occupancy/use: n/a OTHER(describe): n/a L 4d1 GENERAL INFORMATION Pumping Records a " Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume.pumped: n/agallons==How was quantity pumped determined?n/a Reason for pumping: n/a 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,,tf any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) { _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: F 1956 BY AGENT. . Were sewage odors detected when arriving at the site(yes or no) ,r- s Page 7 of 11 _F- a' } S OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C y SYSTEM INFORMATION(continued) Property Address: 75 HADRADA LN CENTERVILLE,MA 02632. Owner: REALTY EXECUTIVES C/O DONNNA HUME Date of Inspection: 1/24/02 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC other(explain): n/a Distance from private water supply well or suction line: n/a ` Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK:X(locate on site plan) fiN Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a r If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8'6"H 5'°7'W 4' 10"" ' Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:32 Scum thickness: 1" ` Distance from top of scum to top of outlet tee or baffle:6" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined:MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related; to outlet invert,evidence of leakage,etc.): z. SEPTIC TANK IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.D-BOX IS BROKEN AND NEEDS TO BE REPLACED.RECOMMEND PUMPING EVERYTWO-YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a U Dimensions: n/a `t Scum thickness: n/a < ` r Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): z n/a i Y Jr =y� �dr R..l k 7 P Page.8 of 110 OFFICIAL INSPECTION FORM—NOT FORV;OLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 75 HADRADA LN CENTERVILLE,MA 02632'" # Owner: REALTY EXECUTIVES C/O DONNNA HUME ` Date of Inspection: 1/24/02 `. _r �h .;.S TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) 4 Depth below grade: n/a Material of construction:_concrete_metal_fiberglass polyethylene_other(explain): n/a . Dimensions: n/a ; Capacity: n/a gallons Design Flow: n/a gallons/day _ Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan)„ r '' Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distributiontooutlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): ' D-BOX IS CURRENTLY AND NEEDS TO BE REPLACED. .. PUMP CHAMBER:_(locate on site plan) " Pumps in working order(yes or no): NO } Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): bi n/a '. A tF R ' Page-9 of I .: , `- g OFFICIAL INSPECTION FORM—NOT FORVOLUNTARY ASSESSMENTS t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM w PART C � SYSTEM INFORMATION(continued) ; T � Property Address: 75 HADRADA LN CENTERVILLE,MA 02632 s^: Owner: REALTY EXECUTIVES C/O DONNNA HUME Date of Inspection: 1/24/02 a SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6'X 6' leaching pits, number 1 ° n/a leaching chambers, number,:" n/a n/a leaching galleries, numbest, n/a n/a leaching trenches, number;length: n/a n/a leaching fields, number. ; n/a t. n/a overflow cesspool, numbed a ` . n/a � n/a t innovative/alternative system i Type/name of technology ' n/a Iv 1 Comments(note condition of soil,signs of hydraulic failure,level of podding,damp soil,condition of vegetation,etc.) LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONINO,-EROPERLY. PIT HAS 6"OF LEACHING LEFT. ' IN IT.BOTTOM IS AT 9'.AT TIME OF INSPECTION LEACH PIT WAS EMPTY CESSPOOLS: (cesspool must be pumped as part of inspection)(locatp on site plan) Number and configuration: n/a r ' Depth—top of liquid to inlet invert: n/a : b Depth of solids layer: n/a " Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no) NO F4 Comments(note condition of soil,signs of hydraulic failure,level of pondmg,condition of vegetation,etc.): " J n/a ' PRIVY: (locate on site plan) Materials of construction: n/a r" Dimensions: n/a Depth of solids:n/a Comments(note condition of soil,signs of hydraulic failure,level of pondmg,condition of vegetation,etc.): u 4 n/a > '; I L 14 { I!' Y J ' Page J 0 of 11 `u:L't Yf�fi OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTSi SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) fi Property Address: 75 HADRADA LN CENTERVILLE,MA 02632 Owner: REALTY EXECUTIVES C/O DONNNA HUME _` y Date of Inspection: 1/24/02 irk SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. fi Locate all wells within 100 feet. Locate where public water supply enters the building. t '7 qt 1 at' Fm` s y s AA I i�' AO2a� � M S�3 a� k3 23 x e C �L t N • Page,11 of 11 fYy'-'+ 'J' j OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Y> PART C _ SYSTEM INFORMATION(continued) Property Address: 75 HADRADA LN CENTERVILLE,MA 02632 Owner: REALTY EXECUTIVES C/O DONNNA HUME ' Date of Inspection: 1/24/02 {?`T SITE EXAM a _Slope Y 4; Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet ` ; Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a �° YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a ht NO Checked with local excavators, installers-(attach documentation) �4 NO Accessed USGS database-explain: n/a t.[SH i�• You must describe how you established the high ground water elevation: }r ' HAND AUGER- 12+FT. y1. i• S+; �y "k {�N Rv A5. ^L:Y� t'N r�4 tt Health Complaints 30-Jan-02 Time: 3:30:00 PM Date: 1/29/2002 Complaint Number: 3249 Referred To: DAVID STANTON Taken By: DAVID STANTON Complaint Type: GENERAL Article X Detail: Business Name: Number: 75 Street: HADRADA Village: CENTERVILLE Assessors Map Parcel: Complaint Description: Questions septic inspection done at 75 Hadrada. She is in the process of purchasing the house. Daciaafaxed me a copy of the inspection by John Graci,because we have not received the official report from Mr. Graci yet. She was concerned about the section on flow. It stated it had normal flow for the past two weeks, yet she was informed no one occupied the house for a while. On the inspection report it stated last occupancy was 11/01/2001. Actions Taken/Results: I went and inspected the d-box that was replaced by Bill Robinson. It was installed correctly in the same exact location as the original d-box. He said the system looked to be in good shape. Investigation Date: 1/30/2002 Investigation Time: 11:00:00 AM I 1 No. 6 2- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppfication for Otopozar OpMem Conotruction permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 75 Hadrada Ln. , Centerville c/o Donna Hume Assessor's Map/Parcel d U S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) new D—hox 6112 010A, �Jlje-d)last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this and ealth. Signed Date 0 Application Approved by �''�< Date —�3�'� Application Disapproved for the following reasons Permit No. 2 Ud —O?Z- Date Issued a 0 7-- No. 0� �i 2 Fee t%tCC 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Ziopoor 6p.5tem Con.5truction Permit Application for a Permit to Construct( )Repair(X)Upgrade(_ )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 75 HadraddaLn. , Centerville c/o Donna Hume Assessor's Map/Parcel Installer's Name,Address,and Tel.No. J Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, -Centerville Type of Building: `. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of'Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) new D-box !u� G i Date last inspected: Agreement: ` t; The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Ce rti cate of Compliance has been issued by this and ealth/,�_ Signed t Date Application Approved by A �- µ Date -.21"G Application Disapproved for the following reasons Permit No. 2 L✓2 -U Date Issued f 3,) G 3 - -_ --------------==-------=------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Hume Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 75 Hadrada Ln. , Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d 0Q-)-U_?> dated / �`0 Installer Wm. E. Robinson Sr. Designer The issuan e f this ermit shall not be construed as a guarantee that the system will function as designed. ! Date 2 Inspector II3�/dz �c Z✓' J*It No. )Co.?- olo, Fee NC THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Hume 1t!5po.5a1 *p5tem Construction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 75 Hadrada Ln. , Centerville and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this t. Date: Approved by etc= TOWN OF BARNSTABLE LOCATION ? 9 A D QA 0P 16 0 5— SEWAGE # Q—y 2s VILLAGE CC tom'tC V1 YL ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. rkb rV SDYJ >e/P6 C 77 S-8'?7,C SEPTIC TANK CAPACITY Off` CGS LEACHING FACILITY: (type) (size) WO g1 NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE:��S/G� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaehing facility) Feet Edge of Wetland and Leachin8QFility(If any wetlands exist within 300 eetof leaching, cility) Feet Furnished by sc S 177 ^� Randy &Dacia's' New Home Page 1 of 1 I �w Randy & Dacia's New Home �1 First Previous Next Last Back to Thumbnails Image 27 of 28 1 of New 46M6 10 FLU This thumbnail page created with CompuPic. http://www.dyreunion.com/joe/images/DaciaRandyHouse/DSCN0961,jpg.html (::10:/4/:20:05) Page 1 of 1 _ — — O — 10 u IT LN ( n pro R,emov�- � UP twit http://www.dyreunion.com/joe/images/DaciaRandyHouse/DSCN0960jpg 10/4/2005 I- i io ._ 16 5 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... `To/wn-.....oF .., 3a r>sfa�ble.................. Appliratilan for Disposal Works Tonstrnr#inn ' amit Application is hereby made for a Permit to Construct (k-)--O,,r Repair ( ) an Individual Sewage Disposal System at: L.QT ter} a.... �r�e----------------- ------- �. � ocatio dress a -•-•--..��' f 1/1/ Y .�1ZA6.. ---.. '�f 1eGCR�tf��A dr NQ. ,�, ..................................... f Installer Address Q Type of Building Size Lot..If�1�---Sq. feet Dwelling—No. of Bedrooms.............3....__ Expansion Attic ( ) Garbage Grinder -------------- No. of ersons.....................__.__.. Showers — Cafeteria p., Other—Type of Building ._ p ( ) ( ) Other fixtures . W Design Flow.....ZW..... ............gallons per person per day. Total da�y flow... 30...•..........:.........gallons. WSeptic Tank—Liquid capacity,"' gallons Length......0..... Width......Y....... Diameter................ De th...7......... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area. __--sq. ft. Seepage Pit No_____________________ Diameter........./...0.... Depth below inlet........1�....._. Total leaching area„�7 P b.sq. ft. Z Other Distribution box (t-' Dosing tank `-' Percolation Test Results Performed by.... L I�e-.�% - �� _- -... Date._..1r�:Ot1 Test Pit No. 1................minutes per inch Depth of west Pit...���-�... De� to ground water... Test Test Pit No. 2__..,az.......minutes per inch Depth of Test Pit... Me! Depth to ground water�/"45VVI C� &I-Mbp O Description of Soil..........a-----/------JIM/ .. ....go...C _W.r.......................................... x Vj........ .............. ............................... Y.._..___.._......- - W -------------------- ------ ••---••--•........10�.._----....c •e l/_?---..n.V.< /lam In_..C�'L.Zn .�....-•-----•---•---•--••---•----._.....-•---............... UNature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------------------------•--•-------•------------------------•-•-....-•-----••---.....-••------••••••---....-••••---•••---•••-•--•••••-••••••••-•••.._....•---•-................. Agreement: The undersigned agrees to install the aforedesc ' d Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary6n ' de The undersig urn er agrees not to place the system in /- operatio til Certificate of Compliance has b ed by the board o ealt Sign -1'1 .......•.--........................... •-•---.........--•-••--... Doe, Application Approved By•-•-•-••••-•--•••.............. . ..... ........... . .............. ............ �.j..at'<e .... ate Application Disapproved for the following re ons:.............................................--............................................................... .........................................................•-••---.............--------------......---•------.....•-----•••----•-•-•-------••--•-----•--------•---------•-•----_..._....-•••.......•-•--- Date PermitNo......................................................... Issued-....................................................... Date TOWN OF BARNSTABLE LOCATION '" 7 S^ d A D QA Dn J A O C SEWAGE # Q—`y 2 `JTLLAGE lJ f6 e- V1 Ilk ASSESSOR'S MAP & LOil T © �� INSTALLER'S NAME&PHONE NO. _J,0 i rV SQlJ SelP6 C 77 S-8 77.E SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) k WO NO. OF BEDROOMS l�yE�.3 ys� BUILDER OR OWNER PERMITDATE: I C7 COMPLIANCE DATE: 1 I SA5 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i �S'7' "' ���, - ,_. , 1 '. ���;�• •-*'gyp_ No......................... FEa............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i ,� / f .. F .............. f . t,;. ...J t Appliratiun for Mipuii al Workii Tomitrurtiun rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................-................................................................................ _......_.....-----....................--------•--••-----...-----•--....................---........ "� r ,Location-Address ! J "or Lot No: 1 ! owner r r� Address f i Installer Address Q Type of B-uilding Size Lot...... ._._..____._...'_..._..Sq. feet U Dwelling—No. of Bedrooms............... .. ......................... Attic ( ) Garbage Grinder a Other r—Type of Building ........................... No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other_fi _tares".- ......•..... ------------------•--.......----•-•-- Q f v W Design Flow.... ............ per person per day.�•Total daily flow...... W/ I Septic Tank—Liquid capacity_ : ...gallons Length................ Width__.............. Diameter_'-_"( .... Depth................ x Disposal Trench—No. .................... Width.................... Total Length;-.__-----____-_•--_ Total leaching are'a........'..__.._._.sq. ft. Seepage Fit No.__---_-___----_- Diameter'.(%!_______________ Depth below inlet.................... Total leaching area.........._.._....sq. ft. z Other.Distribution box ( ) Dosing,tank/( , ) aPercolation Test Results Performed by '--------------- -----•------•-•----... ..-- Date.-----------........................... -Ttest Pit No. 1................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.................... P4 - r - / . -. ...............................................................................•---------•------•--......................................................... 0 Description of Soil.......................................................................................................................................................................... x U ..................... --•••••-•---•-••-•--•-••----••-••••••••••••-•---...-•--•-•-•••-•---•---- ----------------------------------------•-=•••---••••--••...--•---......-•----•......-••---•--------•- w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------••••••••---••-••••••••••••-•-•-••-••--•-•-••-•-••••••••-•••---.........--------••-•--•---••---•-•--•-----•-----•-••-•••••--•••-•-••-•••-••--........_....-----......_..._.......... Agreement: The undersigned, agrees to install the aforedescribed Individual..Sewage Disposal System in accordance with the provisions of TITrLIE 5 of the State Sanitary Code—The unde signed further agrees not to place the system in opeWi4tr''ntil Certiti � v�iance has been issued by the board--of health. t ._..._.Signed.'............--�-•--"' -----------------f--- �l Date Application Approved BY............................ Application Disapproved for the following easons: ----------•-------•••---•--- ..................................•.................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 � ................OF............................................................ ...................... ... C9rrtif iratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------------------------------- ...- `.,c -••---•-------•--•---•-•--•---•-------•--------------••---•--------•----..........-------•--------- s Installe ...._..._...at-•••-•.......... ..am has been installed in accordance with the provisions of TITLE r of The State Sanitary Code as de•cribed in the application for Disposal Works Construction Permit No............ dated_._.___ - . �_______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A Gt1ARANTEE THAT THE SYSTEM WILL FUN TION SATISFACTORY. DATE...................L5. Inspector--•--------____:_..---•-----------------------......_....-----•---------.......... THE COMMONWEALTH OF MASSACHUSETTS No. a:....S ............ FEE....................•___ UisVouat Worku Tomitrwtion rrutit Permission is hereby granted.........._.!?� r+ d v v. to Construct o R air an Individual Sewa e Disposal System at No.•..... (�'.S-••--••..... D R..... �...P_1- ..aV ..................�J-......v ......---••--------•--.... • � Street �6-wS 3 1 4 J as shown on the appl•cation for Disposal Works Construction Permit No______________________ D ted_.•._....-____......................... ...---•............. ------------------------------------ Boar�oa DATE .. FORM 1255 A. M. SULKIN, INC., BOSTON ° `~ I W .) 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's I Q�%. t�^ f ix ('�-R-,: i` PF, , 0,;p".'�/ �i v .kat:a �{ /31s if t x x r. + P1�I�I�+.. `Y �, - / t '# a s f » WElMBERG '' C�CJ't ''CCa .' rt.^,,„ , K °i � � 4 t''r'r'tCb� c S.'�%#i "x+,-+x crx.`•:l.:.y "a`!"';�1 .� .f NO 366.r Q ! � f�lU.r��vS7� 4.: =X''t t S v.�. a [ ;�., x ,T +,,p`t•3" €Y„, F #a" s:3 1��., �! 14.r a4. ✓P tr o �,! r 'i a. ,aN 7 {'r '4.L' t,; Q�. \tS'fR » i!'.5' 9frilE��q �, mAl' ,f LEGEND t ��� ;, r t V5 , *. or�af Le v IEX18T1 ® f r N BPOT ELEVATLON Ox0x' EXI9TIN® CONTOUR -�-- 0 r--- . ':r ., f`, . CERTIFIED . PLOT PLAN f 1�11+918NED ^SPOT ELEVATION , � t 4�t�r t oA Z .4,ra i` tfim,ls"90r�C'ONTOUR �:0 ...,- :f } f�� j1- "V,6—., � -67'; , ,q:,o A .—_4 �/J. '!. ��... ,{ '4,}• - �',,ti .f r - �.,/:-rs.y 10,-1,h x 3Iz:: �°l /'a;� " .G;Fwrelol -�"' Y-�I�i�.S/iRF�.' 'C��.�. ''t I+fG''E 4`Ths,'location of any 'exastirig .undergi•ound sewera9e,4 .," -, -- . T, - 11 w�z1, ,:Qrt thee-utilities.shown:`°,-on tris Zan§ Is,ap rox ' fit,- ) x,, iN e. mate„onl as.I determined ,;from xecords.''and r kue�bal�� ' ? - x =_ a,- /� �VAtAss'• Y t ., �N. A1 f + IF t � £orm tzon,:'`Thet contractor-'a s„r spo�s,ible £or,the s ilk '�; �_°` ` y • - , a ication' ,f ,,, s F ,.! t xk,, f`l i rugfi 4 .th.e existing l'ocat�ons; ln;the� .eldaK ":9CALE$'/">".38' DATES .��.3/�PG ' 11 . ` _ f � aa'j" '°' ak s,;y'Mc { as r � �r x S;�.0 N 4;DREDGE: 64-GINCERIOV6 Cat IN .vim s �w . „ t YC�Li �Tt A• � ICRTIFY . THAT THE PROPQSED #! °�f# E0187' AE4 6iI�Q191'ERF,O �,d J4j® 0, 61 Qr9uI1.DIN.Q '$MOWN ON THIS Pt.AN a 7ifii y hs.,ClV.11,.�� rc *rPr'`` t a- ih + r I„a1N0 , ra .A��: F� 4C�tIaFCRM$ TQ THt;' ZONIN4 lA1MS 1 1t. � ' � E G E V; . - Y,Y.. � Y ,l� , _., ,l3 'i stud MA8s. °i sip:T 12 Ni A I N ` TR EETk CN..BY� , ! 4, h t uz ' u �: nx r Ar, i, x NYAN.N t 3MA�S: ��` � ., , ►r _ 1 r�C . , I. .l.: . 9HEET..�.'Ol",--,! D TES, 1.t RE(i. LAND ..SURVEYOR .. .i ..r. l�.I+ M Z,jY,t at 4.3 y:' {W:4 vL ... w ,r Ail . lu tt',� ;.0 v,0 t�`x , j -Fr xi s i :'-Z ti ♦ O on'^"J "d. >jz,:s� h ~ r r ` k iy - ` '� :� e q Aj Ot ac Ui OC 41 � � � � 0a 4"N w � 1 QIL � v h . . s � ..... . . . . • ` 1. 46. AA 496 11A, R Q: , + tia w b f 14 Aj R 5 14 t 9 2 Fmk e nt s ti ti \ lh O: \ A AL 16) Ilk fk tilQl- ,�1 ` •, o fi ,c Iatic ; 44 " trv'�9 .w �,1 W „`v► F -d �,y �`, a. �, i L r, 7 ...0 1� l ,• v-b �t, rG Q`�k y"'.�' �3. a�i �'� (� .: �� " .(q Q vv � `.:0 ,3''.0 •G r �4�Cr '� t�, ZI f�_.:>r � i 'Vf'y-� , � q° ri ` � W..y<1�.- � v ,: r��..,���' `im �...� �,.,� � ��tryn � ��r•. rr� .� �► Board of Health 1; .. Town of Barnstable P.O. Box 534 60 Hyannis, Massachusetts 02601 ....... THE COMMONWEALTH OF MASSACHUSETTS BOAR®,PF I-IEALT OF.. Appliration for Movasal Works Tonstrttr#ion thratit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ....... ...--•- ... ..... ......... atio ddre �r t !o. ......... •... —.......... . .... ................................ ......... ... ....._......--•-•-.......................... Own-WI dr s ....... ... . .. . ..... '--'..... Insta er Address ��,,�� el of Building Size Lo /�_ .Sq. feet �-, Dwelling—No. of Bedrooms.......... ..........................Expansion Attic 0_1� Garbage Grinder Other—T e of Building ___.... No. of persons............................ Showers a YP g --•------------------ P ( ) — Cafeteria ( ) Otherfixtures ....................................................................................... ----------- --•---. W Design Flow.......... 0......................gallons per person per day. Total daily flow----- 5 '-..-........._.........._gallons. WSeptic Tank—Liquid capacity............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 t //`/ 0py�/ '-' Percolation Test Results Performed by_� .•`1-__ ...... . ........... Date_.,/�-:.7-...0_,.7-...._. aTest Pit No. 1................minutes per inch Depth of Test Pit........... ...... Depth to ground water........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------•---. . ............................................................................................ Description of Soil---.. ..'. ..------ - `1 ----- -------------- / 5 ....---- ---------- ----- ---=-- -; 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 TITILj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in opera 'o until a)Certificate of Compliance has gbbeen ' ued by the board of 1 lth. t r Signed ----- --............... lication Approved B PP PP Y ------------------------ Date Application Disapproved for the f o wing reasons---------------••---------------------------------------------------------------•-------------•-•------...-•--•- .......-•-------•--•--••-•••----------••...---------•-------------•--.....------......--------------•--...-------•----........------------•-•---....•----•-••----•--------•----•-----•-•------•-•-•...--- Date Permit No.---•--�--.�:-�--•-•----._.....-•---•.. Issued-------...�...... _e Date cl.l THE COMMONWEALTH OF MASSACHUSETTS - BOAR D OF HEALTH Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct (�r Repair ( ) an Individual Sewage Disposal System at ..........` / ... ....... ....... �,� e/%a � ................................. ocatio -j ddres / Installer Address UType of Building Size Lq ' .le�....Sq. feet Dwelling—No. of Bedrooms.._.....ter..............................Expansion Attic A10) Garbage Grinder VO) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures ----------------------------•--......----- W Design Flow......... ...._....•.............gallons per person per day. Total daily flow___ ---------------------•.__gallons. WSeptic Tank—Liquid capacity............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 Test Pit No. I................minutes per inch Depth of Test Pit.......... .._. Depth to ground water......................... 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .......................................................................:_......._............ ODescription of Soil---- d�� � '�... --------------------------------------•-----------------------------------•-•------------- x ? ;�� � c., ------------------------ ---------- UW ------------------------------------•-••------------•--•--•--------. . •......-----------•--------------••------------•-•-•-•----••---•------•-••--••-•--------------------••------......_.._--•--- 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 Xoper �fiunntil a ertificate of Compliance has beeen issued by the board of health.Signed_.__l -f .��a. :. .....-----••--- �C/P r rDate plication Approved By..... r 7 ------------------------------------------ ---- Application Disapproved for t ' following reasons:. ----------------- --•---.._.-----•......--•-•---•••-. ------•----•------....-•--------••. Date. PermitNo................... ................................ Issu THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (IrtifiraAr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (� Repaired ( ) by ...._._(f ..: -"-----•----------•-------- =' -----------------------------•------------------------------------------------ ----•-------------------- / J " Installer has been installed in accordance/ ith the provision of TITLE 5 of The State Sanitary Codefas des ib d 'n the application for Disposal Works Construction-Permit No-----1.S-a-J 5........... dated_--..�_.----S - ..__...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUE® AS A GU RANT E THAT THE SYSTEM WILL FUNC ION SATISFACTORY. � � - ..... _gig DATE-----•- -•-•-- � -----�--------------------------------- Inspector....----- -•---------------------•---------------•--------- ------ ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .�....... OF...... � ., -..� / ................... FE 490 No. .... .... '�� ..... s �v• -... Disposal Works Tonstrwtion rrutit Permission is hereby granted..............................................._ to Construct ( �Repair ( ) an Individual Sewage Disposal System tree as shown on the application for Disposal Works Cons ruction Permit eta} ....... Date __ _ _.. ................... - - - ------ -------•-•--------•------••-•- •.-•- - o r a�hv ,DATE..4_12/3� _S•----•..................................................... FORM 1255 A. M. SULKIN, INC., BOSTON S///6t_E FAAN Y -- 3 gEo.2oorvf �?: OA/LY �Lol�r/ //e X _ 2 S /oo Z.Z U.SI o _77- X /d _ p 0 O G T•OT4.0 OEs/6�t/ �rGPv - q OES/G•ci �.E.ecoL.aTioN.24r�' , , ,E U�...•'�` - .. ..moo, tH OF P _. WV ti N1 . PETER : HICHARD "e M o SULLIVAN 6- f No.29.733 o BAXTER v .o� " No.N046� At �!. L Fps B8� TE,SY-,yacE T,y VD A0457- r r : G HO ✓ dim ��crE9 y�o� /,ODO /'vL.� s '', /.t/t/./G L, /.v✓. G.4L. / L—z-Ac ra Pir of'p G SEor�G W-/ %7W* _ TAnirc - ' J;4 •; .Srz,vE /as2 /�jrSL G'E,2T/F/EO f�GOT pG4�t/ :. Y .• 1� � .,-'°'+�•�.,.._. _.� L oG,�T/O�V CE�C�`!'"„E,�✓/LLB. _ 07 -,"'G.' a ota��S.yaW.t/ ,�/E•�Eav G'OMP�Y,,S lviry TyE SioE�NE B�x7�,e€,c/yE; /tic. /QivO.fE'TI�AGlc .eE4v/��iY1�NTS Cl,-- T/�4 ,2E6isrz�,ecO.«✓o.SU,2riE}ia,�s s : Toxiiv aF il/s �L AvO /S MaT- c�sr�.2Vi.�lc a til�S.� LOCQrEv Yt//T///y 7.�E �Lc�voG.4/�V, Ir�11 T//lt A-,oT-04-<6O amv AAA/,oV-r12- - .ShI�K/i!/,�E.��4rV.S�G!/G IJ�pT GtE USES Ta E.s7;4.6L/.S,ed ,far-G/o � � N r � 0 ' ' •< O A N v 20 30 C � 1+1 rk, a+ oa L �. a Q 6 r °r 3 j .. �g ©S Ha USe s L(3 T"�_� HALY r -ao VI EA.,AG E IM. 5TA I. LLR'S NAn & ADDRESS 'o 6/ -U U I L D E D an OWNER BATE ER IT ISSUED 1 PAT I Co0MPLIAN. CE ISSUED � Z /� r . c�a I ry �' Construction Notes >j� � IxtoRsaxnNnows• 25 The new islidingdoer shall be An Andersen•F1rvG 1o08B<(Four penes door) Hzz�rc.. .LAu� I. stoeaeaaanenmfmdtoda the wroasMeaareeaannaawening. j zt:alnewwidpdsenrolmMAnaesan•: t 2. Cam shell be taken to protect the etldmg seek sysem.The location of site system shell m marked M 30.Owner shall be required to approve all window and door urxM prior to purchase and hu tellatbn. ale Owner Dnbr to the shot.work. 31.All new,dons,end windows shell be praP.y fleshed above rod,unit 3. Topsan shall bd stockpiled into ON be spread UP=mmpbFiOn of construction. 32.The helr rune window,Shen b0 purchased wmrehe half mend Interior and extorter him. 4. Beg9nrg at pre now foundation shall be with orhde moaner.Baddilitng obit be pedor ed So that the 33.Exterior door hardware Shall be Selected by the Owner and shall irtdude deedbots. new foundation wan Is not cracked or damaged. .fip�I:SGi00.� S. Fwlmking,sest1n6.and landscaping ehen be by the Owner.i a. Proper compactionmde at the eubg shell he mmpleled prior to;OWN are concrete foundation and � SKYLIGHTS: y�n�.: &r _ embsYstems. - .c 34.Skylights shell be by vein*,sea flashed,Model OVM,30-0116'x 04W.nronuel vennnng with IMenler jrpT- - -.v - FGIINOATION/aIAB ON GRADE: -11.1 shades. . J I&S15�aF 7. Am*I roundan b well,eonawm,and slab lx grade reach adymk SIISII echie ri 2000 pal In 2t days. jaNNTNG: 9. AmpbtreeehenFMG*placed npteendter the-bomOKtoW be Proan apdWCIretefft theptortomddand I � 9. the oundaam:slab on gthe rade systems are nataPic prwecte0 dunrg the Imtellallon a end eRer 35.An enterer ticore,windows,clapboard riding,MOO soffit callings,and ttrrh Mhl m primed eed pialhted ' -Z(e g C mars,ire edetrg octant to m approved by are Ovm.. 'p to.Bnhsenoue damp barrier shall l Mal m applied th rum,W Mare new fouMetion well(below grade one. 37.Cedar nbrlgea ahem roman remain and redalloweddallowed t.. jBT-Z�i V' ZIP �2-TALSe daneb hheen beasmooth no level.,eft o�e.�ed Web an grade. i within iQ-0'. 37.All wolmhnited umber shell mmeht netnml end aliW9d m weather. , FRAMING- . - i}- R '• 9B.The gee fireplace alien be: S. 13.All new framing shall be plumb.oval,wed equere.Incompliance win slamande local ro an codes, with Ft vTL,��tL. BIZ G ... N I 1 y``p good construction"i b View and I � 38.The raw,gas piping o the ex uKed in accordance with are aisting d menufetturefs reqummems end I&All I bar owe,s new and d grad badly shall m connected ro the esladrg gas service within the lade dwelling. 0,,'�n 9. r! h i IN, stow Twiwied bowed,split,cracked,er haey damaged sarong tumbe MMI ro m used. 40.Routs h the new line shall be wcrdkmted or tom salon to srsure the mat and wheat �` 4n'w. 5i ire I3µBNyv.' erg tam Rd 16.All lumber ton exterior deck heating eM eeaang enallmwhmBnbatl. installation. 17.All lumber shall be property drkd. 41.All gas p4 tg shag be in compliance with hl state and last codes and Installled by a lkene rd ill. mg d fu.Bddgell be mishad and Indelled tie required. subcontractor. lti.f 19.New save elevations joining the exfetkg eaves M.1 be to the mme elevator,as indkeled an Ile plans. ... t ' .. s n 1n t�:wEst 27-arAs•-... �' /' °�`�"� NEanNG:rev owned s• \ 61DING: // •FfZOtJTAI�Q i6"•t.3``.• :1 ply' •" a2.The existing rot water props system onto e&extended eta ma new addition and mudroan as 20.New ce Aboard siding it gahes mat me"the exWeg eNngNs m;qumly..tpoaure,etc. . ��jj ��,,I 22:Now Wader Wm f emu mum me s,fach la o ffim, exv�ma.ee:. 43.ennsure he nP a�iwhe root wader(one anmin)piping shot�ba�wo fixated prior to mrr$wd on m �fC Adb kv Fu 141T T' IO�'. / �h/ 22.the ®dens ptme trM-Le tortsr bands.r lees,soffit onm oldirLen rose boards.etcof 1 stet langt ensure the bee and wheat t system Installation. S \ ire shall beexisting�Int Lengths at a of degree or lass ehen m ore piece.Lengths m excess h 1Y-0'm IP.pal alb.The expanded he9tlng system shell m e mmplele,wily operetlanel sysem with an required FIR 4 Gj�Q , 9ECTIOI�I 7iC j 2y\ ryC'f';• rt amn m sPnae andantes a a be deems arse e. '. . . ip Ad°. 23.EdaWg crime and lam,onau m rorentuy removed where the rites mnewcuon nhe.a the ntaung. � components. t'--2 L{-115 �./ #:. r y�; These areas shall be property patched to mmmlatea with the remaining derailing. ELECyppCAL:rev Owner] 7�° av ..J.�t` - +® d j -jiOOFlNG: 45.Refer to Sere._for switches htlupi.c ba connected to,etc. . MT Aj- 24.C�.told�w Inglims"I match me e"ng roof Megles ands shell be manufactured M �stun m mar-teddtto the Obe p Gerv�p ' M�. as.Ina new,eledrcal outthe exhadni; - 301n PeMerwood. 48. eterbksll ewe*Mal be In conhpnerea with en amU a rodeo and htdeoed by a uoaneee _",�,� 25.-thNe new edge vern,tebe properly eddy Wood edge.de.Mhl match fro las to g. efeded contractor. . ,({r�RERT( L IL1E I U FOj'3Mi�T1oIJ �.New root anhgba des m property lapse mto the adsant nor Meglas to em.e a pteperwelaApd , ¢ . 1,,• -,,y x mstoneton. f r CwY•'c �' w7Rr1A-rc;y Tn.kC.4 �tdl .C-XP',."1_F'�%. ._. ��T - Z7.AmuMutm queers anal tlawmwda anal m provwed a ma sus adasron.!)taant ei!aeT aro GENERAL CONDMOMs j. .. - downspouts shell be noditd ee required. "T R-"-:13Y tLt;rW-t tt .:EtY-.jUhXST 44 i��j fir; - 49.All consimdbn delete dell be disposed a off arm. and she be kept ees+ 50.Tmate Mall dean a all ems. G I.V IL t.I.T1t�EK LbTU1� RY�'YC RS I 712. E.. , ..- �/' I`NyF"RIGt1.Rh7...'t Gpbifi 51.The mild.than be fimmed by the State of Massachusetts and SW provide Liability and workxa Al6libj MA- FcVf,:ITT 25;1}L�Da 4 L7� i�ab!$, � cahromaton lmmmeoe. y�. 52,The bultoer Meg be rnspahaWe for all permits.Impeeanrs.d appasls"quknd byatsto and local e C� jZVIU f%1�RSIJS+'lilts'nil ?F{fs{tt<pt E f officials as they appy. i7 4 I«86 6e'k LZ 0--eV. . ' Pfau Posh 2812A64E '12- I T'S - . Y ' f310dM1e/1OTE8: ' .. ... 53.An gypsum wen board tied taping Is not ad to bid. v•� ii - .._. .. _ _ .___.-....._._ - ....._5E��e �aiInte5, q substitution be subtrdd h amma cost foal be acorrro.:ad with manuledu er oat.. 58:The build.shall work with the Owner and advise hem with respect to adsduang the o-de. 57. 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