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HomeMy WebLinkAbout0076 EAST OSTERVILLE ROAD - Health ?6 EAST OSTERVILLE RDC;OSTERVILQ5:1 1 4 yax r COMMONWEALTH OF MASSACHUSETTS FXECuTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTS OF ENVMDNMMTAL PROM now ONE WINTER STREET,BOSTON MA 02108 (61?) 292.MM `Rimr f3(1)E • � .. 9«n+r:wr� ARGIEO PAUL CELLUCCI DAB I D 8.!'[ItIiHS Gavin ttor Cosaswnioaer 14101 i1rPRfACE IPAL UWAGE D SY11 M MPECT10N PART A �1t1tpICAT101�1 Pme ty Ammon: 7 6 6 czf OS�er V tl e 9 path 0 O.mer �L& ,Osi-eCth 1l o MussAddress;of Owner• 2�, e r�- Ele Q� Class 40,apeaetaa: S I-ko o ' , ©sfe ry l ue�iyk ass. Newe.ai tea�aa'oe:11�leaae 1'Ml, 0 essr a OIC� arstan lnp»aser ptretrprrt to Seelloee 15.30 of Tift S 1310(MIA I5.000) Csertp«++r Nesrre: 1 hs pIrms, s A% ttg Address: .n n.►s f't'LLGS S oa_4 {( I cord,)!'that I haw personally Inspected 1*4 sewage disposal system at this address and that the Information reported below its true, accurate end c'XVWete an of the lima of Inapectiorl. The inspection was performed beseci an my training and experience In the proper hinction and maintwonee of on-site sow"@ disposal oystems. The system: ..� tau _ Conditionally Pm-see _ !feeds Further Ed-slustlon By the local Approving Authority Falls 7 tfrsperrlomrs : _s' LPL' Dam SLaoloo The System inspecter shall Submit a a Plf of this inspection report to the Approving Authority lroard of Health or DEP)wftNn thirrp 30)d+t!n. 2f empledng this inspection. if the system Is a shared system or hee a design flow of 10,000 gpd or greater,the inspector and the station owner abed submit the report to the appropriate regional Wee of the Department of Eiwbonmental protection. The original should isa sere to em, syawn ewnw and copies ssnt to the bul'ff, if applicable,and the opproving outhoft. NOTES AND COUN1ENTS 71 i 5 S Lf 5+e rye. Ljo C.-S f"e-C'e l tJ i Ck. CA- 0 t � j & A cA qA 10, y o�ogtisr e0b, a� r 'J revised 9/2/98 MrltNd w RegcJed paper SUBSURFACE SEWAGE 011111POSAL SYSTEM IlMMCTtON FORM PART A CMTW CATM foos4tfs1t" o .e rig MINIMUM SUMMA6": Cleaol: A. It,C. of ®: A. IBVITM PAN": it t have not found eny informaODn which Indicates that any of the failure conditions described in 310 CMR 16.3O3 uxisn. Any fsitavo . cohm a not svohntod are rods wed below. PpMMft�: a. iBYSTM CONMICNALLY PASMI: Ono or more systsm componams as described In the "Conditionel Post" section need bs replaced or repaired. Tho r•y.ri;ern,, upa.ri w completion of the replacement yr repair,as approved by the•oard of Mealth,will p Indivote yes,no,at not determned IY, Ei, or IUD). Describe basis of dMoomination I Instances. If"not determined",explain a h y not. The septic tank is metal, unless the owner or operator has B d the system inspector with a copy of s E;eM Usts 4311 Compliance(attached) Indicating that the tank was within twenty f201 years prior to the date of this lon pec:tion:or the septic ttteric,wheatar or not metal,is cracked,atr turally unsound,shows substantial Infiltration or ezHltrt flan, or tank failure is intminem. The system wit pass inapac if the existing septic tank Is replaced with a complor";selrilc teNt as approved by the Mosird of H64M. ffeawage backup at be,s�as<out of hi stage water!awl observed in the distribution box is due to broken or olwitn�cted pil wo(s) or due to a broken.asteisd tar u von distribution box. The system will pass inspection If(with approval •rl'tM rfaord,V Keetth). lbrcoken "of na replaced e+s ateion Is rottnovad aE bution box As Bavatlod w►eplaeed The system roqui�d lumping more then four tirnaa•your disc to broken or obstructed pipalsl. The syetmn null past Inspoctien If f "jq*drd of the Hoard of)doalth): bnskan pipalsl too replaced .a�battruetfon!t rsnooved se-wised 9/2/98 Peile2ofIt f IIIJB7 UV"CE SEWAGE DISPOSAL SYiITEM MIMCTUM FOM PART A CERTIPICATION toontptuedl P#Wr,►A N 1; 7 b coo. C)sAA4 I/+VC caw.811 111 C. RATHER EVAL"T10N 6 I@ QUIRIN)iDY THE MAW Of HEALTH; ., Conditloea exist which require Airther evaluation by the Board of iteafth In order to a if the system Is fallinil to prr,dect tiv, pubk hu M,safety and the wisironment, 11 SYSTASA W�PAU UPUJ>{S 111UND OF HEALTH DET N AQ:CO WIY1f 210 CUR t6.9Ai tub THAT�ms:tarp n3Il I$NOT PL ItCTIONEMQ N A IAIMM WHICH WILL PROTECT THE pt1OLtC TH AID SAFETY AND THE EDWRIIiIMVIT: casspool or privy Is vrithin 50 feet of tuMaes water 7 Cesspool or privy is within 30 feet of a bordering veget wedand or a saht marsh. 2l SYI3T�1 WILL FAN UNLESS TiAif MAW HEALTH tAlilO PUBLIC 1NATI:A SUPPll9t,F ANY)DET®INBMES T16P6'T T►Ilii St'STtA115 FIJNCTIOIIDIO IN A MAMP INAT THE PUKJC HEALTH AND SAFETY AND THE ASIVlt10NBiT: The system hot a sellic and soli absorption system ISolti and the SAS is vvWdn 100 feet of a surface wl,l-or supiyy or VOKOAry,to a wrtace%r w:wd . The system has a seen tank soil absorption system and the SAS Is within a Zone I of a public water sclopily well. The system has a FV- to tank sell absorption system and the SAS Is within 60 hat of a private water supp iit wiea. The system has alit M*wool soil absorption system and the SAS is Was than 100 feet but SO feet w rrumu from a privats aratar$upfell,unless,a woo water analysis fa ci Wam bacteria and volatile organic compounle Intl sum that eha well Is!Pa• poEction born that facility and Me presence of ammonia nitrogen and nitrate nitrogen Is opuei to'cr here Men 7 ppm. atfrod heed to determine alatso a _lapproodrna on not vaadl. i tl OTHER revised 9/2/98 Pop 3of11 ♦ I 11111JUSURFACE UWAOR D1SPOiAI SVSTDA NWWTION FORM PART A �1TbfgCATlAlO losntbaradb �► a 6F_-2 s4 Q s4ilA v j It Own Dees of betpmstfiset: 3 Q torr�i O. Miff?TAM FALB: You most Indlcate either "Yes"or"No" tea each of the following: r I have determined that one or rn®re of the fodowinp Padure Conditions/doodoWd asl 310 CMR !5.903. The basis flat this deterrrinatlon Is Identified bolo a. The Board of Hoeft should be contwhat will be necessary to ccarucc*a falitirs. Yes No Backup of sewage hn a facility at system aomponsttY due to pped SAS or cesspool. _ Discherea or ponding at offluent to the surface of the grow due to on overloaded at clogged SAS sir Cesspool. Statiee liquid level in Out distribution box above outlet vert tkle to an overloaded or Clopped SAS or cessi:wol. liquid depth in osssp)iA is leas than S'below I rt at available volume Is less then 112 day flow. Ra*dred pumping mote than 4 titres in the I year JW due to clopped or obstructed pipets). Number of tam pumsed Any portion of the Sol Absorption Sys Cesepool or privy is below the high groundwater elevation. I Any portion+of a aesepool or privy ' within 100 feet of a su.rfsee water supply or tributary to a surface wahw tit;ppiy- Any portion of a eselpe"W or p Is within a Zone I of a public wad. Any portion of a Ces664001 privy is within 50 feet of a private water supply wed. Any portion of a cost or privy is Issa•than 100 fast bud,grsstar than So feet from a private water supply well with rio accepsaMe water Gty analysis. if the woo has been analyzed to be acco>ptable.attach copy of we#wester am!Nysis for eoMform bacteria idle organk Compounds.ammonle nitrogen and nitrate nitrogen. fF. IbAROi1:STPW FAM, you anust hndleata altMr "Yes"or"No" t:o each of the fodewing: Ths faorlq crherla apply to Cllrpo systems in ed�on to the a above: The$"tam serves a fao#ity w11h a deelpn flow of 10#000 or granter(large System)and the system is a signifi:ant threat to public health and a0mv and the arty I"W"aovt because ant or a of to following conditions exist: Yes No the system Is within 400 fast of a drinking water supply tM oyster is within:too feat of a to a surface drinldinp water supply the*water Is looated in a oft aanattiva area(bmderlm'%Wmsd Protection Area='MPA)or a mtllpad;ECM !I of a huhlle '— water supply woo) The cm W or operator of any such syt I'm shall upgrade the system In aecordonte with 310 CMR 16-304(2). Please consult idta local n111ernal obese of the Department for fiartlllr infommodon. revised 9/2/98 r OLOWWACIF SUINAM OIIPOl"SYSTEM MPfECTION POW PART a _ C'N1HCtlLOIT • Wit' 76 � ®lea ad btapee8sn: ?� tao 'tom Check If On following have been done:V ou must indicate either"Yea" or No, Iles to each of the following:. Yes No Pumping Inforrnatlon Kr so provided by the owner, eaoupent,ax Board of Mealth, _ None of the system components have been pumped for of least two weeks and the system has been re"v*91q.vmo tkm rates during that parked. Large volumes of water have not been introduced into the system recently or so pout ill'this Inspection. As bulk plena have bean obtained and oxawdned. Note If thsy are not available with NIA. 1 The fedity or dwoft was hrepMed for suns of sewage beck-up. The system does not rfecelve non•sonitary or Industrial waste flow. _ The site was inspected tv signs of breakout. AN system eorn®onents,excluding the Boll Abscrpdon$yawn,have been located an the sits. The septic tank mookOes were uncovered, opened,and the Interior of the septic tank wee inspected for c<xticlition of baflhnr • at tees,material of construetlon,d)wensions,depth of liquid,depth of sludge,depth of scum. The size and Weston irl tM ioR Absorption$Vetern an the site has been determined based on: Existing Information. For example, Plan at I.O.M. Oelarminsd in the flald (if any of the failure adtoris related to Part C is at issue,approximation of distance Is,uns'cceptatis) e )tE.202*11b)) _ The facility owner isnd occupants,if different from owner)were provided with informatlon on the proper malnUi•ranee of svawrfa..a.peaei 1'ratems. revised 9/2/913s�ts ' b 1e4ldi4WACE UWAGE 01181110M SYIPW N PECTION FORM PART C r_ XV$?m1 flr�OiM�ATQN Popnf Atha: Z� m:¢j'� 0 5 'V 4& OM ROAN CONDmDMb Design sow: Numinar of bodroornsa ldsslgnl:� Nwnrnbe►of bedrooms tactual): Tod DESIGN flow.' -40 Number of onrmmt r Mdsnts: Owbrnge IPA W r Ives W no) . 0 laundry(sepwoss systern) (ves er nol:,�s If yes, separate Inspection rogWnvd Cam` Eby systern knspsctsd.IYJN or no) Sets( Sees me rise(yes of ate): ►3 �� 13� Wa t rnstor readinp,If a le(last tvvo year's usage(§Pdl: sun*Pump(yas or net last 4 Meeo of ooarpancv: r Type of establishment; De641m sew: osd ( Masud an 203) basis of design flow _ Oroono trap prassrrt:lysa or no)— Industrial Waste 4telding Tonic p ant:(ass or no)_ Non-:nadtary waste Author to the TH%5 system,lye$at no)— Water motor readings,if oNoble: Left daft of •.._�^ OTfbIIR:(Dose t ss¢deft of cuponey:_ mot.Nr�o�weT1>oN ptsMlbp sECO11Db and source of Intr)n� Systam mpedpu w part of Inspection: lye@ or If yes, volume pu rrpsd:--goons Reason for pumping: SaptiaSspft 1M 6 sot absorption system �._ $Woe cesspool _.._..! Oversaw cesspool _ Shored system(yes or no) (If yes,ottoch previous Inspection r000rds,If any) VA Technology otc.Attach coiry of up to deft operation and malntenunce contract ` Tight Tank Copy of CEP Approve! 0001 AtrpItOXMNATE AOE of am component. iota In wb*d(If known)snd source of Information: `K-- swnsga oAsns dstactod when arriving an,the site:Ives or no) . reprised PW6of11 IRSSUMACE fiMAGE 011111POW SYS M MPECTKM FORM PART C CY;TfEM wamATm('esmboredi : 76 � o- 4 oeratr: Fori .' vl(Ores t� 3 c O f aoL OUL1IM1 SWIM (Logo"ai aft Owl D"01 below grade: Matafal of construction: carat iron d1O PVC ,other(explain) oisttnwo hat wtvato water supply well icm suction Ins - OhsWWW Comnnsnts: (condition of joints,venting.seddenca of lookags,etc.) • t�'TfIC TAB- - (locos on site plan) 0401 below grade: 6 Massisl of oonstrucdon:_Lconerste_rnotal_fibwglus _I►olysthylone_;otMr(exOain) it Canis is motel,am cgs,_ Is age confirmed by CaMfkste of Compliance (Yos/ko) -_ ObvM elons: O - Shwigs depth: 4a Dlstarwe from tap of 1judge to bottom of -xAst tee at befM: - sewn tlileekness:�,� DIOWwa from top of scum to top of audio:too at be"s:-_ it Dista►rats from bottom of scum to bottoms of outlet too or befRe: 6 iew(frnaidons were dWermined: CernrnaMs: . (reeornmer dsdon for pumpl no, eonditi 0 Iniat end outset toes or baffles,dep of Gaul sysl in►�l+pon to outl (nv� stnaatuni�l iInttwity, evidence of leakage, a.) tw n L 6 CJ�� a ��i�T eat i 4 W ea__�,. --_-- MAN (Iona*on sits pien) ®spth bslaMr grade:.,,,,_ Masriel of eormetnatlon:_coi Hu _matai_Fibo►glass •-,_poiyet arse,,_wher(explain) 06rtisraierr: ---- Satam thickness: Distarpoe franc top of scum to top of ouOrt We or Matereas from bottom of scum to bottom► of cud or bathe: • Dots of hot pump": Calm (racconmendetion for pump".oonj of Net end outlet teos or baffles,deptin of liquid level In relation to outlet Irivert,struall wiii Integrity, evidence of lockage,ste.) revised 9/2/98 f'gsTofla i I .IMtMFACE NWA= $yi"M Nri WTION FORM PART C .•-`.. - sY�1T�ilt ffrr+�wloA�topl tasewnrradD ,��►Awe: Z6 - �.,►#� u v tt e fZ� ?1m1T ON HWLDM TAIK: (Tank must be puwood prior to, at urns of,inspection) iteoal�s on olto 0M) Do"i blow pro": Mamial of cons"stlon:_concrete—ivwtW`Fibs ass Pslys"one`o+thsr(explalnl. CapasOMnsnMons: � . ": Bono Design lbw: golione/day Alarm pmswd Alare�level: Alarm In nq!order:Yes , No � DaM of pravlous purt�oing: Corrrrnorres: (condition of Inlet too,00 on of alarm and float switches.site.) . DliT11�1!*f01rf f11QN:� ' fioemis on arts gibe) .Dapol of liauld level above MAW Mvsrt:., Csrrnrsnts: (rats If level and dlstribution is sywai,svj nee of a ids esrr d nce of leakage imor ouutofbo`x,m.) 1 !v n e _�� �� .1J I (bero:0 on oft plan) Peafigis in workkq order:(Yes ar NO)—.- Metals in workkrg erdsr(Yes Or NOW— Corn+nm": (rota condition s4 pwrip ehan►bsr,eorodNS pumps and appuRsnaneos,etc.) ..�...,•.�.�._.� I I i revised 9/2/98 TOWN OF BARN TABLE LOCA"11ON �� " 061Mc/t l�e Q SEWAGE # VILLAGE Q44V'i kt- ASSESSOR'S MAP & LOT 12 Z 055 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY D a t' �i C- LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUU:DER OR OWNER 6-6r4Q0V PElkMITDATE: 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 of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r t � �� + �a �� }�� . . _ � �� � ' a SUBSURFACE SEWAGE DISPOAAL SYST )NISMI M FORM � purr c - srs��aowwn®M lesellnus�P . a -7G �►: o Ono 0 too I I SW AMMOVANW.lars, ISASI:-4 ibeata an rite plan,if p"WM9;exoaysdon not reau)►ed.)oeatlon may be approximated by non-lntruelve nw thods) If not IoaaAod,imphln: Tye, Maddrq pas.nw"bw.. a b»i t,P dwwvdla/e.numbw,_. hraahbPo pMlerlse,rMrnlber.- wwmd aa,movoba►.larytfl: leaddrig fields,nmwAw,dhnonaionse overflow oaeepool,rarw4w:,_s- Altsrrmod systenP:.�__ Nana of Tochneiogy: Carrrrrlente: . (note tgwW *n of cad Igoe of hydrsulk h uve�,t of ending, denep soil. ondition f vipotatiop. 'I _ it 42 f�l�c.5 tc-f�P •Mane h .,n ✓PA, Yalta , C__ } (IoaMIP on axle parr) - • Mwrlb�er end oonfiparratlon: _ ' ��ylh cop of Redd to WM inPrsrt' aptb of eabols ww. L%p*of soran layer: ChnanMons of cesspool: _ Mato ale of eanotmadon: hwA6owde"of warrndwalm: Inftw(aosspori nwst be puPnpl poK of inspeatlon} _ -_-_,_ Corny onto: Into(eerwAmen of Sam, of hydramk fspwe,level of ponding, condltlon of vegetation,ate.) /N0/7 .,_ p000m en sw plan) MlatorlsM of catatnucllon: oknor Mons: Depth of se lft Coy ww": (raw sar►d oaf of Safi,Mons of lvilwe,level of pond)np, eondtlon of vegetadon, oft.) � revised 9/2/98 Agelotu EUSSUNFACE SaWAOE 9WPOSA►SYSTIM WSPECTION fO11M PART C BTSTEN OWOF&MrON feenik+uMD "'. 7.6 U c Vie. . uw..e► +�►: .� l Pv (c:o *KffM OF SWAM 0000 I.SYSTIII: bye tkte to at Nast two peroisnent reforence landmarks or benehnmirks Woete all wells wftMn 100' (Loeirto where public water supply eons i:rft house) 5 O / a7 revised 9/2/98 Per i0of11 r - SUSSURFACE SEWAGE DISPOSAL SYSTEU SASPECTMM FORM PART C SY'STASA NFOOMATI IN loettft" oa1a at 3(20(40 MAC$ Iloport nmro Son Type_ ---_ Tn%d depth to Ipewndwst„ _ - MOS Dne webelte visited Observation wells chocked Groundwater depth: Shollow— Moderate oop SITE EXAM $lope Surface water Check Color Shallow welt Eettmated Depth to Groundwater Foot , Please indicate all the methods used to determine High Groundwater Elevation: Obtoined tram Design f4ons an record Observed Sits(Abutting propertY,ol5servation hole,basement sump etc.) Detwmin d hen local conditions r•�-- Chocked with local Soard of hsaitt Chocked FEMA Maps Chocked pumping records Chocked local excavators,instanors Used IISGA Data aoacrilra how you ostWfthed the migh G camdwat r Elevation. too be complaud) 4 � revised 9/2/98 ftpalattl f b TOWN OF BARNSTABLE L ti �JSdwAGE #LOCATION VILLAGE �ryi /I�'. ASSESSOR'S MAP & LOT I ZZ. O 5J INSTALLER'S NAME & PHONE NO. �; la N SEPTIC TANK CAPACITY A LEACHING FACILITYAtype) ( recAS U COr✓C relc(size) ®®o , NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER e- BUILDER O DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No A� jlje�t� ousc' A i l t - �i No:.Q.!..... ....... Fxs..... mot...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF. i'%.... :.. ... .. ApplirFatiou for Disposal Works Toatstraartioat verutit Application is hereby made for a Permit to Construct ( ) or'Repair ( ) an Individual Sewage Disposal System at: �-...Q.Ae....4............................................................ -----------------------......6............................................................... Location-Address or Lot _ ...................... Nan ---....--••--•-••-------•-•.....................:-•---------. ......... O i.'^ .Lt.Q.�t24. S ................!-..13........................... Owner Address / ...... ,tt v v ? ........................... ..........///241......10_4A,l.....5.1........... Installer Address Q Type of Building Size Lot:...........................Sq. feet U Dwelling_ No. of Bedrooms................. ...... ......__..Expansion Attic ( ) Garbage Grinder Other—Type T e of Building ..... ..... No. of persons............... ........... Showers — Cafeteria - a YP g P ( ) ( ) a' Other fixtures -------------------------- - Q W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. � WSeptic Tank=Liquid capacity.. l. ®4?gallons Length............... Width-,_.._._________ Diameter--------------.. Depth................ x Disposal Trench- No. ............ ...... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No.a/. iameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY................................................-.......................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water---------------_-------- (i ' 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------ ------------- Descriptionof Soil......................................................................................................................................................................... U ••-•-•---•••-•--•--•--•••--------------------------••----------•-----------•---------------....-------------------------------------------------•---------------------------------------•--•-••......--- i W UNature of Repairs or Alterations—Answer when applicable............................:................................................................... Agreement: 4 " The 'undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI.ITL% 5 of the State Sanitary Code—The undersig d further agrees not to place the system in operation until a Certificate of Compliance ha en ss the boa of health Signe - rcA.unon------------------------- -•-'7-------_---------- Date Application Approved 2 BY .. ---•----------•-----.-.--- e :. Date Application Disapproved for the following reasons:---•-------------------------------------------------------------------------------------------•............---- / QQ Date Permit No........ ...... 1... ------------------ Issued..... C..r Date ......... . 1 4: No.Z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ................................OF..........................._............ Applirtt#ion for Disposal Works Tonotrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..........R.......:11.:......K,1............................................................. ..............................:•E:ry................................................................ "T Location Address or Lot N 1.. ! dri W ...f .. ....... ....................... ........-•----.................._ ,r j....Y:_z.. .f�lt�..SI....---••-•----•--•----._.t...................:....... t Owner j Address f �..Q............................ �!1_�.�........��� •af._._.. Installer Address Type of Building Size Lot .s� ....................._.....S q. feet Dwelling=No. of Bedrooms.................I.......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers — Cafeteria � Design Flow fixtures ....................................................................................................................................................... per person D >; W Fl son per day. -Total daily flow............................................gallons. WSeptic Tank—Liquid capacityl.,517V.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. _._.._.t_...._.... Width................_.. Total Length.............. Total leaching area....................sq. ft. Seepage Pit No.�d.. ....�!�(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................._--__-. f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W •-•-------••-------------------•------•-..........----•--------•--•••-•-••--------------•--•----............................................................. 0 Description of Soil........................................................................................................................................................................ 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 TIT E 5 of the State Sanitary Code— The undersig�d further agrees not to place the system in operation until a Certificate of Compliance ha been 'ss the boa•yof health,. Signed>:_ ..... ----� 1 �h.�►-4, lam+' c —!3•. n, Date Application Approved By........... i__ . --, ............. •----- Date Application Disapproved for the following reasons----------------..--•----••-•-------•---•-••----------••••---•---------•-•-••----•-•--.......................... .................. -------------------------------------- -------------------------------------------- -------------------------------------------------------------------•------------------.... Permit No...._.. - . -_ r..--•-•-------------- Issued-•..-.... Dau...... -` Date THE COMMONWEALTH OF MASSACHUSETTS "N BOARD OF HEALTH �" y /.... 'rat:Z.........OF........... , -x ( F ..................................... �rr�ifirtt�r of (�om�ltttnrr THIS I� TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by................ ( 'f ----------------- Installer at.............. . I has been installed in accordance with the provisions of -1" T"-��: j 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 CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FU CTI N SATISFACTORY. • DATE.--- ...�/� -. --... F1 -----•--•-----------•--••---- Inspector -- - THE COM'MONWEALTH'OF MASSACHUSETTS BOARD OF HEALTH f No.. /..`.---.... . .........OF...... � --------------•---- F .... Z r 4 �............ 4 Disposal Works Tonotnidion rnmit , Permission is hereby granted-----•---FV1•i---- ............ :�a="= � >��-.. 1� ................................. to Construct ( ) or Rejair ) an Individual Sewage Visposal System atNo. ---------------------------------------------------•---------------- Street as shown on the application for Disposal Works Construction Permit No. f:_ f`' -�. Dated.......................................... -----------------•-----•--------- zt 1--- ................................................. DATE.................... ........................... Board of Health FORM 1255 HOBBS & WARREN- INC., PUBLISHERS No ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL- H ............0F....... ... Appliratinn -for M_qpniitti Workii Tomitrnrtinn Vrrmft Application is hereby'made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at— �•,...CF !` K.-. (.1..--•- 9 ---- --------- --------• . --------------------------•-- e ---Location ddress ` or Lot�Io. `--•---..... ................... •----•-•-------Owner 14 Addre oa -------400. ��� •----- --------------- -- •--• - --•-- - --•------•------•-•-•- � Instal el r f Address Q Type of Building G Size Lot.......... ...... ?Sq. feet U Dwelling—No. of Bedrooms-_-__-_._.��-----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures ---. . w Design Flow_______________6_=-_U-----------------gallons per person per day. Total daily flow...............'3_.0'_Q..............gallons. PSeptic Tank—Liquid capacitvir-._.__._. a lons Length................ Width---------------- Diameter._._._..-_----_ Depth.-.--_--_...._. xDisposal Trench—No- ____________________ Nyi h_______-_--__-_---- Length------------- ----- tal leaching area....................sq- ft. Seepage Pit No.__ 4`- __________ _-_ ---------- tal leacltitt ttre:t. _D_.�+_.sq. it. Z Other Distribution box ( Dosing t k �h' �G - —2 6 77 Percolation Test Result Performed by.... ...._._ ._ 'IQ___ Date._'__________________________________ Test Pit No. 1_____ minutes per inch Depth of " est Pit-------------------- Depth to ground water..-.--.--.---.-.-_.--_- 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.--..-----------.-.__. l- -----=-------- Descriptio Soil �R o? /' �_ 4�— ------ �------------ _._ -- v --------------------------------------------------------- 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 Article NI 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 he lth. igned �� // ......... / �f Date Application Approved By....... I-� ----- - ----- -- ----- - ---• =-•-------- .-1'� ---7-7 Date s` Application Disapproved for the following reasons:............................................................................................................... --•-•---••--••---•-----••-------•-----•------•---•------------------•---••---•----•------------------•---.._._..--•-•---•--•----••--••--•-•-•--•---•--..._-••---------------------------•----------_-•--- Date PermitNo......................................................... Issued........................................................ Date NO' ......... ,—� FED....... ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARDF HEAL H x: _OF.._......`•���•c./1�!a !v .. . ��"''- ' .-..........------ App iration -for Diq o-qui 10orko Towitrurtion Vanift Application is hereby'made for a Permit to Construct (C or Repair ( } an Individual Sewage Disposal 1�= System at v_ ...................... Lot N .............................. Locatio - ddress _ ............... /pit, _.... or -o. f•'�" � -='�'-� c. e��!.�.`-------------°_.____._......__._.. ................ •'------*-----•...................... Owner ` Addres'rA a ----f-cam 2 :. ......•-- Installer Address Q Type of Building t,7 Size Lot......__ ----------- feet U Dwelling—No. of Bedrooms-_-_--_: -------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.....----------------------- Showers ( ) — Cafeteria ( ) Otherfixtures __ w?..........................--------------------------------------------------------- -------------------------------------------------------- w Design Flow_______________�<.,�____-____-_-_-_---gallons per person per day. Total daily flow--------------- Cl...............gallons. WSeptic •Dunk—Liquid capacitye r?'?^ "a illons Length---------------- Width................ Diameter__---_-..---__ Deptll__-_--_-._.... x Disposal Trench—No_____________________ Wi th___.___________.__..— tal Length........ __ tal leaching area---....._--_-___-_sq. ft. Seepage Pit No... I - -------'..dtkt' �lv�n 'ef' -- ,� otal leaching area O S'__sq. ft. z Other Distribution box ( ) � Dosing t nk Results ( `~�� '" 7—2 • , Percolation Test Resu Performed b � Y-•---- -�--- - a....';i` --- Date------------------------------------ ,� Test Pit No. 1---- per inch Depth of "Vest Pit-------------------- Depth to ground water..- __------..-.----- (� Test Pit No. 2----------------minutes per inch Depth of Test Pit.-.___--_______-__-• Depth to ground water------------------------ - r - O Descri do Soil__.__. !` x T w U Nature of Repairs or Alterations Answer when applicable --- Agreement-t The'..undersigned agrees:,to install the aforedescribed Individual,Sewage Disposal System,in accordance with the provisions of Article \T of the State Sanitary Code—The tinder signed,further.agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. tgned .._ a-- s" ✓Ffx �_•- .fi �/_`='a'• •---- /1 Dat Application Approved B i A--- Application Disa roved or the ollow Date PP PP f f ing reasons: - -----•-------- :_..... --•-•--•-•-•••------•----------------••--•--•---------------•----------...-•••---•---•-••••••-----•-•-••........._...---•----------;---------------------••-------------------------•-----------•---•--- Date PermitNo........................................................ Issued..................................-==•.................... ^L -. Date i< THE COMMONWEALTH OF MASSACHUSETTS BOARDS OF HEALTH, :..1.... ..'"" ` ...........OF... ..................................... �rrtif iratr of fTkoutliliaurr THIS IS (`CERTIFY, That the dividual Sewage Disposal System constructed or Repaired ( ) --•- . - --- , . ,¢ b `Ff`�d'-motfir^ C fiistaller i at - '__.___f --:f3.--ti-- -� ---------------- .... ......................... has been installed in accordai'tce with the provisions of A I+le I of The State Sanitary Code as.described in the application for Disposal'Works Construction Permit No. '______..yr�- .......... dated------- _ ...../P. `.'---./_ ..7.......... 1 THE ISSUANCE',OF'THIS CERTIFICATE SHALL NOT BE CONSTR. ED AS GUARANTEE THAT THE SYSTEM WILL FUNCTI �N SATISFACTORY. ` DATE --•- ~..7_77............................ Inspector------- ......---•-------- ..-- . :_: THE COMMONWEALTH OF MASSACHUSETTS '$ BOARD 9,F HEALTH,,. No.•---•-•.._ [ ' '' FEE--- .. ispwial Norkii 110,001i#r ,r i : :, rrntif Permission is b'y granted_..__._ -%{ ---?-s.__._._..._ ..... .. . ...... _ ... _.. -•-- ------•- to Construct or Repair( )� IndivlduaPIS-ewage spos st �- - ., � _ at No::___ _ �^ r �.rl.✓v1 '1-- -�.-t'�'_ _ .� --------- 4- c.- fp ------ - - = —------ Street as show on the application for Disposal Works Construction Perm' o------- _ ated---- ` _C '_ ............ DATE • a / Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i RESIGF: DATA t Single Family 3 Bedroom a _ ; c' o No Garbage Grinder Daily Flow = 110 X 3 = 330 GPD Septic Tank = 330 X 150% 495 GPD 3 Use 1000 Gal. p 6Af Disposal Pit - 1000 Gal. Sidewall Area - 150 SF PCr 150 X 2.5 = 375 GPD v rnaK J Bottom Area - 50 SF qa'= 50 SF X 1 .0 = 50 GPD Total Design = 425 GPD Total Daily Flow = 330 GPD ! i r Perc Test - 1 " in 2 Min or Less 1-�L/,9 jp ' fttCtfAF?U yN ��' � , :• fit+ 1{ 7 •VT6 M•` L Su 1 1 I TG torn �, - 4• �'1 P c Iva E 96.1 tNV. gsig t -7/La f7j �iE:vz+t 'rAN CEQT 1 F 1�'L7 p 1.0T' Pt_ �i,U U)/ i' 5TOr,� E — v LoCATtot-4 05T C2v1 L.i,... E- , M y5. IV 61 Cr.xZT1t= 4 T1-(AT TNT 5vL) MD Al arA 5"oWQ jZcti.1CC W 1'r" TWG 51VVE LI L O T 6 t�ua 5�T 3�CK j'C-AvIWF_AA."Te, of T1-1e L ,G� 32 Z Z Z fS -To v,/aJ ��c>P Bp,R N 5 T a C3 L L 5 T �, �' , a l._ (64&9 ' `t /77 laA)(TC-_V_ Er t"C. 9ZE61S rr_—VGC> L .1. U 5UZVa`(0ZS. LIOT Bb--SeU) OW A-LJ oS,reavtLLe o Ae(A 11.tst'QeJ.enC�.l; `iU vr_-.Y �taE u: 1=s�=1"4 �,ttGetiJl APPL tC_�i.t�1T C^PF WaDE LrFv �L., t�tC�'(' _ U-iC-17 TO [UC-:1 avMtq& 'L O Lt Wa,5 -