Loading...
HomeMy WebLinkAbout0081 MERIDETH WAY - Health (2) 81 MEREDITH WAY, CENTERVILLE A = 3 I j l���f aE4Vf1Ep UPC 12534 No.2� 153LOR HASTINGS. UN i t I� F i LOCAI�N + A (�C.G� �'l No. _2Z,,o .2� VILLAGE C-Q J`Ike DATE APPLICANT _ FEE vs • ADDRESS kJd a U TELEPHONE NO.11?01_/qCS(Non-refundable ENGINEER _ ELEPHONE NO. JW- 3I 30, DATE SCHEDULED � (Applicant' s signature SOIL -LOG .. SUB-DIVISION NAME � DATE EXPANSION AREA: YES�/NOil�i' �s/Vyc�- /� •ram ENGINEER '?� ' TOWN WATER //PRIVATE WELL J' '�tG475 BOARD OF HEALTH 1O EXCAVATOR SKETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and ` ercolation tests, locate wetlands in proximity to test holes ) • 0 NOTES . A ' 'V b v I /epgo .-• PERCOLATION RATE : TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 1 4 e, E 1 2 S�65o�L! 2 � 3 3 / 4 4 . ' 5 5 6 6 7 7 8 � 8 9 9 10 10 11 11 12 12 13 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD/LEACHING PITS LEACHING TRENCHES_ UNSUITABLE FOR SUB.-SURFACE SEWAGE. REASONS : NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . F . AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT No. / Fee U 6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for Migaal bpgtem Couotruction Permit Application for a Permit to Construct( ) Repai%V) Upgrade( ) Abandon( ) ElComplete System Ly Individual Components Location Address or Lot No. 'RI fX0 t J 2(i_► WA-1 Owner's Name,Address,and Tel.No. A`hqa Col e t7 Ce-14rZ <I e 8 l M er', /d CF( Assessor's Map/Parcel r C17 1/ Installer's Name,Address,and Tel.No.e4peoid, &k irse) Designer's Name,Address and Tel.No. 4 G Type of Building: Dwelling No.of Bedrooms Lot Size &'/a:)o sq.ft. Garbage Grinder ( ) Other Type of Building `J e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank � —� Type of S.A.S. 2 p�`bP 17 �uS�JS Description of Soil Nature of Repairs or Alterations(Answer when applicable) fLato`acy_ A,_j fb Ro 17i�Sors 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 by this Boa d of Health. { Signed Date Application Approved by Llr"- Date =U� Application Disapproved by: Date for the following reasons Permit No. cjo&U Date Issued �� Mee . -.r r r. ..k.. "..� __-:..'.*t'. « ..�,.-.r...,...F,,;.,,.-,w.y—. y-,. ...�.xy_... „^;.a,a..�.r-t.' ..•<..,-�.. .,. «. :.. y t � . Y No. i/ I Fee /U U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Migponl 6pgtem Construction 3perm it Application for a Permit to Construct( ) RepaicZ—) Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. p 01 e✓t t(t, W Ate/ Owner's Name,Address,and Tel.No. A 14,7 60 C y� C�tytfT/ i t(? $! m ev-,C(rit, Assessor's Map/Parcel Installer's Name,Address,and Tel.N044,~ trr��) Designer's Name,Address and Tel.No. Gum Type of Building: Dwelling No.of Bedrooms Lot Size /0/ax) sq. ft. Garbage Grinder ( ) Other Type of Building' 5, 4t , 40mi No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank / !� Type of S.A.S. 2 I%l�—i7, 1 -uS�d S Description of Soil Niture of Repairs or Alterations(Answer when applicable) ►(-az, ace- (�^- �?j�X o, j Pin( Date last inspected: Agreement: 'T 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 by this Board of Health. Signed Date ZOO Application Approved by �) tL�• �� Date Application Disapproved by:� Date for the following reasons Permit No. �2 UUU — Date Issued Ste' U ~ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance (� THIS IS TO CERTI Y,that the On-site Sewage Disposal System Constructed ( ) Repaired ) Upgraded ( ) Abandoned( )by t IR2 evi 0) S-e S L4,5,.. at f 1 _ / has been constructed in accordance Iwith the provisions of Title 5 and the for Disposal System Construction Permit No. a. � - dated 9 .- Installer Designer �� f #bedrooms 6 X C7 Approved design flow gpd The issuance of this pe it sh�Iyl n)tt be construed s a guarantee that the system will f rr tion designed. - Date-_ __. V Q Inspector�,�„_� '""'».^.� No. 7k / . Fee r dU THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS ligonl *pgtem Con.9truction Vermit Permission is hereby granted to Construct ( ) Repair (>4. ) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thhs permits Date ) 7 �/� Approved by I Wes. /�.S Town of Barnstable Department of Health,Safety,and Environmental Services 9� MASS. r Public Health Division ABED Mld 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Health October 23, 1997 Mr. and Mrs. Albert Anderson 81 Merideth Way Centerville,MA Dear Mr. and Mrs. Anderson: Thank you for your cooperation in rectifying the water discharge problem at your property located at 81 Merideth Way, Centerville, Massachusetts. According to Health Inspector Jerome Dunning, on or about June 9, 1997, drains were installed into your front yard. Now the wastewater no longer discharges into the public street through a hose. It was a violation of the Town Ordinance,Article 1, Section 3. Now there are no violations at your property in this regard. Thank you again for your cooperation. Sincerely yours, Thomas A. McKean Director of Public Health Town of Barnstable Department of Health, Safety, and Environmental Services � BAMMM E1 Public Health Division wag. s6J9• �� ATED Ml�� 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Health May 2, 1997 Mr. and Mrs. Albert Anderson 81 Merideth Way Centerville, MA Dear Mr. and Mrs. Anderson: You are granted an extension of time to rectify the problem of discharging water into a public street from a hose, a violation of Town Ordinance Article I, Section 3, observed by Health Inspector Edward Barry on February 25, 1997 at your property located at 81 Merideth Way, Centerville, Massachusetts. On April 28, 1997 we discussed the problem with Mr. Stephen Seymour, P.E., of the Town of Barnstable Engineering Division. He recommended the installation an onsite dry well in order to prevent water from discharging into the street. Once the dry-well is installed and water no longer discharges into the street, you will no longer be in violation of this Town Ordinance. The original order letter to you dated March 18, 1997 stated that you had fourteen(14) days to correct the violation. Due to the fact that you are currently working to resolve this problem, and due to the other factors described above, you are granted an extension of time to resolve this problem. Attached are copies of the complaints which you requested. Please call me at your earliest convenience to discuss a reasonable time schedule for you to rectify this violation. Sincerely yours, Thomas A. McKean Director of Public Health cc: Edward Barry Stephen Seymour Health Complaints 02-May-97 Time: 10:03:04 AM Date: 2/25/97 Complaint Number: 669 Referred To: EDWARD BARRY Taken By: I.s. Complaint Type: GENERAL Article X Detail: .Business Name: Number: 81 Street: MEREDITH WAY Village: CENTERVILLE Assessors Map-Parcel: Complaint Description:,=OBSERVED A HOSE COMING FROM THEIR YARD PUMPING WATER INTO DRAINAGE AREA. IT COLLECTS AND FREEZES AND LOOKS LIKE ALGAE. CHILDREN ARE PLAYING INT IT AND SHE THINKS IT IS A HEALTH HAZARD. Actions Taken/Results: Investigation Date: Investigation Time: 1 Health Complaints 02-May-97 Time: 4:00:00 PM Date: 6/19/96 Complaint Number: 242 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Type: GENERAL Article X Detail: Business Name: Number: 81 Street: Meredith Way Village: CENTERVI.LLE Assessors Map-Parcel: Complaint Description: is complaining of neighbors constantly pumping water out of basement onto street. Rich Stevens of Building received this complaint and referred it to this department. Actions Taken/Results: DZM investigated the Anderson's Home at 81 Meredith Way, Centerville. They have a sump pump in the basement that exits the house underground and terminates at the curb where it runs down the street. The sump runs year round and is heated so that it does not freeze in the winter. This property is at the lowest spot in the neighborhood and receives run- off/drainage from all the properties around it which are at higher elevations. The property was perked in July of 1993-a dry time of the year. Mr. Anderson wants the town to do something about it. He states he has spent enough money running the sump just to keep the groundwater from entering his basement. Investigation Date: 6/20/96 Investigation Time: 4:35:00 PM 1 f 1NE Town of Barnstable -� Department of Health, Safety, and Environmental Services • sA►wvsreer E. M"& Public Health Division 1639•039 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Health April 3, 1997 Mr. and Mrs.Albert Anderson 81 Merideth Way Centerville,MA Dear Mr.and Mrs.Anderson: You are granted an extension of time to rectify the problem of discharging water into a public street from a hose,a violation of Town Ordinance Article 1,Section 3,observed by Health Inspector Edward Barry on February 25, 1997 at your property located at 81 Merideth Way,Centerville,Massachusetts. On April 3, 1997,you discussed the problem with Mr. Stephen Seymour,P.E.,of the Town of Barnstable Engineering Division. He stated it appears as though you have two water problems;one with groundwater and one with surface water. He recommended that you hire a civil engineer to design a solution to your problems. Groundwater Problem • Based upon your stating that your two sump pumps have been operating continuously since last summer leads Mr. Seymour to believe you have a problem with a high groundwater table. Your septic plan from 1983 (which we gave you a copy of)indicates that groundwater was about 7 feet below the surface of the ground. You stated that you lost electricity resulting in an excessive build-up if water in your basement. The groundwater fluctuates from year to year and seasonally. Right now the groundwater is relatively high. • One possible solution that Mr. Seymour suggested was that you build-up your basement floor with fill and cement. This should not be done until after you contact a private civil engineer to determine the highest potential groundwater elevation by utilizing USGS calculations. Surface Water Flooding • Your back yard is one of the lowest spots in that area and water drains from neighboring properties into your yard. The photographs which you provided showed surface water flowing from the back yard down the stairs into your basement. We gave you a 100 scale print out from the Town's G.I.S.that shows how low your backyard is compared to your neighbors. • One potential solution to this problem is to have your engineer design a stormwater collection and infiltration system for your backyard. The system would involve some re-grading of the backyard away from the house,installing a catch basin,and an infiltration system consisting of washed stone and either concrete or plastic infiltration chambers. 1 ' 4 In addition I would note that there was a blizzard on April 1, 1997 and the Governor of Massachusetts declared a state of emergency for three days. The original order letter to you dated March 18, 1997 stated that you had fourteen(14)days to correct the violation. Due to the fact that you are currently working to resolve this problem,and due to the other factors described above,you are granted an extension of time to resolve this problem.Please telephone Health Inspector Edward Barry at 790-6265 within 30 days to communicate what actions you have been taken toward resolving the problem. Sincerely yours, omas A.McKean Director of Public Health IP 339 5?8 783 us Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to St & um er P ce,S ZIPC 44 Postage $ SO Certified Fee , / Special Delivery Fee Restricted Delivery Fee LO rn ReturnReceipt Showing to Whom&Date Delivered n Retum Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ s CO Postmark or Date Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m cc return address of the article,date,detach,and retain the receipt,and mail the article. rA 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the _ gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. CO 5. Enter fees for the services requested in the appropriate spaces on the front of this ' I receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. r I 6. Save this receipt and present it if you make an inquiry. t _ Town of Barnstable • Department of Health, Safety, and Environmental Services IMBNO ABM MASK. � Public Health Division 3639• FORA 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean FAX: 508-775-3344 Director of Public Health March 18, 1997 Mr. & Mrs. Albert Anderson 1209 Tropic Terrace North Fort Myers, FL 33903 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00 STATE SANITARY CODE II,.MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE ARTICLE 51 The property owned by you located at 81 Meredith Way, Centerville was inspected on February 25, 1997 by Edward Barry, Health Inspector for the Town of Barnstabl,e because of a complaint. The following violations of Article 1 General Sanitary Regulation Section 3 were observed. Water running from a hose from house into public street. Water collects on the street and runs down the street into catch basin. (copy of regulation attached.) You are directed to correct the above violation within fourteen (14) days of receipt of this notice by ceasing from this activity. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PE ER OF TH BOARD OF HEALTH omas A. McKean Director of Public Health f The Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 Office 508-790-6265 Thomas A. McKean FAX 50 � $ 3344 /9-t.-Cy", /�! Director of Public Health -�r q NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at$ �` rtdr-,� C ✓ was r inspected on �. � � , � 1997 by, i.�Lj Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 40.5 , S , um an rs o -ZA..� t�7 /19"Coft .� You are di to these o t' s wit wen ou 2 f4) hours receipt o its 'ce. You are also directed tQ correctr� within Fes �;',,>,�.d-re days/hours of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health % SENDER: V ■Complete items 1 and/or 2 for additional services. I also wish to receive the rn ■Complete items 3,4a,and 4b. following services(for an m ■Print your name and address on the reverse of this form so that we can return this extra fee card to you. ai d ■Attach this form to the front of the mailpiece,or on the back if space does not ❑ Addressee's Address 4) permit. y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery to .0 ■The Return Receipt will show to whom the article was delivered and the date a c delivered. Consult postmaster for fee. d 3.Article AAdyessed : F 4a.Article Number � ' `� CL E `� E 4 .Service Type .' d V 1Z 0 ❑ Registered 10 Certified W ❑ Express Mail ❑ Insured CE ❑ Return Receipt for Merchandise ❑ COD ' I c 7.D of Del' e w Z �� 0, 5.Received By: (Print Name) 8.Addressee's Address(Only if requested and fee is paid) c 6.Sign to ssee or Agent) ~ X I i [�, ilii ii 3 I - l it it j >, ' r���p C '�16(✓( l l i i l i 1 i 1 i t It i i i y Domestic Return Receipt Ps Form 3811, De ember 1994 I r UNITED STATES POSTAL SERVICE First-Class Mail 'PostTM Se�_es Paid =USP_-Permit No.G 10 • Print yoyr name, address, and-ZI P'Code-in-this bgzCe --�— w�1 Public Health Division Town of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 I M II I ` Ilisssssi.,iiiss�issis}�Illissssisisesllsi�ssi3,risiisslssi=.�� `1 L,z 29 CHAPTER III. PUBLIC HEALTH, SAFETY, WELFARE, CONVENIENCE AND GOOD ORDER ARTICLE I. GENERAL SANITARY REGULATIONS Section 1. No person shall throw away or sweep into, or place, or drop, or suffer to remain in any street, any hoops, boards, or other wood with nails. projecting therefrom or nails of any kind, shavings, ashes. hair, manure, rubbish, offal or filth of any kind, or any noxious or refuse liquid or solid substance. Amended May 18, 1976. Approved September 13, 1976. Rescission of text pertaining to placing of clam and oyster shells. Section '2. No person shall pasture any cattle, goats, or other animal, either with or without keeper upon any street or way in the town, provided that nothing herein contained shall affect the right of a person to use of the land within the limits of a street or way adjoining his own premises. Section 3. No person shall allow any sink water or other impure liquid to run from the house, barn or lot, occupied by him into any street of the town. Section 4. No person shall barter, or trade, and collect Junk without a license from the Town Manager of the Town. Adopted March 3, 1914. Approved October 28, 1915. ARTICLE II.. ADVERTISING DEVICES AND BILLBOARDS Section 1. No person, firm, association or corporation shall erect, display or maintain a billboard sign, or other outdoor advertising device, except those exempted by Section. 30 and 32 of Chapter 93 of the General Laws. (a) Within fifty (50) feet of any public way. (b) Within three hundred (300) feet of any public park, playground or other public grounds, if within view of any portion of the same. r ' Health Complaints 03-Apr-97 Time: 4:00:00 PM Date: 6/19/96 Complaint Number: 242 Referred To: DONNA MIORANDI Taken By: DONNA MIORANDI Complaint Type: GENERAL Article X Detail: Business Name: Number: 81 Street: Meredith Way Village: CENTERVILLE Assessors Map_Parcel: Complaint Description: is complaining of neighbors constantly pumping water out of basement onto street. Rich Stevens of Building received this complaint and referred it to this department. Actions Taken/Results: DZM investigated the Anderson's Home at 81 Meredith Way, Centerville. They have a sump pump in the basement that exits the house underground and terminates at the curb where it runs down the street. The sump runs year round and is heated so that it does not freeze in the winter. This property is at the lowest spot in the neighborhood and receives run- off/drainage from all the properties around it which are at higher elevations. The property was perked in July of 1993-a dry time of the year. Mr. Anderson wants the town to do something about it. He states he has spent enough money running the sump just to keep the groundwater from entering his basement. Investigation Date: 6/20/96 Investigation Time: 4:35:00 PM 1 Page No. 1 01 2 Pages. PIONEER BASEMENT WATERPROOFING, INC. 6101 597 STATE ROAD WESTPORT, MA 02790-2819 PROPOSAL (508)674-5121 1-800.649-6140 PHONE DATE TO Al Anderson 81 Meredith Way Pe-1v/2, JOB NAME/LOCATION 4/70197 Centerville MA 02632 JOB NUMBER JOB PHONE We hereby submit specifications and estimates for: Install two Super stump with(2)Aquanot primps with 12 volt deep cycle marine batteries(gel filled).71us includes basin,cover,check valves (2)Water Watch Alarm Systems,necessary 1 1/2"pvc sch 40 pipe to outside. Install 2 Ice Guard systems(to protect line from freezing. Install appox.65 feet 4"S/D line to Drywells as per specs page 2. Install 2 Concrete drywells with concrete covers,surround with crushed stone,replace sod,tamp,rake clean. We will move all large items needed to perform work.(HOMEOWNER is responsible for moving all small and breakable items) We will cover all items in basement with plastic. We will remove all debris associated with work and broom clean. All of our employees are covered by Worker's Compensation.We also carry a Complete Operations Liability Policy. Certificates of Insurance will be provided on request. 3 year warranty on Aquanot pumps and batteries,labor and parts. MA REG. 0112382 RI REG. #3934 NAWC #235 We Propow hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Four inousand'rnrce Hundred Seventy rive and 60/100 Dollars dollars (S 4,375.00 Payment to be made as follows: t $1000.00 retauier mailed with signed copy of proposal and balance at completion of job. All material is f guaranteed to be as specified. All work to be completed In a professional manner according to standard practices. Any alteration or deviation from above specifiea- Authorized lions involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes,accidents -------'—` or delays beyond our control. Owner to carry fire, tornado and other necessary Insurance. Our workers are fully covered by Worker's Compensation Insurance. Note:This proposal may be withdrawn by us If not accepted within days. ACC,epilainlce of Proposal —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature —to do do the work as specified. Payment will be made as outlined above. Date of Acceptance: _.._..� .�-- _ -__-_ Signature f � 0 ..... 1 6 1999 REIx1VE .� ID- DEC.;. T0�4N Of BARNSTA9LE e� 1 i HEAITHDFPt• TOWII COMMONWEALTH'OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIR , J_ hnG ac DEPARTMENT OF ENVIRONMENTAL PROTECTION `^�JD P'Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Name of Owner RUTH ANDERSON Address of Owner: BOX 612 CENTERVILLE MA.02632 Date of Inspection: 12/14/99 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: n/a Mailing Address: n/a Telephone Number: n/a CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection Is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Maluation By the Local Approving Authority performing at the time of the Inspection.My Inspection does Fails not imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: ilt Date:12/14/99 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. f revised 9/2/98 Page 1 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: nta 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. Wa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Wa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced Wa The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14/99 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance nta_(approximation not valid). 3) OTHER n/A I I revised 9/2198 Page 3 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an 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 1/2 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 nta. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a 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 I 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No. X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (1 5.302(3)(b)) X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14199 FLOW CONDITIONS RESIDENTIAL: Design flow:JM g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):I Total DESIGN flow: 402 Number of current residents:I Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NO Last date of occupancy: Wa COMMERCIAL/INDUSTRIAL Type of establishment: WA Design flow: n&gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) n/A Last date of occupancy: n(a GENERAL INFORMATION PUMPING RECORDS and source of information: 1993 System pumped as part of inspection:(yes or no):NQ If yes,volume pumped W& gallons Reason for pumping: n& TYPE OF SYSTEM XSeptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM WAS INSTALLED IN 1983 PERMIT 83-663 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14/99 BUILDING SEWER: (Locate on site plan) Depth below grade: V Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n(a Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: E Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) D& If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO nLa Dimensions: L 8'6"H 6'7"W 4'10" Sludge depth: 2' Distance from top of sludge to bottom of outlet tee or baffle: Z" Scum thickness:-Q Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Q How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND,RECOMMEND PUMPING EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nla Dimensions: Wit Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:j3La Distance from bottom of scum to bottom of outlet tee or baffle nla Date of last pumping: Wa Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nLa revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n& Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) n& Dimensions: n& Capacity: Wa gallons Design flow: nla gallons/day Alarm present: NO Alarm level:jVi Alarm in working order:Yes—No—: NQ Date of previous pumping: n A Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Wa DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nla revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: WA Type: leaching pits,number: n& leaching chambers,number: 2-FLOW DIFFUSERS leaching galleries,number: Aita leaching trenches,number,length: n(a leaching fields,number,dimensions: n/a overflow cesspool,number: WA Alternative system: nta Name of Technology: jVa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE FLOW DIFFUSERS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. CESSPOOLS: _ (locate on site plan) Number and configuration: Wa Depth-top of liquid to inlet invert: nLa Depth of solids layer: n& Depth of scum layer. n& Dimensions of cesspool: D& Materials of construction: Wa Indication of groundwater: WA inflow(cesspool must be pumped as part of inspection)WA Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n& PRIVY: _ (locate on site plan) Materials of construction:WA Dimensions:Wa Depth of solids: Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa I revised 9/2/98 Page 9 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a Al�a Ded A I A� r� A� ad ,q� ISM �4 53 5iL Pic ro3 ► revised 9/2198 Page 10 of 11 I o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 81 MEREDITH WAY CENTERVILLE 147 113 L 21 Owner: RUTH ANDERSON Date of Inspection:12/14/99 NRCS Report name: Wit Soil Type: n& Typical depth to groundwater: n& USGS Date website visited: n& Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 7 Feet Please indicate all the methods used to determine High Groundwater Elevation: XObtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records Checked local excavators,installers _ Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) GROUNDWATER WATER IS AT 7'BY ENGINEERED PLANS BOTTOM OF FLOWS IS AT 3' revised 9/2/98 Page 11 of 11 LOCATION SEWAGE PERMIT NO. t ,!3 F �-c l �2�� ; (r17� g 3 •- ��� VILLAGE INSTALLER'S NAME A ADDRESS A4QA to ? d UILDE. R OR OWNER V O DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ID t,c).4y ✓/ J G -- // FES...... ............ (o T THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ....................OF.......................................................................................... Appliration for Diipn,ial Workli Tomitrnrtiun Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..<....` ....... �:.�s .. •----•-•-•............... W �y r ...... ..................... ---•• { .... Loy,;-Address or t No. = =... .:.... .. ....................... ............. /. l G % 1�.- . L� r. , .-- / caner dre s Installer Address UType of Building Size Lot... fee Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Pk Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Othep3 fixtures ------------------------------------------------------........................................... ••------•... W Design Flow...............©............................gallons per personr day. Total dailx flow...........�.....�• ................gallons. WSeptic Tank—Liquid capacita✓XO..gallons Length.. ............ Width..... ......... Diameter.___.=..__..... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C4 ••••••••••••----------------••••••••-••..........•••••••...........•-•••....................-•.....---•......------•--•••......•-•-......................... 0 Description of Soil........................................................................................................................................................................ U ---------------------------------------------------•--•---------------------------•------•---•------------•-----•------------------------••..... W x ----••---- -----------------••---••-••••-••••-•...•••--•....-••••••••••••••-•••••••-•••.....•••••••-••••••••••-••--•-•---•••••--••••-•-••••-•••••••-•••••••••-••••••-•-•••••..........•••--............. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ••••• ••••-•••••-•-•-•••••••••••••--•-••••••••••••••--••••-•-•••..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITA 11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha be . issued by the and of Health. ned. ......... ? ----------------------- •----��3..-�`_--.-. Application Approved BY -....... ...............••... - .� •• ..... 'Date.............. Application Disapproved f e following reasons:................................•----------•----...........---------•--•---------------•-....--••••-•-••--••-•-. ........................................•••.........---••••••--•...... Date PermitNo......................................................... Issued.----•-•--•--•-------------•---------••••.............. Date ..... ....... FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F Appliration for Diiipo,ittl Workii Tonitrurtion rruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at , Y _�. ............. 6,eil....z ..!�..�_. 1 Lo on-Address or No ` g/j .. . .............................................. 7��[.. __ ..... ...... - R caner dre s Installer Address 'tiff UType of Building Size Lot_._/ o.�Gn_.---..Sq. Dwelling—No. of Bedrooms............. ............................Expansion Attic ( ) Garbage Grinder � aOther,—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) ° 'e'B bxtures .... . ....... .. - - ._... . ........................................... - W Design Flow............................ ..gallons.per persorYer day. Total d90 flow............................................gallons. WSeptic Tank—Liquid capaci ............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width:................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________ _______ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) . aPercolation Test Results Performed by___________________________________________ ------ Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------=--- ODescription of Soil.....................................................................................----------------•----•------•-----------•----------•--------------•-•------------- x W VNature of Repairs or Alterations—Answer when applicable................................................................................................. ••-- ...•-•------•...•-•-•-•••••-•-•----•----•----------••••••-•-••••••••-• ------------•-••-•------------•-•-•------••-•••-------•-------•••••---••••--•-•-•-•-••-•--•---•-•--•----------•••----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witl 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 ,- , be issued by the and of health. Application Approved By......--•••--•-•--•-••••-•..............•-...---•-...--••-...............-----........._..--_-- Date Application Disapproved r e following reasons----------------•----•-------•----------------------•--------.....---------------...------.....-------•--------- ..•••......-•-•••••-•--•-•---•-•---•--••-•••-•-•----••••----•--•---•--•--...•--••-------------------•••--•--••---•-•------•---•----•--•••-•-•-•--••-•--••-•---•----•---- ----•••---•••-_-•---•------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................... ................................................................. (9rdifiratr of Toutphalarr THI CERTIFY,'hat the Indj* i al Sewage Disposal System constructed ( ) or Repairedby .a� ----- ------ ------. ---- ............. at.................................................. ............................. - . ............ has been installed in accordance with the provisions TITL ', r iietate Sanitary Co cribed 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 ATE_ Mli FU TION SATISFACTORY.r- D _ . ...�..__o................................................... Inspector..--- -•- ------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... FEE........................ Bilijroott, I p Toni#rnr#ion Prrmit Permission is here , granted...... to Construct (P. 1 pair <( I " v' S '� Disposal System atNo. ----------------•------•---•• ................. Street as shown on the application for Disposal Work truction Permit No C'.. Dated.......................................... ----------------------------- ------- •--• --•-•••--- ---•-•---•---•----••••---•-----------•-----•-•-- Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON } f ',•;; t�i�lGF.1 -DATA - - - - 9�o,va - r. �F P-AMILlf 3 SEDIZdOtitS Nt LIo 6A28A(ol= Qzi UoE2 AV 6 pn l LY F Lo w 3 X 11 o s 330 &P > 5Mj=T1c -TA►JLe a5o % Iso • Aq5 GPO usr>= t000 Got.. . 96 p 99 LrAC44 ' FtMua • USE :2- VL" VtFFUS5oZtlp 97 5 t t>ay./W-L CZd+•t-8Zt•o8)(-Z,5) = t94' 6.PD. Bo TTEM A.Za A . 288 5F F^�a• ; '." : . �IZ'tZd.��t.o� = 288 b•P�-. : . ToTAt_ '�St 6N = d82 v.PV. o 97 7 P GOL./�.Tt o GZd.Tt- l I U 'C MI u- OR.Lam. aox \ VET4tt_ of '1::)tSFb5&L -51=p ZZ ,g " 9G •e 97.3 i t 4,.0 00 ^d � � � `�•G 2-4xg 1 r1 1=Y 'i "AiT ,T1-a C--- FND. 11=1 ED �1-C�T PL15,N SIDEta�16 ANn 5r--T84c-v- tz E50 u i e EM F-WTS T Ia E -t-ow W of C3A.2.. ST !- i CEA/T,E ✓/4 Lam' i �U• LANn u vt✓`1oP.. raGbl.� ;l,,,T S fo'• 'dA71"s- : �� i 84�CTmz uYr-- lwc- - . Die.33Z; PG,81 ozT�Zv I t ► e - l,us�r7. �fArE2/./G Fob /o ' 44,G 4,2ovti� 0 Z.Q i c LE.q.✓ F/L c_ TAT e; p �3,If totowIUV It1J V4L 98fU✓ Svl��o.� �; �- ., (54L. 8.0 978 Bob // fa.•QG `v VJILLiMv! Tau IC / 3 e ,a. NY is W 1 TI.1 A'OF 3/A 1-o I�c• WAS►t 6D +'. 4TDUF- ALL A2oV"D. Z• of 1 w4,sU&> Pr.ASTONE. oU TOP WATR2. 1-Ls9/-6 *`tH OF PP_oFl L� oF' P20pp5ED _ �, a''P • - � ALA for i�