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HomeMy WebLinkAbout0083 BETH LANE - Health (2) 83 Beth Lane Hyannis P A 171 I' L7 / RECEIVE® COMMONWEALTH OF MASSACHUSETTS EXECUTIVEE OFFICE OF ENVIRONMENTAL AFF S E E P 5 2002. _ - --- = T - TOWN OF BARNSTABLE I)EPAItT1VIEl�TT OF' ENVIRONTMENTAL PItOTE TIO ALTH DEPT. e TITLE S. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A MAP CERTIFICATION PARCEL . 7 Property Address- LOT 4 4 Owner's Name: 1_' �Ie0 ®�✓c��&�' Owner's Address: Date offrnspection: �' 2 4o Name of Inspector:(please print) �i9 y.v;,�/z Company Name: Mailing Address: ® 0OX / Telephone Dumber:__3'y 7 7 11 / E Z 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 Sect* n 15-W of Title 5(310 CNII U5.000). The system: r/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature Date: "Z' 7 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 10,000 d or eater the inspector and the system owner shall submit the report to the appropriate regional office of the gP i�' Pe Y � aPP P � DER Theoriginal 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 perfform in the.future under the same or different conditions of use. Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARy ASSESSMIENT'S SUBSURFACE SEWAGE DISPOSAL SYSIMMINSPEMON FORM PART A CCERT MCAT'ION(continued) Property Address- F`3 • }YA/�0-41 zS Owner. Date of Inspection: =Z Inspection Summary: Check A,B,C,ID or E/ALWAYS complete A of SecBon D A. System es: I have not found any information which indicates that any of the failure criteria described in 310 CNIR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below_ E Comments: B. System Conditionally Passes: One or more system componen escnbe3-'m the-5,Foonditional Pass'section need to be replaced or repaired.The system,upon comple ' of the replacement opTepair,as approved by the Board of Health,will pass. Answer yes,no or not dete d(Y,N,ND)in the for the following statements.If"not determined"please explain. ' The septic tank 4dwi and er 20 years old*or the septic Lank(whether metal.or not)is structurally unsound,exhibits subsal' onorexfiltrationartankfaintsis-imminent System will pass.inspecti ifihe existing tank is replace complying septic tank as approved by the Board.of Health. *A metal septic tank will s ction if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank' less 20 years old is available. ND explain: Observati n of sewage b kup or break out or higft static minter.level in the distribution l ox.due to br€l=or obstructed pipes)or due to a bro en,settled or uneven distribution box.System will pass.inspection if(with approval of Board of Health); 2. ken piers)are replaced obstruction is removed. distnbution imx is Icveled.oc.reglaced . 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 o.f.the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: jPage 5 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �� �C����-✓� ��ii Owner;/IJA& a OW cf¢ vas' Date of Inspection: /02 7 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes 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? Z Zave the system received normal flows in the previous two week period? large volumes of water been introduced T � to the system recently or as part of this inspection . l 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,excluding the SAS,located on site? z Were the septic tankmanholes uncovered,opened,and the interior of the tank inspected for the condition of the es 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 o i 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 t " Page 6 of I I OMCIAL-INSPECTION FORM-=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL-SYSTEM EgSPECTI0N FORM t' gART-C ,�?? /SYSTEM INFORMATION Property Address• F3 /JET�i 1i.9�E OwnerAA,i1G7 o sr/C IFS Date of Inspection: DoL FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): _Number of bedrooms(actual): DESIGN flow based on 310 CMR 15203(for-example: 110 gpd x#ofbedro=s)Z3 a Number of current residents:� A/ Does residence have a garbage gander(yes or no):`1�G Is laundry on a separate sewage system-(yes or no)-.&jif yes separate-inspection required] Laundry system inspected(yges�or no):_ Seasonal use:(yes or no) _/ Water meter readings,if avarl ble(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: U, �J� COMMERCIALIINDUSTRIAL Type of establi a t: Design flow(based o 310 CMR 1 . 03): gpd Basis of design flowXtaresent /sgft,etc.): Grease trap present Industrial waste holent(yes or no):Non-sanitary waste the Title 5 system(yes or no): Water meter readin :Last date of occupanOTHER(descibe) GENERAL INFORMATION Pumping Records Source of information: 690J t.icle— W-as system pumped-as part of the inspection(yes orno):,A/— If-yes,volume pumped._gallons—How was quantiry.pumped-detzrmined`- Reason for pumping: _...... F-SYSTEIGF . Septic tank,distribution box;soil absorption system _Single-cesspool Overflow-cessgoof —Pjivy _Shared system(yes or no)(if yes,attaclfpreviots inspection-records,if any} _Innovative/Alternative-technology.Attach:a eopy 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 awe of al-comp ents,date install d if known,)and so ce of information: J<Z Were sewage odors detected when arriving at the site(yes or no):_ 4 Page 3 of 11 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART A CER'ITFICATION(continued) Property Address: 3 13,C%4 G•3--1,6 Owner: 09da'iy a B '_a_T Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exi which require further evaluation by the Board of Health in order to determine if the system. is to protect ubl heal —failing p p th,safe a environment.. � 1. System will pass u rd of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not ctioning in nner which will protect public health,safety and the environment: C pooh or privy is within 50 feet a surface water sspool or privy.is within 50 feet of bordering vegetated wetIand or a salt marsh 2. System will fail unless the Board of Health(and Pub)'Pub)M Water Supplier;N any)determines that the system is functioning in a manner that protects the pu ic:health,safety and environment: _ The sys has a septic tank and soil abso ' n system(SAS)and the SAS is within 100 feet of a surface waters ply or tributary to a surface wa r supply: The system h a septic tank and SAS d the SAS is within a Zone 1 of a public water supply. The system has eptic,tank and S S-and the SAS is within 50 feet of a private water supply well. _ The system has'a se 'c tank SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*.. .Me d used to determine distance "This system passes if thew I water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic o pounds indicates that the well is free from pollution from that facility and the presence of ammonia , oge and nitrate nitrogen is equal to or less than 5 ppm,provided that no ether failure criteria are trigg d.`A cop, of the analysis must be attached to this form. 3. Other: } Page 4 of 11 ®F ICL41 INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SERFAGE DISPOSAL SMMI•NSPECTMN FORM PART A CERTIFICATION(coed} Property Address.• 13, % Owner• 111fl/l td Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"yes"or"nb"to each of the following for all inspections: Yes No _, ackup 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 dogged SAS or cesspool Static liquid level in the distribution box above outlet invert-dueto an overloaded or clogged SAS of ,,--cesspool / 'quid depth in cesspooI is less than 6mbelow invert or available-volume is less than'h day flow equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)_Number f times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface E �ater supply. �y portion of a cesspool or privy is within a Zone 1 ofa public well. y portion of a cesspool or privy is within 50 feet of a private water supply:well. Any portion ofa 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 euliform bacteria.and volatile 3rgauic compounds indicates that the welf is free from pollution from that facility and the presence.of.ammonia nitrogen and nitrate nitrogen is equal to or lei th2a:5 ppm,provided that no other failum cede are triggered.A copy of the analysis must Ibe atached to-this ftn n.1 (Yes/No)The system fails.I have determined that one or more.of the above failure criteria exist as described in 310 CM—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 con ' ered a large system the syst s -a facility witka-design:lbw of 10,000 gpd to 15,0€0 gpd- You roust indi either"yes"or"no" each of the-following: (The following cri apply to large ems in addition to the criteria above) yes no the system is 0 feet of a surface drinking water supply — — the system is feet of a trfoutary to a surface.drinking water supply — — the system i ocated in a itrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of public water s ply well If you have ans red"yes"to any questi in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system 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 CiI R 15.304.The system owner should contact the appropriate regional office of the Department. o Page7ofII If OFFICIAL LNSPECTTON FOR.t NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACESEWAGE DISPOSAL SYST Fm INSPECTION FOI3hJt PART C SYSTEM EITMRMATION(continued) Property Address:F3 6,T'/Lz"P- - Owner:/494eJ 1007 i9 vES Date of Inspection: 7�a� WELDING SEAR(locate on site plan) . grade: Depth below ell Materials of construction: cast iron 40 PVC_other(exxplain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK- (co to on,site plan) Depth below grade: Material of construction: 1£onerete metal fiberglass__polyethylene . _ if tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): certificate} _/ _(attach a copy=. ' Dimensions: S x 5— x S . Sludge depth: �'• �� Distance from top of sludge to bottom of outlet tee or baffle: � Scum thickness: 3 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. ^ ,6A5%,R r:Z:g —& Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid lev is as related to outlet invert,evidence of-leakage,etc.): -UREASE TRAP:_(locate on site plan) Depth below grade: Material of constructs :,concrete m fiberglass_polyethylene outer {e;cplam}: Dimensions: Scum thickness: Distance from top of scum to outlet lee or baffle: Distance from bottom of s to bo of outlet tee or baffle: Date of last pumping; Comments(on pun ' g recommendations,' et and outlet tee or baffle condition,stntctutal integrity,liquid let GIs as related to out3 vent,evidence,:of leakage, tc.): - r Page 8ofii 0MCI14L INSPECTION FORM-NOT FOR VOLUNTARy ASSESSME-N SUBSURFACE SEWAGE DISPOSAL SYSTEM ITSFE ON FORM- ' FART C S' '1M WORMATION( ttinued) Pr6perty Address: F3 /3e 7--� LA.� V/ Q�Fvner�A�tb �.vGA a�� . Date of Inspection: .2 TIGHT or HOLDING TANK: (tank rust be pumped at time of' -naspectism)(locate on site plan) Depth below grade: Material of truction: cone metal fiberglass_golyethyiene tsther(explairr): Dimensions: Capacity: ions Design Flow: _,gallonslday Alarm present(y or no): .Alarm level: working :Date of I umpmD order(yes or no): omm {condition of ala*m.and float switches,etc.): DIS'IMUTION 1A-X: �(ifesent must be opened)(locate on site plan) Depth of liquid level above outlet invert: ;p Comments(note if box is Ievel and distribution to outlets equal,-awry evidence of solids carryover,anp evidenc4 of leakage into or out f box,etc.): o X E el� _MP 4= B (lo a on site plan) Pumps in working or r s or no): Almms in working o (yes or no}: CorhmeT is(dote co" ofpump charnber,cndition(fpUmps acid appuftmnces,etc.)= ' Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C f� SYSTEM INFORMATION(continued) Property..Address:. J'fI ivri is Ownerv`742 i d Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):. (locate on site.planrezcavation not required) If SAS not Iocated explain why: Type leaching pits,number: leaching-chambers,number: aching-galleries,number: leaching trenches,number,fend- 30 x leaching fields,number;�dimensions: overflow-cesspool;'uamber. 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.): „ F a CESSPOOLS: _ g�cesspool must b mped as part of inspection)(locate on site plan) Number and configurati , Depth—top of liquid to t invert: Depth of solids layer: Depth of scum la Dimensions of esspooi: Materials o onstruction: Indicatio ,of groundwater inflow(y or no): Co nts(note condition of soil,si of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate site plan). ` Materials of.construction: Dimensions` •� Depth of solids: Comments(note condition of soil; t of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 O-FFICIAILANSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWA-OE-DISPOSAL—SY TMINSPECTION FORM PART-C SYSTEM -INFORMATION(continued)_ Property Address:- 3 �'( Ate.✓i l' - Owner we'ed OyGg vas" Date of Inspection:. ao2 SKETCH OF SEWAGE DISPOSAL SYSTEM` Provide a sketch ofthe sewage disposal system including-ties to at-least two-permanen reference landmarks or benchmarks.Locate alTwelE within 100 feet-Locate where public watersupply-enters-the building. � E- 3 G Sock r3 92 �ood c 7.1 s� r ?2Q� 1 I di 11 O C"IAL INSPECTION FO "V�1-NOT FOR Vo LuN- ' Y ASSESSMENTS SuBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). 1?ropert: Address: F3 O�nerl�lA a.a o v cA �t�s �atP of Isspeet�ri: ���7�d� SI$:E EXAi 3 i Slope SA rf ice water Check cellar - Shallow wells Estimated depth to ground water3e77) feet Please indicate(check)all methods used to determine the huh ground water elevation: Obtained from system design plans on record-If,checked,date of design plan reviewed: bserved site(abutting property/observation hole within ISO feet of SASS) Cbecked with local Board of Health-explain; 17, T Checked with local excavators_installers-(attach documentation) Accessed USGS database-explain: You must describe bow you established the'nigh gro-und'seater elevation: TOWN OF BARNSTABLE LOCATION F3 �3 -/4 SEWAGE # VILLAGE e YAA-f1t. / S ASSESSOR'S MAP&LOT Z - I1! INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY FX ,s T /Ooe, -,g LEACHING FACILITY: (type) L%=Ate-l i/�z,r✓��F s (size 2) 3 o X q X,Z NO.OF BEDROOMS BUILDER OR OWNER PERIvITTDATE: COMPLIANCE DATE: . Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 d- C � 3� X Xu2 No. Fee THE COMMONWEALTH OF MASSACHUSETTS v Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mi!5paal *pztem Construction Permit Application for a Permit to Construct(,- Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.YJ /jE TN I—OV,y, Owner's Name,Address and Tel.No. / 1/)A Ny/S 7 3 oti r& L.4 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 77s � 3Ga Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A�d! Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and of to pl c e the system in operation until a Certifi- cate of Compliance has been issued Board of Health. Signed Date Application Approved by Date Application Disapproved for the following reas Permit No. Date Issued TOWN OF BARNSTABLE LOCATION L6T-3 � T�'' L SEWAGE # 9 7 , `� VILLAG ASSESSOR'S MAP &LOT 2 • I Z/ INSTALLER'S NAME&PHONE NO. 142 e� <"'s 7 -2 2 SEPTIC TANK CAPACITY H.x : T loon e -,? LEACHING FACILITY: (type) (size) 2).3 o NO.OF BEDROOMS _ BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 r' ' Ye e. ..—..- a ,. r .... ¢� — R.. .a - .. r— :;,,,•.._ , w - � �' /O 7I No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for �Digonl *pgtent Congtruction Permit Application for a Permit to Construct(,/Repair( )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No.8� ��Tf1 yE Owner's Name,Address and Tel.No. ,yY.9 w.�.� s 5F 3 F� r lv� Z A.✓ Mr Assessor's Map/Parcel /, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. , iz e/4 �0�✓3/ �� 7 5- Type of Building: Dwelling No.of Bedrooms_ 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and of to place the system in operation until a Certifi- cate of Compliance has been issued b Board of Health. � Signed Date "/ " i Application Approved by Date Application Disapproved for the following reas Permit No. Date Issued y` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance - THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )�( )Upgraded ( ) Abandoned( )by 2"" s r att 4F -7 L3 G T i-a L,q .,.E w,vi 3 has,b en constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer . The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date _1A / C r, - '7 Inspector — --_---------------------------- ------ No. -v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal rRepair( feat Congtructton Permit Permission is hereby granted to Construct( )Upgrade( }Abandon( ) System located at 73 1,?,C- 7-H G�9.+�t and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 's/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons ction st be completed within three years of the date of pe it. 0 2 Date: Approved by o _,,c19;hIIVA JUNQUEIE A Shoreland Reg bstste One Page View Cod i Islands Multiple Listin service-8! 7MI8s LP-..V5 :2 6h�—�StaWe: ve Cat:Single Family HHome .0280100 dd s:83 Ilm LN Unit 'nty:BARNSTABLE Subdlvlslon:ome:0 FullSeths: a 8edetooms:4 HalfSaths:0 General Information Zoning:RES Lewis:Z UIVSpa: 1,501to1,800 Yr 1311: 19791APPROXIMATE Bsmt Baths: Levi Baths: L v2 Baths: Lsv3 Btsths: Found:Main Width:32 Main Depth:24 Wino width;12 Wing Depth: 12 Irreg:Y easement: Y/Fuil Rd Fmtg: Assoc,Fee Includes' ^� Gor/NCars:NIS Lot Depth.0 MP Lh/airs:Y/ Assoelstkn:U Lot Desc:Cleared, La Gasps Dena: Year Round:Y servkaes; Waterfront:N/ WaMrvlew:N/ fro Beech Dose:Ocean Beach Own:Public MIIes to Beach:2+MI Mbrshp Req:U street:Paved,Public Water Acc: Foundstion:Concrete Convenient To: acres:0.35 Ann Aso Fee:SOIL) Beschlt.ske1POnd Name: I Exterior Intbtmation style.Cape/pook W Dock:U/ 1 Exterior Features:None Owing:Shingle Roof: 8VhSK Mad onlwl Information --.. Henting/Cooling:Natural Gas Ail:P Nat Wabr:N Gas UNIQUE 4 SEDMBATH CAPE.PLEASE CALL FO OETAI S.NOT A LEGAL MULTI FAMILY BUT OWNER OCC ANT THE RIGHT TO RENT TO 3 ADOIT! RS. PRIVATF BA IN HOU TEO FOR$000.OWNER PAYS UT1LI U ET:$78 GAS ANb $165 ELEC AVEKAGE$W QUARTERLY)NEED SOME WORK. FULLY REN D. ax Inforn►stbn Irnprmts Asmt: 0 Annual Taxes: $1,271.40/2002 Tide Referooce: 0/om Land Assessment: 41400 AnmW eettsrment: 0 Plan: Total Asmt: 104000 Unpd Bettrm: 0 UFFI: N To Be Assessed: U Spec Assessment: U Mess Use: 101 Assessors Map: 272 Assessors Parcel: 171 Undgrnd Fuel: U Asbestos: U Lead Point U CertfTreat: Flood Zone:Unknown Documents: Deed, Field Cerd Listl And Office Information Owner:GONCALVES CantractType:ER Orig.LP:$290.000 LO:SHORELAND REAL ESTATE (508)771-2008 Ext: Off.Ernall: LA;CRISTiNA JUNQUEiRA (508)M-9998 Exi: Agent Email:oftJunqualreSSChotmat,com Ust Date:Aug-22-2002 SAC:2.5% BAC:Z59b 185 Directions:Pl 'S WAY ETH LANE MISER 83 SIGN ON P TY. EO 24 H00AS NOTI .NOT A li=OAL MULTI-UNIT. B ACCORDING TO TOWN OK TO ENT UP TO 3 BEDROOMS WITH UT KITC NS.SEPTIC HAS BEEN REC Y INSPECTED AND HAS PASSE OR A 3 BEDROOM DAELLING novmAR i nm—vctMI11 niiviivL, 16lWnW6 IV ! I1ni1IV,YIIWIMP' I iM Vitt I'll crisjunqueiM66@haun&il.com (508)771-2008 W ]5 •` No..... 3. . • , D -� Fim$....................."�—..�... } THE COMMONWEALTH OF MASSACHUSETTS BOA R® F 1-I EALTH w= Allp ira#ion for Bwvoiiai,Works Cnnnitrnrtinn ramit Application is hereby made for. a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at• 4 . ...... .. ......�. ---.....4� .._..... Hof ��----•-....----------•-------...------........•..........----------- tio - d ress r o e //?��./�- ---��...1 ..__ PS ......., 1 eX!,,`` ..-...f�L/1 1..L. -- .... a ... .g ...�J� fe[..wner --•--------------.._.........--•-------- .......lrvw..fl a_._..b:���K. Installer Address Q Type of Building Size Lot... ..., i0Qd_......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other.—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures -----------------_--------'--. ----------•-_--••---•_---•-•- W Design Flow....................... .............gallons per person per day. Total daily flow.._..............._33.0...........gallons. WSeptic Tank=Liquid capacity[P�4'.gallons Length! °...... Width.�f°��"_ Diameter________________ Depth..X'.'Y_" x Disposal Trench—No. .................... Width i................. Total Length..................... Total leaching area--------------------sq. ft. Seepage Pit No..........I.......... Diameter._lP_.!�..._...... Depth below inlet.......-_....... Total leaching area.� S...sq. ft. Z Other Distribution box (t-f Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1 -----minutes per inch Depth of Test Pit_____t_�......... Depth to ground water_._.��/e'�4 Li, Test Pit No. 2__<-.� >1�....minutes per inch Depth of Test Pit-_-___ _ water-_'Pt,Depth �o ground water_ ______ a ----- JJ 1' O Description of Soil------... ----. 2- U ---•--•----------------------------------•-----------------•---•------------------_..........•-----•----••-•--•--•••---•---•-••---••-----•-••--•-•••••-•----•_-••-••-•-••.........--...---•-_----•-_... W UNature 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 TITH.;;:. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is e by the board ealth. Signed -- � ---- �' ✓------- .e� ..1�![•'//_(.O__..._ Date Application Approved By...... -- • ..... ..... . ....... . ..� ` �� ----- ate � -7 Application Disapproved for the following reasons:.....................................................................................................:.--•------- ---------------•---•--_-...........--_--__-••----_-_-----•••....••••--•••.....--•••_•••-_---__----•--•-•••--_---••--•---•-••---_••-------•-----•••............---- •••----•-----_._...-------------- J r` Date PermitNo......................................................... Issued_............................. --------- ------------ Date ;2 No FEB.............................. ...... THE COMMONWEALTH OF MASSACHUSETTS BOAR =EALTH • .....OF. .......................................................... Applik4tion for Ilhqvoiial Works Towitrurtion Vantic Application is hereby made for a Permit to Construct (,() or Repair an Individual Sewage Disposal System at: MIS... .......0/4.5-14 ............. .4& ........................................................................... LV A M. 11,�res, I N 1-4 ............ .. .....•.. 666 .........AXL4..#0. M. . A .......................................... I.....W...... Installer Address "r ___Type of Building Size Lot/,..P ........Sq. feet U I Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons__--___.________:___________ Showers Cafeteria ( ) A4Other fixtures ....................................................................I.................................................................................. <W Design Elow............................................gallons per person per day. Total daily flow............................................gallons. . - 9 Septic Thnk—Liquid capacity............gallons Length________________ Width____._.__._.__.. Diameter...-...._._.-__. Depth__._._______.... Disposal Trench—No_.................... Width______..__._.______. Total Length______.____.________ Total leaching area....................sq. f t. S6epage:Pit No..................... Diameter._.___._....____.__ Depth below inlet____.___.___._______ Total leaching area..................sq. ft. Z Other Di4r'ibution box ( ) Dosing tank ( ) Percolation Test Roistilts Performed by.......................................................................... Date_______________..._..______....__..___.. Test Pit No. I................minutes per inch Depth, of Test Pit..._____________.__. Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit_..____._.___.____._ Depth to ground water....._......__.____._._." Ai ...................... ....... 0 Description of Soil-------- ............................... ....................................................................................... - U ------------------------------------------------------------- ---------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------w....................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..................... --- ......................................... --I------------------------------------------------- .................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT 1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'slued e a the bo do lh .P 4ssile t Signed ... .. . ........ .......... ..... ..................... Date Application Approved By........ ....... ........... ....... ate Application Disapproved for the following reasons:--- ............................................................................................................ ........................................................................................................................................................................................................ Date PermitNo................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD /OFEALTH ........... OF....... ......................................... . .......... TH 17 TO CEJq1F at the Individual Sewage Disposal System constructed /r-oor-Repaired I e ...................t... .............................. by-r-- 7.... at..�... 4 taller f has\been install td�' in accordancewith the provision 0 fi o The Late Sanitary Code as flescribe ,in the Permit -26 406-3 ated appfir,ation,f6r Disposal Works"Construction Perm.it No. --'7............ d, ........... No THE ISSUANCE OF THIS CERTIFICATE SHALL.NOT BE CONSTRUE0,AS A'GUARANTEE THAT THE SYSTEM. Wlkt FUNCTION SATISFACTORY. DATE................................................................................. Insp ector...........................................I.......................................... THE\COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ........ OF........... .............................................. 1) 1 N .... FEE......a-,>.......... ion prrmit . ............ ..................................../... ..................... .. ...............Permissioi hereby granted...... to ConstrFc ' or Repair dual e Fage Disposal System at No.... ........ `Stree --- ---------11 - t, pti as shown on the application for Disposal Works Construction Per i ... ........ .......�_ Dated.. .. ....1A....7t...... ......... . .. ............ • -7 of e DATE---..... ... .. ... .............................................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TYPICAL SYSTEM -- . EM PROFILE A R E A PLAN FINISH GRAD FDN TOP E NOT TO : SCALE, . 11 _ 4 I 52.oa_ `/ �FI I _ C� N. S H r SCALE . I FINISH GRADE OVER TANK SI,Oc:7 GRADE -->OVER PIT=_ , ---__ T A 44 METH S LANE . .. .... , O P V C OR O O 1 • ,e 15, Ott . , F", Q .00 q8.b? C. I. TEES : ► ,-� • / • e .e 0 BSMT , : 7. FLR .+ IOOC> GAL. 411 r e , , r • • 1 e REINFORCED DIST. BQX 1 ► e • • •' e • e ;/ 1 CONCRETE 8 ... .. . _ TO BE,:INSTALLED`0N � ,. .`: ._ .. .... _..o . ... .b .. .... . : a.: .. . A LEVEL STABLE_BASE ... , a' . '• • / o' i / e SEPTIC TANK ' 6 1 , e • • • '• a e 1 e TO BE INSTALLED ON A • 1 • • • • e / ' LEVEL TAB , ., .. : EL STABLE � e_ • • • • � • � r � 2 18 112 WASHED:PEASTONE ALL :. BRICK a,MORTAR 000RSES AS AROUND FREE OF IRONS FINES ' e e •' a • : • • 1 e REQUIRED TO BRING COVER'TO GRADE AND DUST IN PLACE s r 11 _ 11 LEACHING PIT 24 ��C.I.'MANHOLE COVER 8► 3/4 TO._I 12 • WASHED CRUSHED A TO - BE <. FRAME -,;SEf DETAIL` STONE ALL AROUND FREE OF `� BASE :_ LEVEL, IRONS FINES AND DUST IN PLACEI FOR IN GRADE SEE SYSTEM PROFILE , SOIL AND PERCOLATION ' r „ is Q r _ 11 DATA N I3. 25 �$ -- — -- - ._.. LOT 4 `T 8 P RC. RAT MIN.' IN. 12 5,00 L E E : T �/� a F OR INV.ELEV SEE , 4 0 , C. D. S`POHR LT 4 '�w ; Area k�dlt PI"T _ _TAKEN -BY CIG = 1r I N LET SYSTEM PROFILE 11 8 N 0 0i2. AUf t �Q ! REQ0/ I FL.i,E . I TI�iLS LINE ��,!,,o�4 C\E I . , - . - ` WIT .•.R.N%r.A.Qt Ba. o� +t: = �1 ,o WITNESSED BY. $ OPENINGS W 4 0. S DF 1!96 P2£ 'Aa�" C1.'X*Ih:T °.Ib11:"`�?It3U1 1thd . o . . ,,,., OUTER DIA. B, I -3/4 o -� . , , DATE. i 1 o p e - eo .�:SE�.4C3I� E INSIDE DIA. ; 7 r e TEST PIT-GND ELEV._ 51 . 9Q i 6 Nr TOTAL 4 t< cas G� t o o p p , 1 O00 G ► .- P T c M apa AREA SEPt1r : k^ P F1 D o _ Jro M 5, ._: o a �e. � a D .5'T'" bE3 CScD ) •�1 5 r _ 0 0 0 :0 o ` ONE� OR .WA�)*(2 — 0 u'oo • � � Sim. � ' GRAVEL 170WYiATM J 40 z �/� fRWT 1_ u r 2 6 6 DIA. 2 1 125.00 ICE' �1� EFFECTIVE DIA. � �� BOT° PERC. HOLE - S Is 25' S8 w DOWN 3 COARSE :SRc�YtiFl�l Q' LEACHING PIT - ' SECTION I SAND SMALL STOfZ NO SCALE DESIGN DATA : BETH -S LANE NOTE: DO .NOT RUN HEAVY EQUIPMENT OVER SYSTEM ,3 NO. OF BEDROOMS . No DISPOSAL LEACHING PIT NOTES; a EST. TOTAL DAILY EFFLUENT 3.52 GALS. CONC. TO BE `4O�J0 P.S.I tl 28 DAYS . SEPTIC TANK 1020 GAL. ` 2. REINF. W 6 11 X 6 11 #6 GA.-.W. W. M. 3. 2AND 4SECTIONS ARE AVAILABLE FOR GENERAL NOTES OWWR:S 4 BU I LD E R - GREATER DEPTH REQUIREMENTS ' I . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN CL \: V ee F;I_Ylu`I�: .��.�1L.DEW-a NOTE . ACCORDANCE WITH TITLE5 OF THE STATE SANITARY CODE SAC0N ., AIZIV1 f2 A ,. EXCAVATE TO ELEV.LIO.Ot� OR LOWER AS DATED JULY 1 1977 1k ANY LOCAL RULES APPLICABLE. FAI�;MCaUT�-1ASt :' REQUIRED TO REMOVE ALL LOAM'AND CLAY CONTAINING 2. ANY CHANGE TO THIS PLAN MUST BE APPRD. BY THE MATERIAL BENEATH PIT. REPLACE EXCAVATED MATERIAL BD- OF HEALTH, AND CHARLES D. SPOHR. WITH `CLEAN,CLAY FREE GRAVEL, MECHANICALLY COMPACTED IN PLACE. 3. WHEN CONSTRUCTION IS COMPLETED, TO BACKFILLING - NOTIFY THE ENGINEER FOR INSPECTION. SIDE AREA - S.F. _S.F./GAL �4`�5 GALS : .4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. ` B. M: NOT E • _ BOTTOM AREA= 87 . S.F. I .O s:,F./GAL >37 GALS _ fir 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN t TOTAL AREA S.F. TOTAL GALS ,A.L.I..., tLEVS. 6A5ED 0M .. A\/ _ APPROVAL BY CHARLES D. SPOHR. LOT' � A S S LIMA 1..1 Q, 6.FOUNDATION INSPECTION READ: WHEN EXCAVATED. - - , � �, S � ., .LEGEND - + 50.0 EXIST. GROUND ELEV. 50.0 FINISH GROUND ELEV.-UNDERLINED AREA ; PLAN . REV.. DATE DESCRIPTION 47"50 PIPE INVERT. CLEV.: , R _A PRE _ . �t� ''f='{2ot� , �URrY��'. �?'L.;At` TEST p •.; o ES IT LOCATION SEWAGE DI SPOSAL SYSTEM CST `IS P: a L , FOR , 8Y ..j . ..; . .D �..� : R , S- .. ° _- : o ' . :_o SEPTIC • TANK .CLA F BUILD _ - RK . LYN NEIR DISTRIBUTION : BOX 0 LET 4 H 11s 4T _S LASE 4 . PIPE ,�: C i TO . _Y , �, TOWN . ,. _.ATF�• . I THE . „ RS 1Y HY N. I S =4 BIT. FIBER PIPE`-TI HTJOINTSC1sazTea, -t tt+i-Hi-I- G a Sp© f i C,D.SPOH.RDATEC�rcC . 7 a � DESIGNED: J�a ,� . ;DRAWING N0. PROPERTY LINE. o,`p n . 7�6� o, w .. . '. SCALE:ASSHOWNDRAWN: 2 MIN CODE DISTANCE 00MAP SEC PCL LOT I J. CHECKED: C. D. S .