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HomeMy WebLinkAbout0172 ZENO CROCKER ROAD - Health 172 Zeno Crocker Road,Centerville ,y ,SIIII 2J�QECYCIFp�Om mena�o UPC 12543 'o No. 5 3LOR HASTINGS, MN .o\ COMMONWEALTH OF MASSACHL•SETTS '1 8 _ ? EXECUTIVE OFFICE OF E?'VIRONMENTAL AFFAI �o DEPARTMENT OF EN PROTE O?�(�G, /�E. :. , ONE WINTER STREET. BOSTON. NIA 0210E 617-292-5:00 8 O P" WILLIAV F.W'ELD TRL- Govemc• S etar, ARGEO PAUL CELLUCCI STRUI-1S Lt.Governor .SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissiom PART A ` CERTIFICATION , Property Address: • Address of Owner: p rty �2�e hc�c.�sL— IPA'- �.�e�,�`G�E Date of Inspection: 45 ,3 f > / ° (If different) _ Name of Inspector: tyA a 0! / ��CL�o I am a DEP approved system inspector pursuant'to Seotion 15.340 of Title 5 (310 CMR 15.000) 7ZG,012:> Company Name:lq"/Lw 41-7L1•c En YY'f r-1&1 064 e N Mailing Address: Pin os,,x e_35?!4 - H eg6' P2Q /Y Ig-© 2(-4-5/ Telephone Number: rSe2f`Z G�19— /Lrc ZO --7 CERTIFICATION STATEMENT I certih 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 inspectoo-.. The inspection was performed based on my training and experience to the proper function and maintenance of on-site sewage disposa� systems. The system: 4 Passes _ Concitionaii, Passes tieea� Further Evaluation B, the Local Approving AuthoriN Fa•!s Inspector's Signature: Date: The System Inspector sha!' submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system o, ha; 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 orig:na! should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Aj SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: 41 oN&*jo_ j..a e.\ ii VJJ Z Osct,r_ s4by\6, \a.*- ev Vy-'Q d. BI 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. Indicate yes, no, or not determined (Y, N, or NDi. Describe basis of determination in all instances. If"not determined", explain why not. 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 conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the Wond Wide Wee htW lA vww magnet state.ma.us/dec > Pnntec on Recycied Pacer i 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION (continued) Pro pe ty�Address: Owner: ruts T . Date of Inspection: B] SYSTEM CONDITIONALLY P SSES (contin,,-d C' Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced - obstruction is removed distribution box is levelled or replaced 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 pipets) are replaced obstruction Is removed C] FURTHER EVALUATION 15 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, safer•and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER ., WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or prI„ Is within 50 feet of a surface water Cesspool or priv, 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 APPROPRIATE) 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 to a surface water supply or tributan• 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 (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 1 C/ER/�TIFICAfIIIONn(continued) Property Address: / 2 Z e LA_C> Owner: �w ��� Date of Inspection/ 3 1 ) C7 D) SYSTEM FAILS: You must indicate either "Yes" or "No' a�to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessam, to correct the failure. Yes No Backup of sewage into facility pr system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution boa above outlet invert due to an overloaded or clogged SAS or cesspool., Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flov.. Reauired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe's:. ~umber of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation Am pornon of a cesspool or privy is within 100 feet of a surface water suppiv or tributary to a surface water supply. Any por,;on of a cesspoo' or pr;,.y is within. a Zone I of a public well. Anrn po'',io o-a cesspool or pri\,1v is within 50 feet of a private water supply well Am por,Or o' a cesspool or pri\ti, 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 cope of well water analysis for coliform bacteria. volatile organic compounds, ammonia nitrogen and nitrate nitrogen. EJ LARGE SYSTEM FAILS: You must indicate either "Yes' or "No" as to each of the following: The follow:g criteria app"v 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 safes and the environment because one or more of the following conditions exist: Yes No . the system is within 400 feet of a surface drinking water supply 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ��� Z12. d C�o�if/�� � �►tiTet !/"{ �`� ' Owner: CVej0U1N5VWNv\ Date of InspectionQ /3 1 Check if the following have been done: You must indicate either "Yes" or "No"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. t4 As built plans have been obtained and examined. Note if they are not available with NIA. The iacili-, or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site .,as inspected for signs of breakout. All system components. excluding the Soil .Absorption System, have been located on the site. _ The septic tank manholes Here uncovered. opened. and the interior of the septic tank was inspected for condition of baffies or tees, materiai. o'construction, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption Svstem on the site has been determined based on: The facilit, ovine, ;ano occupants. if different trom owneri were provided with information on the proper maintenance of Sub-Surface Disposal Svstem. M64 Existing iniormation. Ex. Plan at B.O.H. "'-- Determined in the field :)i am of the failure criteria related to Part C is at issue, approximation of distance is unacceptable (15.302.31tb)] (zaviaed 04/25/5?) ?age 4 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propert, Address: Owner: N�w�(nwr„� Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flo%,%.53Ci e.P.d./bedroom for S.A.S Number of bedrooms.6- Number o'current residents:_Q_L Garbage g,; der (yes or no}:_VJLs4 Laundry co-•-ected to system (yes or no',,tkf'5 Seasonal use (ves or no+:2�5) Water meter readings• if available (last two Q year usage tgpo):N0 Sump Pump (yes or no): 1-LO Last date o'occupanoo IQ.�Qf�1 COMMERCI AL'INDL'STRIAL: Type of establishment. Design fio%% ealionsida% Crease trap present. Ives or no' Industna! %%aste Holding Tani; present. Ives or no_ 'ion-sanitar, waste discharged to the T:tie 5 system. ,ves or no_ \%ater meter readings. ii a,adabie Las,pate o: o .upanc, OTHER: Describe Last dare of occupant. GENERAL INFORMATION PUMPING RECORDS and source of iniormation System pumper as par, of inspec,ion: t,es or no:'1Jp r ; If yes, volume pumped gallons Reason for pumping TYPE OF SYSTEM _ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Pn,y Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sy BLS Sewage odors detected when arriving at the site. (yes or no)�10 (zevieed 04/25/91) page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM (INFORMATION (continued) - Property Address: c c-e' Owner: �,ft►JwI�WS�►M'sV� Date of Inspection: j 3 1 /C7 BUILDING SEWER: (Locate on site plan) N C7 Depth below grade: Material of construction: _cast iron _ 40 PVC _other (explain) Distance from private water supply well or suction Ire Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:AeS (locate on site plan Depth below grade Material of construction: _concre:e _meta' _Fiberglass _Polyethvlene _othertexpla)m If tank is metal, list age _ Is age con',irmed b\ Ce-t,f)cate of Compliance _(YesNo Dimensions Sludge depth 1 y Dtsfance from top o: sludge to bottom of outie. tee or ba^le AV Scum thickness: Alf It Distance from top of scum to top of outlet tee or ba^ie %1 Distance from bottom of scum to bo-o•n of outlet tee er bane Now dimensions were determined McAUA--91 Comments trecommendation for pumping, rondition of inlet and outlet tees or baffles, depth of liquid level in relation 't10 outlet invert, stru ur I integrity, evidence of leakage, etc.) wig rA Ea Ine- �w►a4(`.�T �Z4-`S Imr1kc-z-- � T— �' J GREASE TRAP:-90 (locate on site plan) Depth below grade: Material of construction: _concrete _metal Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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.,, (revimad 04/25;97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propem/Ad'dress: 2 Owner: l,�rJrl►a,y n,.\ "l Date of Inspection: `3 1 l TIGHT OR HOLDING TANK: 7ank must be pumped prior to, or at time, of inspectioni (locate on site plan, Depth below grade: Material of construction. _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capaclt\ gallons Design floe. galionssda. Alarm level Alarm in working order_ Yes, _ No Date of previous pumping Comments. (condition of inlet tee. condition o! alarm and float switches, etc.) DISTRIBUTION BOX:1lV (locate on site p;a^ Depth of liquid level above outie; in\e,7 ItIL4 wn r � Comments: mote if level and disv, ,t, is eeual evidence or solids rryover, evidence of leakage into or out of box, etc.) ►-Pao r-+w �,-�l� sT`1�b,► .,� \1 � . No - (DnibcS 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.) (revised 04/25/97) page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: c of co Q�/•Q1 ��( c'`—��V''-v17 Owner: G�*�►w►N�4.to:w� Date of Inspection: O� `-2z l SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits. number. Aws 41y tor— leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions, overflow cesspool, number Alternative system Name of Technology: Comments inote condition of soil. s,er.s of hydraulic failure, level of ponding, condi 'on ot. eg tion, etc.) O� O" e+ Arr CESSPOOLS: _ (locate on site plar. Number and C01f1gur2;,0n Depth-top of liquid to inlet Inver, Depth of solids layer Depth of scum layer. Dimensions of cesspool Materials of constructior. Indication of groundwate- inflow tcesspool must De pumper as par, of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc., (revised 04/25/97) page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: tag �/ Owner: W►W1+'sS nV., Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) P d , 3 Z 4 (revised 04/25/57) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) r ,, Properh ddress: f?�`_ 2�uE� C.�oGI�,Q,�_ �p[ _ aj9a -. — V c Owner.aN Date of Inspection: 4 t Depth to Groundwater`ZOFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Cneck &ith loca! Board o- nea!ti, Chec� FEMA Maps Check pumping records Check local excavators. installers X Lose LSCS Data Describe in vour_own.. %.oros r.o,.% \ou established the High Groundwater Elevation. (Must be completed: �r�J45t`t���1a+�1 t L6 P►. (oc1Z S 3)t�. (rev-mod D4,25'9-. Pago 10 of 10 Bk 28777 Psi 171 14033 04-02-2015 a`l 021229p. DEED RESTRICTION WHEREAS, Michael C Broomfield of 172 Zeno Crocker Rd, Centerville MA is the owner of 172 Zeno Crocker Rd, Centerville MA being shown on; Map 170 , Block 12.8 , Lot 228 ; Duly recorded in Barnstable Country Registry of Deeds in; Plan Book 11004 , Page 342 Or on Land Court Plan number WHEREAS, as the owner of.said (owners signature), lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms to a maximum of 3 as a pre-condition to obtaining a construction permit for the conversion of a single car garage at the above address to a workshop; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a construction permit for the conversion of a single car garage at the above address to a workshop and authorizing the issuance of the building permit, is requiring that the agreement for the restriction on the number of bedrooms in the house be put on record with the Barnstable Country Registry of Deeds by recording this document Commonwealth of Massachusetts, County of Barnstable On this avk� day of NzAd , 20 , before me, th'e.undersigned notary public, personally appeared k't 6-\qj_0_ kname of-document signer), proved to me through satisfactory evidence of identification, which were MO\- Dn JLi'SU , to be the person wh`o signed this document in my,presence, and who swore or affirmed tome that the:-cqF ?Dtts.a,hq document are truthful and accurate to the best of his knowledge and f�� F - r` LYNNE N.OAKLEY Notary Pubfic,ComrnornreaNh of Maesflchuseris (seal. '+ o c, ignature yco ��a.,z,z�, BARNSTABLE REGISTRY OF DEEDS John F. Meade, Register LOCATION SEWAGE PERMIT NO. L©-f ?a8 RD sjS - el- o VILLAGE Cc�Aexv ,i Ile INSTALLER'S NAME & ADDRESS R U I L D E R OR OWNER I-e&ff- Sn Ac, DATE PERMIT ISSUED D`A,T` E COMPLIANCE ISSUED q �- 8 1Jj'�]2� .. 5� i �k � 1� �� JS' � a 7 � ----�� _.____ J M No... S = Fps... ... ......u.. THE COMMONWEALTH OF MASSACHUSETTS ,�- . •�,� BOAR® OF HEALTH r° � Iir�t#i�an nr `�� A�tt1 rk Tonstrnrtinn Prrntit Application is hereby made for a Permit to Construct (o or Repair ( ) an Individual Sewage Disposal System at: L ca ion-Address or Lot o ....................................... /t—/I *ner�7, Address Installer Address UType of Building rS Size Lot.......G�...................Sq. feet Dwelling—No. of Bedrooms.........-•..............................Expansion Attic ( ) Garbage Grinder V aOther—Type of Building ............................ No. of persons.- ":.........._........ Showers ( ) — Cafeteria ( ) Otherfixtures -•-••-•••-----------•---•----•••••••------------••••---•--•-•••------•--•••.._..----••-••...-------•---...------•---•-----------------•-•••-•••----- W Design Flow........_�tk...........................gallons per person per day. Total daily flow............33. ...................gallons. WSeptic Tank—Liquid capacity..W—..gallons Length Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........t--------.- Diameter......1.. ....... Depth below inlet__�?i......... Total leaching area.Z.4.,'�....sq. ft. z Other.Distribution box (A Dosing tank•( ) . Percolation Test Results Performed b .. ..` !. ... ' a4S l ............ Date_.....ts2j �.y F'j697Test Pit No. 1................minutes per`inch Depth of Test Pit-------q1 ....... Depth to ground water......................... PL4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 �` 0 Description oSoil �'? s7.-•- ----------------------------------------------------- -- x ......--••-----•--------------=-•••.......,h ��� ����kr,!..._.i�!.C�?�-----••--�!�I-----••----....------•----•---••----------------------•--=-- W � — U Nature of Repair .. terations Answer when applicable........................14. _f_____---....--.:•-•-••------•-•-•-•----•-•••-•--------------•-• ..� - t * f f t Agr Th a ign d *agr`ees to install the aforedescribed Individual Sewage Disposal System in accordance'with-+. the rovi ns of 1I.L.tJ 5 of the State Sanitary Co — h P The u ersl ned•further agrees not la h Y g q g top place the system in. operation until a Certificate of Compliance has bee I u d y,t b �f health. Signed-. .....--- (=• :.: ''. : ` {�.� r Dat ApplicationApproved By................. "✓--------------------------------•••................................ .........................................* ' Dite Application Disapproved for the f oll ing reasons:.............................. ��• ....................•-------------------•-•--•----....---•-•-----•--•-•---------•-----•--....-----...........................-.......................................................................... Date Permit No..... ._._.. `� ---•----•----•-•= Tsm d =- • 0 Date ---- -- ---- • •,sr s No........................ Flms.............................. THE COMMONWEALTH OF MASSACHUSETTS m`N- BOAR® OF HEALTH ..........................................OF... ApplirFation for DiopnoFal Works Cfonotrnrtion omit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 1 L c tion:Address or Lot No. rier — Address W --------- `-•-------- .: Jll - -------------------------- -•-------------- ...._•------------------------------- nstaller Address UType of Building Size Lot...'.2,.U! d--------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder % WOther—Type of Building _------------------------- No. of persons............................ Showers ( ) — Cafeteria � ) dOther fkxtures .............-............................................ ............................ ............................................................. W Design Flow.........6............................gallons per person per day. Total daily flow...._......3.3_ ...._...............gallons. WSeptic Tank—Liquid'capacitylv2..gallons Length__�.TD... Width................ Diameter................ Depth................ x Disposal Trench—No...................... Width......1.............. Total Length............. Total leaching area....................sq. ft. Seepage Pit No........I........... Diameter.....1.21_------- Depth below inlet_��___._..... Total leaching area 4f_'2...._sq. ft. Z Other Distribution box (✓) Dosing tank ( ) aPercolation Test Results Performed byw �U!_4�.....r `�4 :�._.1.1 �--______________ Date...... 0-4 7 Test Pit No. L....``7'.'_..minutes per inch Depth of Test Pit------ .....__.. Depth to ground water_____..'-"'_____________ Gq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---------------------------•--. ------------......-------•-•-....----...-•--------.........--------•--•-•---•--••---••-------...---.........•--••-•---••-- Descriptionof Soil.................. --------------------------------------------------------------------------------•----- W .................................................. '-� .......CA _�_A�..... ��---...'—At-j)�---------------•----------------•-------------........--------- Z --------------- ------------------------------•-----------••----•--••------------------....---------------------------------•----------------•---------•------------------------------•-••••----------- V Nature of Repairs terations—Answer when applicable._...............................................__._..__...._.............______._.........._. Agree � Th un igned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provis is of TITU 5 of the State Sanitary Code—The u ersigned further agrees not to place the system in OD ntil a Certificate of Compliance has been ued by t b r of health. �.-- / f '` Signed------ .=r �� ........................................ +�' �••1' Dat ApplicationApproved BY................................................................................................... Date Application Disapproved for the following reasons-------------•-------•---......--••--------------•-----------------------------------------------------....------ -------------.• ......................................... Date PermitNo......................................................... Issued......................--•------•-------------••-••---- Date THE COM1V1ONWEAtA10F MASSACHUSETTS BOARD OF. HEALTH ..........................................O F....... ............ ... Trrtifirav Of Tomph aata THIS IS TO CE;2TIFY, That the Individual-Sewage Disposal System constructed r Repaired ( ) by . } nstaller has been instal1 ed in accordance with the provisions of TITIF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... d-ated_-...-........................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SY4TEM WILL UNC�IOV�TISFACTORY. DATE..... ---------.......•-----................................... . Inspector---_--- THE COMMONWEALTH OF MASSACHUSETTS BOAR C HEA TH d No......................... FEE-----........ -_.... rn gispooal Works Ton rtot nio rrrifit F9 } Permission is h reby granted.. •• j C =, ' ;, ........... '............................... to Constr ct (ds)`or Repair ( ) an Individual SedTage Disposal System. at No Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ---------------------------------------------•-------------•---------------•---------------•-------. ,.. __-__• Board of Health DATE ..... -- --------- FORM 1255 A. M. SULKIN, INC., BOSTON S/TE PL A N sHEEr l of 2 SCALE: l = Z o 5� S o \ 100 /& . 5 fiat Alzoc�►.J 1 Pf�vro��D � dw L Y•r 7• D � �; � OF LUAW yJ l l✓— �:`M �ECISTER�`�J FOR- RE6/STEREO LAND S!/RVEYOR L,g, Z ZONE PLAN REF DATE !?t vr�e,t2 ► fes BENCH MARK DATUM L WM. M. WARW/CK B ASSOC., INC. j DOMESTIC WATER SOURCE- --r-'- BOX 80/ - NOR rH FA L MOI/TH 6 D ZONE. -K ,2 >-� - H A �'' f� IC y MASS. 02556 (6/7) 563 -2638 LEACHING DASIN SECTION NOT TO 'SCALE M Sheep z �� z COVER EARTH FILL BRICK AND MORTAR COURSES AS REOD• TO BRING q"• _,r•y_ ., COVER TO GRADE 4' B"FLOW LINE / INLET _i_ _, __ __ 2'=/g TO%"WASHED PEASTONE FREE. OF IRONS, PIPE FINES AND DUST/N PLACE / 1 3/ " TO /%"WASHED CRUSHED STONE FREE OF ':' OPENING WITH 4/B IRONS FINES AND OUST /N PLACE �jOl OUTER DIAMETER AND 13/q"INS/OE DIAMETER ' 1. CONCRETE TO BE 4000 PSI 28 DAYS ,.' ZZ 2. REINFORCED WITH 6%6" NO. 6 GA. W.W.M. � Aol-1, PIT 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS 410" � � -6'p' I '��--� 4. NUMBER OF PITS REQUIRED o� - M/N., i 12 EFFECTIVE DIAMETER NOTE: EXCAVATE TO _ELEVATION 4-OR (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL - war£R raeLE - LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN TYP/CAL PROFILE GRAVEL TO DESIGNED GRADE. —/B'STD. LT. WGr. C./.MH COVER 4"C./.PIPE. 4"8/T.FIBER PIPE OUTLET LEVEL DWELL/NG FLOW L/NE TIGHT JOINT TO FIRST ✓DINT --;--l�,-, Ra �;_. 14„ O oo I IU�00 10 `I7 c.I. rEE 53 ��. ► 10 100 to �}(a• o STD. PRECAST CONC. 6•t}I T. BOX TO BE Io:OD ' + f 0 00 00 1 1 I . `. GAL.SEPTIC TANK. INSTALLED ON LEVEL, 1 11100 0 0 0 1 I I ; STABLE BASE I; III 000 0 0 e 1 i I �BEPT/C TANK To BE I If 0 0 0 00 1 1 + I INSTALLED ON LEVEL I if 100, 00 1 1 + , ; STABLE BASE. I I 1 0 0 0 0 , 0 I 11 111100I001111 ' LEACHING BASIN : i 1 1 0 Q O 00 0 1 + , BASE TO BE LEVEL + + t I 0 O 00 1 1 , , { it L t\/,17-4 SOIL AND PERC. DATA .`PERC. RATE ` �- MIN. /IN. 0�+ TEST PIT NO..P 3&-p� 0+� TEST PIT NO. 2 TEST BY : ItIz U5—�- 'I—;:-L,0 3' -row/SJ�Sdt� WITNESSED. BY: IZoN p GL a A 0 MAD- TEST PIT GR. EL. ANJ fl .. DATE: }c 3/0+ Iz eL. f4a &leoLjr l D wAT �6•v DESIGN DATA GENERAL NOTES BEDROOMS 3 NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. DISPOSAL No SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD �°� EST. TOTAL DAILY EFFL. GPD. PRECAST REINFORCED CONCRETE UNITS. SEPTIC. TANK ►ova GA ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE .5 OF THE STATE ENVIRONMENTAL CODE SIDEWALL AREAZ'`' GAL./SQ.FT, MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA I GAL,/SQ,FT. SANITARY SEWAGE EFFECTIVE ON JULY 1 , 1977. LEACHING REQUIRED 2dp SQ.FT. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL~LEACHING AREA OF HEALTH. �Q:FT. AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE h.,!..DEwA•Ll. : l'>5.7sf,�z,5z ��� ��( BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. D!!! 'fz tI-A: 0 jc-� PITCH ALL SEWER LINES 1/4" / FT. UNLESS INDICATED OTHERWISE. oN au SEWAGE DISPOSAL SYSTEM o MARTIN ' Li -JowoW 5 ' E. FOR -, w 21 17�('►AN Z f`10 0F�s c/s'r SCALE AS INDICATED DATE Z 1-7 µ WU. M. WARWICK 8 ASSOC., INC. - 80X 801 - NORTH FAL A90!/TH ` LASS• 02556 - 16/71 5 63 -2638 'PROFESSIONAL ENGINEER GENERAL NOTES I NEW HARWOOD FLOOR ON TOP OF Y X 6 P.T.F IN ON TOP RAM G OF EXISTING CONCRETE FLOOR 1 No. REVISION/ISSUE DATE X REPLACE EXISTING WINDOW EXISTING HOUSE W/NEW ' EXISTING FRONT ELEVATION ' ORIENTATION STAMP INSULATE EXISTING 2 X 4 WALLS R-15 GATT INSULATION I I I C REPLACE EXISTING GARAGE DOOR \W/NEW FRENCH DOORS AND WINDOW \ � au wwwnYGsaaE rNEFROPErtTroF THE aEswNERANo NIEYARENarTU8EREWDIIJCW94IMMaRWPMT . _ WRNONTTNE*VrMNCOAMEWOFWEDEWAR. LONMCTOR TOU¢CXAND WERIFYALL DMAMOM BEFORE COM ME RaW WORK AND TO REPORT ANY MSCRERANOES TO WE DEMIER. veadsoft _ LL, MTI HOME DESIGNS - =_- 62 LAKE DR 2'-11 1/2"' X 3'-9"5'-1" X 6'-8 1/2" I POCASSET MA OM9 / PROIECTNAME: - == - -- ROOMFIELD RESIDENCE -- ---� - -- _ 172 ZENO CROCKER RD - -- - PROPOSED FLOOR PLAN BROOMFIELD IL L � j I J LLLLJI oRAwnNc " ' FLOOR PLAN BROOMFIELD t1. SCALE:Iles r-O* DATE:AJAN,2024 . r- DRAWN 0Y: SHEET: . RORAWN BY PROPOSED FRONT ELEVATION CHECKED DY. RC,EDRY APPROVED BY: RAPPROVED B i exist.SEPTIC TANK J X�, 1 8'-G" ro I -K «s xsc wzx wx Aux) wxu �v �j13 r - - � — � I exist. I s` OUTSIDE WOOD DECK O OO Prop. SHOWER BATH 0 o proposed a l I KITCHEN 0 1 2'-0" 5-2" BUILT IN r — — �� I STORAGE at ' ® I exist./renov. WASH DRY �— — =J� I OFFICE proposed LL —— tb Md 9js j 9 MUD ROOM proposed b BREAKFAST NOOK z i BENCH,HOOK5 O / \\ O i B SHELF { to proposed L j DINING OZI . Wo o 0a m exist. � ++ WOOD DECK W v c F - - as CLOSET { J p c Lu - - - - c u exist. G! LL `proposed a CAR PORT WORKSHOP 0 CZ_ N I ON N O = c 0 0 N W — — —.— — — — — — — — — L. m d I exist. U LIVING )F- J o I � o_ I UP DATE: 03/21/2016 - - - - - - - - - - proposed 12'-0° FIRST FLOOR PLAN SCALE:AS NOTED DRAWING#: 3/16"=1'-O" EXI5TING WALL5 —_ — — DEMOLITION p PROPOSED ADDITION EXISTING HOUSE ��,'>^""*k^•— NEW WALIS — — — — — — — — — �— — — — — — — — — — — — — P— I I I I I rn I o I I ° W Cn o I CD m I o II n y I T o Z a -- — — - - - - - - -I - - - - - - - - - - - - - - - - - I v 7 o rn I I Z I I I II I WX o~ I ,..;. o m �; _ _ o Io o � F � � 11 ' I O K I D � � L � I F � I I I — - I I z Dy I � I I I I I I -n I � I mX I I I o I I I I L — — — J v 0 o PROJECT: N m m proposed renovations and additions at C BROOMFIELD RESIDENCE Z N o 172 Zeno Crocker Road, Centerville, Ma m 0 0 0 TITLE: PRELIMINARY DESIGN