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HomeMy WebLinkAbout0020 MICHELLE AVENUE - Health 20 MICHELLE AVE, COTUIT 027 072 r i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission o era e. ou must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. a�trr a DATE: r 1 Fill in please: mrW'd¢ g��'�$E :.Q APPLICANT'S YOUR NAME/S: s..,y _ BUSINESS YOUR HOME ADDRESS: - ! DOL-t(�7 .� I ktz E=xfi! afYisa + i w . - ' 4 TELEPHONE # Home Tele hone Number l - NAME OF;CORPORATION k = NAME OF,,NEW BUSINESS ` `1 , .^ _ _- TYPE OF BUSINESS IS THIS A_HOME`OCCUPATIDN� YES NO ADDRESS:OF BUSINESS MAP/PARCEL NUMBER Cam : (Assessing]` When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable: This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate our�'stl�°"iness in this town... 1. BUILDING COMMISSIONER'S OFFICE r. This individual has been informed of any permit requirements that pertain to:this type of.business. Authorized Signature** i COMMENTS: 2. BOARD OF HEALTH This individual ha beern�fg, M of the permit requirements that pertain to this type of business: y Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has,been informed of the licensing requirements that pertain to this type'of business. Authorized Signature* COMMENTS: ,q COMMONWEALTH OF MASSACHUSETTS g EXECUTIVE OFFICE OF ENVIRONMENTAL S C DEPARTMENT OF ENVIRONMENTAL E TO '19 ONE HINTER STREET. BOSTON. MA 02108 617-29 00 /r ►d Lie roo. tS �9 VvILLIAM F.WELD. Robert J. e 11D_<�� �E;7 �DY COXE Governor Robert C/o Argon - ties D ID B.STRUHS ARGEO PAUL CELLUCCI up1 Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ti Commissioner PART A CERTIFICATION Property Address: 20 Michelle Ave . , Cotuit Address of Owner: P.O . Box F Date of Inspection: /—;Z T_q '� (If different) Osterville , MA 02655 Name of Inspector: Wm E Robinson Sr I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: WM E Robinson Septic Service Mailing Address: PO BOX 1089 , Centervi 1 1 e, MA 02632 Telephone Numberj _508 j 77S-877A 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 see age disposal systems. The system: sasses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: ZI, Dater The System Inspector shall 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 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. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: 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. CO MENTS: B] S STEM 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. Ind' ate yes, no, or not determined (Y, N,or ND). 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 World Wide Web: hnp:ltwww.magnet.state.ma.us/dep Z�'j Printed on Recycled Paper • A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) s Property Address: 20 Mibhelle Ave . , Cotuit , MA Owner: `-Robert J.-GQ 11a Date of Inspection: / — oZ ! `�� 'S B] SYSTEM CONDITIONALLY PASSES (continued) _ 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). 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 pipe(s) are replaced obstruction is removed C] FURTH R EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: onditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the ublic health, safety 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 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 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 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 (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 L #: c �tx e .'.,r. ,r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART A CERTIFICATION (continued) Property Address: 20 Michelle -Ave . , Cotuit , MA' Owner: Robert J. Gonell'a Date of Inspection47 : r " D] YSTEM'FAILS: A You ust indicate ei;•;er "Yes" or 'No"as.to each of the"following I have determined that the system violates one or more of the following failure criteria.asAefined 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. a Yes No Backup of sewage into facility or 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. t Static liquid level'in the distribution box above outlet invert'due to'an overloaded or clogged SAS or cesspool. M H Liquid depth in cesspool is less than.6" below,invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times'in the,lastyear NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption,System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or;privy is w6i"n a Zone I of a public well. ".Any 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: If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,`volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARG SYSTEM FAILS: r You mu indicate either "Yes" or "No -as'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: Ye No the system is within 400 feet of a surface drinking water,supply M1 the system is within 200 feet of a tributary to a surface drinking water supply - s 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 ow er or operator of any such,system shall bring the system and facility into full compliance with the groundwater treatment program require ents of 314 CMR 5.00 and 6.00. Please consult the local regional office'of the Department for further information. (revimed 04/25/97) Y Pages 3 of 10 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 20 Michelle Ave . , Cotuit , MA Owner: Roberti. Gone lls Date of Inspection: 9- Cr 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. V _ As built plans have been obtained and examined. Note i1 they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. 1L _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. V _ 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. j The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (raviaad 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 20 Michelle Ave ,, Cotuit ,• MA t Owner: Robert J. Gonella Date of Inspection:cZ 9 .z FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):.A—d Y Laundry connected to system (yes or no)': '3 Seasonal use (yes or no) 1998 49, 000 gal.' Water meter readings, if available (last two"(2) year usage (gpd): Sump Pump (yes or no): 1997 46, 000ga Last date of occupancy:—/ COMfo ERCIAUINDUSTRIAL: Type of stablishment: Design f ow: eallons/day Grease t p present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sani ary waste discharged to the Title system: (yes or no)_ Water m ter readings, if available: Las4da of occupancy: OT (Describe) Las ccupancy: GENERAL INFORMATION PUMPING RECORDS anid source of information: ILIA System p ped as part of inspection: (yes or no) 1. If yes, volume pumped: _gallons Reason for pumping: TYPE OF STEM 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)/tv rb g 44011�C.� I (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Michelle Ave . , Cotuit., MA owner: Robert J. Gonella Date of Inspection: BUIL NG SEWER: (Locate n site plan) Depth bel w grade: Material o construction: _cast iron _40 PVC_other (explain) Distance f om private water supply well or suction line Diameter Comme : (condition of joints, venting, a"vidence of leakage, etc.) SEPTIC TANK:_ (locate on $ite plan) i Depth below grader Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: bl Distance from top of sludge to bottom of outlet tee or baffle: 9 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: fib' How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet to s or ba!�J% dept5 of I iquid level in relation to outlet invert structural integr ty,evidence of leakage, etc.) b 0 .d l,t� tv GREA TRAP: (locate n site plan) Depth ow grade: Material f construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensio s: Scum chic ness: Distance f om top of scum to top of outlet tee or baffle: Distance om bottom of scum to bottom of outlet tee or baffle: Date of I t pumping: Comments: (recommen tion for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evi ence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Michelle Ave . , Cotuit , MA Ow"er: Robert J Gonella Date of Inspection: p, TIG T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (loca a on site plan) Dept below grade: Materi I of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dime lions: Capac ty: gallons Desig flow: gallons/day Alar level: Alarm in working order— Yes; _ No Date of previous pumping: Corn ents: (con it, of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_V (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evi ence of solids carryover, evidence of leakage into or out of box, etc.) PUMP HAMBER:_ (locate n site plan) Pumps working order: (Yes or No) Alarms n working order (Yes or No) Comm ts: (note c ndition of pump chamber, condition of pumps and appurtenances, etc.) r (revised 04/25/97) Page 7 of'10 " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Michelle Ave . , Cotuit , MA Owner: Robert J. Gonella ' Date of Inspection: ,—;L??9 _ SOIL ABSORPTION SYSTEM (SAS): r/ (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: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) �%D s-C> r^ .o L ,,S�d.►�e:Y �� X u�1 Lr ,YJ� G ei®C/ 4!f a CES POOLS: _ (local on site plan) Numbe and configuration: Depth-t of liquid to inlet invert: Depth o solids layer: Depth of cum layer: Dimensio s of cesspool: Materials f construction: Indication f groundwater: i flow (cesspool must be pumped as part of inspection) Comment (note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate n site plan) Materials construction: Dimensions: Depth'of so ids Comments: (note conditi n of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revimad 04/25/97) Page a of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM JNFORMATION (continued) Property Address: 20 Michelle Ave . , Cotuit , MA owner:, Robert J. Gonella Date of Inspection: oZ p g 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) A 4� oZ (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 Michelle Ave . ,C otuit , MA Owner: Robert J. Gonella Date of Inspection: Depth to Groundwater Feet Please'indicate all the methods used to determine High Groundwater Elevation: btained from Design Plans on record V Observation of Site (Abutting property, hole, basement 5Ump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers , Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) P/00s.-3 1-36,yt /F <t r r j (revised 04/25/97) Page 10 of 10 4A 'o ?, 7 /0 7 z-- �p zoo K)U ts} �.fz J I F is a 1 � To FF i Cra-T146bL>a1 5 c FP IV NEDz B G� , v I . 3 ^ V __....._--.__�_ I i , � 1 t J � I ; i O i I i i I , 0 IF s e t i i ! , f LOC TION � •SEWAGE PERMIT NO. 6 - C VILLAGECl 1 �p FTI i �� INSTA lE". NAME i ADDRESS 1 �® U I L D E R OWNER lei� � o1v DATE PERMIT ISSUED 7 Li-7Z,9y' DATE COMPLIANCE ISSUED e/ c_ No.0-2 THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE_��L-mj .........OF..............et-_L4 Loo� r�.......................................................................... Appfiration for Disposal Works Tanstrurtion Vamit Application is hereby made for a Permit to Constru �. or Repair an Individual Sewage Disposal System at:- A� .a --------- � .------- .......................- . .. . -- cation dress ................. . V.. ... .. ... . ... ....... ......... Lt...... . ... n ddress C4 ............ ...... . .................................... ... ... . . .. .... ............ ............... Installer Address Type of Building Size Lot....C26,.M.Sq. feet U Dwelling—No. of Bedrooms----------3..........................Expansion Attic Garbage Grinder PL4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Other .......................................... fi2gures ............................................................................. --n-ow Design Flow_.._.__4;F?1ft.... ...gallons per person per day. Total daily flow"'-.-,- W ........................gallons. 9 Septic Tank—Liquid capac' ....gallons Length________________ Width_._____.________ Diameter._._.____.______ Depth___.______.__... Disposal Trench—No_.......... ..... Width ....... Total Length__._________ ... Total leaching area....... ft. ter Depth below inlet_____.__.___. Total leaching area..."/ S...sq. ft. Seepage Pit No - - V ---------- Z Other Distribution box ;) Dosing tank aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit__._________________ Depth to ground water__-____________________. (4 Test Pit No. 2................minutes per inch Depth of Test Pit______________,_____ epth to ground water_______.._.._______.___. - ---------- ............................................................. _44.... . 0 Description of Soil...... ....... ........W V4 ......... ................ .................. U -_- ------ ------- .. .. .......... ...................... --- --------- ... . ...................... ....................... U Nature of 2- epairs or Alterations—Answer when applicable............................................................................................... ...........................................................................................................7........................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLI'IlL- 5 of the.State Sanitary ode he ersigned further agrees not to place thysyste7m operation until a Certificate of Compliance has b i e b t e board of health. -7 Signed ..... . .... ........ ................. .. ............................... 7 . ............... ApplicationApproved B ... ..... Z............ . .................................................................. ... ... ............. Date Application Disapprove or ' a following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date ------------ --------------------------------- ----- No.l......... Fizz.....`._.. ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD�/)bF HE L IF /�f IDA ' l � e ............... ............................................ Appliration for Disposal Works Tonstrurtion rumit Application is hereby -made for a Permit to Constru ".--or Repair an Individual Sewage Disposal System at: ................_"...%........... ........... .. . .................... ......... .r . ........................... re Lot, ................. .. . ............. ................... .................................... .....p . -- -.. ... _ -0. n 0( ddress ...............4t# .. ..... ...... .... ..... ..................... ...................... —..... ............ ... Installer Address Type of Building Lot... ..Sq. feet Dwelling—No. of Bedrooms.._........3 SiZe..............Expansion Attic Garbage Grinder Other—Type of Building ............................. No. of persons............................ Showers Cafeteria OtheL-fixtures .........................................I........................................... . ................................... Design Flow......4711� per person per day. Total daily flow--.- .....................gallons. 9 Septic Tank m­Liquid capafc* . r.-....gallons Length________________ Width........_._..__. Diameter..._._....__.__. Depth....._.......... Disposal Trench—No.............. ... Width---.. -- ------- Total Length......_____. . Total leaching area-____--- _�Sq. ft. Seepage Pit No ter.......... Depth below Total leaching area._ Sq. ft. z Other Distribution box Dosing tank Percolation Test Results Performed by........................................................................... Date....................................... Test Pit No. I................minutes per inch Depth of Test Pit._____._............ Depth to ground water.......___.._........__. f%4 Test Pit No. 2................minutes per inch Depth of Test Pit___,..........I..... epth to ground water..._-___............_... .......... ..................................................................... 0 Description of Soil.......6), ------------------------- .. .. ............ ....................... z ---- ----------------------- ------- .............. - ' 2------- ----------- ................................................ U Nature of 2- epairs or Alterations—Answer when applicable............................................................................................... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T LZ 5 of the State Sanitary, e h- -_ .ersigned further agrees not to place thysyste7 in operation until a Certificate of Compliance has be n i e b e board of health. Signed ............................. .............................. --- ----- ---------- Da't ApplicationApproved ........... ................................................................... ...... ..z.... ... .............. Application Disapprove or fefollowing reasons:...........................................................................................Date................ ......................................................................................................................................................... ............................................... Date PermitNo......................................................... F r Issued..-•---------------------...........----••--•----•------ f Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF H EAL/TH fl ........OF......Z 1).......4 If .................................... Trrtffiratr of Tompliaurr THIS IS TO CERTIFYThat the Indict, I Se, a e isposal System constructed or Repaired by------------------- /r -.�........ -. ......... ............................................... __j,.!e 171.. ....... ............ at............................................................................ 1) C--X 3' / ..... ..... ........­.................................................................. ......... Cod cri e in the has been installed in accordance with the provisions of T�� E_ d s Vhe State Sanitary C� application for Disposal Works Construction Permit No........................................ dated. --------------*----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL 0 NC SATISFACTORY. •DATE....... Inspector------ .. ........................................................................ ---------------------------------------- THE COMMONWEALTH OF 4SSACHUSETTS BOARD Lr .......................... .... . ................................................. NoZ2...................... FEE. `,... ...................... Permission is h y granted...___.._�Z'...... ------ ------e-4— ,ern ------—--------------- -------------------------------------- r ------------------------ -a ---Z —t- to Construct or',Repair IndiviAlual SLP atNo................... ..................... ..................... Street as shown on the a/Ilica n for Disposal Works Construction- Pertnit-Wpq ... Dated...... ............... ............... .......... .................................--- ........................................ Board of Health DATE............................................................................ FORM 1255 A. M. SULKIN. INC.. BOSTON 1� FAM1L`( - � f• y 1. GLG-=• BGpR�OM I '; uo GARBAGE G�tio�2 �� �-3.3 j A LY FLOW ... ilU x 3 -- 33oG.v � T G TA�JK = 330x15o% - �49 J 6.P � '''`�• j. SEP, ,IUS� 1 00o GAL. � �°Z...�'a Z Z� G.3�� •� PIT VSE . 1000 GAL. •Sf,DCY,/ALL A2CA. = 1 JoS.s= �I � � i E-t� � '�50 5.F X 2.5 3? 5G.P17 ' &OTTo/A ARZ A- �0 5•r - �\ ti -QvX F . X 1 1 } ' "TOTAL- pES1GN - .425 G.P. D. /O�•S ' % .S U PEE- tas�L-r►ou R�.TE 2 MI nl iI �OF syc OF 414SWILLIAM 3 G NIA THULIN N Y E ` ,A No. 19334 0 �. `cv� No. 199L60 w - 1 }- w T Sir .I LI •T�sr�.�/.7. Al I I C l• /�3. >�Y / � ' ���.sJ-aye �. : /�Z • �=?, ,.I�� '' I -��-��F i � .. , '' tom• /a/,o / D Z O i M 6' 1000 15T. INS. Gay. D r3So/c_ 0� 5SPTIG 000 I N`/ TAN K (I 'PIT� INV. INV. �i Mom. WIT14 /ee. Z. G,�AI/rG. WASNGD ` � al CE2TIFICD PLOT PLAN PRU i(/o �i�•�� W O 5 CALE S cA L.E. 1„_ `�U AT E i — • P L-P N tZ E F E IZE N GE RTN COMPL`!5 V��N `TH P 1 c���N �4YN A► P 56T5AGK 26RV12EMEN�'� or- -Tµc O F 1 S f10 - LOGp.TED1 WITNIIJ T 6 GLoop PLv IW D•K't'E--2�i � B A xT E cL a NYE i N C. A., REG 15T f�26�'I-Au D 5 u 2v EYof�S 'T►AIS a3'rG2.VILLE - MASs• IN,5-r'RVMENT SvQv>:`( � -TNE 01"r.SE75 5 5UL ►4o-r U5EDT0 0E-TEFL/n111E �.oT -INE f�PPLICA►-I'r'