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HomeMy WebLinkAbout0138 PHEASANT WAY - Health 138 Pheasant Way Centerville A=208-139 l E `I,-- IFpCo^ llll UPC 12543 N3.53LOR HASTINGS. MN it : .... .... _{ {_1 , _ __. {. . _. I 1 i -8 ..... .. L..... lm ........ df ; . : . r wj f I t ? : l i I I I `,. i .... ; ; ( I i.. ; [ 1 .... ........ ...., .._... ...... .._.......r ......_........ - A � {�� R o0 1 � � _ -SAT �__. EG _ �pA'h I E _3 _ .. - _.-_ _ } 1 } 1 , , ; ? 3 , DATE: �4 01------ - PROPERTY ADDRESS; 3$ Pheasant Way -- Centgrry.L ,le.�s------ � 'vT — -------- On the above data, I Inspected the septio system at the above address. This system conslsts of the following; 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. G G / 5 3 . 1 -1000 gallon precast leaching pit. 0 6 eased on my Inspectlon, I certify the following conditional. 4•. This is a title five septic system. ( 78 Code ) 5 . The septic system is in proper working order at the present time. 6 . Pumped the septic tank at time of inspection. There were heavy scum & solids layers. 7 . The leaching pit was dry at time of the inspection. SIGNATURE,, _.,C:. Name ;_,1,_P .M.oSsmtat.,L �_-_-_ Company; Joae�h_P _ Necomb.r_b Son , Inc . Address Sox 66 RECEIVED-------------------- __CanterviI12L Ha__02632-0066 JAN l 0 2001 Phone:--- 508-775_3338------- TOWN OFBARNSTABLE• HEALTH DEPT. THIS CERTIFICATION OOES NOT CONSTITUTE A OVARANTY OR WARRANTY J6SEPH P. MACOMBER & SON, INC- T+nki•C9+spools,Lsachf kids Pumpsd & Instsllod Town sewer Connsotlons P,O. Box 6775,J338e�77, MA 02632-0066 3 ,per T \ 'CO MMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1 38 Pheasant Way Centerville,Mass Owner's Name: Mary Flanagan Owner's Address jQZ A, 1yoard Place South Hadley,Mass. 01075 Date of Inspection: 1 /4/01 Name of Inspector: (please print) Joseph P.Macomber Jr. Company Name: J.P.Macom er & Son Inc. Mailing Address: Box 66 Centerville,Mass.02632 Telephone Number: 5 0 8—7 7 5—3 3 3 8 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). The system: ZE/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: W The system inspector sha ubmit a copy 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 the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 1 -r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 138 Pheasant Way Centerville,Mass. Owner: Mary Flanagan Date of Inspection: 1 /4/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A System Passes: _4,�O 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: NONE B. System Conditionally Passes: _l,a One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes. no or not determined (Y,N,ND) in the for the following statements. If"not determined" please explain. A110 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 Health. '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. 5 ND explain: _i& Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed 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 ND explain: 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 obstruction is removed ND explain: 2 1 c 1 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 138 Pheasant Way en ervi e,Mass. Owner: Mary F anagan Date of Inspection: 01 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(l)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: AJ,0 Cesspool or privy is within 50 feet of a surface water 2D Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 public 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 supply or tributary to a surface water supply. V0 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supple. Ab 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 supple well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate 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. 3. Other: �i �r1�C•• 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 138 Pheasant Way Centerville,Mass. Owner: Mary Flanagan Date of Inspection: 1 /4/01 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no" to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to 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 distr}}�lution box above outlet invert due to an overloaded or clogged SAS or cesspool !-,tea4c�►;N� /,,+ ( or 7 Liquid depth in sesslaeal is less than 6"below invert or available volume is less than '/,day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped jL. Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of 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. _ y portion of a cesspool or privy is within 50 feet of a private water supply well. y 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 if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate 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.] _(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. 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 a 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 / the system is within 400 feet of a surface drinking water supply Al<e system is within 200 feet of a tributary to a surface drinking water supply _ ✓the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— I WPA)or a mapped Zone 11 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 threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 r Y Page 5 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:1 38 Pheasant Way Centerville,Mass. Owner:Mary Flanagan Date of Inspection: 1 /4/01 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health Z"Nere any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period ? ZHave large volumes of water been introduced to the system recently or as part of this inspection ? — Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? — Was the site inspected for signs of break out? Were all system components,,.@"Iuding the SAS, located on site? — Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum ? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no — Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)J 5 r Page 6 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 138 Pheasant Way en ervi e,Mass. Owner: Mary Flanagan Date of Inspection: 1 4 01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): J_ Number of bedrooms(actual): / DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x # of bedrooms): 5 XI)hC�� Number of current residents: 0 Does residence have a garbage grinder(yes or co ._ Is laundry on a separate sew, a system (yes o no _ (if yes separate inspection required) Laundry system inspected a or no): Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): pvawlQ Sump pump(yes or no): Last date of occupancy: — COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): elf Grease trap present(yes or no): M Industrial waste holding tank present(yes or no):V Non-sanitary waste discharged to the Title 5 system (yes or no):'J& Water meter readings, if available: A& Last date of occupancy/use: A.)X OTHER(describe): �f�1 GENERAL INFORMATION Pumping Records Source of information: 7/ —/�� /Ly�J .� 11 zi 14� Was system pumped as part of the inspection(yes or no): Vlor— If yes, volume pumped: ego gallons--How was quaintt ty pumped determined? �pJgs'LJ/^t Reason for pumping: S'Gdn1 f c elr TYP7 OF SYSTEM Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool V Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) /OInnovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) I(ID Tight tank 11 Attach a copy of the DEP approval /Other(describe): 414 Approximate aee of all com onents,date installed(if known)and source of information: I OF Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 138 Pheasant Way en ervi e, ass. Owner: Mary F anagan Date of Inspection: 4 01 BUILDING SEWER(locate on site plan) u Depth below grade: 2— Materials of construction: qacast iron 240 PVC mother(explain): ^i,4 Distance from private water supply well or suction line: /0`A Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight,No evidence of leakage, System venteq through the house vent. i noe Q,4W 4 SEPTIC TANK:v"' (locate on site plan) Depth below grade: oi Material of construction: metal Na fiberglass.VOpolyethylene /✓Oother(explain) A/y If tank is metal list age: 41,4 Is age confirmed by a Certificate of Compliance (yes or no):.fO(attach a copy of certificate) Dimensions: Sludge depth: d Distance from top of sludge to bottom of outlet tee or baffle:—� Scum thickness: _0 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto of outlet tee or baffle: Hogs were dimensions determined: un� 'e2- ":6r Comments(on pumping recommendations inlet and outlet tee or ba a condition, structural integrity, liquid levels ,as related to outlet invert, evidence of leakage, etc.): Pump the septic tank every 23 y ears_ ' Tnl Pt & n,tt 1 Pt tees are in place,The tank i_s sf-rnctura11v _so_u.n.d_a.nd shows—ns evidence of leakage. GREASE TRAP:,IIL(locate on site plan) Depth below grade: Lvj Material of construction:A14concrete,&ymetal;/ fiberglass gpolyethylene4401other (explain): /Urw Dimensions: A14 Scum thickness: it// Distance from top of scum to top of outlet tee or baffle: NiO Distance from bottom of scum to bottom of outlet tee or baffle:-/`lk!g Date of last pumping: &W Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present 7 ` Page 8 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 138 Pheasant Way Centerville,Mass. Owner: Mary Flanagan Date of Inspection: 1 /4/01 TIGHT or HOLDING TANK:.NJ4 (tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: AJA Material of construction: do concrete metal ND fiberglass j/y polyethylene other(explain): Ah$ Dimensions: Capacity: 41A gallons Design Flow: XM gallons/day Alarm present (yes or no): Z- Alarm level: A)/j Alarm in working order(yes or no): IQ4 Date of last pumping: /V14 _ Comments(condition of alarm and float switches, etc.): Tight or Holding tanks are not present DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distrihtitinn how has lateral No evidence of solid carry over.No evidence of leakage into nr ni,t- of the hnX PUMP CHAMBER:(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Pump chamber is not present. 8 Paee 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 138 Pheasant Way Cen ervi e,Mass. Owner: Mary Flana an Date of inspection: 1 4 01 SOIL ABSORPTION SYSTEM (SAS): _JZ(locate on site plan,excavation not required) If SAS not located expl why: rest/ T LY V' LA,&Wi Pit is drV Tv e leaching pits, number: leaching chambers, number: AA leaching galleries,number: leaching trenches,number, length: 0 i leaching fields, number,dimensions: n 29 overflow cesspool, number: 0— _&0 innovative/altemative system Type/name of technology: 4z Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand to medium fine sand.No signs of hydraulic failure or ponding.Leaching pit is presently dry Vegetation is normal . CESSPOOLS:/I,&L(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cesspools are not present. PRIVY:/�(locate on site plan) Materials of construction: 4Z4 Dimensions: Depth of solids: 4M Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present 9 lgage 10 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 138 Pheasant Way Centerville,Mass. Owner: Mary Flanagan Date of Inspection: 1 /4/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. , 3Z !V y 10 LO ATIO SEWAGE PERMIT NO. VILLAGE C _ L.-1,7/1 INSTALLER'S NAME & ADDRESS �\ o U I L D i R UR GWWER DATE PERMIT ISSUED DATE ; COMPLIANCE ISSUED I i I i J {� . c'[; rrE t i i Page I I of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 38 Pheasant Way en ervi e,Mass. Owner: Mary Flanagan Date of Inspection: 1 4 0 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: fC�hecked ained from system de ' s on record- If checked,date of design plan reviewed: - —derved site(a utting roe bservation hole with' 150 feet of SAS)cked with locaof Health-explain:with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used Water Contours Map. Gahrety & Miller Model 12/16/94 11 y••nr�r+�nr�rr' 'rrr mr•nrRrrrtr•rnr.rerr.:•.�rre�wr:t+r-+-r.•n nsrti+nar�rrsr.'+s+ .�.��^�._ _. ._...' 1 'TOWN OF Barnstable L10ARD OF HEALTH SUBSURFACE SFWACE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I .•••T••••.•..—r.1i1.^.-.T.T.!'T11•t1.TT1TT1tT1fTTn:rat'1+'RtfTR't7S'R1rT'ATI'1'R'OIR RPRIIRI'i'tA'}T� IRifnTiTJ�RTO�TI"�fTT.—.rrrr � ._../1 —TYPE OR PRINT CLEARLY— PROPERTY INSPECTED STREET ADDRESS 138 Pheasant Way Centerville,mass . ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Mary Flanagan PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J•P.Macomber & Son Inv: " COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State E I P COMPANY TELEP14ONE ( 508 775 _ 3338 FAX ( 508 1 790 _ 1578 q CrRTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa`1 system at this address and that the information reported is true , accurate , and omplete as of the time of :inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check ne : r .� System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to Protect the j)tlblic healt1i and the environment in accordance wit), Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date ne copy of this cer .ification must be provided to the OWNER, the BUYER ( where applicable ) and the DOARD OF H EALTII. * If the inspection FAILED, this owner or""" ` erator shall up grade 'pgredo ' the ayetem wir,hin one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 . partd . doc AT III SEWAGE PERMIT NO. rill ,%/.e a INSTA LLER'S N/A ME i ADDRESS �i h e U I L D E R OR OWNER L�✓.�l' I�Y�l�1 �G lam' . DATE PERMIT ISSUED '. DAT E COMPLIANCE ISSUED - /� -ice - �� t t 32/ A.6 o r 0 .............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .......` 10W10...............OF... fR1V��i`f 4�!a.---------•---...-•--------.........-......_- Appliration for Ui ipasal Iforks Tomitrnr#iun ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: c ....... _..:... . s W ........ twy►Ar-......................................................................................... Location-Address or t No. 9�,J na �.l`_..>_.��.&5U. �.�.��?....0 ilvu E....... .�� Owner Address w a J® �?...._�_....Ps -' _..... ._...--•------ •-• ----`--rVm__... '� d.: . Installer Address Type of Building Size Lotl ft QS3__...Sq. feet ..� Dwelling—No. of Bedrooms.......... ...........................Expansion Attic (W Garbage Grinder (v� aOther—Type of Building 1�.P�&31UA.._.-.-____ No. of persons............................ Showers ( ) Cafeteria ( ) Other, fixtures \...%P1"Tt i-----_------------------------•---------------------------------------•------------------ •-------------.........---- 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 by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......-................. 9 •-•••---•••••••••••-•--••-•-- -•-•••••••-••-•••--••-••••--...•••-------...-••••-----•-----•--•--._...--•---------•-•...............•---•---••-•--------_•••-- oDescription 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Vissued. Qboaarrd,of health. ,�/�� II to Application Approved By.. _ � � ...._.. Date Application Disapproved for the following reas ----••---••-•••••----••---•---•--•---•-••---•••---•-•----•-•••---••-•.._..•-•••-....------ ...........................................•---•••-•-•-•--•...•••---•-••-......_..••--••-----••-•---...--•--•--•--...-_.•••••-•-•-•-••••••--•••-------••••-•--•••------••-- ••••----••••--••••:--------- Date PermitNo........................................................ Issued------...--............................................ Date -' S , THE COMMONWEALTH OF MASSACHUSETTS Fizz.............................q 7 BOARD OF HEALTH ................0F.. �a S ' y�. ............................................ Appliratiou for Disposal Works Tonstrnrtinn Verntit Application is hereby made for a Permit to Construct) or Repair ( ) an Individual Sewage Disposal System at •------------------------•--•----. . -------•-------..............--- • Location-Address or L t No.. . --. Owner A dress W r Installer Address Type of Building ; , Size Lot...... .....Sq. feet I-I Dwelling—No. of Bedrooms.......... ..........................Expansion Attic PJ 7 Garbage Grinder !(U cl aOther—Type of Building Rt4Ar,�----------- No, of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . .I.. P-C.Vt!_.. r'.. 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 ( ) aPercolation Test Results Performed by......................................................................... Date....................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..---...........---.---. 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....--..........--.---. a' -----------------------------------•-------•-------•---••------....------._.................._---_--........................................................ 0 Description of Soil................... x V •---•-•-•---------•.......---•--------•-------••---••----------•---••••----------•------------------------------•---------...------------------....-•------•-•-----.......------------•-----•----------- W x •---•-----------------------------•--•••------•----•----------------------------•-•--------•-----•-•-----------•--••---------------------•--------------------------------•••--------••--••-----•------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------•------------------------------------------------•--•---.....--•---------...--------------------------------------------------------------------.........-•---...---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the 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 ba issued,by fj board of health. jab me •rsA / Date Application Approved BY = A._.. -�..r_7�... . ------ -- ----- ---------------- L f`� .......-- Application Disapproved for the following reason:.�...................................................... ..Date......------. .......................................................................................................................................................................................................... k Date PermitNo--------------------------------------------------------- Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................I..........OF..................................................................................... z (Irrtifirate of Toutp iatta THIS IS T ERTI Y, That the Ind vidual Sewage Disposal System constructed ( ) or Repaired ( ) by............... - ---•--•--------------•------------•------•-- ------------------------•---•- nstaller has been installed in accordance with the provisions of TILE �,�r` of The- State Sanitary Code as described in the application for Disposal Works Construction Permit No......- 7'n--_- 91.--.._... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................ e•---....='-=-?7......................• Inspector...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH } ......................................OF...---------......................---....---........................................ FEE...... ............. Dispoli l u k pan irnr Ilan rrmit Permission iS ereby granted----------------•-•-ef = ^' = to Construct �r�,,o»r.Repair ( ) an ndividual Sewage Disposal Systems A at No............-sr.�. �. �/ ................r -----------�= - Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated.......................................... ----•----.....---/0-- .....------------------------------------------------------•----.....-------- X' Board of Health / DATE................................................................................ FORM 1255 A. M. SULKIN, INC.. BOSTON PLAN REFERENCES: all eO n ASSESSORS MAP 208, PARCEL 139 A/N ST PLAN BOOK 195, PAGE 1 LOW S �y F PLAN BOOK 236, PAGE 73 u PLAN BOOK 236, PAGE 75 F w w PLAN BOOK 122, PAGE 97 S to � � F wit ` V F � ASSESS. MAP 208 y CENTERALLE, MA q PARCEL 138 KEY MAP Doti � Q�o.�op NO SCALE 5 CRC W•W. A r_` Con ASSESS. MAP 208 PARCEL 69 .L I HEREBY CERTIFY THAT THE EXISTING q �, sc DWELLING SHOWN HEREON IS LOCATED AS IT W Z Z Ekt o�sc �o� EXISTS ON THE GROUND. FW a DATE EXISTING SEPTIC SYSTEM LOCATION \ q OF o P.LS q o JOHN � EMAREST,JP, N ti� ,o No. 36859„ V) Ei N �o��� / lyp�Fssx0 W �" LOT 4 "OsuRv;E�a C7 3 AREA = 11,1170 f S.F. PLAN BOOK 195 PAGE 1 ASSESS. MAP 208 ASSESS. MAP 208 PCL 139 PARCEL 141CD p�Oti MM wd ^, v ASSESS. MAP 208 N a M PARCEL 140 � N 0 PLAN 20 10 0 20 601 E-+ o � � i inch = 20 ft N � � gggi� W U- CL LU nl U CV F. QL z lu 14'-O" 11'-O�� } e e R.O.2'-2 x 3'-416" R.O.v-8 x 4'-416" cq . -; TW2032 TW2042-2 1: L U 0 T C T 0 z` 3-Zx� wow ~ . II N o m N z ATHROOM PROPOSED RE EATH , w�'�- ry QUJI �W- - Q cb PROPOSED UNFINI ED BONUS ROOM O d O " x I Nt Z 0 x I ,I BEDROOM *3 H,4LL 1 - BEDROOM 02 Q --� DOWN � x B 2xS CEILINCs JbISTS �+ 16" o.c. '' O CREATE OPENING TO Z 'O ° u ACCESS NEW BPAGE - ❑ [, 46 O CV-' o O 1 i ge (3) �Z Clu`r✓�`fS Z . LU 5.M c ( r a ccq i \4 f ' 4 EXISTING2ND FLOOR PLAN TO REMAIN AS IS PROPOSED AREA OF ADDITION TO 2ND FLOOR `O U . , cn Z ¢ cLU U s f t rNo.34774 OF Mq "QC+ �CHEO y�tp UDIL p f— ZSUCTURAL W O U cp (� REG! U Z F- �i U j s. srpNptE oC X N X Q ' � w 713i7- UU w U g ,2� - 1 - v p C 8 VIE 10000 I SCALE:114,LrI 161 APPROVEDBY: DRAWN BY DA:fi: REVISED DRAWING NUMBER 1t%7t P tKM oN%0.100 CIEA MjW. � _...m,...�......�....._.�.�...�......_a.W„_.,.,.,...._,...,......_.•.,.,,�...,.�.w�?v��4Y....�..,.�.�.....,�,...�..._..,... �xy Ud!1 Ld J 7��;�r_G d...f�.. ,�� '"'_..."., Q-- 7:x s� ./ rye(/.� ,.1 t�I J�16l.1 J�s Q�(J/'n�..� ��•-- -. :.,t 1• ! p ,.� — ___... •».,-..-•�—�__..+._ �I�fFTIIi'11+r �ll>I W6fn��(/6,JiIlA�'��MN`� � •1 (+y'� / _�_..__._ '� 1 FA(] kl � c=•ir41',rk'.��.I ,��4iLli•7AL�r cXlL�JAtJFr. �2RATHti s s � , , q -snt;;- CX{J_��t�"a�K�,l„lG�.�t[•6�, r�v,_ 1��`' F C_,�Cle�("da,1V�lM_.(_.. 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I UA]FI ,I c�N E �53t" "<.-r ORN t Ail ! 1P t tR q t 8 I�p ,r ' I p / , 71 SCALE: ,!/ '.' f ,N APPROVED BY: DRAWN BY HATE: REVISED "I Aij ;!h.!:�� ,:�r,, '1• �. �'rye DRAW iNNG'NU MDER 1E It2! MWEOONNO,MMCL ANPRMT• GENERAL NOTES: _�a LOCAL.BUILDING CODES SUPERCEDES ANY AND ALL ~"-""�'- '� -�•'�"" '�'�".--'',*""+"� = '' DRAWINGS AND SPECIFICATIONS • ALL DRAWINt.cS MUST BE CHECKED BY THE BUILDER ' PRIOR TO CONSTRUCTION AS TO ACCURACY REGUARDING I I MEASURMENTS SPANS AND.DEMENSIONS DESIGNER IS NOT RESPONSIBLE OR ACCOUNTABLE FOR 7 ANY ERROR$AFTER CONSTRUCTION HAS BEGUN. I !• ALL GRADES,LEVELS AND STEPS FOR FOUNDATION MUST W ESTABLISHED AT THE JOB SITE BY THE BUILDER PRIOR TO CONSTRUCTION. • THIS HOME IS FIGURED ON EAST COAST LUMBER SIZE 1' r-•(- AND GRADING RULES ,�Yk�Jifa fl M pp• ALL FOOTING SIZES SHOWN ARE FOR IDEAL SOIL CONDITIOPS E i ALL KITCHEN LAYOUTS ARE LST"ATED,BUILDER TO CHECk -P f ALL DIMENSIONS PRIOR TO ORDERING KITCHEN CABINETS ' ALL FLOOR JOIST RUNNING PARALLEL TIP PARTITIONS ARETO 7E DOUBLED UNDER THOSE PARTITIONS AND AT EACH EN!a \ r• !„: • FOUNDATION WALL HEIGHT TO BO ADJUSTED TO FIELD CONDITION ' ALL ENCaI7,lEeRED LUM>�ER SPECED 16 TO BE VERI-TIED AS Ely SUPPLIER, =QUIRICI� I �/ ,ter •--- i 3'�� -__—_.__ ._..._ 5 F/�.1 .... _ _......._._._....___.._,__;__. ' , �"_ i% �'oe"`Z� - ri II.J�� �y(•' _ �or.s�"Fx.i L"Ya_-�I';. � �I ,I , �...—tlnaCsi�,;-IC� 1 "1_ 'tP> i,�.( {✓//s fl i� �p/5 I vm,,. 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