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HomeMy WebLinkAbout0395 STRAWBERRY HILL ROAD - Health 395 Strawberry Hill Road Centerville P -A 245 253 Slu'neacrDm & s UPC 12543 No.. 5_..OR NA&TIN48.4N I TOWN OF BARNSTABLE 00CATION_395 iA 01 ND SEWAGE # ?✓II.LAGE�AVI1 e-c U o i1 e— 1 MQ ASSESSOR'S MAP & LOT yINSTALLER'S NAME&PHONE NO. `'�n SP EGA iOkl SEPTIC TANK CAPACITY 1600 G CA 1 LEACHING FACILITY: (type) Q Or (size) /e 7f Ca NO. OF.BEDROOMS, �. BUILDER OR OWNER Owi ,e r —MctjrrCA ®®nrJ Q n( 0--5 PERMIT DATE: COMPLIANCE DATE: 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 �� �/ ���1 '�`�1 // ./ � .� �i � 3 1 a�� �1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF-ENVIRONMENTAL PftOTECTIOIN ' tOAP PARCEL. :0 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: �ernerJili� ► MQ Owner's Name:_Inc,r in PO - 3 k[-s Owner's Address: Iil�rt�c�.na �r AlD RECEIVE® sect i, ill- 0940261 Date of Inspection:_Ll%/ff5*10 - NOV 2 4 2004 Name'of Inspector: (please print)S has 3 C 'Company Name:��p� i_� ,j e- �C�(��c��� L LC TOWN OF BARNSTABLE 'Mailing Address:_Q eD; Oil .7 Co:3 HEALTH DE PT. 0 en fzry i 11'e'i CAU � a Telephone Number; So?,•-W a�S.,-Nootg CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the int'oimation 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: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority. Fails Inspector's Signature: _shone- 15,yrT-aic:i Date: Jl z © The system inspector shall submit 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 Io,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 t_ time.This inspection does not address how the system will perform in the Y future under the sam e me or different conditions of use. Title 3 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM'---:NOT FOR VOLUNTARY ASSESSAg T8 (� SUBSURFACE SEWAGE IIISPOSAL}SYSTEM INSPECTION FORM PART,A CERTIFICATION(continued) Property Address: ` 1 5T w-c,-)ibdcty_'if 01 {�D I:�ntsc-a�ill�. � tnu Owner: Date of Inspection:_i 1 1 ,g,tba Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section.D A. System Passes: I 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: B. System Conditionally Passes: } 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"nof determined"please { explain. A)R-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 exfihration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank e4proved 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. ND explain: Observation of sewage backup or break out or liigh 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 pipes)aae3eplaced. .obstruction isr'emoved distribution box is leveled or replaced. ND explain: j} 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: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: VW Owndr: P" bW-9ne 0i � Date of Inspection: idl if,slo0 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 health,safety and the environment: jj L 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 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: IZ 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. OK The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. Dk The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Q The system has aseptic 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 *"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: Page 4 of l l OFFICIAL INSPECTION FORM—NOT*FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DPOSAI�-SYSTEM INSPECTION FORM s FART.A. . CERTIFICATION(continued) Property Address: q_j� tfixcZnnrt`y 141`U RO t arter _� Owner: M aj!I a Pa�r�LP(5jc , Date of Inspection: i I v�i d vi 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 R Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool y. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool k Liquid depth in cesspool is less than 6"below invert or available volume is less than''/day flow -J_ Required pumping more than 4 times in the last year NOT due to clogged of obstructed pipe(s).Number of times pumped 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. X Any.portion of a cesspool or privy it within a Zone 1 of a public well. Any.portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.-{This system'passes if the well water..analysis, performed at a DEP certified laboratory;for caliform bacteria and volatile organic•compwwds indicates that the well is free from•pollution from thskt facility.and the presence of ammonia nitrogen and nitrate nitrogen is.equal,to.or less than S ppm,provided that no other failure criteria are triggered.A copy of the analysis must'be* tacked to this form. R.(:)L(Yes/No)The system fails. I have determined that one or.more of the above failure criteria exisf 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 hpd. �. tni 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 jL(� the system is within 200 feet of a tributary to a surface drinking water supply DL the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone lI 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.. ' Page 5 of 1 I OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 391 S-=r`tCcii,J berCu u i L' en}z�J ll�; mu Owner: ;); Date of Inspection: Check if the following have been done. You must indicate"yes"or`9no"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health _ Were any of the system components pumped out in the previous two.weeks? _ Has the system received normal flows in the previous two week period? _ Have 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) r. _ 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, excluding 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)) Page 6 of l l OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ( SUBSURFACE SEWAGE:1aISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: S S fiC'eA L 'n��(`y ►}i 11 i �nfi�(ilil1�� PAC. Owner:_ rare[t � �G� cz5 Date of Inspection: oI i'K ibiA FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual):_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):99L6 Number of current residents: Q Does residence have a garbage grinder(yes or no):W Is laundry on a separate sewage system(yes or no):_, [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): Da->. Li�l,c0CI Water meter readings,if available(last 2 years usage(gpd)): /q, Sump pump(yes or no): Last date of occupancy: nCt COMMERCIAL/INDUSTRIAL Type of establishment: . Design flow(based on 310 CMR 15.203): and Basis of design flow(seats/persons/sq%etc.): Grease trap present(yes or no):,_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 'y fie- Q qeJ cAA- rime nQ j:nsPej,- tton Was system pumped as part of the inspection(yes or no):— If yes,volume pumped:[0Q gallons-How,was quantity pum ed determined? Reason for pumping: n _; ].P t- (� P_r a TYPE OF SYSTEM Septic tank,distribution box,soil absorption.system . _Single cesspool Overflow cesspool _—privy —Shared system(yes or no)(if yes,attach previous inspection records,if any) _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): Approximate age of all components,date installed(if known)and source of information: 10/,10.f Were sewage odors detected when arriving at the site(yes or no): Page 7 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2 14111. p,0 L'e�r c- a�11. i MCA - Owner: tnaC kca PC•tTaQc ices .Date of Inspection: ii J��s 10j4 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _k_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) t Dimensions: lCta� C,rs , Sludge depth: f Distance from top of sludge to bottom of outlet tee or baffle:xuz(— Scum thickness: no Distance from top of scum to top of outlet tee or baffle: (� . Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): oai- r-I'Mr. , I GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3Ga f faobc;cr Owner. N�'� P�0 T xriCa Putt �p Date of Inspection:j 1. TIGHT or HOLDING TANK: n rt (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal - fiberglass_polyethylene other(explain): Dimensions: Capacity: Qallons Design Flow: gallons/day Alarm-present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): ( DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:4CL 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.): 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.): 1 , ' Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �( PART C SYSTEM INFORMATION(continued) Property Address: 39Sr rvJ i��cN 1+� 1 R 0 Owner: mr,rLG P®nraran nicks Date of Inspection: ►.1 I ids 6 i SOIL,ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _)L leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc:): t, h CESSPOOLS: (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 layer: 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.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.): ' o Page 10 of l l OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'PART C SYSTEM INFORMATION(continued) Property.Address: •t-r't -Pri.)i'�1�� MO Owner: CJ1C�r 'Date of Inspection: _i I 1 isslo�f 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 w'thin 100 feet.Locate where public water supply enters the building. Ir HOaS 1 • i Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART SYSTEM INFORMATION(continued) Property Address: 3q S 1,t cu J' grty 14,1\ Owner: of,, PCA � 0i os Date of Inspection: 1 a 1 i a1 o" SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water u feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) —1—Accessed USGS database-explain: }' You must describe how you established the high ground water elevation: . 11 a►�) �� TOWN OF BARNSTABLE � Y C LOCATIONIjitC . Cfi T� /1 & SEWAGE # J ?f—r -VILLAGE � � n [//���, ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. �, fIbwr,r 3 G Z ,3V67 SEPTIC TANK CAPACITY. Ingo q p/, LEACHING FACILITY:(type)/(>j�p/= n�,o, �(� k size) Q ,o NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 71.0 a No....-. SIGN r4C; ,_ Y 6 9� SL ` NST T _ Z ars'YSTTION AND CEjj' �"Y�. U?[RVIS A�Gp EAq WAS INST TIFY IN WRITIN E O A R D OF HEALTH RDANCE M p� AILED IN STRI G . cr :.:....-CZ?W.... h .:...oF.......... ,t ............... Appliration for 11ispoottl Morks Tonotrnrtion Frrntit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: -�� Location-Add;ess, or Lot No. 14. -. ... ............ .................... - l i I�. .... - ... ............^.......... ..............._./- ,ol �.yLf�.127 ..R........................... ........ • Installer Type of Building Aaares's Size Lot.....L.f.3%Sq. feet 0-4 Dwelling—No. of Bedrooms.............�........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ......... ............ Design Flow................tj.t>.................gallons per person�( per�day. Total &� y flow..............�� .............gallons. GI- Septic Tank—Liquid capacity..I �.L�allons Length.._.g.. ... Width:.._.,_..�1,1�� Diameter:... _............ Depth...,S. .4-�, Disposal Trench—No. .................... Width.................... Total Len .................... Total leaching � � CP. � area....................sq. ft. 3 Seepage Pit No..42N� C.. Diameter........1.Q..... Depth below inlet......CP.1...... Total leaching area..ZCR7 dsq. ft. Z Other Distribution box (N Dosing tank ( ) aPercolation Test Results Performed by......... Date..........-1 :SNp.. 0.4 Test Pit No. 1....._�.minutes per inch Depth of Test Pit........lZ'_._. Depth to ground water.......--�........ L� Test Pit No. 2......�7 minutes per inch Depth of Test Pit........1:�1_..:.. Depth to ground water..........-''....... O Description of Soil ).... :..l.rL? --.`.......... a r3�1.!--_�. ..1 .._ L....... ........�...... - ` -•---- •. --••... - ......... -�- x ��- U Nature of Repairs or Alterations—Answer when applicable........................... ......... ...................................................... Agreement: The undersigned agrees to install the aforedescribed' Indivi a Stw e D al System in accordance with the provisions of LITL LZ 5 of the State Sanitary Code-T nd signed further agrees not to place the system in operation until a Certificate of Compliance has been is ued y t oard of l ealth_- Signed... .l.......... . .. .....9/Y ate Application Approved By........ ... . . ..• ----- -- ............ ..':......•••_...........__--•-'•....... •...•---- ..( . Z..... Da e Application Disapproved for the followi reasons:.............:...............•-•-•----.......-•---......-----'-'-•-'••••....._......... ...................... ........................'--•---••-----..............-•--•--�.j................--•-•-•'---•--.....•----...............--•---.................'---•.........._•--......_:......-•---•-...Date ...........� Permit No....•--..a..v'-�-._'.-�-.0..................._. Issued----------•--.. ................................. Date NO.....V.L_ff THEAm iNWEALTH-OiMASSA-CHU­SETTs �" BOARD OF HEALTH TAWKA........:.: of.........K111 ................ Appliratiun for Disposal Marks Tonstrurtiun 1prutit Application is hereby made for .a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal system at: , L� or Lot No ........... i�Address � � �-�-• l .. W •1 J `' �. Jker�"^-7.� ._..... ..Address •................................ - .................. Installer Type of Building / Address � � J YP g Size Lot............... ..........Sq. feet a Dwelling—No. of Bedrooms.............* ?........................Expansion:Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No: of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ...............................:..: W DesignFlow................1.r. ?:.. ]lons e per day. Total daily flow............. �� gallons W Septic Tank—Liquid capacity 1 X4� a Length .�,l Width:�'�.I' Diameter_-'•''".... Depth..�..� _ gallons r person . 1 x Disposal Trench—No. Width................... Total Length Total leaching area............._......sq. ft. 3 Seepage Pit No.. r� lam'.. Diameter......... ..\ Depth below inlet.....(_?� Total leaching area..26f?2sq. ft. ......... .. Z Other Distribution box (X) Dosing;tank ( ) Percolation Test Results Performed b ..... Date........... �. .:. � Test Pit No. 1.....f 7-_..minutes per inch Depth of Test Pit....... ':.... Depth to ground water:.....' ......... f� Test Pit No. 2......Gc'?—minutes per inch. Depth of Test Pit........ ..... Depth to ground water_ ._................. a ------------------=---- D Description of Soil�� ?' 1 F� `�/� ` L_1F al l l h' C� -. .1,r�.............................................. far ice'. 1 I C, J ' ..( ,r'a, t�-�t �-, I U . .....••• .......................... .. t�^ :ti�� .....r I GI�I1 t..�.................... U Nature of Repairs or Alterations—Answer when applicable......._. 1.......�... ..e...................................................... Agreement: f The undersigned agrees.-to install the aforedescribed Individtial�Sewage Disposal System in accordance with the provisions of.TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. _�Z ........ !.... .: . .......r ..._.... ..... ............ Application Approved B PP PP Y...... .. �. ......................................... .........I. ...,` ate�/ ..... D e �s Application Disapproved for the f ollowi reasons------------------•---..............-----------.......••----•-•............••---.........--•..................... --•--•--...---•Permit No......TL_.--ill.y..................... ......................... • ---Issued.. -_......... .•--•.... . ......_.....nau.----...---- •Date THE COMMONWEALTH OF MASSACHUSETTS �l BOARD OF HEALTH ( �� ............. v........OF....... 1V `'��r-:............... 01rdif iratr of fauut rlittntp THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.............+........�............�...�<�t:` :.........I.......'---..............-•----. --.......---... ---...........------............................. ..... .. at .� (,.>.T.......� ..... _ C l 1. ;r....�- nstall.�...... .�/�...:............ ' has been installed in accordance with the provs4efi�s of T ^L� of T e State Sanitary Code s de ri ed in the application for Disposal Works Construction Permit No.. �. �-.. ._.._...... dated...._..21;ji� . �.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. I` '.../` ... .................................. Inspector.._.............../f+ . .................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1. .......OF.........� - .................................................`� V i No.. .......... FzE........................ j Dispas'ttl arks Tunstrurtiun Pprutit, Permission is hereby granted...... _....' ..............w� ' .... ... : .................................•--.....••-••-.............. ........................... to Construct ( ) or Repair ( ) an individual Sewage Disposal §ystem b at No...4,-Orr............7................. ..... ..a (.,,� ................ ::E;� _!' S reet as shown on the application for Disposal Works Constructi Per •t No.��..6--:1.�-- 4jad....._'�..-.. .'..4: '...--.... .....................••-...../ •-• -•lloarit6 DATE...-••--_--•--/O J �� LO &TIION : SEWQC�E PERMIT UO. 1 57NLLER5, )J&ME ,� DDRESS B I DERS F- ADDRESS - � &M - DATE PER" T -155UED _ - 1� - - - - - - D ATE COMPLI-bJ ICE ISSUED ._ . ��.., �,� �� � Ij e� OD � f �. (1 h/�� ��� � �� .`. ., �,� AV No................. Fim... .. ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ✓vim _:.--- ....OF......... .................................. .......... Appliration for Uhipoii l Works Towitrurtion Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal hi Sy .- Locati� or of No er _ Ad 9s T � ' Lam(. F�tr/)-- ------------ ------- �..r ----- Installer Address • T e of Buildi g �. Size Lot............................Sq. feet Dwelling;P-No. of Bedrooms..__d—a.-------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a'' Other fixtur W Design Flow. - � .._... .........gallons per person per day. Total daily flow------9_©..Q�..................gallons. d S Peptic Tank L quid capacityla_,'ggallons Len t�______y_�:__. W' th .............. Diameter.........------- Depth................ W Disposal Trench 4--No..................... Width_.1 �.-I - bttal►L �... Total leaching area. sq. ft. x Seepage Pit No--------------------- Diameter-------------------- Depth below inlet..... ....._._... Total lea area.__-__--.-._..__sq. ft. z Other Distribution box ( ) Dosing tank ( ) dr . �` aPercolation Test Results Performed bY-------------"............................................................ Date------------------------------------.... Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.._--__.-___-__.-.._...- L14 Test Pit No. 2----------------minutes p er inch Depth of 'Pest Pit-------------------- Depth to ground water_------------.___..--. - --- ----- --------- - h = :�: .. .: :..�Description of Soil----"... / 2� - - `--- ---.�.------- ---------------- - ---E "` = �� -�s'7s'- C •%1. -- --- ----------------------- ------------ ----- U Nature of Repairs or Alterations—Answer when applica.ble------------ ----- ----- ---- �' _/� ------- ---- --------"------------------------------- ------------------------------------------------------------------- ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wt _ the provisions of Article`XI of the State Sanitary Code— The undersigned further ees not to place the system in operation until a Certificate of Compliance has een is ed by the boar heal Application Approved BY... ---�---��✓✓ ----•- �0- ✓-. /s Application Disapproved for the fo lowing reasons:................................... -- --------•-----•----•-----•--------.............................. ------------------------------------------------------------------------------------------------------------•-••--•••--•••------•---•-•----•--•--••--------••--•--- ••--•- ------------------------- Date PermitNo.-------- ----------------------------- Issued...................................................... Date No.......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..._ ------OF........ '- Appliration -for Bhipvii al Works C omitraartioaa Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Y§ e' .. t ; ----- ------------ Locatiy�$n-Addre s , or t . ess OvJn^erl � � '`-1 /� ,/1 Adcttess � �++ Installer Address U Type o Buildi,g Size Lot-------------------------Sq. feet Dwellingo. of Bedrooms----.---------------------------------------Expansion Attic ( ) Garbage Grinder ( ) p�.I Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a , Other fixturea ---------------- ----------------••-•---------•-•------------•---•-----•--------------•--•-•---------------......---•---------••----•----..._..._._.. W Design Flow.: ,,�- 4.��.�_�_�_, .....__._gallons per person per day. Total daily flow.....__2,___(7 P' WSeptic Tank---L}qutd capacity-j A..�ggallons Length-__ ----,____-- Width_#............._ Diameter---------------- Depth---._.-_-.----- x Disposal Trench , No. .................... Width: '_ ____Total e tg h __._:......._.... Total leaching area--------_-----------sq. ft. Seepage Pit No--------------_----- Diameter-------------------- Depth below inle _.....:.__......... Total leac])iug area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 41, C� �� / aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------.._-------.------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-._.-----.--.._-.----- fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.-_._---_---.-__---- P4 -------------------------------- •--- ---' r ------------- D Descriptton of Soil y �" •`".... `t - - � — 3 -,F.�ct. J/))_-- /. '-•---- ----_. ..° To........f--, ____---•--•�_ f !i'__ ^`�'-"__i'_ _• - � - /...n.,.5"1 C�--�---------------------- ---------- ----- x ---------------------------.............. 2-i7_7 r ;.> f/ ` � --•-------------------•----------------.----.-.-----------.------------•-••-----------•--- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b� slued by the boaarfd,�of,hea if,. ,�L • . ! / 6te Application Approved By.............. r' 1 .,. r�_............. .. - /..��•�D _ > . r Date Application Disapproved for the following reasons:.................................... .................................................. ........_.___ -------------------------------------------------------•---------------..._...••••--••--------••-•--••---•- ----------••---•-•-•---•-------•--•----------•-••-----------•--- ��^-� Date PermitNo. --- -----------------------•--......•. Issued.-------------•------------------------•--------••-----. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7...........OF...............t .•-.�?``.'..`.--.............................. C9rrtif irate 11f f�nnapliatta THIS IS TO CERT Y, T�_a the Individual Sewa e Disposal System constructed ( ) or Repaired ( ) _.. . by..... �7 --------- =` ----- ------ stalle at...m <y��f .�. �'�ram✓.... "z'L.- -------------•-----...-..-.----------------•---.--•-•-•--•----•--•---•---------•--- f f has been installed in accordance rovisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. �3____.._��-------------- dated_.-. �'l..__ t-1-__). ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA I FACTORY. -< DATE Inspector------- ----- THE COMMONWEALTH OF MASSACHUSETTS ,�.... t..__ BOARD OF HEALTH 3 / / .a�....." ......OF..........!..,, .r -- - .=''�- '::�= `-_:... �. ! ,�JJJJ . ... FEE...=�E,................ . '1 , eta ��r�aat lVarkii (ynaatitrurtaoat rrrutat Permission is granted... ?�- .,%> "--7 . ° ...........................................................-•-•.........._... to Construct ( or Repair ( ) an Individual �ewage Disposal Syst in at No...•_ - = - - '-? --=ate - P �Street PerDated .. � '��� as shown on the application for Disposal Works Construction Permit No. ____________%1 Dated .. .-- _-__-- _................. a ' �`= •..... Board of Health DATE..........=----- (I ... FORM 1255 HOBBS & WARREN. INC,'-.},PUBLISHERS ' k� s SECTION ' SEWAGE r I 1 -SEPTIC TANK- G'• -"D"BOX- c..� -LEACH- TOP FD ( ©., :P � O MSQr T0�h" ( I WASHED r5 ONE -fir- �'I �` —l.ct�,Ll� �• I m IN- OUT • �. Oi ,.ONT," rIN. � ` ii I SEPTIC 1 ELEV. TANK ELEV. ELEV. I ELEV. 2� # \ 47� I j/ la \ ` \ V" \ \ 1 ELEV. ELEV. J •WASHED STONE 62 t �1 } TEST HOLE LOG. 5?SZ El. = 37 62 I /, _ '}-,J 2 �\ "? � ° u \ : . TEST BY R.F6JRBA1�1K,P.E. 1"IC TEAS TEST DATE _ TI T�� 3 BEDROOM HOUSE DESIGN o bb T.N; s 1 E T.H. +� 2 h p a _a[ ELEV.�..0 ELEV. :Y RI(3 \ (� l + PERC RATE. G2 MIN/IN. DISPOSER ISPOSI FLOW RATE'I 10. •(GAL✓OAY)/6 SEPTIC TANK 3�. (�,51= - `ta REQ'DSEPTIC TANK SIZE C G _ A).J LEACH PACILITY :: •� SIDE WAL l = 8• 2{). _ 7L,Z GID, l�D�I BOTTOM• P\Z TOTAL ZCo7,(7 �'� a -7 CT�.D � 2 I I v• + s r .� >; �T�a�; �pDt�l (' o - �TE�R. ►;..►H IT�=--��_ li �(o, I Ir S I USE: /�1�1G LEACHING !n' FCC r A!`1. f�,A \ E� WATER ENCOUNTERED �S Z53 DESIGNING ENGINEER MUST SUPERVISE ► _ . 1 4, . NOTES: (UNLESS.OTHERWISE NOTED) INSTALLATION AND CERTIFY IN WRITING 4(0 ���� 1 ; ;L-� THE SYSTEM WAS INSTALLED . 1.DATUM(OASL)+TR.KEPI FROM.-1=1..1':- — QUAORANCLE MAP.. 2.'MUNICIPAL WATER I G AVAILABLE ACCORDANCE TO PLAN. 3.PIPE PITCH:1N'PER FOOT 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO• - -44 ARNE H. S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:( j FT. a OJALA 6:PIPE JOINTS SHALL BE MADE,WATER'TIGHT CIVIL 7.CONSTRUCTION DETAILS TO 6E ACCORDANCE WITH COMM.OF MASS. No. -`_ SITE: ry A� STATE.ENVIRONMENTAL C06E TITLE S r(� I ' 'c'cx c.�,�•c a.sa �+-w���.v G&f,'� 3T O f. Of Mks LOCUS:_L49r -�f12AWf3E�ZR'i' H�tlw��n� .go (Fi�t2r:14rbF3t� - AflkE • '('61:1TE REG.PR ENGINEER b OJAu �. r f 4 REF. �� .� dowa ca►�e. ea�i�eering \,.ems PREPARED FOR: h� IAM E aQc-��E o�M'II�I . _ •' CIVIL E GINEERS, � -.._ _� ..... BOARD OF HEALTH - I ND SURVEYORS SURVEYOR LA REG LAND f '�'�^�- scAL 1 OEO -O- ECONTOURS ((PRO -APPRO/ lsGW4A ... ...-..t. ..i,,.......... .. .... .i. .... ..s.v...f_:. ... ..... . .. . ..:,..,..a..._. .-, .. _-._... - - .. ... -.. a.. .....-.. .. ". .., ... ... i'5 ..1 - av ..E _ir .,..., r.P...Ye-s ._ .. .:S..s... e...,f,t w_.� ... _..... - ..*L..t. j� I fI i 'A00 Or i 1 I j �9 I j /�/�c.t.>/�c^.i S i.= Q � •F�" x•_c, T � �.��'r �'r� ..,• S T•�cJ G T/[,7�/ ,��, ,.) Q.h►+ �` rr s` .eq- 'Ei Try J ,� -,��- . ' �,,•. ,q /5P 1 .0 c c A 77-, C) O N T.h'� /c'Ju�J•ca _57 rr o u���' ,y�.f%�' n ^/ -09 T,.--49 �- . � T .CIO 4=" -31 TGro `- i•M ^'� e n,•, �i n',rQ>IJAMES OF - c` �'4/�yS O �"= �` �✓ �"'" �^cJ s O OF A14S S JOSEPHELY G No. TO yid +c, :lOSEPH M. MONAHAN,JR. n (dry C/STER J4 q�0 S U M