Loading...
HomeMy WebLinkAbout0031 SCUDDER BAY CIRCLE - Health 31 Scudder Bay Circle, Centerville A= 188 - 095 Said �� UPC 12534 No.21�OR �,,, r* HASTINGS MN TOWN OF BARNSTABLE LOCATION SCuAd � SEWAGE # P7'9 VILLAGE( �c' le- ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE SEPTIC TANK CAPACITY --0O ��Qr LEACHING FACILITY:(type i/ (size)' Xg NO. OF BEDROOMS _PRIVATE WELL OR BLIC WATER BUILDER R OWNER i DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ear r :3qr' ," h/ TOWN OF BARNSTABLE ';.00:A'11ON 3/ 94,,-e X 9,aL SEWAGE # VILLt.'GE ASSESSOR'S MAP & LOT Bfs cf sr- S NAME&PHONE NO. // /7'/GL iC QL 33 3k SEPTIC TANK CAPACITY /ScvO '4 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS R OWNER PERMI'DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility a O 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 leachin ac'hty /J Feet Furnished by �� � �"� i ��Q �_ .�""' �F �� • �1 ���, N r O b II �� h • u l� �� �T No. 7,oN — 7-7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Misposal 6pstrut Construction 3permit Application for a Permit to Construct( ) Repair t Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No ( Ow er's Name,Address, d Tel.No. C 1 R<< G CT 6/owAY r'o �T Assessors Map(Parcel -- 095, I I`le�Name Address,and Tel.No. C,�— q�y �� Designer's Name Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms p4A Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) or gpd Design flow provided N�} gpd 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) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance a afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and of o place the system in operation until a Certificate of Compliance has been issued by this Boar f H th. 7Signed Date Application Approved by Date II Application Disapproved by Date UI for the following reasons Permit No. Z�6 f Date Issued Z17"I zo G No. �� 0Z� '� � Fee THE COMMONV)/EALTH OF MASSACHUSETTS Entered incomputer: ✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitatlon for Disposal 6pstrm Construction 3pPrmit Application for a Permit to Construct( ) Repair i Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3 IRC s r �rj Owner's Name,Address,and Tel.No. Assessor's MW//Parcel IRIller's Name,Address,and Tel.No.�'N_ 9c� Designer's Name Address,and Tel.No. I J DT h �� c�SIC/8✓�o�"%GtJ Type of Building: N Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) tjo'. gpd Design flow provided NIl} gpd 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) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance a afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and of o place the system in operation until a Certificate of Compliance has been issued by this Board f H th. AMP) Signed Date Application Approved by Date , .Application Disapproved by Date tVfar the following reasons Permit No. 7o16—dZ5- Date Issued 712 Zol --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS U� Q G� Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by 72� )(Z /I l- at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7 ),-p2— dated Installer Designer #bedrooms A141 Approved design flow AK gpd The issuance o this jermit shall not be construed as a guarantee that the system w', funoti n as desi ',7np (` Date Inspector / / (�,, J --------------------------------------------------------------------------------------------------------------------------------------- No. �/ Fee$ 95 •' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *pstpm Construction Permit Permission is hereby granted to Construct( ) Repair(L-< Upgrade( ) Abandon( ) System located at �j_1 —r— 9A T-l L 7_�:' ////L i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. I i Provided:Construction must be completed within three years of the date of this permit. Date Approved Approved by AsBuilt k Page 1 of 1 (i1yp&e— 101, /M 7 TOWN OF BARNSTABLE LOCATION 3/ 544�--,aora 1/17X SEWAGE# 213-C7k VILLAGE 4V 41roe d,L` ASSESSOR'S MAP&LOT �cfi 5' IN& S NAME&PHONE NO. A/ //&Z-�d SEPTIC TANK CAPACITY /5c47 �✓�4 LEACHING FACILrN: (type) (size) NO:OF BEDROOMS, `r B;MMW,OR OWNER i°`i Rim r --- PERMrr DATE:_1 `j/S 3 COMPLIANCE DATE: fC/5 Si Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility °�co 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 leac ng ac'lity� /J � Feet Furnished by / I Cs�a 6 O t a http://issgl2/intranet/propdata/prebuilt.aspx?mappar=188095&seq=1 2/2/2016 r CERTIFIED SEPTIC SYSTEM REPORT ob p A LOCATION I tC IVU 31 SCUDDER BAY CIRCLE cc OCT2 8 1997 CENTERVILLE, MA 02632 �, joHEq�H�lABlf coMAP 188 PARCEL 095 DL 33 & 34 S � PREPARED FOR I� SELLER MR. R. RICE 31 SCUDDER BAY CIRCLE CENTERVILLE, MA 02632 BUYER MS . EILEEN GAENY 31 SCUDDER BAY CIRCLE CENTERVILLE, MA 02632 PREPARED BY HILLIARD HILLER P .O . BOX 250 CENTERVILLE, MA 02632 508-778-1472 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ,kq JF_ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. NIA 02108 617-,)92.5500 WILLIAM F.WELD TRUDY CORE Govcmo: Sccrctarg ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION Property Address: 3i SG v©,l��R 4�'Y c/✓IGG,� G f2, oOw^er. Date of Inspection: Of different) Name of Inspector: zV. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Mailing Address: 2 /s,,11+ a,7C 33 Telephone Number: 52::2$ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete'as of the time of inspection. The inspection was performed based on my training and exPerience in the proper function and maintenance of on-site sewage disposal systems. The system: _✓Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: d The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: ChecV(5)B, C, or D: AI SYSTEM PASSES: �ve not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system co 'ponents as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the repla ment or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determin (Y. N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tartlk is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance ttached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic to k, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is im inent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page l of 10 DEP on the World Wide Web: http:/Nwww.magnet.state.ma.us/dep Printed on Recycled Paper t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addre�s: Owner: �++ isa Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continu ) _ Sewage backup or breakout o high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, se led or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe'o servations: broken pi (s) are replaced obstruc"o is removed distributi box is levelled or replaced The system required pumpi g more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval f the Board of Health): broken pe(s) are replaced obstructi n is removed Cl FURTHER EVALUATION IS REQUIRED THE BOARD OF HEALTH: _ Conditions exist which require furt r evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the enviro ment. 1) SYSTEM WILL PASS UNLESS BOA D OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PU LIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is with n 50 feet of a surface water Cesspool or privy is wit in 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septi tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface ter supply. The system has a septi tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septi tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a sept tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply ell, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from Ilution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Me hod used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Paga.2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D) SYSTEM FAILS: You must indicate either "Yes" or "No" as t each of the following: I have determined that the system iolates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into acility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding f effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in t e distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cessp of is less than 6" below invert or available volume is less than 112 day flow. Required pumping re than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pu ped _. Any portion of the S it Absorption System, cesspool or privy is below the high groundwater elevation. Any ponion of a ce spool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. An onion of a c sspool or privyis within a Zone I f a public w_ — YP P o pbc well. Any portion of a c sspool or privy is within 50 feet of a private water supply well. Any portion of a sspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water uality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or " o" as to each of the following: The following criteria ap y to large systems in addition to the criteria above: The system serves a facili with a design flow of 10,000 gpd or greater-(Large System) and the system is a significant threat to public health and safety nd the environment because one or more of the following conditions exist: Yes No the system is ithin 400 feet of a surface drinking water supply the system is ithin 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any s ch system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5. and 6.00. Please consult the local regional office of the Department for further information. (roviaad 04/25/97) Pay 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address: 3/ pp.Ei2 �✓9Y !_'J•�'GG,,[' > Owner: /y X Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. ✓' _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. L/ _ All system components, eafEiuding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. f The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. i/ _ _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (ii any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 3/ v�1p ��yy _/ Owner: �y/ G�' 2GLL' jc Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: R.p.dJbedroom for S.A.S. Number of bedrooms: Number of current residents: S Garbage grinder (yes or no): V9 Laundry connected to system (yes or no):, '-S Seasonal use (yes or no):_&::!�' Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no): Last date of occupancy: .QL'SLr�?Zy COMM ERCIAUINDUSTR L: Type of establishment: Design flow: Hallo s/day Grease trap present: (yes or no)_ Industrial Waste Holdin Tank present: (yes or no)_ Non-sanitary waste disc arged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupant). GENERAL INFORMATION PUMPING RECORDS and source of information: fai ley . �/2/sy � 3/" System pumped as part of inspection: tyes or no)_J If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM L,f-5eptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components,M , date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) ' (revised 04/25/97) page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3/ SCv/✓OE/1 13/i'y C i.QG G c° c,E,v T �/G[�,z Owner: Date of Inspection: /o��y7 BUILDING SEWER: (Locate on site pl ) Depth below gra e: Material of const uction: _ cast iron _40 PVC — other (explain) Distance from p ivate water supply well or suction lira• Diameter Comments: (co dition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grader. Material of construction: i­ concrete _metal _Fiberglass _Polyethylene _other(explain) If-tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: /V`G ,r Ll �� O, Sludge depth: L/ Distance from top of sludge to bottom of outlet tee or baffle: / .r Scum thickness: !/a � Distance from top of scum to top of outlet tee or baffle:__ Distance from bottom of scum to bonom of outlet tee or baffle: /G ' How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 719.CSif',,✓l7 L9 GREASE TRA : (locate on sit plan) Depth below grade: Material of c nstruction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions Scum thick ess: Distance fr m top of scum to top of outlet tee or baffle: Distance fr m bonom of scum to bottom of outlet tee or baffle: Date of I pumping: Commen (recomm ndation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (r•vim•d 04/25/97) P&g• 6 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: ,ij��,y Date of Inspection: TIGHT OR HOLDING T NK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: I gallons Design flowjinlett gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of prevg: Comments: (condition ondition of alarm and float switches, etc.) DISTRIBUTION BOX:_v (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) G-f//9s v�o , ,e-� 6/G,v 4/,�.- G1/0's iiTlJ'l�Gi� .�'eP� �re.c T2C.�T x 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.) (rovia*d 04/25/97) Pago 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3/ $Ld0.0�/! /�/9Y C✓2GG/c' G./�v?�illiJGG,E Owner: 14-i1^ Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: /dF/4— 1?�/1S 2 Name of Technology: —T Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 7'/ 29' CESSPOOLS: _ (locate on site plan) Number and configurati n: Depth-top of liquid to in et invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction Indication of groundwate : inflow (cesspoo must be pumped as part of inspection) Comments: (note condition of soil, si ns of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: _ (locate on site plan) Materials of construction: Dimensions: .Depth of solids: Comments: (note condition of soil, si s of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page a of 10 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3/ UOO Owner:Date of of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supply comes into house) Z""< t , . I n,. o 1A t M I i I (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Pr operty As. / Owner: s G/� Date of Inspection: /r j 7 Depth to Groundwater,��tFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers J,Z'Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) Th',e SrT . /� %/yam f�T/vim, �t %iyc /vIeLTi�i��s /S ✓9�ia��Xi��9T. 'G Y S (revised 04/25/97) Page 10 of 10 I TOWN OF BAR STABLE LOCATION �j S�-u04 L 1 0 SEWAGE # 9 G 7 y VILLAGE ASSESSORS MAP & tOT INSTALLER'S SEPTIC TANK CA 'ACIT:Y ( / LEACHING FACILITY (type) idaJ5LTnCSC�1 ,(size) 7x c31 NO.OF. BEDROOMS PRIVATE WELL OR '_� BUILDER OR N:E �' DATE PERMIT ISSUED DATE' COMPLLANCE ISSUED /A/s�y ; VARIANCE GRANTED Yes .: No :.. Rear Z, ' LOCATION WT SEWAGE PERMIT N0. 31 se-Ader pAy re. -s:q VILLAGE Centro lie- A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER 31 SGttMer` AAt cL DATE PERMIT ISSUED 70&- 0,? DATE COMPLIANCE ISSUED /yj� �0 e No....3...s� Fss.. ...10.00..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......................T.Own..........O F...............Ba=s-table......-----------......---................._.... Appliration for lliipniiaal lVorko Tnntrnrttnn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: ......31 ScudcI? _.Bay--- ,,._.Csx��e�t�.11e.,..slA----.A26_2............................................................................................. Location-Address or Lot No. ...... .............................................................. 3�._.Scuddsr__Ba�t..Cr�7 .Cent>rs�ri]le,..�1A.....D2632 Owner Address a -••---A--�--B._Cessyool__Service....................................... 128.31s_hogs.....Ts-xrace.,__E.%azmis,,..AA.....Q2.601..... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.............3................ .....Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building _____________•_.__----_---.- No. of persons 2.............--_---. Showers — yp g p ( ) Cafeteria ( ) Otherfixtures ------------------•---- ....--••------------------------------------------...------------------.......-•----••............. 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........................................ W 4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -•--••-----------------•------•------•--------------••-----•--------•••....-•-------•-•••••......_..----------•...............-----------..._......._...----- Descriptionof Soil Sand------..•......................•---------------------------------------------------------------------------------------•- x W UNature of Repairs or Alterations—Answer when applicable..installat A.on._of stone -packed leach Dit (overflow -------------------------------•-•--------•------------------------------•--•--•.......---- 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 . een issued the boar f h: ` 7/26/83............ P PY .� p Application Approved By..•.----•- .....• .. ............ -------------��m -----..... ....................................................... Date Application Disapproved the lowing reasons-------------------------------------------------.............................................................. ................................. ................................................................ . -/-- Date Permit No.... 3 Issued 7�26183 . ....._ Date �� Od THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................T.oWn.........OF...............Pa=M.tAhle ApplirFatiun for Uiovoii al Vorkg Tomtrur#iun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: ......3� Scudder..;.aj.jCx,.�.. '.A.....926 .. ............ .... Location-Address c p p D or/Lot No. p�/ n .........Agnes Durkin _ ............................................... 3l.3.ousi�eS_.Bl ay.r.Z'i. ...Gen tery-illeai..YA, .....D26,37 Owner Address W A_ & .. Cssspool_geryice...........-•--•....................................... 1a�L.T: sh%. '..r Installer 00 Address UType of Building Size Lot............................Sq. feet I—I - Dwelling—No. of Bedrooms..............3............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons._•-_Z............-_..._. Showers ( ) — Cafeteria ( ) d 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 ( ) aPercolation Test Results Performed by--•----•......---••••-•-•-....•••-••-•-••---•••-•---.....--•----•--••-•-• Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lx, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..____..•--------------- W ------•-•-----••.............•-•- 0 Description of Soil....................................Sand••••---•---••....._..-----•--•--•---•••---••--•----•-•--•-•••••--•-...._...-••••----•••-•------••--•-•-----•••-......----- W x ••--••••----------------•--------•---••-------••-•-••---••-•--••-----------•-------------•--•-••-•••--•----•....-----•----••---------••--••--••---•--•-••••--•----•-----••--••-••-•---•-•--•-------•---- U Nature of Repairs or Alterations—,Answer wh n applicable..installat or_ of a__1,_000___gallop. pre-Cast. stone packed leach nit verflow . .....-•-•••-----•......-- •-••-•••••••••--------------------------•-•......-•.............................................................. 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 een issued by the boar ;of h 1'th. Application Approved By r !.. 7/2$.t83 Date Application Disapproved f the llowing reasons--------------X--------------------------------------------------------------------------------•---------•------ --------------•----------------------. ........................\.................................I.................................................................................................. / Date Permit No. -3 Issued83 -....-•---•••-_.7/26•-......-•-•---•--.......-•----•- *p Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH m t own `iarnstable OF.............::.........'......... .. ....................... € :... 'rrtifiratr of Toutplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) by......A.&--°---Des ffne,...1?.. .. :i_-�L,o.pS_.Terar-e___N3man_is-'_M&....mt ��..............•--•--._.........--------- at._31 Scudder ?gay Cr., Centerville, M Mgj� -- Ames Durkin has been installed in accordance with the provisions of TI F................................................ 5 of Th State Sanitary Code asA1. 3 scribed in the application for Disposal Works Construction Permit No....��...Y5. 7 9,h dated /:_.. " THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....---7/Z / 3.................................................... Inspector..•--- •- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................:�'..oti'�??.............OF.................._=aris tatle.... ................... Noon?'.. ....... FEE.` ..1...00--•--- %Vas al Workii 01111no#ratr#ion rruti# Permission is hereby granted--------A & T3 essp 001.S ryice.-----------•-•-----------------------------------------•-......---•••••--.••... to Construct ) or Repair ( X) an Individual Sewage Disposal System at No.._..31eudder _ay Cr.-l_..Cntevillez..N .._._p�632_-._-Agres Durkin.................. Street 7/26/83 as shown on the application for Disposal Works Construction Permit . ............... Dated.._.._. ! _........................... .......................... .••--•-••-------•••---•----•---•--•-----•-•••------•••-•---••--•-----•-_.... 7/ /83 Board of Health I)AT •... •.--- FORM 1255 A. M. SULKIN. INC., BOSTON