Loading...
HomeMy WebLinkAbout0159 MARINER CIRCLE - Health 159 Mariner Circle Cotuit P A _ 023_ 053 i f I it OFARSTALETO •LOCATION _ SEWAGE # VILLAGE ASSESSOR'S MAP &.LOT ,;_1"CISJ QST � —&P—HONrM. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS— BUILDER OR OWNER for�f PERMITDATE: COMPLIANCE DATE: !U Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet ot leaching facility) Feet Edge of Wetland d peacd* Faility„ any wetlands exist within 3 o Feet Furnished y l J-6U � F � t ' � l DATE: 9/4/02 PROPERTY ADDRESS:-159 Mariner Circle ---------------------- Cotuit,Mass. �iJ ------------------------ 02635 ------------------------ On the above date, I inspected the septic system at the abovE adgk&EIVED This system consists of the following: 1 . 1 -1 000 gallon septic tank. SEP 2 5 2002 2. 1 -Distribution box. TOWN OF BARNSTABLE 3. 1 -1 000 gallon precast leaching pit. ( 6 'X9 ' ) HEALTH DEPT. Based on my inspection, I certify the following conditions: 4 . the septic system is in proper working order at the present time. 5. This is a title five septic system. ( 78 Code) 6 . Waste water in the leaching pit is 42" below the invert pipe. 7 . This house is used seasonally. SIGNATUR Name: J .- P . -Macomber-jr. Corripany : Josepl, P._ Macomber & Son, Inc . Add ress :__Box _F��............ Cen-t-erv_i11e,_ba-_Q2632-0066 Phone: 5 0 8-7 7 5-3 3 3 8 --------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Eox 66 Centerville, MA 02632-0066 775-3338 775-6412 -\ COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 159 Mariner Circle Cntui ,Mas _ Owner's Name:Mary Beth D' Aueteui 1 Owner's Add ress:50 Rexhame Road Worcester,Mass. 01606 Date of Inspection: 914 f 02 Name of Inspector: (please print)Joseph P.Macomber Jr. Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 Centerville' ent eryi11 e'Mass_ 02632 Telephone Number: 508-77c;-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP appr'pved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Zo/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails 1-1 Inspector's Signature: Date: %�' ��✓ The system inspector shal ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform i.n the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I f Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 159 Mariner Circle Cotu}t Mass Owner:Mary BeTT u ueu ll. Date of Inspection: 9 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A System Passes: �� have not found any information�vhich indicates that any of the failure criteria described in 310 CMR 15.303 or to 311f(_MR751-04 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the preqpnt- time- B. System Conditionally Passes: �i. 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. ,C�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: d,jj 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 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: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 159 Mariner Circle Cotuit,Mass. Owner: Mary Beth Q'Auetpuil Date of Inspection:g/4/o 2 C. Further Evaluation is Required by the Board of Health: AV 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 Svstem is functioning in a manner that protects the public health,safety and environment: ,4� 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. �d The system has a septic tank and SAS and the SAS is within a Zone I 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 10 feet,bu`t�5 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: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propem Address: 159 Mariner Circle Owner: Mary Beth D ueteuil Date of Inspection: 9/4/02 D. System Failure Criteria applicable to all systems: You must indicate "yes" or"no" to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 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 b x above outlet invert due to an overloaded or clogged SAS or slcesspool �i/0Z/o L -1X Liquid depth in c®sepool is less than 6" below invert or available volume is less than 'h day flow Required pumping than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface /water supply. E�/Any portion of a cesspool or privy is within a Zone 1 of a public well. Y f�ity portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.] (Yes/No)The system fails. 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 _ no 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 Zthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone 11 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. 4 Page 5 of I I OFFICIAL, INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 159 Mariner Circle Cotuit'Mass_ Owner:Mary Beth D'Aueteuil. Date of Jospectioo: 9/4/02 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No Pu_ mping information was provided by the owner, occupant, or Board of Health / !' Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period ? XHave large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out ? Were all system components,�luding the SAS, located on site ? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition oZle files or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? Was the faciliry owner and occupants if different From ( p 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: 1' xisting information. For example, a plan at the Board of Health. '/De(ermined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 159 Mariner Circle Cotuit,Mass . Owner:Mary Beth D'Aueteui l Date of Inspection: 9/4/0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_,�_ Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of-Zed—rooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system,, es or no):a [if yes separate inspection required) Laundry system inspected(yes or no): _�(,y Seasonal use: (yes or no): 5 Water meter readings, if available(last 2 years usage (gpd)): 2 0 0 0=4 2, 000 gal lons=1 1 5. 07 GPD Sump pump (yes or no): At 2001 =77, gallons=21 0 . 96 GPD Last date of occupancy: �,g COMMERCIAL/INDUSTRIAL Type of establishment: /} Design flow(based on 310 CMR 15.203): 4�gpd 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):Ae,# Water meter readings, if available: JJ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Alt, Was system pumped as part of the inspection (yes or no): _ If yes, volume pumped: 0 gallons -How was quantity pumped determined? �l9 Reason for pumping: TYP�OF SYSTEM �//Septic tank, distribution box,soil absorption system / '?)Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be objained from systertp owner) /,,V Tight tank /0 Attach a copy of the DEP approval XD- Other(describe): 12) App ate Ase of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):A 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert) Address: 159 Mariner Circle Owner: Mary Beth D uteui 1 Date of Inspection: 9/4/02 BUILDING SEWER (locate on site plan) Depth below grade: ' Materials of construction:A)Ocast iron _40 PVC 4 other(explain): 4-14 Distance from private water supply well or suction line:�10r-A Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight. No evidence of leakage The system is vented throZlocate gh the house vents. SEPTIC TANK: on site plan) /d -90�� Depth below grade: � Material of construction: 1,'concrete..y,,e metalA/d fiberglass 46epolyethylene .d/d other(explain) If tank is metal list age: Ve is age confirmed by a Certificate of Compliance (yes or no):.G6 (attach a copy of certificate) 'Dimensions: 6r Sludge depth. i Distance from top of sludge to bottom of outlet tee or baffle _ Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet t e or baffle: How'were dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump the septic tank every 2-3 years Inlet & outlet tees are in place The sPntic tank is -,true orally sound and shows no evidence of leakage.The liquid level at the outlet invert is fifty one inches. CREASE TRA (locate on site plan) Depth below grade: A Material of cons truction;RA concretV2Ametal,�%9 fiberglass.*//olyethylen 0 other (explain): A Dimensions: Scum thickness: ti Distance from top of scum to top of outlet tee or baffle: l/� Distance from bottom of scum to bottom of outlet tee or baffle:d Date of last pumping: XW Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Grease trap is not prPsPnt I 7 Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:1 59 Mariner Circle Owner: Mary Beth D uteui Date of Inspection: 9 4 0 TIGHT or HOLDING TANK(mnk must be pumped at time of inspection)(locate on site plan) Depth below grade: AM Material of consmruction: ty concrete metal hl,4 fiberglass&ZRpolyethylene -M other(explain): N.� Dimensions Capacity: C� gallons Desien Flow: �/� gallons/day Alam present (yes or no): ,t, Alarm level: � Alarm ir, working order(yes or no):,t)4 Date of last pumping: /10 Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not presen DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakaee into or out of box, etc.): Distribution box has one lateral.No evidence of' solids carry over.No evidence of leakage into --o—r--o—uY—of tne 56R. 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.): Pmmp chamhPr iS n0 present 8 Page 9 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 159 Mariner Circle Cotuit,Mass, Owner:MAr RPth D' A iteuil Date of Inspection: q f 4.109 SOIL ABSORPTION SYSTEM (SAS): !/ (locate on site plan, excavation not required) 1 -1000 gallon precast leaching pit. If SAS not located explain why: Located: See page 10 Type leaching pits, number: 1 leaching chambers, number: 441 leaching galleries, number: leaching trenches, number, length:767 (} leaching fields, number, dimensions: overflow cesspool, number: innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to fine sand No signs of hydraulic failure or nondina Soils are dry Vegetation is normai.waste water is 42" below the invert pipe. CESSPOOL5(,�,,t(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 laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no):22 Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cesspools are not present. PRIVY4±(locate on site plan) Materials of construction: Dimensions: 2 Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): _Privy is not present 9 Pagc 10 of I I OFFICLAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMEN-rS SUBSURF^CE SEWAGE DISPOSAL SYSTE M M INSPE CTION FARM PART C SYSTEM INFORMATION (coniinvcd) Pcoper7 AoGrc„Mary Beth D'Auteuil 159 ariner i le Oxocr: (ant-n it-'Mao Om Of Inipcciioo: 9 14 /_02 SX-ITCH OF SCWACE DISPOSAL SYSTEM h011Ot t tkcich of the Icwtfr ditpottl tyltcm inclvding Oct 10 11 Icasl fwo permancnl rcfcrcncc Ia,nCmcrx, �, ocncnmVki lo<tic tll/.<II� ..;th;n 100 fcct. locctt whcrc pvblic wctcr Ivpply cnlcrl the bvilo;q • � f I l0 I �I Page 1 I of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propem, Address: 159 Mariner Circle Cotuit,Mass. Owner ary Beth D'A uteuil Date of Inspection: 9.14.109 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _ feet Please indicate (check) all methods used to determine the high ground water elevation: N_Q__ Obtained from system design plans on record - if checked, date of design plan reviewed: NA Vpq Observed site (abutting property/observation hole within 150 feet of SAS) NcL_ Checked with local Board of Health-explain: Y_F�_& Checked with local excavators, installers- (attach documentation) YPG Accessed USGS database-explain: http• //town. barnstable.ma.us. You must describe how you established the high ground water elevation: sed: Gahr-etY & Miller Model 12/16/94 Ground water elevations above sea level- sed: USGS s obseryet.-J on tine 1 Q g 2 sed: USG . water elevations. F_ Leaching �r Pit "eet Croundwater- `'Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottgm , of the leaching pit and the adjusted groundwater table is feet. r 11 y:,.rrn r•,.—n :a—.-n—Zrn—err.nmm+r..rrrr.rrr.:•.�e-:+v.r:+rr-s+�r.�mnvt.srrrer.mn . TOWN OF Barnstable LYJARD OF HEALTH 0 -T -"--311I1Sl1fZFACF SEWAGE DISPOSAL ,SY�STF,M INSPFCTION FORM - PART D .- CERTIFICATION esssmnarr+�•ort ssm n•�mrrtrstrrrrs*rm.•.—rrr-•r•-.. —..� -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 159 Mariner Circle Cotuit Mass. 02635 ASSESSORS MAP , BLOCK AND PARCEL # �✓2�"® OWNER' s NAME Mary Beth O' Aotevil PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P_Ma .omher Jr- COMPANY NAME J.P.Macomber & Son inc':` COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or Clty State lip COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of :inspection . Tile inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of oil- site sewage disposal systems . Check one : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 16 - 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this forum , System FAILED* The inspection wlticlt I have conducted has found that the system fails to p Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date ne copy of t11i c .ification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEAL'I1(, * If the inspection FAILED, the owner or"'.operator shall upgrade ' the ayetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 , 305 . partd , doc ON Fi$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEtA -�Ti-I ..................OF....��.........✓..... �..... -------------------------------------- ,Z pplirativit for Disposal Works Toniitrurtinat Frrutit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System===aLoc X .... � toyy..s � ....................................................... r Lot No. W a s ..AdAlu f• . ..................: � �( ............. r V One o /` ., .... Installer Address d Type of Building Size Lot_c _0®®..Sq. feet Dwelling—No. of Bedroom ._._.____. ..........................Expansion�Attic ( )- Garbage Grinder ( ) P4 Other—Type of Building .... . ........ ... No. of persons...__....(.�................. Showers ( ) — Cafeteria ( ) aOther fixtures - ------------------------------------•-_..... W Design Flow..............j�---------.---gallons per person per day. Total daily flow.........3 ......................gallons. WSeptic Tank—Liquid capacity.gallons Length.A_.�i..... Widths; Z..... Diameter________________ Depth................ x Disposal Trench—No--------------------- Width.................... Total Length............_........Total leaching area._ ft. Seepage Pit No......:...... ..... Diameter....... ....... Depth below inlet....l -----.-.---. Total leaching area..................sq. ft. Z Other Distribution box ( I) Dosing to ( ) ��?!� Percolation Test Results Performed by.... .....P f t'C..... .... ........................ Date... __...__-----.--------1........ ,aa Test Pit No. 1................minutes per inch. Depth of Test Pit-------------------- Depth to ground water.s� � Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water. ____._..__..._..___ O Description of Soil......C..... ..... W ..........(0 L •••. --------3� • •------ UNature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersi ed further agrees not to place the system in operation until a Certificate of Compliance has been ssued by the b of heal . Signe . .. ..... ...................... Date ApplicationApproved By........- -------•-- ------•---••--•-....-• ..= __...1.�.2............................ Date Application Disapproved for the following reasons----------------------------- D -------------------------------------------------------------------------------------------•--------.------------•--•................................................................................. Date PermitNo......................................................... Issued....................................................... Date NO................ _..... Fic$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE A TH GULCJ ------......OF..._ C l f'L,7... ....._.''':...... Alip irntiun for Disposal Works Toustrnr#ion ranfit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at __.._-r... ........................................................... dLocatio�Adress t No- .......O ner ..... - ...... Installer Address i U Type of Building Size Lot.c;.C'�C?��..Sq. feet Dwelling—No. of Bedrooms._.__._.:::.........................Expansion ttic ( ) Garbage Grinder ( . ) a`4 Other—T ype of Buildin _____g//..�'��� �•--; No. of persons________ _______________ Showers ( ) — Cafeteria ( ) d Other fixtures , W Design Flow..............--5-5....................gallons per person per day. Total daily flow..........- .....................gallons. V W Septic Tank—Liquid capacity-/ZTI. -gallons Length-AL ..... Width.___� !..._.. Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length................... Total leaching area..._.f:'-...��q. ft. Seepage Pit No............../..... Diameter.._../�__..... Depth below inlet----!y'........... Total leaching area.'')._.........sq. ft. Z Other Distribution box Dosing tank ( ) '-' Percolation Test Results Performed by. .t ? (r ���:... ( `�2 oZ'37L1s.(.... Date..-ZI ........ ----.................. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.._._/4_1/1If jr P� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............... ------•------=.................................... •-------••-•--•--... ............ .--•--------- ------------------------------------ •--------- ... D Description of Soil...... .- ..('�....._ � �``..� ............................................................................................................................... V _--.--_--•-•--•------ ------------------------------------- •----------------------- --•-----•------•--•------------ W ••-•-•---------------•---•--•-. `1�l------- • ���� .. 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 TITTIS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeniissued by the bo rd of health. ` . ate Application Approved B ................................4?� � Da......••---•-- Application Disapproved for the following reasons:................................................. ------------------------------------------------••- •--••-----...•--- Date PermitNo........................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH l .....................OF....... ....................... ..T__ :....,.... ..... S (9r I fifiratr of 0imp trp THIS IS TO-C RTITY, That'the,Individual Sewage Disposal System constructed ( or Repaired ( ) Y 1 Installer/ / f{/ at r�1(�,� t-' = . '�fca ,t f has been installed in accordance with the provisions s of T �4 jhe State Sanitary C ��s jkescpkeen the application for Disposal Works Construction Permit No......................................... dated...._�_... . .._.___..- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION,SA ISFAtTORY. M!A DATE �:...........................1.b �. .........._ k�. 1 1� Inspector..... THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF HEALTH �.,.....r... , 0 ,:7,03 .....................0F......... .. G- ����:. "`.........---------•--........ d �J No...............•_.-•-• FEE........................ Disposal Works Tonn#r ion- arritit Permission is hereby granted__ !^. !rf1......-"--/K-,/Al..:......---•---------'•......................... to Construct (�,/) or Repair ( )-an ndiv�dual Sewage Disposal System �,- St- 't / as shown on the application for Disposal Works Construction No�_..__ ................. P ... Board of Health DATE....... ..................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 1 f ASSESSOR'S MAP N0.{ 2- RAXCEL �S L,OCA ION SEWAGE PERMIT NO. VILkl. AGE l I N S I A LLER'S NAME A ADDRESS �(UCNY1 \ `� i��• M4-) U I E-R OR OWN ER DATE PERMIT ISSUED . a°� kC(,�Co DAT E COMPLIANCE ISSUED - J� , P0, R- }j 1 '� r LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME R ADDRESS BUILDER OR OWNER %1 ne, 5 DATE PERMIT ISSUED _T DAT E COMPLIANCE ISSUED A p r z( 7 ASSESSORS MAP A!O: c 'AR(11F_ <<0.: FRZ'1�.- ....... THE COMMONWEALTH OF MASSACHUSETTS SOAR® l�,2EALTH ­77. ................ . \3. OF........-................ .._........ Applira#iou for Biupuutti Works Toustrurtiurt ramit Application is hereby made for a Permit to Construct ( ) or Repair (k--ran Individual Sewage Disposal System at: -• - � K�N `" ... r ��.1�................. ............. Location-Address or Lot No .. . ... .... ........ ....•---...-----•---------....---...._.._........._..........--•••-•...... .•-• - -��-1 . ........... ...................................................... ner .........................Address --------------------------•---•--...------ Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grinder ( ) PL44 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .................................. w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ 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______-______-__-_____. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •----•-------•---------------•••--•-•-•----•----..........••-•-••-----•---••-•-•---••--•-•--••--..._.......................=................................. 0 Description of Soil---•----•-----------------------•-•-•--........---•-----•--.........._.....-----------------------------------------•-•------•---------------••---•-••-.......•-•.----- x t., ------ w -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable................................................................................................ •••-----•--•--------••-------••••--•---••--•----••--•--••••-•-•---•-••---••••-•-•••••...............•-•-.....--•--•--•--•----•••••-•----•-••••-•-•-••--•---•-•-•---••••••••••--••-•-•-•••••-•-•.....••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ii 1 i.a. p 5 of the State Sanitary Code— The undersigned furtl er agrees not to place the system in operation until a Certificate of Compliance has be I e b oa of health. Signe ............................................... Application Approved ----•--- .......... Gl........6. ................................... ................__ �z Date Application Disapproved for the following reasons:..................................... ----------•..................•---....----....------•-------------•---•----...----------------..••......•...----•--------------------------------------------------------------------------------------••- c� Date 7ER Permit N ----•-1• .................... Issued-........................................................ Date rt)r yrA 5 _ _J 1�='��...� . FEs..... .. .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.....�...� . Ajip ir4tion for Diopoottl Works Tonotrnrtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair (..-'f'an Individual Sewage Disposal System at: --------------.� ....`..I�M�v . .....__.....--•--._.-_--•.----.... 1. ------_ _---_...-.-------._........._._....-.---.-------- --�.. � Location:-Address or Lot No. -------------•-•------• --------------------------------------------- --- k-L-fir- --------------------------•-•---••------••-•-•---•---- -�.. ner Address ta Installer Address Type of Building Size Lot______•_-_•__••_•__________•Sq. feet Dwelling—No. of Bedrooms......_..._�...........................Expansion Attic ( ) Garbage Grinder ( ) p-I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------•••-• . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench-:Vo_ ____________________ 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -----------------------•------------------------•---------...--••-•-------------•---------•------•--......................................................... ODescription of Soil........................................................................................................................................................................ W V -•-•••••-•-•------•----•--•--•--•---•--•--•-••--•--••--••-•--••----••-•--•-----•••-------------••••----------------•••-•...... -•-•-••••-•---•••---•••-•-•••-•-••._..-------------•--•-•--••-•-------••- W ....................... ...............................................---------------....-••-•-••--•--•••••••..._._...--------------------•------------------------...-------------------------_-••-•- 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 1_'p or the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n i e&bWe_1-3`.rr4of health. Signe •••••-•. -_.._ ................................................ Application Approved - Date Application Disapproved for the following reasons:................................................................................................................ --...•-•••-•••••••-•••-••.......---••--•--•-----•-•••---••••------•-•-•--....•-••••••---••-----......••--•----------•----•--•-••----•••••---••-••-•-••---•------•---•--•-•-----•--•---••--••-----.._..-- Date Permit1r -�..................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS �.-- BOARD OF HEALTH ............. .1�-� .�U....O F.......... u ►.............................................. Cwrriif iratr of Tontph atta THIS IS TO CER -IFY,,That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) �y Installer r ------ has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code s des ribed in the application for Disposal Works Construction Permit No �!____ PP 1 .__._. ��...... dated----- - �-�. -��.2---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUA ANTEE TIiAT YHE SYSTEM WILL EON . 10 SATISFACTORY. � DATE. `............. Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF_HEALTH ....... .. FEE.1:....r_............. Fio.o-Fa. Works Tonuirurjtion anti# Permission is hereby grantedlE'�_ °.•`'4_f<....... brr't to Construct .. or Repair ( ) an Individual. Sewage Disposal System atNo....... ..._...____ � .;...1. .... ..�y.. ..._.__._...._.._.._.____....._............_._..__.._.................................................. as shown on the application for pp or Disposal Works Construction Permit Dated__ L.? r� ........................��:._....' ............... •! - Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS, �,�E I� o rJ V 5.C � G•5 C�TL.3+✓ti C�L..�1.r,.I IE ;�� _� -----.• -•-t j I ---- � _._._ ,. P t TG N i..t ti.1 Eg A Mt►sj+"v t-1 Orc w#/ , 3. -- A L-L- Pt PE,s -ro ,coo o itj n4a i54 STe?v 1 S it AAA.. •M. G`E GA ST t R-osJ Or- p v C . ® ALL- -3 E PT'Ic TA"V-S, 0t5T iZ%j% T WhJ e0k, AII J 0 oco -- UHIA 2F-WcKJC A+.�- __ 10c � � v � -r� i f,-1VEf�T" CLEVA' -i©o X% OF Lo-Aj 4 t� PftS u , ftic _I._ ,_ ,�1 - A 2ACw US OF Z 5' A&.30 �K.��lt..l.. 1cJ t'� A Ctk..A.y FONUC I BAR" Stry IbLL 0 ©f • a _ l I .�' �� ' �' J � � � t�t i`,E.0 �c./NEl.1 T� 3w�'S'7"i� 1°�i LIST Za` � o- 1 � '� � � v O (� � ® �� `� � � C.C�(Pt_ram+o til A+..►C� Pt�l oil "rc� !*5�►+C.�.:l�'/�+,.��. J I v c r yo�....��,-�.e� a--- vis l...E'�'S oT1-1>✓it'..v:..i IS E l•.�oT>i�tom, .�1k..t►... �'r'''1�.>� Z?My" 1 0 J .�C aC C T1�.+JC E. VJ\T" T iT t.-,..E.. :5r CstF' -T�•+� ' '�''A't"bT a o o 1, 'f- -T<-� c, L F _L 4 1` -•-"--�`-• '^ .w= G LPL 1L7TTc c:>�3T ' i JT c» Sob< A.°S r-> T\Z p t CA.L i C000 Ca A sc'E��,-�Or2C$i� 5�-lc Tt+�l ikt $y AME2,�.I►.^_) Pa.'EGhST _ CiR- E p c�P•t,. ��� ►.' �. rA+`I K 5 i2E,til F-•ocGE v T�+ea�.�H o�� , S T K , E r.l M E i'S KI CITE. ACCIES•5 M,+► 5 Tlb �b' 7 oTa►�) . � t. � , P5S ; Z ti%00rl ` S t J� .4✓E k►Sin �'i""S c� T' -17 ?t LOAM F-t a..►,Sc-1 G„2�.c� �t,,.-►�5�-� �,c��,� F�.....i�gf•-1 FSrP..�kt�E c�J� F 161 S4N CAq_b1VE_ 'h ° Ne-0 T-A.-4 Y--- '�,X6 oie V C' is�ere _.__ •;� � 5u� sort~ E►� _ • . Skit rs►tL G-r 0 r M E C +off ^mix-n I +# - I I w To COD T !2 ms i t %1-14. �o • 4x m fte,k..kPot[,Eo ccw-.-- L71ST E'jUX. • m c) o o m • PIEoP 1�WElL. A F i!'t.fir►.z", . 144 'J CD - " icf'TI c- x: C��SEt2l/ATtc�.JS c3`� : PA,OL " � ► O r3is� /t/. Y'SC7Af2 7 n F H E At - TVA PNOV Pt opo'srz0 �..,.Lik1cp Lo cArl t o4 Xf, AF, . 1NIER. -7K! C.. I C LE. 7)44r PROP05ECO 5F. rL Dtsposw. Svsmm — Q __ i X sr►r ��, cL�• ►Tcky2 G 8 x 7 E x,ST S Po r �E J L o'r 4 7 /v\ f: CAA t_+_O„,15 P 2,SD►J pEiZ. DAY _`�.2_ PEE c c?�.At i lot.. t—K'ST r io L h , a?�v t -i 3 3 © F,D m c�gs iv 2✓A.T t o.J z .sue I�c�,.. a T u ►T A1Gt ST I'��! »�,� IA. 3 C A,L.F A5 ►+X:IrE.O 1 '5 P L 0 T PL A," / /� y, i .ae � -�.-•���� � i- i�c ti.SC-�c t►J��� � I�.tOQ MAc..� G-��5'� , 'P,�, -C� T �1IGWh! rj� ) f`� •t' {.-i�> `C _ n �� r .-. C . t�