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Home My WebLink About0522 OLD STAGE ROAD - Health 522 Old Stage Road Centerville U A= 190 074003 �IACYCI&pco UPC 10259 ' No.H_16_ �„�'� NAITIN04. UN TQ OF BARNS ((L��E � y LOCATION �� J SEWAGE # VIL�.AGE � �MAPT 1QU '��' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f LEACHING FACILITY: (type) - �1�,�w � S (size) C NO. OF BEDROOMS BUILDER OR OWNE PERMITDATE: COMPLIANCE DATE: 7'a 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 � �� f � _ � � �� b t � �� '�o � � � ,� - �a � �� . f � _ �� l ,,, N,. JCA- FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, 13A Kma 5-TA 15 L f- , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade(i-�/Abandon( ) - ❑Complete System Individual Components Location 5Z?. OLD S'),6V-, Ywykv Owner's Name Map/Parcel# I Q — 01 — QQ Address Lot# 3 Telephone# Installer's Name Designer's Name C;;.Kq-L, L;)140 S V RI M V I XIC Address Address 3p6 QLD PLYrnov�}� RP Qd1��Zrv(G Telephone# Telephone# 8199— 54159 Type of Building !�`� Lot Size 17 0 3 0 sq.ft. Dwelling-No.of Bedrooms Garbage grinder Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures /� Design Flow(min.required) 7 YD gpd Calculated design flow Design flow provided gpd Plan: Date 10 —1 • G Number of sheets j Revision Date Title PLA1.1 S} jk�11�� } pRn�('�SE'Z�n l)g6VA 2Vf, Description of Soil(s) S[�W12P�� -fl-En L 1 CPdf L S!d7syv) Soil Evaluator Form No. Name of Soil Evaluator H . Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS RAP J �fG ��i11Q�C L —.. '�`�)O�6 _moo E 6h N1 The unJ* grees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further ce the s n in operation until a Certificate of omp ance has been issued by the Board of Health. Signed Date•Inspect lb �� FEE r ^� Board`o Health, KN. "` Z MA. f >~ APPLICATION WIMISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(' ) Repair( Upgrade(%,)/Abandon( )`- O Complete System ZndiVidiialC;4o_WTtl Location' 5 oL v ij'A&e, x.o r p Owner's Name f ro ` Map/Parcel# Address Lot# 3 '. r` Telephone# d l y t 5,; Installer's Name Designer s Namepf SL>RV if 1 AddressVY Address *36C ()�.D PLYi v'�'}a �pfi Qogmzo4E Telephone# 8 Telephone# �� Type of Building Lot•Sizee,=^4 03.01 s . q:ft. Dwelling.-No:of Bedrooms Garbage grinder(#)„S b t Other T e of Buildin V No.of persons Showers YP yg P Cafeteria( )zc `•~ Other Fixtures + � r* Design Flow.(imn.required) %- q 10 gpd Calculated design flow Design flow provided gpd � r '°Plan: Date r V Number of sheets Revision Date „. Title ShkS1 'P �� ?P�C�>&C 'i �4 t� 4..� S�G�t1C'�'") 6 1 Description of Soil(s) S taPa�l� � � P" 1 C.` 1 C(761`�41 S S`1" .y1n r }�� Date Form No. Name'of Soi l Soil Evaluator- valuator k. DESCRIPTION OF REPAIRS OR ALTERATIONS ' � � �'`'�"�r�..Yu1 "T'"�1 L.)�'�I�..,+�,t��C:l�.,� I�� "2.fi rir1 � � � "...b�,r'�d JI�••.' The undepsi'gn agrees to install the above described.Individual.Sewage Disposal System in accordance with the provisions of TITLE 5 and ` further agrees _,to ot-toiplace the !W n in operation until a Certificate of omptiance has been issued by the Board of Health. Signed• 1M,.. Date Al Inspections tYVV t Y No.��.� y w FEE ...� g Board of Health, AMCERTIFICATE Of COMPLIANCE ti. i Description of Work: U Individual Component(s) omplete System.. The inn ersigned hp-eby ertify that the Sewage Disposal System; Constructed ( ),Repaired (*;,,upgraded (M bandoned ( ) r by: �y ' . at-has been,ins talled.in.a_ccordancc with the,provisions of,310 CMR.15.00 (Title 5) and a//a``approved design plans/as-built plans relating to applicatio rN dated Approved Design F low (gpd) i Installer P _ ' Designer:. % J a r .�f I V kVq lihra"�ector: .. �. �"1�!�(v . Date: YGF' 4 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. fit- ... ,..,.y{. ,� xra :,♦��,�.,;.`.,,�, e� ' k :h". 4. �r`s, �L: � +, No. i/ FEE ` V COMMON WLAETH OF,MASSAC14USETTS Board of Health, �.?� 1"ti- MA. DISPOSAL. SYSTEM CONSTRUCTION PERMIT Permission is hereb grante to; Construct( ). Repair( ) Upgrade(to< bandon( ) an individual sewage disposal system at .� ` � � " as described in the application for I j Disposal System Construction Permit No. / dated , hProvided! Construction shall be completed wi thin Three years of the date of is 19? l local c ditions must be met. i // plForm 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA DateJ( Bo7,rd of health �J� ' INSPECTION AND ABF "E?"E':? HISTORY Name and License Number of Inspec__-- ::ho performed Initial Inspection (if any) Douglas Williams I1843 Abatement History (extent and method == ---authorized deleadin , deleader clean-up) Windows were replaced by unlicensed Paint by numbers Inc. performed lead removal on allo-1fier surfaces an cleaned dwelling in accordance with regulations. AREAS WHERE LEAD PAINT OR OTHER LEADED HAS BEEN COVERED AS A LEAD ABATEMENT METHOD. I_NITERIOR Room No. (As Indicated on Initial Inspection Report) Side Surf�oe Fixture Type of Covering Kitchen C exterior sill vinyl EXTERIOR Side Surface or Fixrure Type of Covering A all window sills and casings aluminum B all window sills and casings aluminum C all window sills and casings aluminum D all window sills and casings aluminum & &we,&fig f 5. ,;a"and a4�?zan,ura William F.Weld 096a �✓ 'Z&Z �l ' • ChUdhood Lead Governor J��,Zae ja��✓�� Potsoning David P.Forsberg �GtS t-JPUl7LCJb'P,cO Preventlon Program Secretary , O&COY�" 02,00--YV7 . SOD-532-9571 David R Mulligan 'I' DID Commisaloner av' LETTER OF LEAD PAINT (RE) OCCUPANCY (RE) INSPECTION CERTIFICATION UNAUTHORIZED DELEADING Dear Mr. f1i kkonnen Date: September 14, 1992 , This letter is to serve as not_i_f.i_cat.i-on that a (re) occupancy (re) inspection was performed_atf 522 03d Stage Rd I in the City or Town of Centeryi11e___.11'--- and all applicable common area and interior surfaces have met the conditions for (re) occupancy set in 105 CMR 460. 760 (A) . This notice does not constitute deleading compliance. Prior to the (re) occupancy ' (re) inspection, all sanding was completed and no additional sanding will. be permitted following the clean-up provisions required by 105 CMR 460. 160 (D) . No other interior abatement may occur unless the conditions of 105 CMR 460. 160 (A) through (E) are repeated. This letter certifies that on September 14,1992 —, no violations of the Lead Law exist in the interior of the dwelling unit, relevant common areas and exterior. NO FINAL LETTER OF LEAD ABATEMENT COMPLIANCE WILL ISSUE ON THIS PROPERTY DUE TO UNAUTHORIZED DELEADING. ALL OR PART ' OF THE WORK PERFORMED TO CORRECT LEAD HAZARDS WAS NOT. COMPLETED. BY A LICENSED DELEADING . CONTRACTOR AS REQUIRED IN 105 CMR 460. 110 (D) . A complete clean-up in accordance with 105 CMR 460 . 160 , by a licensed deleader (invoice for clean-up attached) was performed on August 21, 1992 , by_ Paint by Numbers, Inc. license #_ DC 000021 Massachusetts law does not require the abatement of all residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain free of violation of the Lead Law only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded materials and as long as covering forming an effective barrier over such paint or other leaded materials remain in place. See the reverse side of this letter for the location(s) of surfaces which were covered to correct lead hazards, if applicable. sincerely, nI spect DPH license Susan G. Rask # A1239 r T OF BARNS LE 2 SEWAGE ii LOCATION OR'S MAP & LOT VILLAGE XY INSTALLER'S NAME'&PHONE NO. SEPTIC TANK CAPACITY f LEACHING FACILITY: (type) _bQV W ' (size) C NO. OF BEDROOMS BUILDER OR OWNS COMPLIANCE DATE: PERMIT DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility - Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by 79. 1F, 0 LOCATION SEWAGE PERMIT NO. VVLLAGE INST-A LLER'S NAME i ADDRESS �2.5 —3el, o1, BUILDER OR OWNER DATE . PERMIT ISSUED DAT E COMPLIANCE ISSUED _� � �- xC kA a � No._L . ..... Fxs......f.. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......................................................................................... Appliration for Bhipos al Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: < ' Location-Address or Lot No. �wner Address ................•......... ....--••-----•---------••--- Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.....___________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of persons............................ Showers a YP g ---•--•-------------------•- P ( ) — Cafeteria ( ) Q' Other fixtures ...........................................--......................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityl4'.62-egallons Length---------------- Width................ Diameter...---------_-- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........I........... Diameter........-........ Depth below inlet.....4�.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ Test 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........................ a -•-•--•---•-••------••-•-•--•-•---•-•---•------••--•--••.....--•----------•......-•-•-----•-••---••.......................................................... 0 Description of Soil........................................................................................................................................................................ V ---------•----------------•---.....-------•--.._...•..---•--------------••-•--------.... -•--•--- -•. -- ••---•--•••---•--•-•••-----•---------•••••--••---•------------•---. x --•------------------------------------................................................ - ----------- U NWure of Repairs or Alterations—Answer when applicable-.--.----- o .`7`- ---•.............•--•----------------------------------------------------................--•---•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i ITLE 5 of the State Sanitary Code—The undersigne furthhe . rees not to place the system in operation until a Certificate of Compliance has been issue y>the it Sined-/- --•------ ---------------•---------- ----•----------•-- .... Date ApplicationApproved By...--• r .•.... •----•........._--•-----•...................•-•-••-••-•---••--• —.. !-- . Date Application Disapproved for t following reasons------------------•----------•-----•---•----------------------•----------------------------------------........_ . . . ••. ---•-•-•-•............. Date J PermitNo.-----•--�-------.._`_�-•----- ---------------- Issued------------------...-------- ............. Date -------------- -- -- No"..............J.:_.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.. „- ----- --•---------------• .. .4111tra aan,fur Dwousaal Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal . qTratem, .2 a d '. Location-,Address or Lot No. .................................................. ............................................. _ ..--............................................... � Ow Adressp 004 ......................................... .............................. ......--•--•--------..._._...-•-•----•--_-•-•-•---._...........---.........................._..._.Installer Address Type of Building Size Lot.................... .....Sq: feet U Dwelling—No. of Bedrooms__.................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ______________............. . of persons____________________________ Showers ( ) — Cafeteria ( ) PL4 P Other fixtures _----••-••------••-••-••-•----•••. •-••-•------.•-------------••-------•-••----------___-•-------------------------•------_------------••-•---- W Design Flow:...........................................gallons per person per day. Total daily flow............................................gallons. . WSeptic.Tank—Liquid capac(tT _____gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ............._..... Width.................... Total Length.................... Total leaching area_____.______________sq. ft. Seepage Pit No..................... DiameterY.._____.____.__ Depth below inlet*___...__________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test 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........................ -----------•------------------------------:......................... ---................................ -------•---........--------._.....-•-•---------- --- O Description of Soil...................................-------------------------......-•----------------------------------•----------------------------------------------------------•.••--- W U -----------------------------••-----------••--------•------•---...-----------......---.....----•----••----•----------------•--------------------•--•---------•--•-----------------------•----•-•--•-•-•. UW -- -------------------------------------------------------------------------------------•--- �7 ature of Repairs or Alterations—Answer when appli e._- a,ev '7� �� ___�__t,... �� --_- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is i9d by t ei b f li Date Application Approved B __..:.. :-•-------------------------------------- --------- -_--------•---------- ------- Application Disapproved r the following reasons:----=------ = i ..........................................................---...--•---------------•----------•-•-••-••-•-••-----......•• •----•......••-•-••------•---•. r� Date Permit No. L2..: :' ..... Issued. `.�.� ?nice ----------------------- THE C8M,M,ONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF . .:��pr��f�lctt�e oaf (�unt�rlt�anrr THIS OOV A TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairedJ"Ae ( `) y ----- -•-- .------ .....• -_-----_•-•-••-•••-•••--....•-•••-•-•----•............................•......... .........--••-_-_•----•--•--•--•- `� ' /"g / r Installer has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----<2- -:_. -4 _____________ dated......�5._:JR._:'9-_................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTAUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... .•-.. ... .................................. Inspector--••-- ............................................ THE COMMONWEALTH OF MASSACHUSETTS -- BOARD OF HEALTH 9 .........................................OF..........................................................................._......... � ..... Disposal Worb TonotrnrtUan anti Permission is hereby-r9ra 4 Al... �: �� r� -------------•-- -----------------•.................................. t st�uct ( 0 it ( ) an Individual Sewage DisposaNystem ram.. Y P ^Vw allo.. 1.._..00�..........- �--•----••--------•--.-------- ------------ •------ ---------------------------------------- ------- Street as shown on the application for Disposal Works Construction Pe ate _______ _ ."r••---•---•-•-•-----•-•-•-•-----•--------------•-----•------- 'Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON GENERAL NOTES: _ -�-by o� �ov��,T�o+ �+s o u-2g-r rE� SOIL TEST PIT DA TA' J. Tr IS PLAN I S F3P 1"N ANLI 1.�. � )0• D �EAT ELEYN T�'ONS.' A v�1El;EY. 9�•°10 T.P. -2 CDNSTRUCT.ON OF T.YE SEl✓4GE DISPOSAL � �S1 y�� GRND. ELEY FACILITY L?NL Y. INVERT AT BUILDrNG R. ALL `CONSMICrION XET/099, MATEr Y4LS AND INV.CRT IN. AT SEPTIC T.!NK ,26 MAINTEn:4NCE' FOR THE sepYrC SYS"E/! SHALL INVERT OUT AT ssp Ic T4NK' �? 01 ACCESS comsgS MUST BE MITHIN 6 ' OF FINISH GRADE. CONFORM W MASS. D.E.0.E. TITLi 5 AND LOCAL a — F 1.F.,r 1$�, 6 yQ� . BOARD OF HEAL TH Rffior LA 7I0NS. INVERT IN AT DIST. BOX c1 6. 7 OA R .� •9 _ INDl CA TES (0."1 D T•3 :� R PE . TEST 3. ALL SEPTIC SYSTEM COMPONE71TS SIBJECT TO INVERT OUT,AT DIST. BOX q i.'tA V,- L• a-7. 6 O VEHICLE LOADING (I.E. UNDER ORIVEHAYS, ETC. INVERT IN AT S.A.S. 9 6 60 ; MIN. 2 OF SHALL BE DESIGN ? TO 1rITHSTAND'H-20 LOADING. 1�'� i o 4 !/8'-il, ' DIA. BOTTOM OF S.�/,S. , 4 11IN. I t o �o o MASHc� STONE INDICATES 4. ALL SEh'ER PIPE SHALL BE SCHEDULE 40 OR OBSERVED Gf CXfi7DMATER •9�' i o D D, i OBSERVED r� I,0 Q 00 APPROVED EDJAL !0• ( `+ DIST. t� GROU'UDYA TEA ADJUSTED GROUND!✓ATER q O. W r /4 1 1/2 DIA. p D BOX W W h'ASHED STGNE 5. 8-800 322 44844 FOR NLOCATION 0 CALL DIG SAFE ""e'f Sr TIC TANK N t Q UNDERGROU1D UTILITIES. ,Gd INDICATES I - _ ._.._ :.. ._. P. '1 C_TAT z !�-BGLY TO BE S�'T 7W A •` u' H TEST PIT G' BED CF C ACM CRUVED SY YE. � � µ � �6. DATuM IS �c5SL31►��'C,'V PRC-6C7 �k �( I Z 104—f L VTAACTGi9 TO HATER TEST 0- 3.4 TO f'AOP. S.A.S. ? �? 7. NO DETERMINATION tAS BEFY MADE AS TO.COWL1ANCE ��l'., N SPIV �. x _-_ __� -2 4 L KITH DEED RESURICTIONS 0,9 ZONING REJLATIONS. N' 6 y ��buvW��F'� Q �(� �� IT SHALL REMAIN THE Oh'NER'S RESPONSIBILITY TO g -bS"V$11AN�Ca-�'T _--__. _ ' OBTAIN ALL REGUIRED PERMITS, SPECIAL PERMITS, t 1 DATE m C'T' 7.001 VARIANCES, ETC. FOR THIS PROJECT. d m iN,S K . . vtl�•'L•L S'D1+�1 2 5`Z Z•� ' ®. IT SHALL REMAIN THE Dl✓NER'S RESPONSIBILITY � _.._ .._�. VISA i>� �5�� TEST BY. _R_�A�N�� TO HAVE THE PROPOSED DMELLING FOUNDATION - - __:- ___ �.) •..� g6� vim'• E R G�.u•*i klTl►EBBED BY. 8 , At AN9 SOIL TO ACCOUNT FOR THE 00AUING GRADE Depth from Surface Soil Horizon Soil Texture Soil Color ZOi.�� 19 AND SOIL CONDITIONS AT THE LOCATION OF THE PROPOSED DIYELLING. PERC. RATE ' S MIN./ IN. (inches) USDA) (Munseil) AVT\>S�v1C15 So-swr �'. T"�3-•1 S ).O'� 15 �s o"S L b G�--T��'7 1 S 2.'7�� to ZO�� DF C1J1..5`CR�BU't'1U� `To ,R- PuZzrlc v�7wT .� sv LY .. `` S, ✓r OA'�L 23 DESIGN 071TE17.1A. 3 ��CtS�'1�1 BSc,TaRD41►nS As-OD P�oQostiv F3�-vs�onM G.W. S L g 6 .01 • 4J DES GW FL 0,Y /Q�{ t �}}" ` /� � � / "b�VS`T" •.D %31 BE11,900M 0#YELLING P 110 GAL/DAY PEF BEDROOM OM W ,E L 0 GAL.S. EOUAL c a-� "' PEA DAY. SEPTIC TANn; RFGUI17ED. GAD X 2001 a S Q GAL. SEPTIC TANK PROVIDED' _ 1 S O O GAL. me 1114 D /Pv h 6 ;� SIZE OF LEACHING fXCILITY REOUIREO r GALLO,US .R AY PE D SIZE OF LEACHING FICIL,TTY P.G.�VIDED. 41 _ +� 5 ' �C$Y cauca.�.-re. � "� ; 4ao sAL� g c f �� Lp W I•fA 4 -�o�cr eAGu l ` SIOEW L L 1 Qi b S.F. X O."i "i4 sc BOTmv! _ S.r �7:7 i,PG TOTALS Z - C.F GFG ;;�� - / / ;1A Zoe ,�c�,oisesp �'��. S •.�. �,', �y�,w �� ao ERPA IL 111. r .I h11C1-tN :V'!IC e� .. REVISIONS*E-xlr 'ti 6 R. IL 4 { NO. DATE REYT,970Y r7�MOV�, L��1 Q1�- �, �4 <�c.� r � �� `�� T1�V��7�i i/��1.4.��"'�� V(J��.��"l�•, �! sfcvnG T ,.►x 178.22 q - OFESSIO L ENG EA 'Pita?0901T7 } 5z� DAE °1`71S"r. CbsurOUIP F'f��Q. GbAsT Q 2Af* .� S• 4? , c,� °; 7 PA UL c R R. sm LL B.M. 0 0 0 N A 0 w 5n a No.32448 Q $ w • . ' � �o � PLAN _:SHORING A PROPOSED UPGRAG�E TO AN EXISTING SUBSURFACE SEPTIC DISPOSAL SYSTEM q-i --L O _,. �� LOT .� OLD STAGE ROAD, BAF�NSTABLE., MA 1703fI- ..�,F OCT08ER 9, 2001 SCALE 1 " 30 ' ,? OFESS ONA LAfG 19bPYL jR CANAL LAND SURMEYING 160.33 9k� 306 OLD PL MOUTH ROAD SAGAMORE BEACH, MA _- _ RA TE PROJECT NUMBER 01-094