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Home My WebLink About0074 JASON'S LANE - Health ',Y JASON'S LANE, OSTERVILLE A 121116 a NAME OF OfFENDER°`j t7f) it (y BA 7030 TOWN OF ADDRESS OF OFFENDEERl3`''� .,�( f BARNSTABLE CITY,STATE,ZIP CODE f} } �,. )( DATA/M OBIR 0[fENDE�t �.VIE Ipw MV OPERATOR LICENSE NUMBER 1T _ (Jl rJ✓ MV/MB REGISTRATION NUMBER �-� OFFENSE— / y- �j� w F' s'�/y p[ ,(' / ¢p�1 1 BARNSIAR1.E.� �Ilt-/V1 1 9(4 Sim9P (icPe � —3— I. '" �c.! 0f�)1_ f.4 , .{/�: -ui' NAJS' 4 N J ED LLJ TIME AID DATE OF VIOLAT N-� LO ATION OF VIOLATION -- ^y / LU Z NOTICE.OF fib: ,(�A.M. ,P.M.)0N cf" �21,200.G 1 ra v :a 4� }ht suet SI ATUR 0 NFORCI 6.REASON r NFORCIN D T. _ _ BADGE NO: N VIOLATION RAJ P+t✓ ,: tlr +rr p OF TOWN r I— �FIEREBY ACKNOWLEDGE,RECEIPT OF CITATION X a ORDINANCE ® Unable to obtai stiig aatutr offender.�pf offend a t� THE NONCRIMINAL FINE FOR THIS OFFENSE IS S W. Date mailed w OR YOU HAVE THE FOLLOWING AL ERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL. a DISPOSITION WITH NO RESULTING CRIMINAL RECORD: w REGULATION a (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, W . before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 430, _J Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. CL VIf you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST UNSTABLE DIVISION,COURT COMPOUND,MAIN STREET BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or H you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature �� YOU WISH TO OPEN A BUSINESS? For Your.Information: Business certificates (cost$30.00 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 to operate.) usiness Certificates are available at the Town Clerk's Office, 1'FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) j DATE: 12 ill DG g,+ gNEIY Fill in please: � I APPLICANT'S YOUR NAME:, r�ccnr fh s s BUSINESS YOUR HOME ADDRESSIZ TELEPHONE # Home Telephone Number '77�-39a-/glC NAME OF NE.W BUSINESS I s� TYPE OF BUSINESS IS THIS A HOME OCCUPATION?. YES NO:.. Have Yqu been ADDRESS OF BUSINESS. a (�� MAP/PARCEL NUMBER -2 [� 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 your business.in this,town. 1. BUILDING COMMISSIONER'S OFFIVtBr This individual h een in d f any permit requirements that pertain to this type of business. - 1 ,',_ Au horized Signature* LOW -HOME COMMENTS: OCCUPATION RULES 2. BOARD OF HEALTH This individual h e n info ed of the p r;4it rQ&uirements that pertain to this type of business. Authorized ignature* 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: 1 t. Commonwealth of Massachusetts Executive Office of Enviromnental Affairs Dept. of Environmental Protection One winter Street Boston,Ma. 02108 "John Gt uci ' D.C.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 wILUAM F.wELo (508)564-6813 Governor r ARGEO PAUL CELLUCCI / Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION - . Property Address: 14 Jasons Ln.Osterville 02655 ° Address of Owner. oe 1998 Date of Inspection: 411198 (If different) �r Name of Inspector: John Graci Mary Lloyd I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: 8 �v L�. 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 sewage disposal systems. The system: x Passes This Inspection le based on criteria dented In Title V _ Conditionall Passes code 310 CMR 16.303.My findings are of how the system Is performing at the time of the inspection.My inspection does _ Needs Fur er valuation Bythe Local ApprovingAuthority not impy any warranty or guarantee of the longevity of the Fells septic system and any of Its components useful Ilfe. Inspector's Signature: d Date: 412108 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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: " x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. ` COMMENTS: 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of . Colhpliance(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 04127/97) One Winter Street • Boston,Massachusetts 02108 is FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 74 Jasons Ln.Ostervllle 02055 Owner: Mary Lloyd Date of Inspection:4nres _ i he distribution box is a to a broken, - u or h• h static to level obse ed n t d �u du Sewage backup or.breako t. to water ry , or obstructed pipe(s)or due to 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 leveled 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. 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 of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 Hof a public watersupply 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 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more.of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. — Discharge or ponding of effluent to tho Surface of the ground or surface wa(oi*5 du() to un ovel lod,led UI Clugged cesspool. SAS is.in hydraulic failure. 5 (revlaed 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 74 Jasons Ln.Osterville e2655 Owner: Mary Lloyd , Date of Inspection:411111s D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged "SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers 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 1 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. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: 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: Yes No the system is within 400 feet of a surface drinking water supply.- the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA).or a mapped Zone.Il of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (reylsed 04117)87) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 14Jasons 1.n.Osterville 02655 Owner: Mary Lloyd Date of Inspection:411198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: ,c_ — Pumping information was requested of the owner, occupant,and Board of Health. .' x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. -x— — The site was inspected for signs of breakout. x — All system components, excluding the Soil Absorption System,have been located on the site. x 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. x 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 Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] ^ . (revl99d 04127)97J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 74.1asons Ln.osterviile 02655 Owner: Mary Lloyd = Date of Inspection:4f7l98 FLOW CONDITIONS ` RESIDENTIAL: Design flow: 330 g.p•d./bedroom for S.A.S. Number of bedrooms: s Number of current residents: t Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): nfa Sump Pump(yes or no): No k, Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: " Type of establishment: n0a ' Design flow:U gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or po) No Water meter readings,if available: nla Last date of occupancy: n1a } OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION r • 3 PUMPING RECORDS and source of information: System has rover been pumped. System pumped as part of inspection:(yes or no)Yes If yes,volume pumped: 1500 gallons Reason for pumping: MAINTENANCE y TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions 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 Information: 17 years Sewage odors detected when arriving at the site: (yes or no) No a irevlsed04f27187) s i •' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 74 Jasons Ln.Osterville 02655 t, Owner: Mary Lloyd Date of Inspection:411igg SEPTIC TANK: X (locate on site plan) Depth below grade:2' Material of construction:x concreate metal FRP Polyethylene—other(explain) If tank is metal, list age Na . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Lg'1157^we1' Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:25" Scum thickness:u Distance from top of scum to top of outlet tee or baffle:S" Distance form bottom of scum to bottom of outlet tee or baffle:o How dimensions were determined: measured 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.) Septic tank and all components are structuragy sound and fundloning property.Recommend pumping every two years. L GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRp_Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:nra Distance from bottom of scum to bottom of outlet tee or baffle: Na Date of last pumping;,la 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.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 27 Material of construction:_cast iron X 40 PVC_other(explain) Distance from private water supply well or suction li OO- d Diameter: 4 Qmments: (conditions of joints,venting,evidence of leakage, etc.) , Y (revlaed 041 27)87l l L ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a PART C SYSTEM INFORMATION (continued) Property Address: 74 Jasons Ln.Osterville 02655 Owner: Mary Lloyd Date of Inspection:41119s TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nre Capacity: Ne gallons Design flow: rda gallons/day Alarm level:_wa Alarm In working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into orout of box etc.) rVa » t PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) jo Alarms in working order(yes or no)vea Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda i (r9v1sed M7197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 Jasons Ln Osterville 02655 Owner: Mary Lloyd Date of Inspectlon:4/11e9 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: S Wa Type; leaching pits,number: one leachptt leaching chambers,number:Wa leaching galleries,number: Wa leaching trenches,number,length:Wa leaching fields,number,dimensions:Wa overflow cesspool,number:ma Alternate system: n!a Name of Technology:_a. Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Leach pit and all components are structurally sound and functloning properly.Leach plt had 4'of water In It - CESSPOOLS:_ (locate on site plan) Number and configuration: nla Depth-top of liquid to inlet invert: Pia Depth of solids layer: Wa Depth of scum layer: We Dimensions of cesspool: Wa Materials of construction: Wa Indication of groundwater: Wa - inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) nra _ II PRIVY: (locate on site plan) Materials of construction: Wa Dimensions: Ne Depth of solids: Wa Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) n(s - - - 4> . (revlaed 007)97) . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 74 Jasons Ln.Ostervilie 02655 Mary Lloyd 411198 y , SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, laridmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) ' AQAL. 11,, (revised 04)27197) Page t of 10 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 74 Jasons Ln.Ostervllle 02655 Mary Lloyd 411198 1 Depth of groundwater 12« Please indicate all the methods used to determine High Groundwater Elevation: r Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions . Check with local Board of Health Check FEMA Maps , Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) r. USGS maps and charts t . (revlaedOWT197) page 10 0[ 30 Vol L O CATION � S EzP6E R M 1 T NO. tea ' t 1 Z4 V I L L A G E V / / // //7 nA INSTALLER'S NAME & 't'DDRESS ® U I L D E R OR OWNER DA T E PERMIT ISSUED DATE COMPLIANCE ISSUED 1 3�-i � -2y �, ., 3�, , ga �, �. F�s..`P� ...... .... t« --, ..v.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE Z . ..............o F..... �t . Appliration for Bispvii al Works Tonstrnrtiun Vamit Application is hereby de for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Syst t -Add es or Lot No. ...... .u� -. � ner ... . ............................ ...... -......._. W Address `-- ---------------------------------------- ..... Insta r Address U Type of Building Size Lot---1r8 -..Sq. feet Dwelling—No, of Bedrooms......_..�F____________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building a Other—Type g --�� ---- No. of persons-,ram-�------------ Showers Cafeteria Other fixtures -s ...... Design Flow...... .gallons per person er d V. Total,d 1 fl w.............: ...0.._.. gallons. ,� WSeptic Tank—Liquid*capacity. ]ions Length. .. _._. Widthl".- /4. -,Piemaher__�,t� _ Depth................ Disposal Trench—No.....al�. Vidth._ x p Total Length............. Total leaching area...__— sq. ft. Seepage Pit No.....�........... Diameter.._., '..... Depth below inlet.... Total leaching area. ,60..sq. ft. Z Other Distribution box ( 'A Dosingeaa ( ) Percolation Test Results Performed by.��l .46!'t -..---------•---•--•---- •---••------ Date 1I/ . Test Pit No. 1,2;0......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.. a --------- O Description of Soil..----ram----�....•.... .01..... .. r'�...�......................�`�....................... f t C "� W U Na r f Re irs or Alterations—Answer when ap licab .................................................................................... l ...._•-•-• ----------------------•-•--•-•-•_.___ ".________...._______......._._..__._.._._.._..-------V---•-•••-----'-------'--••---•-------•...'_•-------------.....__.....---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with .a the provisions of TITLE 5 of the State Sanitary Codoh e undersigned further agrees not to place the system in .; operation until a Certificate of Compliance has bee y ;rd of �th. Signed--- .. .. . .... -- .............................. � --•• e Date Application Approved BY ..f ,.._...: .--•---.... J........... Date Application Disapproved for the following reasons:.............................................-------=--------------=------------••---•--•-••---•-•------....... 'i •---•-..........-•-----•-----•••-------•...---•-•---•---••••-•••••---------•----•-.:.--------•----•••-•---•--•••-•-•-•••-•------•••-•...•••••-------•-----••••--•-••--------•-••------•----••••--....._. Date qPermit No.......................................................-- Issued...........................................--.......... Date j. XT4...... .... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HF T ...............OF..... ---------------------------------- . .-: .`L �?........ A tkation for UhipmFal Works Tnnitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t .:. �_�-�/ ' ....... � .. --........ --..-.---•------•----------•-.----•-•---- tion•Add es r� or Lot No. . yd°�i ... r..t' =................ .............. •........_....•••--........---•--••-•--•---.....-•------•----•--............--- ner Address ... 0. f_...e•.c.... .. .......................................... •..............----......._ Instal r Address V Type of Building Size Lot.1-:5.p ®-.....Sq. feet Dwelling—No. of Bedrooms--______ =-Expansion Attic ( ) Garbage Grinder ( ) ------------ p`�, Other—Type of Building __, �'. .. No. of persons.-----""-------"-__-__-____ Showers (. 1 — Cafeteria ( ) Q' Other fixtures ................. •.•--•-----•- g _....._____________gallons per erson d Total 1 fl w____..... .. ... gallons. Design Flow-•••••. -• ... P P ,Y WSeptic Tank—Liquid capacity./�allons Length._............ Width_�r....�.... ..: n.,,�`.... _ Depth................ x Disposal Trench-No....._/r! .f —�1Vidth_._._ ""....... Total Length.. _.__ Total leaching area....................sq. ft. Seepage Pit No...._/............. Diameter ._.. Deptli below inlet .. ._�.:_____ Total leaching area.07.(0..sq. ft. Z Other Distribution box ( r Dosing nk ( ) - „ --�<-t �``t I Percolation Test Results Perfo reed by. '__...._ ... ...............2......... ____Z Date....111.41 d '� � � ; per inch Depth of Test P:it �* ,ground water � Test P>;t� o�1 � � ...mmu GL, Test Pit No. 2__�_._ ri�esper/�mch epthpof/T st ' ' �` j t�ground water " aJ J .. d_.. r 5 ..._.3.. ��Y� O .......C Description of Soils_.. �� !. � f"cfi� � - ',.C�... fTT `e�'- � �GI(• `� S� -- ----------------------------------------------•-•---•••--•----••-•••--•-----------------••-•-•------••-•-•••••-••-••-••-•••-••••••••..................-•---•••. UNa r f ReaArs or Iterations—Answe when a li ......................:.............................................................. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Cod he undersigned fur - r agrees not to place the system in operation until a Certificate of Compliance has bee issue by and of th. Signed. ._. ............. ..... r .............................. /Date Application Approved BY -... ` -------------- � --•-------- Date Application Disapproved for the following reasons:................ .....1(.................................................................................... --•••...-•-••---••--•-•-•--•••-••••--••---•---•••------•--•-•----•-•••--•-....•••-•.............•-- -f�- _._............••----•-•-------•••-•-•••-•-•-••-•-•-••-••-•-•-•.........-Da....I.•--------- Permit No..................................----------- .... .. Issued. ...... - Date l F THE C+ MmONWEALTH OF MASSACHUSETTS J/ BOARD OF HEALTH - ..__-Y,�--.�.---.�-�--`-�-��" rr�ifirtt�.e of �uIt�nr�e f THIS IS T ERTIF'Y,.That t divi Se age-4 disposal System constructed ( ) or Repaired ( ) bY...................................• .....• -• . r................... ........................................-............................. alt------------ ----- r-- has been installed in accord e with th: ovj i ns of T ; 5;3,011 fThe State Sanitary Code as described in the application for Disposal Works Construe io f1'er it N l..N_ ................ dated................................................ THE ISSUANCE OF THIS, RY�Q DATE SMALL N T BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA ACTORY. , DATE 3 =09 Inspector... A THE(COI M� NWEALTH OF MASSACHUSETTS BOARD OF HEALTH /..41"fr.3I ..............OF..... ,cx,,,...�Zt.!,�i...................................... '` FEE....3-0......----- Dinprrsnl Workii Tn #rnr�ilan rrndt Permission is hereby granted.... ............................................................a................ to Constructor Repair ) an Individual Sewage Disposal System at No......... -,AT /lr.`.. � --......_..�.� Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... / rd of Health DATE.............Z. �� ?'"._. ................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 4 ^^r_•- - a,.s1 f r' ��,,ggy�AAP'��Y-}�w f P ♦.P ■ 4JY'`,r - Yv4r C.d. � +{,: r j. - � , -,;, *0.t�Z�`kh�4^1 � �/4 .�..?{y .,�3. 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S®/L M•5'T'02 .�®�L '�� C �c�� /7 -6 *VU OP_�4cmiRo.R/rs_•=� ^EL�� L � ,C�.�4're,OF So/i- -rss7' &.-ACE' IMr, PER P®Y 1 � 'P..� � RE��9e��E Mgr6�l&SSX® B2' ! o497-rO ea�CsfsA++C-JPOR pAr 7?-- on_ Z �R�®L�a�-B®moo.fie r 0 � s �vB i�elca� T®YAL ACNlAol4G AREA. j S�13 Jt1 Lo g ca 6 Sop. , p �► s v a/ MC R , P. 1!1 J" +•k 9 l+' Y. ..t. 1 - y�- �.T M vr• s -w. .r_. I >L.:� S.. 5-. .1F 'e'Y•".�- .f: •• T, ��. ♦-....S-L::r :-C ..{� y._ { .; h�i„R -y. 'S .,�.,, - _.•�- '+. a- �' � .'S kJ4, R-a a. r.xti� i-...,,att;c k .:.7, c .•.'=a _w � :.,-:,,.;` bs- x�>. -`^! '''c _ o. �a, ,y,,,. h$+ 2. .,f t fySZ.s:.S s Y�.ry _ �.., a:. .,-a`7'..„ .r.-..._-.:rc�;. � - .. .x.�... �e '-lt r". - �• �,'t...c.7,•�b v r.4W' _ �:�E'.a"-.'�z. ��.�� f.:..... a4 r�''` 3 z< 'w�'s iw•,^sap '�.� ":jNa��s'"4,- .E.�.. .r:e-�.,i.'"t �_ v ;'=�.' �$�, ,:�.<e'-' � v �.. �y �-Y-` �,,.1, •'•t I .. 'fii�"' .; ..a'T ,. _ - .. _r�.v -,-. x. j "mod? - x - R+c _„t°� ^r,+ x.' ?•i'''n.:;-_ .f =�.. :- +v T.�:..' ,� � t.. , pye�rvy may. :�' r'•,. .-s ;� ' �„" r. :�.t*t,A-.s ...s s• ,•- ,.; iV' 't 4 'z ,v , � 5 '-a.�.. �, '••.> .+,. e�,.17- :�. �,...t- �- tie -I.: ,• i' S=:,z<. _ 7.r.,,, F rr �.. _,t' t.A - a'-t. e 't .L' .- ,d'. '•`.�F.•.i - ,t� •c�, - :�- '3P �.�x_.35;�:m'=�i:�s�t�µ'�:-.•C.�':8�'., �. �:z':�`= +�.£� ,c7�•:E .7'w�sylti!is> -4-F•.�;�ih�,6t_..r'. '1'�1 �•��s1�'�El, % FIN ��'-�G`.d'�i�� F-u N THE COMMONWEALTH OF MASSACHUSETTS Lj BOARD F HE _r . ....OF.................XA— W------- .................... Appliration for Disposal Works Tonstrurtion ramit Application hereby made for a Permit to Construct (-,-)'-or Repair an Individual Sewage Disposal Syst at: ........... .............. .............. . Loc ton . ........ - -Address :1 or .. ........ --- --- --- ... .................. Ow Addr/ss .... ..... ................................ .................................................................................................. Installer Address Type of Building Size Lot____ .17..Sq. feet U Dwelling—No. of Bedrooms---_..-. ._---Expansion Attic Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons___.__.__.__._...... Showers Cafeteria ( ) 04 Other fi tu ....................................................................................................................................................... Design Flow............ ... .......:::......gallons per person per/day. Total daily flow.........................*...................gallons. 04 Septic Tank—Liquid capacity............gallons Length________________ Width_.___._._._.__._ Diameter...-.-.___..____ Depth................ Disposal Trench—No_.................... Width_____...._;1........ Total Length.............. ?......Total leaching area....................sq. f t. Seepage Pit No________ -------- Diameter......./40-. .... Depth below inlet_.__. ........... Total leaching area..,- 6,45'sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by_________________&4-6a;t�0"40,Date.•. Test Pit No. I......�...minutes per inch Depth of Test Pit____________________ Depth to ground water.______________________. (s, Test Pit No. inch Depth of Test Pit____________________ Depth to ground water_______.....___.__.__... 0 . ... ...... .........r... .......... ..;........ .7 ..- ---Description of SOil... . .. - ----- ........i. .. ...............I---I..................... . .......... 1-:1�2 _ .................................................................................................................................................................... .................................................................................................................................................................................I........................ 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has heen issued by the bo d of I th Sied.... .......... ........... ...... ...... X7� Date . .... ................Application Approved By..... ........................... Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................................................................................ Date PermitNo......................................... Issued....................................................... Date. THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH. ... ................ 0 F.. ............... ToWrtifiratr of Toutpliatta T,41S IS TO CERTIqY .Th t the Individual Sewage Disposal System constructed K) or Repaired by.....I .. .. ... .... ........... ...................... .......... ..................................................................................... s ller at....... ........ ........ ....... . ... ... ............... . . .. ........... . ....... .... . ............ ......... ... ....... .... .. ..... has been installed n accordance with the provisions of 5o T 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 FUNCTION SATISFACTORY. 1 41- 1 1 .3.-� -............... ................................... ......................... No. .__ ..1�. ' ��$.. .d.... .... THE COMMONWEALTH OF MASSACHUSETTS t;�•::` •-�`' BOARD OF H E MT , �¢ a. .";:. .-•----.....-. `"" :/ r`""'�....OF ........................................' Applarafion for Disposal Works C�onDtraartw' n, .anti# Application is hereby made for a Permit to Construct (_Vt or Repair ( ) an Individual Sewage Disposal System at ? - Loc lion-Address. ........ ......... A. ..............(� or Lot N •!./ Y"i':te"._ ....... .:1_>L:�l.R. !�^g ^�: XI..7.A4ar_• ' J ? _d•- -..J-. __ (. ..Y.::...5/..!� ..�...::.:t... ................. / . T wn (J// Addr s ..�.. . ..... ----- --- --------------------- ...... Installer Address r� Type of Building 's Size Lot____________________ _____Sq. feet U Dwelling—No. of Bedrooms......... .... ................ .....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............Z_..:-._._. Showers ( /) — Cafeteria ( ) d Other fixt a ...._ . WDesign Flow_______________ _____ ________________gallons per person per day. Total daily flow............................................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......./0.... Depth below inlet.................... Total leaching area.__. ..........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �•--� a Percolation Test Results Performed by---------------- ! L,�.- !`� Date. Test Pit No. i _!._.�^__minutes per inch Depth of Test Pit____________________ Depth to ground water........................ fs, Test Pit No. 2__ ... m'nutes per inch Depth of Test Pit.................... Depth to ground water........................ ---- .... ...," --- s D Description of oil---- -------------•-•----------—--- .._.1�+ - ...................) ------ = `=.2'-- ......... UW -------------'----------------------•------------•-------.-----------------------------...------------------------------------------......-----------•---------------------------------------------.•••- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en i d by the bo >d of1th .4 e' er Z- t _ Date - Application Approved By---•••• '�"` 1 . ram. .............. Date Application Disapp1 roved for the following reasons:___._._ a e _ .....................•--... 1 ..... ................................ Date ' 3 Permit M .................. ....................... Issued:--•---------... .. .............................. Date THE COMMONWEALTH OF MASSACHUSETTS ---�'� BOARD OF HEALT /..:.. °✓'' C�bF.. :.......-..-'°... . ... .................... %rdifgratr of Tom"'Pfianu T,,HIS IS TO CERTIFY, >Th the Individual Sewage Disposal,System constructed (, ) or Repaired ( ) by -�. �.:.. -----•-• .....-- ........................................................=.. ` _ stall.' Ol "/ 1/// - has been installed n accordance with the provisions of 5 o The State Sanitary Code as described in the application for Disposal Works Construction Permit No.'____________ _2_Ae._........._.. dated__../z-_`.__/A_----!P........... J THE ISSUANCE OF THIS CERTIFICATE SHALL NOT IlE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ° �$ .. ...... wti r r} t * Inspector ,, w_: as< {. . yr t �� 3 srM,tiYY ,a` +^•ti;;t f^ n ........................... e�Y�P'S�t`"" _; .u.._„�;:�"` �f��;,;.�s �°�.,:.-#1 ww� st.��'y�.•'`fir`s„+r„��- ��'{�u°� G`�,�"� '� N�^+A � �*s: ,,� a'��t+a"� z��h �� {a i , ':Sitt""_�F"" .. ,.... .. .._ �,.s�� ..... .•'-^.•�_xxi?$}',s'€' �k�r�"_.,�5�;. �`;.�:;"aS+wF�.�F�:^:4i `',... � .'":"�_.✓rau=Tf�k'�e�.-. THECOMMONWEALTH OF MASSACHUSETTS BOARD •- F HEAL :...a/j ,4112 :...�� '''�....OF.. ..�'-fir......... ........................................ . No........ .... .... f FEE... Q............ ffispollFal Works feigtfilrgdiott jprrmit Permission is hereby granted................................................-------------•------...................................... to Construct ( ) or Repair ( ) an Individual TagP Dispos Sys atNo................................................................ ....••• A =._..._,., Street as shown on the application for Disposal Works Construction Per No.___ ._ 4- D;.at ted_.,...................................... r --------- �' ' J.................... Board of�'Healtfi DATE----..1. = �'"..0` FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 4 a i �sl,Na� 1 '�� i d-'t a1 �,�`� d Y 4 --'� r d t� .v ,j`,t`r.•� <+_�.�. � � �� i�'ti G � ��rF� p�,`At^F�ta t ,7�.r � � '.1,� i � ; N '•114h q} �y 7 .. �s. 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(7 ,+ r o Tt't tip \ �y 4 rti ak rot .fit q} � 1 � fJi' ROBERTq.,: b. J �,+t9 �/,., "" u BUNIl�lst u P �p v.s T No 22162 Q t'f• .+ 1 - d 4ir- t i a' f,•rT ONA1' p , xffm dd & ' +�11 1eC r a „s a 14R 4 h .a 4 r r,y��^is�j rl { Aki Y b .• { r t ' l tr q., �-�—er'�• r �. RTIFIE'D' PLOT Of p SPOT{pp�JJ�� yp, -ELEVATION tt ypLQ E�_A�6®N p 0 . n Al tnF 4 t,r RV F..�GN {®�Vf�• e ® LN Y .t�A WIt rd �/Y�'•� p tl ��✓ +•J"� a �P®4 »ELEVATI®N cam. `7 "r''",t'•.° v M 9�ahII 4ti fi O N n c , :7 x \ SCALE g / 3 DATE o rr AGENT y . OS .� INEERING CO !�! CLIENT I CERTIFY THAT '-THE P,R REGISTERED J®® NO.go!1 q9 BUILDING SHOWN ON THIS CONFORMS 'P® THE ZONO d® LASS , 3lO . LAN® FMASS. �rl IrR SURVEYOR DR.BY ®F BAR-MSTA®�E ,l S ,r �712 MAIN ST Yr a , 4zi r { HVAR1P11S, MASS. 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