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Home My WebLink About0075 SANDALWOOD DRIVE - Health 75 SANDALWOOD DRIVE, COTUIT A= 010 011 I LO*CATION SEWAGE PERMIT 1110. VlhLAG.E IN=STA, VVER'S NAME i ADDRESS a WUILDER OR OWNER DATE PERMIT ISSYED _ a4 , DkT' E- COMPLIANCE ISSUED `4/ \ J REA R No.. Fps.. .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. .................. t=L............................... Appliratiou for Bhipoiial Works Tomitrurtion ramit Application is hereby made for a Permit to Construct (K) or Repair an Individual Sewage Dispos;il,-"."1,i'�,' System,at,-: SAP')C31- IAJ D.e ,.... .... .—Alp�b . ................................ ........................ ............................................................... L Add r-1 ...... ..............i C-.H If----L- .1 C-0-ru I M ---------- ........................................................................ er Address _V......... ....................... .............................................................................................................. ..61,4 Installer Address Type of Building Size Lot_-- .....Sq. feet U Dwelling—No. of Bedrooms___......S.............-----------------Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Other fixtures ------------------------------------------------- --------------------------------------- ----------------------------------------*.......Design Flow.................:�5.5)..................gallons per person per day. Total daily flow______.... 15.....__51..0.....................gallons. .... . 1:4 Septic Tank—Liquid capacity_t_qwgallons Length................ Width_._._.........._ Diameter._._......_..._. Depth...._..._.....-. Disposal Trench—No. ....................Width.................... Total Length.................... Total leaching area....................sq. f t. f_..0 p -57-6-0 - 67 Seepage Pit No......I-------------- Diameter--- Depth below inlet-C,..... ......... Total leaching area................. Z Other Distribution box ( � Dosing tank ( ) Percolation Test Results Performed by........W-1--e....oze/k_aem...................... Date�_rf..t Test Pit No. I.......4......minutesperinch Depth of Test Pit.l.Z:::�.0.... Depth to ground water-/./ A-14F r3:q Test Pit No. 2......Z—.-.-niinutes per inch Depth of Test Pit_ Depth to ground water...&0A-j_C7--- -- ---------------------------*------- ....... .............................4 0 Description of Soil. 44 ......................./. V--- Al2a........................................................................................ U ....................................................I..................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable--------------------- --------------------------------------- .................................. ...............................................................................................................I........................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in I- operation until a Certificate of Compliance has been issue-,d by the board heal .......... . . ... (-..!........I& ............... ... ----------q .... --------------------- Date Application Approved ... ...... ...... !,00e,_:�.................................. ---5V ", "2 �------------- Date Application Disapproved for the following reasons:............................................................................................................... ---------------------------*----------------------------------------------------------------------------------------------------------------------------------------------------------------*------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ... .... ..............oF..._.....,.................`�..:- Appliration for Uiipniia1 Workii Tomtrnrtinn ramit Application is hereby-made for a Permit to Construct OQ or Repair ( ) an Individual Sewage Disposal System at: ................-................................................................................ -•••--•-•---••------------....---•••-- --------------.........--------•---------................. ......... .............. Address Installer Address � ®.. Type of Building Size Lot.........A....... .......Sq. feet U'• Dwelling—No. of Bedroom s___._._..:..............:..............Expansion Attic ( ) Garbage Grinder ( ) ,p Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixture d :. W Design Flow............................................�� gallons per person per day. Total daily flow.._...._.__ _�'_�......._...•....._gallons. W _"r Septic Tank—Liquid capacity.1�� gallons Length................ Width................ Diameter---------------- Depth........... x Disposal Trench—No.______-. --__ Width.................... Total Length........... Total leaching area....................sq. ft. Seepage Pit Nei......-_.-__-_� Diameter___°F�__�___��.'-. Depth below inlet.��.�.-.--.. Total leaching area.-F�_...M.-f C�,Po Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed b �_!_ . ® C .. .................... Date_.�-�i ............ Y--• - Test Pit No. 1...... ......minutes per inch Depth of Test Pit---.�y'. .... Depth to ground water_' ....._. Test Pit No. 2..._............minutes per inch Depth of Test Pit_!_ __` ____. Depth to ground water-_A OA) D De c iptio144 n of Soil E?-f-......-. Eye ven �'`�__ � ar�i � ®--•-�-• ��f 60 I_f.. ..m. /� t' T yra W •------------------•-------••---•••-------------------•-•---------••--•--------•----------------------•--•---•--------....-•-------••-------..__...-••-••------•--••-•--•..._......•................. UNature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------_................................ ----------------------•-----•-------------------------•-......------------------------------------------------------------------------------•-•--------•------------......------. ...................... 'Agreement: { The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with !'1T/'1'�'• the provisions of �T:LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation u til a Certificate of Compliance has been issued by the board of hetallth.�f !-�- �t � r�6 " 1. ,.,fir/ •. .----i ,;� •. � � --- -- -- .."�, Date Application Approved By.... !'-�G,�, • , ._.:. .P (//� ------•----- ... 1 3j s ------------- Application Disapproved for the following reasons:-------•-----------------------------------------------•---•-----------------------------------•••-------------- ---------------------------------•------••---•-----•---------••--•----------------------------------•-------•-••----•-•--•--•----•-•----•--•••-••--•••-•--•-••----••...------......---•......----------- Date PermitNo.......................................................... Issued....................................................... Date s THE COMMONWEALTH OF MASSACHUSETTS �--' BOARD OF HEALTH 1 ....O F..................................................................................... - � fer�ifirtt�e ,af f�u�t��i�anrr- THIS IS'TO CERTIFY, That-the In'; ual Sew Disposal Syst constructed ( ) or Repaired ( `) by............... .... -••-•-•-•--------........-- -•---- .•--••--•......---•••---------•--..........-•-------•----•-----------------...•-•-......-----..... _ at -- -�-----•-•-• y^�2- -@i9 -•------I-------- Z-'-----•---� •---•-•----------•-------------------------------------- has been installed in accordance with the provisions of T `. _7. ` of The State Sanitary Code as described in the application for Disposal Works Construction Permit No � . " ................ dated---------------_-----_______-_____-_-_-_-_--_--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.DATE.............................................�--��-$.�� !----.------ Inspector....i•--- alfd ............................................. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v'...................�.`...................O F....... !r-. ..d' : .................................. ............... FEE.' .......... Permission 's-hereby g'ranted-•-••----•-•-••---•--- ---.....Ile •------•-•-•••---•--•-•--•--•••----•...............•......................••-•-••-•....: ......... to Constr ct ) Repair an I i idual S. i a Disposal }��t g at No L1� Street ds shown on the application fo'r Disposal Works Cori struction_Permit No........... Dated...................................... �/ /G'�/ Board of Health DATE .............................. ------ FORM 1255 HOBBS & WARREN. 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' _ .• - .� 'y�.i' -a.a:•• �yz s� �x _ �-,.rr� r �•; _ r� _- 'E rzT .� ..�.11 s •��c- `'� n 3 0/0 ,�s ♦ f/�. _ << aw lk Commonwealth of Massachusetts J Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Trudy Coxe Governor Argeo Paul Cellucci David B. Struhs LL Governor D�'1 C nunitaionsr SUBSURFACE SEWAGE SPOSAL SYSTEM INSPECTION FORM PART A _ CERTIFICATION Property Address: Date of Inspection: 7 I�a 9 Address Owner. me of Ins tor. (If different) Na � 17orra Mtn► Company Name,Address and Telephone Number- CERTIFICATION STATFUMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _✓Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Q Inspector's Signature: C(�� V Date: 7/'a 1 7 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: 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. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection- Indicate 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, cracked, structurally unsound, shows substantial infiltration or exiiiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston, Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-55M w it Printed on Recycled Paper (4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property A�dd�re�ss Owner. C ►mac- Vh 2 G S P a g e Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obi pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution boa 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) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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. I 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and 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 is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for ooliform 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. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) fA� Property pAddress:� p G l e Owner. SG v►+e as Date of Inspection: Dl SYSTEM FAILS: 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 necessary to correct the failure. 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. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth _ qui p in cesspool is less than 6"below invert or available volume is less than i/'L day flow. Required pumping more than 4 times in the last year 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 within 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 LARGE SYSTEM FAILS: 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 east: 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 lI 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 CI R 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: e Cts P'OL 9 IP Owner. Date of Inspection: Check if the(following have been done: &H S. w A S Rtmping information was requested of the owner, occupant, and Board of Health. (}W0 v-, CA.'j P--peck 6 yea--s a� 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 bee introduced ' to the systemce3 tly or as part of this inspection. l {-� oVse has been coca.% pqs S 'tr1 ✓'As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. ZAll system components, excluding the Soil Absorption System, have been located on the site. ZThe 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. / f The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. ZThe facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: IS �`�'�.w OOc� �.; •-c`� C o"�v�� "�A� Owner- i laoke aid �ws4h Ctas 1C Date of Inspection: 7/1-4 I FLOW CONDITIONS RESIDENTIAL.• . Design flow 3 O 0.gallons Number of bedrooms: 3 Number of current residents: Garbage grinder(yes or no): eS Laundry connected to system(yes or no): Seasonal use(yes or no): DO 1 Water meter readings, if available: /V Ot C.JVc�' a Last date of occupancy: re' ))b �b COMMERCIAL/INDUSTRIAL• Type of establishment: Design flow:----gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or of P ��e y,eArs A U If yes, volume pumped: gallons Reason for pumping: TYPE W SYSTEM �/ Septic tank/distraution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known) and source of information: 11R 1-7 Q6 H Pet r rw:'t I cf C a�c�nc�d� Sewage odors detected when arriving at the site: (yes or ao _ (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C !! SYSTEM INFORMATION (continued) Property Address:l5 L.,MWoOd CG�-dt I CL4Q;r �� Owner.(A.yic. .Say.•e a S pa g? ) Date of Inspection: �ll?.I klv SEPTIC TANK: (locate on site plan) Depth below Bade•� - Material of construction: ✓ concete_metal_FRP_other(ezplain) Dimensions: ar 0 O O 0. Stodge depth: F Distance from top of sludge to bottom of outlet tee or baffle: _ Scum thickness: a it ! p Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffie: X Comments: (recommendation for pumping, condition of inlet and outlet tees or taffies;depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) N O ,-v A e ,c: d•� @A ta-$f . V e 1 nt o off`}ej i h V e r 1- S•�rJc.$'Or 0J14 .Sou►-A . GREASE TRAP:Np (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP_other(eaplain) 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: 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.) (revised 11/03/95) 6 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C //s� SYSTEM INFORMATION (continued) Property Address: �5 C1MWb COv c—a L bf'oi T- Owner. ea SCw w.e Ci 5 9 P Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP_other(explain) - Dimensions: Capacity: ¢allons Design flow: callonsiday Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) /l10 p�— 1`P \<a /UO Sbi.ds PUMP CHAMBER. (locate on site plan) Pumps in working order-(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc. (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM IPFORMATION (continued) Property Addre�= Owner. ZA69,- D&t4p of Inspection: 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: leaching chambers, number._ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number. Co eats: (note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation etc.) n v evl hence d f b �-O'rir CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer- Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part 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 11/03/95) g .... tea' NO.... 11 d Fss........./�.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .7 to 0 of ...../JR r.`x1.s.7 4 It.......................................... ,��irFt#itltt for Di ivoi d Wor1w TowitCttf#U11t j1pr tti# Application is hereby'made for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System at i.ncation-Address or Lot No. .. , Address gw.ver o24 ` .ra.�............................ ... J ••••••-•• - AJress d Installer U Tyl,c uilding Size Lot..PZ........a'9- --..Sq. feet Dwel g—No. of Bedrooms..............3...... --_---•...Expansion.Attic (n a) Garbage Grinder 47 0) other--Type of Building ............................ No. of persons..........G_---_--..•....• Showers ( ) — Cafeteria ( ) 1 • a PAOther fixinres ---------------------------------------------------------.-...-...-..---•---•----------------------..-..--..... .......gallons per person per day. Total daily flow..........- E'�.................._..gallons. W Design blow................�la.............._ g; 1 1 P' Y Y WSeptic 'I;ail:— Li�lnicl a,p;,cit. . ..gaIIons Length................ Wkith................ Diameter_:..... ..-•--•- llepth.,............. - . x Disposal Trench—No. ...----. --._- Width.................... Total Length.................... Total leaching are a........_...........sq. ft. Seepage Pit No........../........ Diameter_.�K.9......... Depth below inlet.................... Total leaching area.................. tl. it. Dosing tank !>�'/�� 'y S^- 7 -7 7 Other Distribution box (Alg ( ) ......... Date..........: ......................... Percolation Test Results Performed b -----••--•-•--••-•. . ... 'Pest Pit No. I................niinutes per inch Depth of Test Pit.................... Depth to ground water........................ a 1 Depth to ground wate.r......._................ Gi Test Pit No. 2................m per per inch Depth of Test Pit............. -...__4_..._.. •- s Q................ — �s'1 O Description of Soil-........PJ- -_••-•-LfO ....... v - ..........••. --..... 1..�.. .... f" .....--••--•--•----•-•-......-•••--...:---•----•----•----•----•-----••---...--••---• ----------------------•--------....... .......•.----... 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 Article X I of the State Sanitary Code— The undersigned further agrees not to place the system In operation until a Certificate of Compliance has been issued by the board of health. 'igncc �i!l/ <�et , , VID.1c Application Approved B .-- �- �f.(4!1�1. .�. Date Application Disapproved for the following reasons:............................. .....:............................................................................. ----•..............:...•--........--•••-•-------...---•--•---.......--•---•• .................. Date l l Permit No------------------------------------------ Issued........./.- ............... Date ..,...,... ---....- _.......... - ..----- -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /..! .. . .!..................OF..........rJ.A..rn.S.. G.IV. ........................:........ �pX#ifirtt#P of (�tlttt�.t�iMttlP THiS I TO CIs1�711 Y, That the Individual Sewage Illisposal System constructed (�O or Repaired ( ) O« .............. . y.•......._.. stiller at....... ...........,�a. .. . .............. lE_.Fu1tG. r C. f------•-•---=---...----••--••--•.............-----...___.... has been installed iiI accordance with the provisions of :�r�1 of The State Sanitary Code as described in the application for Disposal Works Con struct ion'Permit No.... ..�.........11.1)-___.__-•-•• dated.......,y.`r..3..�--.et ........... THE ISSUANCE OF THIS.CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DAT1:........ _..f ...... ................................ Inspector.---•----..1•.Y.------- c_.f.. _._....... _- THE COMMONWEALTH OF MASSACHUSETTS BOARD /qF HEALTH —� OF /J a�`i�S.. C.f��P.................................. v J Q .. FEE...... • ... .... ........ No............... . I rttr#ilttt �irt•tni# ................ .----•--••---................. Permission is hereby granted.....G.��.•--•�•�•r•--•-•--•---••`�G- I to Construct or R�,air (// ) an Individl al Sewage Disposal System. at No. �j... ...: �r!fl.[P..u!. 0 `U ---_.-.-.---•.............. .. y i I as shown on the application for Disposal Works Construction Pern ' No......... .... I� ted....r....J�_.'.....:.?. ......... F • Board of llcalth DATE.............................................••-----••---•--•--._....._..._.__. FORM 1235 HOBBS & WARREN. INC.. PUBLISHERS,//~ - " I n � 05�^,.sue. 7-o W-J r,�specrola 1 i 4 A .d-6^ SOR Lol1M \�by , y✓ _.ram l ' Ze .. 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IO��M/N. � �GALL.ON �I_I WgSriFD /4 FQOT / Fi L S7/3L -- t� (6 P/T Ictc ALL 1 j /L/v 'Rr fr .n G L N L o C i y' CA Pfi c/TY 1 /NVFOT 5E.)-7;C ._ j r.v vE Rr /NVEaT J I I �WfITERT/GHT� I1 JjELOI•✓ II.'V FR7' NO G 9RB/�6E GR/NDER • 41 _.._. -.._.... ----ZO'MIn//MUM ------- ..........._....- CERI rIFIED PLOT P1 i9/v CGTU!T 4 O' DATE.' S/z/l7 L.07 n;/ i? r�L/7,�/ E?F_ CO eD E.'D //V 7NE BAeN SF_.'P7'/C 7""f7n'K 7 o BL i`I /-1/,V' /lF3[_F Cnr.JNTy eFG/SrzY of DEEDS .� `'' aAGE 4Z �' HOla4ti ; ,,c/h/D/r' /�✓ PLf)r/ /�O(�I� 284 n ''';;� /NIu/ ,' of /o' FROP-1 7'/0N AND /_E f3C!l / l7-.5 C�E01zGE LOGY LE/�Cff/NG P/ 7s -ro ar: //`1u//1 OF P,e0PF,k Z T7JfZA/E1Z /-A/V6 �OuT71 yfi/Z/L� MA -79, c_rs�rtp%�QL_/N E"S A ND S.E P7"l�_n f' n1 A 0UrN/ . 0SURJ = AND ZO• FROM FoL)nfD'q7 Z CE27"/f' Y 7Nf77' '7 .: FOUNDf�T/ON • D .SHot✓N Uf•/ T'/l/S A rah/ 7'"f�l F_ G R D UN D 3 SHOWN /4EREO/�J — — T1 TL E — ..--- --- -- - j /rti/D T/-1F7 - / 7- •DOES CONFORI"l DA�EJ - -.- -- -- -- ' 1 TO 'T NF.' BU/LG/,i/C- S6TB/9CK REQU/RE- -HF.' 'COh•/A/ 75, l-1F�r7/ -... 4 k c ' R LO•CA Y IONS C�' / . EWA G E PERMIT N0. VILLAGE v � ! INSTALLER'S NA & ADDRESS B U IL DER OR OWNER DATE PERMIT ISSUED Sri DATE COMPLIANCE ISSUED N I Fsic.........1 . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , ..................oF....... / '......................................... ApplirFation -for '%gpoiittl Works Tomitrurtiota Prruid Application is hereby'made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: �...................... ................................... --`=--------- ------ Location-Address or Lot No.� ill .e---------------------------••-------------- •------•---••--- ---...----------------------------------------- ® �} er Address .f.....` LC/`..---- ...................................... ............................................................................................•.... Installer Address Type wilding Size Lot_.��__ ---a-./_�----Sq. feet U Dwell g—No. of Bedrooms_______________ ._---Expansion,,Attic (n a) Garbage Grinder (,7 p) aOther—Type of Building ---------------------------- No. of persons.--__--._----__-_-_______ Showers ( ) Cafeteria ( ) Otherfixtures ----- ----------------------------------------------------------------_-- -----_-- W Design Flow.................6.....................gallons per person per day. Total daily flow............3.00.......................gallons. WSeptic Tank—Liquid capacity/ --gallons Length---------------- Width------...---.--. Diameter-------.-------- Depth----._-.----_-. x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area-------------..-----sq. ft. � Seepage Pit No----------�-------- Diameter_K.9......... Depth below inlet.................... Total leaching area-------__ .......sq. ft. z Other Distribution box Dosing tank Percolation Test Results Performed by---------------- ----------------------------------------- --- Date----------------------- -------------- a_l Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-------------------- Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--------------- ----------- e. ---r------------- ' --•- ....... � - - O Description of Soil---------0 � - - .. f-------- ------ - --------------- -=-_ - ( ; -- •••• -•-•.�- 2. /X V W --------------- -------- -----•----- ------------------------------------- --------------------------------------------------------------------------------------------------------------------------- VNature 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 Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. " igne .. '.• .I... . � .....VDa Z3 7.7---- r �., e / Application Approved B �-' PP PP Y•-.... ••. .---------- ------- ..... Date Application Disapproved for the following reasons______________________•------_---___--__--____.--___..__-________________._________._-.__ -_-..---__.--- --------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued.......... -� ......................... Date __ _ ____------------------------------- -_ __________._____________-_____ t� FEs........ �.........�... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7<i wo.. ✓! .. OF...... .. .. # .......................................... a ,��Iirtt�i�n •fu�:,:��a�ttl �xk� Cn�tt��tr�intt Prmit u�,Application,is hereby'made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal R.""Sstem At: Location-Address or Lot No. er Address Installer Address Q Type o uilding Size Lot_.Q�___ __3'�. ____Sq. feet U Dwell g—No. of Bedrooms_____________ Expansion Attic (mPQ) Garbage Grinder 0) a ther—Type of Building ___.----_-.___:______--____ No. of persons____________________ ( ) Cafeteria ( ) ___.____ Showers — QOther fixtures -•-•--------------------•-----------••-•------------------• ---•-•-•-•---•---- ------......-------•--.._._.-._.-•-•-•----------------•..--•--••-•---. W Design Flow________________;� ___Q-_____-___:________--gallons per pet-son per day. Total daily flow _______w�p.____>_.___............gallons. WSeptic Tank—Liquid capacitv0 __gallons Length------_---_--- Width_------........ Diameter_.-------------- Depth..--.-.-_-_-_. x Disposal Trench—No_ ____________________ Width-------------------- Total Length.................... Total leaching area..-:_._-__--..-___-_sq. ft. Seepage Pit No----------I-------- Diameter_AKS:____---- Depth below inlet______ _________ Total leaching area-.___ -. ---__-_sq. fI. Z Other Distribution box (� Dosing tank ( ) oVo-�C . Al- SP-7 7 aPercolation Test Results Performed bY.......................................................................... Date------------------•-------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-...._-..-_--_--------- f� Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground' water........................ --- `max _- D Description of Soil - -d "" -- ---- �--- ------ ' --------------- ---------- - x -... .--- `-- _... ----. ------- ` ------------------ x == =------------------------------------------== -------------------------- V Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------.. -----. . Agreement The undersigned agrees to "install'the aforedescribed" Indivtdtial``Sewage Disposal System in accordance with the provisions of ArticleXI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance.has been issued by the board of health.-" J Da Application Approved BY-- - ., � %�-l�1✓1�/." ---- -----------•• �----* � -------- Date Application Disapproved for the following reasons: _______._ _•____________________ ____________________....................................................... .............................................................--___--------------•-------•---•----•-------•-----•-----•--_____--•----•-••-----------------•--_-___-•---------------•-•----••------------- _ Date PermitNo......................................................... Issued.....................7--7-2.7.................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.:......... � a ?, Cq: t �.............................. s 19-pdifirate of Tomplialtrr THIS I TO CERTIFY, That th'e Individual Sewage ,Disposal System constructed (off.) or Repaired ( ) at............•_.-. .°.......... �,1uer `!.__� ___________________________________•••.._.__._-________._-_ has been installed in accordance with the provisions of Art' XI of The State Sanitary Code as described in the application for DisposalWorks Construction"Permit No--- __ ` ___------I-y-d------------ dated....... r`r ...77_................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------•.77�/....----7-7---------•-•••------------•...•----•---•-••--••-•, . _Inspector- / ) THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ..............................O F...-..............----•-----........... .................................. No-----_------ �-+" .d FEE...... ie.--••- i� rr 1 Norho CIO rurtion rrmit Permission is hereby granted b ___:. ----`--�----------- to Construct (X or R . air ) an Individ al Sewage Disposal System, at No.----- ,�� ,� -�--•-•---••-•----•.• Street as shown on the application for Disposal Works Construction Per No.________ ted._..� -� ' 7 7_----.•_ -- dui. . . Board of Health DATE....................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS; 6 L0•CAJ�ION SEWAGE PERMIT NO. VILLAGE _ INSTA LLER'S NA & ADDRESS BUILDER OR OWNER DATE PERMIT. ISSUED DATE COMPLIANCE ISSUED b 013 �z 4 �¢ c lJ I � v t { r , b�� \ � 1 �I II >l.G c . . I� 3Y + zc>� e �t F l if 7 _y -DIN 1 k X" .#A,+•.•._-.-.-�.A� "-"+';Y _, s. ... : , _ "`�"" r r.a t`}.. . C•r•t F C^:'. ..x. .y,,,7r ifA ,. �,... i- . 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