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HomeMy WebLinkAbout0130 LEWIS BAY ROAD - Health 130 Lewis,=Bay Road Hyannis 326 108 i i 0 TOWN OF BARNSTABLE LOCATION 30 i -6 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT.- v INSTALLER'S NA&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ('size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: i� Separation Distance Between the: . Maxidium Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist otvsite 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 ��' ��b �i. � .. ti_ 4 r""� , �� � ! ` •'I���� / ` � I � i �� �;, � 'f -- �� ��. � l No. p`;J(,p Fee ®C� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYicatiou for Zigpogal 6p5tem Cou5tructiou permit Application for a Permit to Construct( ) Repair(-,)' Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 00 Wls lap• Owner's Name,Address,and Tel.No. i gyp, t s 32 Assessor's Map/Parcel 32 UVEKS L,nJ b 30 u Installer's.Name,Address,and Tel.No. C I bE signer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size ( i — sq.ft. Garbage Grinder Other Type of Building N No.of Persons Showers(./f Cafeteria Other Fixtures Design Flow(min.required) 55b gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title //�� Size of Septic Tank tow Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �Le 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 not to place the system in operation until a Certificate of Compliance has been issued b this Board of Health. Si ed Date G L Ob Application Approved by Date, fI Application Disapproved by; Date for the Lfollowing reasons Permit No. (0 Date Issued No.rQ�0 O"f.J�O Fee C/ ; THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for �Diqo,5aY *p.5tem Cong4ruction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑ omplete System ❑Individual Components Location Address or Lot No. oo t ay.5 Owner's Name,Address and Tel.No. Assessor's Map/Parcel 3z b I V a u m �•,1-� . nI`?7 - Installer's ame,A GI�cP�l1)E &kddress,and Tel.No. �signer's Name,Address and Tel.No.. ' - P o• M)OfO3, iCIE,MA• !gg)L4.2 - - Type of Building: Dwelling No.of Bedrooms Lot Size I f — sq. ft. Garbage Grinder Other Type of Building No.of Persons o viJ - Showers( /j Cafeteria Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title' Size of Septic Tank Ow Type of S.A.S. s LC.(a3 Description of Soil Nature of Repairs or Alterations�Answ�er.when applicable) ST_k t S 4..,E 440 Affi �r Date last inspected: \ t Agreement: `\ The undersigned agrees to ensure the construction`and maintenance of the afore described on-site sewage disposal system in r accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of -Compliance has Been issued by thiis Board of Health. S i - ed Date Application Approved by Date �✓ � I Application Disapproved by: Date for the following reasons - r-� Permit No. r--)Q(� � — �J Date Issued ) - t - _._ _ .. THE COMMONWEALTH OF MASSACHUSETTS R° BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( off Upgraded ( ) Abandoned( )by C w�( 1b& �(� at has been constructed in accordance ,with the provisions of Title 5 and the for Disposal System Construction Permit No. �' O` dated Installer C6�1 bc tom\ Designer #bedrooms Approved design flow gpd The issuance of this permit sh//11 not be construed as a guarantee that the sysetem wrl, func'omas designed. Date Inspect' or-.,-,1, No. � _ Fee THE COMMONWEALTH OF MASSACHUSETTS` PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Wigpogar �&pgtem Construction permit Permission is hereby granted to Con truce , ) R, air ( � Up de ( ) Abandon I; ) System located at t Con and as described in the above Application for Disposal System Construction Permit. e_d plicant recognizes his/her duty to comply with Title 5 and the following local provisions or special cc Zitions. Provided: Construction m 'st be completed within three years of the(date of this,r it. Date l(/ � Approve Iby - 41 ZA 4- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS b DEPARTMENT OF ENVIRONMENTAL PROTECTION r -IVE® David B.Mason,R.S,Certified Title V Inspector,508- 33-21777 ` 0("T 0 6 2004 TITLE S TOWN HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A yL Lo CERTIFICATION Property Address: 130 Lewis Bay Road,Hyannis,MA 1,0T Owner's Name:Hansen - Owner's Address: The Lewis Bay RD Realty Trust,600 County Street,Taunton,MA 02780 Date of Inspection:July 27,2004 Name of Inspector: (please print)David$.Mason Company Name:^N.A. Mailing Address: 4 Glacier Path East Sandq ich,MA 02537 Telephone Number:508-833-2177 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 systet'ss.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sys?cm: X Passes _Conditionally Passes _ Needs Further Evaluation by the Local Approving Autl4-)ri Fails Inspector's Signatur . Date: -7 Z-7 a The system inspector shall submit a copy of this inspection report to the Approving A thori (Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: System as inspected appears to have operated based on occupancy level. Increase in occupancy may cause hydraulic failure. The information as identified represents only the condition of the system on July 27,2004 at 12:30 PM. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 130 Lewis Bay Road,Hyannis,MA Owner: Hansen Date of Inspection:July 27,2004 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"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is.replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced (THIS IS REQUIRED TO BE COMPLETED) ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 130 Lewis Bay Road Hyannis,MA Owner:Hansen ]Date of Inspection:July 27,2004 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: _, 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: _ 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. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water 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:The primary cesspool is not a typical configuration for a cesspool. It appears to be a pipe cylinder with an inlet pipe and outlet pipe with tee connected to a pre-cast 4'deepx6'diameter leach pit with stone. Permit on-file with the BOH for the pre-cast leach pit. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A Page 4 of I l CERTIFICATION(continued) Property Address: 130 Lewis Bay Road,Hyannis,MA Owner:Hansen Date of Inspection:July 27,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. }X 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 is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X 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 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.l No�(Yes/No)The system Lai s.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure, E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ T the system is within 200 feet of a tributary to a surface drinking water supply — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 130 Lewis Bay Road,Hyannis,MA Owner:Hansen Date of Inspection:July 27,2004 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No XT Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X— Has the system received normal flows in the previous two week period? _X Have large volumes of water been introduced to the system recently or as part of this inspection? X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ Was the facility or dwelling inspected for signs of sewage back up? _X Was the site inspected for signs of break out? _X_ T Were all system components,excluding the SAS,located on site?(INCLUDING THE SAS) _X _ 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? _X ____ 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 X _ Fxisting information.For example,a plan at the Board of Health. X_ 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 130 Lewes Bay Road,Hyannis,MA Owner: Hansen Date of Inspection:July 27,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):5_ Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550gpd(768gpd cap.) Number of current residents: Does residence have a garbage grinder(yes or no):NO(Not Allowed) Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required]Per owner Laundry system inspected(yes or no):NA Seasonal use: (yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2003:15,000 gal. 2002;46,500ga1. Sump pump(yes or no):No Last date of occupancy:(current) COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): LnA Basis of design flow(seats/persons/sgft,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:Property owner Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_ 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 T Other(describe): Approximate age of all components,date installed(if known)and source of information:Certificate issued by Barnstable BOH on 5/I8/83 Were sewage odors detected when arriving at the site(yes or no):NO Page 7 of 11 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 130 Lewis Bay Road,Hyannis,MA Owner:Hansen Date of Inspection:July 27,2004 BUILDING SEWER(locate on site plan) Depth below grade:Approximate;34 Inches Materials of construction:,cast iron _X_40 PVC other(explain): Distance from private water supply well or suction line:_NA Comments(on condition of joints,venting,evidence of leakage,etc.): Appears in good condition. No evident leakage. SEPTIC TANK: N.A.(locate on site plan) Depth below grade:25" Material of construction:X_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) Dimensions: Typical 1500 gallon tank Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 14" Scum thickness:2.5 inches Distance from top of scum to top of outlet tee or baffle: 15" Distance from bottom of scum to bottom of outlet tee or baffle: 12.5" How were dimensions determined: Actual measurements with tape and scour stick. Condition of tank(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) Recommend maintenance pumping,tank appears in operating condition. GREASE TRAP: N.A. Depth below Fade:_ 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 130 Lewis Bay Road,Hyannis,MA Owner:Hansen Date of Inspection:July 27,2004 TIGHT or HOLDING TANK: N.A.—(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: gallons 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: YES_(if present must be opened)(locate on site plan) Depth of liquid level even with outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Clean condition,no solid carryover,no leakage,effluent level with outlet invert. 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.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 130 Lewis Bay Road,MA Owner:Hansen Date of Inspection:July 27,2004 SOIL ABSORPTION SYSTEM(SAS):—X—(locate on site plan,excavation not required) If SAS not located explain why: Type _X leaching pits,number(2)6'wide x 4'deep w/approx. l'of stone around(see attached plan) _leaching chambers,number: leaching galleries,number: ' leaching trenches,number,length: T 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, etch no indication of staining.No effluent in bottom of pit,no ponding or damp soil,no vegetation over pit. 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:_N.A._(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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 130 Lewis Bay,Hyannis,Ma Owner:Hansen Date of Inspection:July 27,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. c i a7 � ✓ l �� cyw--A THE COMMONWEALTH OF MASSACHUSETfS rev HOARD OF HEALTH 3a 00 !. ............OF_........ R.�r.R.U. t�-! _..__.r ..._...__ Application for Misposttt Marko TanoUvrzintt Permit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Sys r3 b 1_�a��....�?.� ��.�-• _ ......_......-----___... _ _. (;,r�11—►z... J �- `'4 T(.rr-r���E'�.. 'P.n; z t�rc,t�e rot NcLa�`..�a..�.�. ow dd Type of Building Size Lot... Sq. feet U Dwelling—No. of Bedrooms__!.__.».._-_---.._. ..Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building __........................ No. of persons............................ Showers ( ) Cafeteria ( ) a Other fixtures Design Flow—.'S_ ____.. .............gallons per person per day. Total daily flow__.— -------------gallons. A4 Septic Tank—Liquid capacity-W gallons Length........_..._.Width.........._.... Diameter-_..__....Depth Disposal Trench--No..___..__._-- Width. ..._.........Total Length._-.____..__Total leaching area_.___.._._.._sq.ft. 3 Seepage Pit No._2__.____ Diameter__G..----_ Depth below inlet_:�f�_.._ Total leaching area 3fi.`_L_Sq.ft. z Other Distribution box ( ) Dosing tank ( 7468 G-p"D, Percolation Test Results Perfom-A b '�fjlee- t— t�31—.�-3_----. y- _ 1s. r- Da /a 'a Test Pit No. l__2-___mmutes pc inch Depth of Test Depth to ground water_&-10-+-- ti Test Pit No. 2..._.___ ttetmt tes per inch Depthh of Test Pit....� ._' ... Depth to ground water..B_ ...... ....... Sod._-_,�.ee,�4.1_. . ?�..._._$�1..._ O Description of _a!_.!! ? - ._..... .. ...---.- VNature of Repairs or Alterations—Answer when Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Di Systems cordance with the provisions of Ti'11! 5 of the State Sanitary C — tees to place the operation utdA a.Cicnificae.af Coarpliatrce has i th. ..Sig - -- -� Application Approved By—____.... ---------------------- _._.. Date Application Disapproved for the following reasons:----. __ _.-_•__.,..._.... ..,._._._ ._�._........_-.._._-_-•----__._. Date Permit No........._...-.. — Daft THE COMMONWFALTH OF MASSACHUSETTS BOARD OF HEALTH M .. .__...OF..................... er#i£ e ofalisnrle I O ERTIF • That a ndual Sewage Disposal System constructed ( } or Repaired ( ) by .....—....._. _.._. ._—_.... has bees installed in actoVe ith the provisions of TIME r5�U�te State Sanitary Cod as.described in the ve_. 4 AT.. elated . . 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Ve C'rvs j En;'"Cc - A No......................... Fizim............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... .............OF..... ................................. Alipfiration for Dwposal Works Tonstrurtion Vamit Application is hereby made for a Permit to Construct or Repair ()<) an Individual Sewage Disposal," System at: ............. ...U...4......lz'x.......R.9k.!.................... .................................................................................................. catipri,-Address , .�L r Lot No_,,OV f­t I A 0—C ' ) 4_A4 ek%v 21 Prc3i pe ...Al .... ..................... .................... --------------------------------------- Owner Address ........... ......... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.......t..................................Expansion Attic Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Otherfixtures -----------------_--------------------------------------------------------------------------------------------------------------------------------- Design Flow......rS.* ...........................gallons per person per day. Total daily flow.............. .................gallons. 9 Septic Tank—Liquid capacity],JSq.gallons Length................ Width........_._..... Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....__2........... Diameter................ Depth below inlet...#.............. Total-leaching area..qe.q....sq. ft Z Other Distribution box Dosing tank 748 6- p-D . Percolation Test Results Performed by..................... Date.._.r,.Z�.l..�3.............. Test Pit No. I......Z minutesperinch Depth of Test Pit....ZI............ Depth to ground water.ti9!?.£.'_-.------- Test Pit No. 2................minutes per inch Depth of Test Pit.....5P............ Depth to ground water---a..,.............. .................. ............ ............................ 0 Description of Soil..........�_ *�A­ I A- ..............; ......2A..... q ............................................................ ------------------------- -----------------------------------*.......""-----------------*----------------*-----------------------*--------------**---------------­"-------*---- ......................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................. ....................................................................................................................................................................................................... Agreement: The'.undersigned agrees to install the aforedescrib In i 1dual Sewage Disposal S em in act�rdance with NL i i�- the provisions of'ITY 5 of the State Sanitary e e undersigned furtber-agrees of to pl e the ystem n operation until a Certificate of Compliance h- - een i b Signd.. ....... . ......... .................................... .... ..... .te.... I ApplicationApproved By.................................................................................................. ................. ..................... Date Application Disapproved for the following reasons:............................................................................................................... .....................................................................................................................................................................I................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Irdifiratr of Toutpliatta TAS'JIS 0 ERT2, That qThe dividual Sewage Disposal System constructed or Repaired b ....... ...... . . ..... . ................................................................................................... ........ .............. y Installer 5, at_ ....... ......................... .................... ---------------------------------- has been installed in actor ante with the provisions of T.-i;1 0 1 rL�E, e State Sanitary Co ./as' described in the application for Disposal Works Construction Permit No......................................... dated__....._._.._.._.___._.____.___............._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ . Inspector...................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / 0 ................... .......................OF...................................................................................... No......................... FEE........................ Maps kA4%lu V Permissionh by ..ed........... .............. ------------------------------------------------------------------ ........................ to Construct epai, dual-Dwage_&sposal System atNo........ .................................................... .......................................I............................ ...... ................... ........................ Street as shown on the application for Disposal Works Construction Permit No.............. ----- ated....................................... ..................................... ................................................................. Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS i3 Z_ .._ FRINZe._............... y •. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Tw......-- ----0F......... .uS " 3. ................................ App iration for Uiopooal Works Cnonotrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ()<) an Individual Sewage Disposal System at: qr�� .............�3.b....?:Y::M:ad.---.: .��`......... �......---•--•-------... ..................••----------------......-----...............................................-•-- L ati n Add or Lot No. errne en, z! Pro. e� �A .....�..........----•••---•-----••-----:�................•....... ................... ..........-. ......... ....... Owner Address w �-�..+_ 1. ... .......1 1�ry /.fC..----- .............................. .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.... ....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ---------------------------- W Design Flow......_S7__S...........................gallons per person per day. Total daily flow................ ................gallons. WSeptic Tank—Liquid capacity.423 u.gallons Length................ Width................ Diameter--------.----.-. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......... ......... Diameter....G............ Depth below inlet...4............ Total leaching area...3ga! ...sq. ft. Z Other Distribution box ( ) Dosing tank ( I / 768 G. ?.D ' '—' Percolation Test Results Performed by.......---1 ✓ - !' l '. !?� �_�st Date-.-�'_ik�e_3............. aTest Pit No. 1..... .....minutes per inch Depth of Test Pit...../L.......... Depth to ground water--Xul.t-........ (TA Test Pit No. 2................minutes per inch Depth of Test Pit......;'........... Depth to ground water..-.8................. ...................... ....-----•--...... O Description of Soil2 ,.�n.�..� ... r7 iL•-••-✓ 2fT ►te e��.................................. 0 ------------------ •---------------------------------------------------------------------------------- ---------------------------------------------- •--------------------------- •------•----- W UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ....................••-----•-----------------•----••-----•---------------•-----------------------------------------•-----------•• --------------------------------------•..............•••............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dis a System cordance with the provisions of iITY,; 5 of the State Sanitary C — } ee rees to place the ystem ' operation until a Certificate.of Compliance has en iss h o 1, a th. Sig? d. -• ...... - .... p Application Approved By-------------------------------------------------------------------------------------------------- _ Date . ?1, Application Disapproved for the following reasons---------------------------------------------•---------••--------------------------------..._....--------------•- -•-----------------------••-•----------------•--.............................•-•-•------.._..---•---••---•-----•--•-•---..... Date Permit No......................................................... Issued_.................. -- Date................................ i j i i ',�• �Tad `,\ Q J a'oe SJ�FTG O F O P oS E D A LT E R AT1 DAJ S�QtIc SySrsr-1 - 13vl.ewisBa k�� . moo+ Iv Ica I-e lei 83 ,q )b�,-f A • �F'esrro� ,�c , C��� i E���necr- /V 0• p- �qzz 3.n�tiiR{tprsALpi64��*9LLS�Y�t.6R�I"-.y FZ I;AA(4'ANO LOVEH S 3Me uarir %O FIN/SH GRADF lS... RFOu/RtJ . 14L1,.1;,;:., ui..i.. + � ui1.J1uu14L'tut..a..l..l!I ii__y, ,,•u ltuu:uii?.t+.i.l{!L�llL1=1!::141 uILL:uu/a�JlWii!li.LL/1LLluLLit " ' ,.'� .:/c t lll'll/i.11 .. 9 _ d'uNPERFORATEO Z _2"//8"r0 1 - . ' C UIFR�RFORATED -_. (Y ' ..I '- \ P/HE - � - P/_PF _ � .l. Nf4✓7�L ST� EVEL ,YI 7 sg�P/PF. -OC)kQp00000 = 1_.....t 0000000 ' -9 PVC QQ�QpppQ pp " SAN I � 4 ttiC -\, I :. �WOQb00 - I.. - /FE v S4N O 00 7FF. p p T4NR ry .. wIL'f J.!()U rL1 TS - f 2�� HEQV/RED ✓ / GALLON.SL�PT/C TANK D/STR/BUMN a BOX - GlY0111OW47EHrABLE`�., SE MOEP/TAND LINER 8. .. PROF/LE I,*CA 6ATF. 41L UNSLI ESOIL rUADEPrH -- _ OFIAPPrS�JX/AlATELY Fr 41Y('REFILL WITH CLEAN COARZWASHEO SA NO:AN& \ W4SHF0 SKY✓E GH4VFL BELOWARE4 OFSEEPAGEPIrSAAf9 FOR A OIS7ANCE OF 10'IN 41 L.OIR£CTIONS. UVPERtaRgrED ,�'�� - 4CCESS I IF THE SYSTEM IS BELOW NAYURA[GROUND, Plfi� Ai4VC E`'' OR'FORADISTANG£OF25'INALLDIRECTIONS IF NE SYSTEM IS 489W N4TUR4 L GHOUNO REGULATA9N2..I7 of r/r[.E,Jz � b-D/A LINER - •. '{ MASSW URYOL^R�SAL t�ICIL/fYSN9LL dE LYaVSTAICTED/NACQr1WDMIL WLTNThE Rwu#m rsof T/I,L£ ? OFrNESTATEawlRONArami cemeAwAfo IRGTLQVS + Y ow rM/S OESIGN SN4LL cE ALLL>N'f0 WITN01/r AitOR.4pp wL or rN/S mncr. SEEf�GE P/T AND LINER " Z lyy 1 p, E D snit.c w lriow w�r£R rABLEEavArlov AND Acc£PTABLF MAric ttx�,a CAN VARY AW AUSr W VERIFIED AwR ro,rw row OF Q;11lSrRItCT O .' PLAN ' ELEVATION:SCHEDULE, DESIQ'V ELEVATION ` roP oFFouNDAriOni /ci o LEACHING AREA DESIGN ANALYSIS FINISHED BASEMENT FLOOR FINISHED GARAGE FLOOR —: REQUIRED Z , P)75 O F t:D E D SEWER INVERT'A FOUNDATION _ 9 S• 6 �B£ORocws Ar l-c Gpalw- ��© GPO SErYER./NVERT.!N7t2SEPT/OTgNK + 50�FORGaR�aGEGRiNOER = 000 y' AES/Gfr: Gi�7 TOTAL EFFLLiENT ,SEWERINVERTOUTOFsEPrIGTANK�.' D£S/GN F'E'RC RATE?AIM INCH SEWER INVERT INTO DISTRIBUTION BOX_ `I t.} `2, 8ormw AREA 1?-�SF 0 = LZ GPD SF-WER INVERT OUT OF D/STR/BUT/oN BOX L} o -WEWLL AREA = S.£,r. 7' GPD SEWER INVERTAT SEE.PAGE P/TS �3•( row LEACHING ARC4 '�sF w1:�ANQc rr nFZ��c' ELEVATION OF GROUND WATER TABL£: BS t O S X EXAMINATION REPORT, ! EXAM/NATION TAKER/BY A r pcZ�J ON S/a /93_AND WITNESSED BY Joh H .Jdt.�� i BOARD Of HEAL/�i.s7GENr rEsr P/r No TEST,P)T NC) '2 /4`4 T6��'1C1 13 v ��w IS SAl — ��Itv�Clif,..A�A GROUND SURFACE EL 9 s'3 GFeoulvo SUR�ACE EL. �o��,�.4 S14SO,J f° t�a ,�-sk b�oA ON-SITE" SANI URY. DISPOSAL SYSTEM z z — AL.SERF A. PEARSON., JR Medlfr�M Ne ►�►� C/V/L ENGINEER 4 — q ° 26 LOWER COUNTY ROADNN/SPORT,MASS 02639 s I CERTIFY TNAr rHESEMNGE LYSR7SAL iACLCi 1 Y siY01NV H£REW HAS B B } _ �- t1 GN£0/N4=RDANCF.W/rH RE19ULATIONS Or rtE LOUL 00ARO "2 r hEAL7t/ANO 7/TLE 5 OF r S 4rE,6WIA0NME r4 crw /0 OArE OVAL E/VGINEFR F y ALBERT A. 14 /4 $ PEARSONJR. ' No.22618 , PERC TEST PEFK" TE'sT ?p fIJ TAKEN AT FEET TAKEN ,fir FEET ,r I RATF —&_MIN I/NCH 4. RA £= MIN.ANCH ��IC.V/�L �•aG`� —�`"! A..T.wr+.+•J1�++!rrti'Tw�nw.+.n•,•a+.T�.•.+�;n—..r ..*tm+.wfe•r/*'..T:pr+p.+,M..:m..mq.»nnm�.•:m�.r..n,..ww+..i�'tee+f..�+7•mml�•.w+Yn•.er 1 oJG i �n o i � r✓ ' n�rx y 0 �y -KETG OF 1C SySr� M 130pewitS� k�� �lJof -ca �e C III En�,neCr sly ee+ ► °f Z A PPL�C T r��.J N O• P- 19 z-Z 1 y'�'r'mr'3rwwrenr�srw� � gHmp�7a�Mkni4aYRM� ' /nAacs,AnU�U✓L"HSdm.)UGH1 � , . - -` Acp i fO FINISH GRADE.IS - ! ,H£OU/HEI7 . I.L(!Wi.....La11LL(-+U.� �' .1[LlluillilllW+LLW+1::L4JILIL�LL1f1't11�1111141'IUL.LILTI - L.�.!'.'1J/[L{I;!>.i1LL1.lUL.LLII q.r UN s. ...J _.. <.AI'L�HFDHATED _ �4 Pf OR4rE0 1 N[A 'D 57�NE PIPE-..'/ - I PIPE �. - IL 4'r,7 1�4t �. 3 :�- ._ 1.Q..._� iC.a-QpppOppU�pj _ tWASYfO SIVAE- _ PIPE I - I - } I:OQ� C10 JO t L �,• I CXn�pp00000 ( \ COQ�I'lplQp0p 0 ' SAN i. 1 .r I:.L..�q'PK; I 00000 7EF-- v:,` 7ff O �E 888Q080 i L . . I OOC._COC.O 74NX 'S. . WILT I `j S'4 REOVIR£D .- - -- - -- - - GALLON XPT/C TANK D/STR/BUrION a BOX crr�L✓vp w4IEk.rAec€ SEEfEP/TANp L%HER F - PROF/LE EXCAVATE ALL UNSU/T ES'0/L 70 AUEP7H^--•-- "�` OF1APRRox1NArELY FT ANr-REF/CL 1"J,-'�7"7ri[•v?" - WJN CLEAN COAR-W W4ShTV SANU..AND WASHED S7OVF -' ' 1 f GHAVFL BELOW ARE4 OFS£EPAG£PIrSAAt7 - q„ �9 j FOR A DISTANCE OF,O'IN ALL DIRECTIONS uvPMVwrF r• - 4MES4 i- IFTHE.SYSTEM`15 BELOW NATURAL GROUNO, P/FLU E OR FORADISrANCEOF25'INALLDI�'C7)GYVS - - IF rW SYST MISAWW NATURAL'NOW) - ['- • lrEQULATIONB./7 OF rlrL£X ;T ti'0[4 I INEH THISSIN/rARYO,-RASA W11.ITYSMU W C1W.5MOM AV ACa*DMIGEW/TH?w I.' . R�A/i NTSA°T/2E 3 OFTHESTATE6VV/RONMEM4C0Df*ONO{4RIArW$ (} Fgw TH/S DESIGN S/ "ef ALUIWfO W/THOUT A9'Q9 4PPAUL Q�''flllS rl'1�7CE. SEEPAGE P/7'AND..L/IVER R r q V 1 xx AA4f reams"areR 7ABLEEamnav 4YD ACcEprmt c MATERIAL R�1MrJ CAN AW AV57 aF VER/FAEO fWR TO 11E TAIL''a°COWNUCT M PLAN r ELEVATION SCHEDULE. ELEVATION s TOP OF FOUNDATION LEACHING AREA DESIGN ANALYS/S FINI5HED'B,4SEMENT FLOOR REQUIRED F/N/SHED GARAGE FLOOR' { SEWER INVERT AT FOUNDATION -- 9s, C7 'i� BEDROOMS AT /10 OPalWz�,,,`,'L�p GPD SEWER iNVERT lN'TO SEPTIC TANK + 50%FOR GAR&GE GRINDER = -: WO G�TOTAL EFFLUENT SEWER/NVERT our OF SEPTIC TANK y y DES/GN PERC RATE z- 40,V/INCH SEWER'/NVERT/NTO D/STR/BUT/ON BOX BOTTOM AREA .; 17-15F L== J�_GPD- SEWER`INVERT'our OF D<STR/BUT/ON BOX; 9 y+ f) . -WEW9LL AREA = S.F. x'S = Lf a GPD SEWER/NVERT AT S EPAGE P/TS. -3 S'# r F Cf3..� TCJTAL LEACHING AREA 5'£ W.iCAPAC/, YOf •P! EL EMTION OF GROUND WATER TABLE I SOX EXAMINATION REPORT; t EXAMI/VATION TAKEN BY PCB' r:J +�• ON S`/J /963 AND WITNESSED BY JOh �1az-o� ! BOARD Of HEALTH AGENT TEST PJT NO _ TE T P' T NO i GROUND SURFACE EL 9 S'3 j;RovND SURFACE EL. _ °�.. oa•ri ��sp;t �° L a•,.'. sk bs�, ON-S/TE SANITARY. DISPOSAL:SYSTEM 2 z � ALBEERT A. PEARSON, JR mejiliM CIVIL ENGINEER 4 4 26 LOWER COUNTY ROAD DEiV/V/SPORT,MASS 02639 - - /CERTIFY rosr.1NE,SENgGEO/Sft�SAL FAC/L/TYSHdNV NEREf7M"HAS$N Q fj F 11 CWD LNAAa140ANCE W[7H REGULATIONS Or TIE LC AL WARD ' "2 r/EAL7M ANO TIME 5 Of 7 S ATf EhV/R(ll✓MF TLY)D£ --- — p M /0 /0 a4TF O[V4L ENGINEER - - /2 I2 ! ALBER,A. 14 /4 $ PEARSOM,,JR. tJo.22618 PERC TEST PEM' TEST 'a TAKEN AT 2- FEET TAKEN 41T FEE �ECI$TF." �/p ',x7 p72 I- RATE= IN INCH RATE= M/N//NCH �Fe�/C a ./'� .• f "J - r, ""^^."r .o�,..'�.^''T"•��`.,�..r...n,.+.,m,•..—__ ..-.,.-^.-m+-,•..*.n++++.+...-nT„-•..++.+,.r..,-.+-...,.-„r.. ......,. ..s+n..�+...-.+w.w..,.�. .�.e..n,-.-. -...-+_-..,.r.-�.. ,,.. .,..-•.,,,..,____.�_—.........