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HomeMy WebLinkAbout0259 NORTH BAY ROAD - Health 259 North Bay Road Osterville A= 072-011-003 ° , a.• m y !• � r 0 9 . ° w 0 d^ ° e � s ° ° m' ^ f � i s ^ d 4 ° basement ram.F � . L 10'4" i trine room (1) CN 23 .8 in co - /00 z 10' (V 60 d 50 r. ' M ` N Basement livina.snace 33'.4" 34, J'����/�L� G2�.�c�G�/r1 // � ��1'S" cr�Gr�!—rv1✓, II 4 fi basement 20150023_REPAIR 3/19/2015 Page: I . 1 main L evei 1 29 511 i 3�-1 Master Bath N iR ba O 0o Master Bedroom N o 5r 6„ c s _7 ., 6�t111I 11" i N 14' o Hallway (1) C° c� M f 21 10° 712n . v 10'7" l Closet (2) `* �m11'3" /` �.Lyl� L��fl/�•C/y /��v� /T4, /e Dvo Z � /�J`1��� /.49 fir✓Ifi7c.�, r �--T 10r' —I C �/yL0✓G S`Z P�Ci2C�, fs✓d�lS 3 �� �� O Main Level 20150023_REPAIR 3/19/2015 Page: 2 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE-OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTI ON 57 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 259 North Bay Road Osterville: MA 02655 Owner's Name: Gay.Thomas Owner's Address: Date of Inspection: June 9. 2008' Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford a > Mailing Address: P.O.Box 49 Q` e Osterville,MA 02655-0049 " Telephone Number: (508)862-0400 w r CERTIFICATION STATEMENT ca M I certify that I have personally inspected the sewage disposal system at this address and that the it formation reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)-. The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fa' Inspector's Signature: Date: June.13, 2008 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or PEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall:submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report.only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 i h OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 259 North Bay Road _ Osterville. MA Owner's Name: Gay Thomas Date of Inspection: June 9, 2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System ys em Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is inuninent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water.level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken.pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 tunes a year due to broken or,obstructed pipe(s).,The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 259 North Bay Road Osterville MA Owner's Name: Gay Thomas Date of Inspection: June 9. 2008 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to detenriine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of'a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for colifonn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and . the presence of ammonia nitrogen and nitrate nitrogen is equal to.or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to.this fonn. 3.. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO RM PART A CERTIFICATION (continued) Property Address: 259 North Bay Road Osterville MA Owner's Name: Gay Thomas Date of Inspection: June 9, 2008 D. System Failure Criteria applicable.to all systems: You must indicate either"yes"or"no."to each of the following for all inspections: ' Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution 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 '/z 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.SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface_water supply or tributary to a surface water supply. ✓ 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 316 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to detennine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply y 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 II of a public water supply well y If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered yes in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 ! , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 259 North Bay Road Osterville M4 Owner's Name: Ga .Thomas Date of Inspection: June 9. 2008 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner, occupant,or Board.of Health ✓ Were any of the system components pumped out in the previous two weeks ? Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ — Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is_at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 259 North Bap Road Osterville MA Owner's Name: Gap Thomas Date of Inspection: June 9 2.008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 7 per as-built Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 770 Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: _ Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): _gpd Basis of design flow(seats/persons/sgft,etc.); Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infonnation: never numved Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: Maintenance TYPE OF SYSTEM ✓ Septic tank,distribution box, soil absorption system Single cesspool . Overflow cesspool Privy Shared system(yes or no) (if yes;attach previous inspection records, if any) Innovative/Alternative.technology. Attach a copy of the current operation and maintenance contract(to be obtained froin system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 5125194-as built card Were sewage odors detected when arriving at the site,(yes or no): No 6 Page 7 of 11 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 259 North Bay Road Osterville. MA Owner's Name: Gay Thomas Date of Inspection: June 9. 2008 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC - other(explain): ------------ Distance from private water supply well or suction line:. Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 4 Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confinned by a Certificate of Compliance(yes or no):certificate) {attach a copy of Dimensions: 2000 gal. H-20 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baf fle: 6 •� Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recoimnendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,.etc.): Tees were resent. The li uid level was even with the outlet invert. There did not aRvear to be any signs o leaka e. The tank was pumped after inspection Inlet steel cover is too grade GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): 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: Date of last pumping:. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 259 North Bay Road Osterville MA Owner's Name: Gav Thomas Date of Inspection: June 9 2008 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete._metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: allons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Commments(note.if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was clean. No solids were presenr Steel cover is too grade. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alar as in working order(yes or no) Commments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 259 North Bay Road Osterville MA Owner's Name: _Gay Thomas Date of Inspection: June 9 2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: ✓ leaching galleries,number: _8-36'x8'x3 3'n&as-built leaching trenches,number, length: leaching fields,number,dimensions: ' overflow cesspool,number: Innovative/alternative system Type/naive of technology: Comments (note condition of soil, signs.of hydraulic failure,level of ponding, damp soil, condition of"vegetation, etc.): The alle s were clean. The scum line was 6"up from the bottom. There did not avv ear to be an si ns o ailure.A camera was used for the inspection. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments. (note condition of soil,signs of hydraulic failure,level,of ponding�,condition of vegetation, etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued). Property Address: 259 North Bay Road Osterville MA Owner's Name: _Gav Thomas Date of Inspection: June 9 2008 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. g GAr�9� • o . a o a - ac, ag EEi yff 10 Page 11 of 11 h OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: - 259 North Bay Road Osterville MA Owner's Name: Gay Thomas Date of Inspection: June 9 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of.SAS) ✓ Checked with local Board of Health-explain:_TonoQranhic and water contours mans Checked with local excavators, installers-(attach documentation) Accessed.USGS database-explain: . You must describe how you established the high ground water elevation: ..Using Barnstable to o ra hic and water contours ma s the nta s were showingsite, a iroximatel 25'+/_to roundwater at this r I This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection,. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic systent, the inspection, this report and/or any components of the septic system which have not been located and inspected. G - 11 ToWn of Regulatory Services. BMWSTABLE, : Thomas F. Geiler, Director �ArEn �a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 -REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit".. If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. a Q:ISEPTIC\Disclaimer Private Septic fnspections.DOC TOWN OF BARNSTABtE LPC lei ,: SEWAGE # VILLAGE ASSESSOR'S MAP & LOT0721,1 ,'4C' 'INSTALLER'S NAME PHONE NO. ,TO li SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL O`R PUBLIC WATER BUILDER OR OWNER !O/ S fu s DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: ` . - VARIANCE GRANTED: Yes No e e s .1 3 OWN OFBARNSTABLE I,6 CATION S nor-1 SEWAGE#9a- S /a VILLAGE 03'r ya I ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) rjAILY 1 (size) NO,OF BEDROOMS OWNEROM�c1S PERMIT DATE: COMPLIANCE DATE: 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 77 Ford (o C! GAr�g� � f3 33 a8 O O 3 3a. y8 y 13 a T) -r 2 Q fV/ � Q �-� �4-curt ��—� 6C3 e Noll.— ...._Y F>�s�.�....._............_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH `l.©mod.0................OF..... ...��NS �' Appliration for Mynvi al Workii Tomitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual"Sewage Disposal System at ..... 25�.---i�o..:�.-�-���--�:� b . 1- �A..---©��-�...< <..�,�........................ •- Lo ggYIl��oo. ... 1 Ul e7�1-CjL\�catio Address .......................... `22........... C9Chl7S'Z7��� caress ��L; -. `�+� ...---• -- e.7 .......................................... -. ...... �P` CAL J ner W Installer Address d Type of Building Size Lot_28� ....Sq.. f t Dwelling—No. of Bedrooms_._...�.................................Expansion Attic (�(� Garbage Grinder (;e 5 Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ . W Design Flow....... SL5.............•....•...•._gallons per person /per day. Total daily flow.......�_�.S........................gallons.�� WSe tic Tank—Liquid capacity_ _gallons Length_1....,1__-__ Width_. .'..__ Diameter—.._ Depth. . _. x Disposal Trench—No. ....._I..._....._.. Width.......12......... Total Length..._..___•..... Total leaching area_.7Q` ___....sq. ft. Seepage Pit No--------------------- Diameter-_.____-__---_--_-_- Dep'tili below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Y�j Dosin ank ( (� ~' Percolation Test Results Performed by.---�T _...!• _____________•_. Date___��"'_� _'_ __.._____. aTest Pit No. 1._4_Z-----minutes per inch Depth of Test Pit..... 1........... Depth to ground water._ _ i).1.......____. fi Test Pit No. 2-1-7.,.......minutes per inch Depth of Test Pit-----J. --------- Depth to ground water_ CCX?l4.M96�) a' •-------•-------------------------------••--•--------------•---••----------------------•------...------. •_ ---•------------••--•-------•-•--------•- O Description of Soil...�_'.i...UZI... ....... _ "Z Lo&Nw�x 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has boop ijgued by the board of health. Signed ......................... Ihf­- .. .� � ......... .......� L!°. Date Application Approved By ............00e.�-�.---- 006n.� �l .......................... .. .. . . ... . .. .. ... Date Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------------- .... . . . .................................................... ..................... .................................. ............................................... ........... ........................................ qq d� Date PermitNo. ......-l-- ..-.... --1... ... .................. Issued ...........:......................... ----------- Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) A-- DATA r No......................... Fzes .........U........_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH \�..� -... O F...........r-\'L 1 L.1 .....!!4t3�.:. , ............................................. ..... ..... Appiiration for Bispoott1 Works Tonstrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (e` ) an Individual Sewage Disposal System at: ` v -5 TL—e— A .� . ................................ --- --.........................••----•----------- ..................I.....-•--•-......--•• ---•••••--•--•...................------ Location-Address 7-� i or Lot,No. 1 .A•, t �' .feu 1 ................................................................................................. ...............................:..................................................................'• Owner Address W ..T_ Installer Address U Type of Building ,�, t' Size Lot.2_ __ `-�`.._..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic (qI>> Garbage Grinder Other—T e of Building ... No. of persons............................ Showers — Cafeteria al Other fixtures ............................ W Design Flow....... _ ?J........................gallons per person per day. Total daily flow.......1\_�5...............................gallons, , , P' Septic Tank—Liquid capacity Z _L.gallons Length_1(..`K)".. Width... Diameter".—.,.. Depth. __.._ .. r Disposal Trench—No.................... Width.......`......... Total Length.....��1,....... Total leaching area___M....._.._.sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area------------------ ft. Z Other Distribution box O� Dosing.tank ( i') t ~' Percolation Test Results_ Performed by....�%!'............. ...I..! .f..:...i `�-:................ Date_._l.�.............................. Test Pit No. 1_.l.''......minutes per inch Depth of Test Pit............. ........ Depth to ground water.). J-____-------------- f= Test Pit No. 2. ........minutes per inch Depth of Test Pit-----M. ........ Depth to ground water. '�(� ?" ?Y�I'-��> a --- ---------------------•--------•-•--........--------•--------•-.----•-.----------------------=--••--........----------•---------•••-•-•-_•-•-- O Description of Soil--- . . ...---`''-.....Y• � � L G � =� -t L�'''sv L � �`.............................................( �1`J�--•••-•......... x 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 TITLE 5 of the State Environmental 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. Cam`".."....f .......................................... . �Y.�. ' Signed .----..... Application Approved B ............. p `� � ..., ....--_.... .- pP PP Y L = -"" i Dace J Application Disapproved for the following reasons: .......... ...................... ...................................... . .. ......................... .................. ------------------------- -- -- - -------------------------------------------------------- ------------------- --------------------------- -------------- ------------------------------- ---------------------------------------- `f ' Dace Permit No. -------j- " I - Issued .. Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 C�\r,t..!U..... --. OF ....--. /-"Z t1.1 -T3-2 i, C_C'. ................ ------------ -- C�er#ifirate of C�umyliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( K) by .. -- -- ------------------=------------ - ---------------------------------------------------------------- ----------------------------..........................--------------- -------------------------------------- at -------------� s- 1---- U�ti'1�•�'....�LJ7 -- ------��.'-..!- :\. ,/nscaller has been installed in accordance with the provisions of TITLE 5 of.The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........ ............ 'r.`.--....... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... " "' -- -------------------------- Inspector . �....../ -------- ------_------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ j IY . s;?\A.l '0 OF......... ��( i r�..r.�i t ?�: 1........................ FEE �� .0C.) . �i��o��l ork� �ot���rion rrnti� Permissionis hereby granted.............................................................................................................................................. to Construj�( ) or(Repair (�)4n Indiv-id al Sewage Disposal System ,; ) r� at No.----•---- C�..................................................tQ(_ I lam- 1... � °t l t1� E `l'11 -f�:. �!�e� 4 S Q� ' �.� l�=-fg--• ,.......---•-•...............------..... Street as shown on the application for Disposal Works Construction Permit No_,...:.......------- Dated............... ........................ �� ............................... 1`;,�`° 1-------------------------------------------------------_ (,/ G V Board of Health DATE......................J 1=- f/f FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - ZJTSI 6 ti 77ATA - SIt�GI-� va t't4�t �6A1�A1�E (�RJIJ�EJZ. _ l tp::x.. 1 .1155 6cf SEAT l C . TatJY,i 7 k ►l0 1C toot,. a I S4Q G�At.tn ni S { Gear. - Al UISPoSA L FiT_t_D '40'xF�' tiu t'tt1 4.x4 &ALLC 1. , 51DEWUL ' AWeA (40+4.0 +Pa-t-®)=96 x4` = 664 SF Bo77oM ARC, 4o Y,Qa 320 5 F qL- 320 e-ml iA e�iv T ZOC"Z TOTAL ti16N = IZ80 6fv, TOT•AL DAILY FUW = 1155'GP"�► `�Z M t aA P�4mG k+ � tt\,J \NA IFIAJ PMER ` E' SULLIVAN � v No..2y733 .._ .`� �. o T�5 T t2" a t`c�- 2 ZE4. Cr 4./• �O.V'b"28 t LOCE P�; Gar.a lax/ 2�N�ers DKT �t1rr GAL -F-L231 . ts.s. to N� P '72 EL 11-3 PW - 2` C(Lu S,N ESQ tST�t.t1✓ PLA 14 D ,-t5r-A L LZK14�kT;A Ao aroke csrlr� ms Z Ed_(.,p . . Gie4Ltr,, �°F 8J4'1`�8� �zlvla, lt �2. PLAN R.E EfzFJC.E`y' MAI A.C(ffl4, 1 ' C=F( 144kT THE b\k)GLL j U(, �G MA t2�94 '%OW N HEZEoN GoMIPc. S 11Tµ "ME '51VEUIJE �L'�� � 4-79, 7, = o, > { IDWN off, ►� itx DA krEL/. NYE (IJC QZOPE-%10 JAL LAQD 5uwEyce5 79K R.AW IS: NOT- ?MED oN hN SupVey A1JD %f- OWieTs 44ouLD tour 'DE o5TER iZVILL.E MASS , SSG-'1� ro E5TQ8usF� PtzaP��t y U Nei dPP�ICAN-1-s � `�.I S i of TS x •- a � f . J 1 ��'1, r 1 .i y � �, ..`fir \ ?..► � �� � -. 1 11 �`,p 32•o � m �� � r'frU14P eg $. ! \ \ G ? •:..ti1�'-- � �'��i1�•G ```.34 1,_ i ! r33 q j � � �.' "S1` �0 X.�SQ.: S.a� w Gt7 77 I sEv o _ ` -- �a LEAr.�• _ aQ r. 3 LCCArF— ?tZOit6CD aA /� �- G �4 - PITER S:ILLIVANrn NO. M33 O TIE'. il(O.� it)199Z 2.5..�� e. VAX-( 4, 1994 m MAY 12119R3q ,. ._ i ` wit t'T�°} 'l�A1Z73AGE l�RINDQZ, , 1 tO Sop C-�A►.ca�S LXiG M 6AL LO l'- t "'e"'AiNll DISPOSAL F►ELD` ; 4o'x8' WMi 4XA &A,LLC�( C 1Qe1�, ; ' � 51DEWQLL -AREA. �4o*�.C► +-e-r®�= 91a x4` = 38� SP . : ' , ?OTToM AXA ac x b 37.0 6 FC? A 32t� �,� A: 1 s 3?O epv, �TDTAL�I6N = 1260 �•`I-OrAL SAILY F1 W = l l SS 6r- T-S¢ V .ATI 014 BATE. L Z M►tiA Fc-z I UG}4V �wm ` OP ♦}� VG jrl-. s' ,, eeS SULLIVAN •E�. ISO- 'IF _ . .. ►2 of�t� Z? 2Ep. . E�oLt Gr +�' �, 20bp ^� U uvDIKTT 5 ric d �' �o -F-03 j Z BBC 25.d �N 25.L ,' �r CaJc - El �9 S . N2a a � ' 9 Z (� -Z _ t QC- � 11-3 1 1 S GrA LLF�(S 1R.1►Tt1 �FIED ` FlCr 'FaN c czu6,N F-v $TOu� - Tdrn c t, n, ru AO LoG�t'TIDN QY �� . . _ 2 Ed�G,�p`� _.,�FdJ8 9 DATA-, ` ti`Uwll 92. h - ...._... .. . ,_,. `1• MAY 4, FLAN RE'!rarz JC& CE T-Y T4IAT TNT V\Aju 4.1 U to I"�Y�z�sd SFtow.IJ N aN M�Lyy-S- yvrCµ Tit 5lDEU�JE -79, T1& `DWN off.8>a.Qu t.1�Lz 1.-ocQ� :wrt-9 u TES '1 ZOO � IMU, -L"�-- lad kre z NYE (W 'FZOFE'7510$44L .LAtJ� Su�Iv/cIZS -114K FtA►J IS NOT" T3MED oN tiN M'tLMVr Sub A14D T6{ oFFSet'S 414ticx.D utn' 'QE a 5'('ErzUlu.� titA,� . APFLICAh4T,' RCN:1 S 10 1�4 `j _.._.. . c � s "{} I ; i f , JJ 45 Go5•�g a �� ,�� `\ ,.� � � A 1 34 1 Q.29 1 "'..�_ ` 1 ` i 1 p Re ;d a h157r1r043" •O � 1 1 �� 1 \\ i "' r 1 � ,, � � 'y.9 O._• /.T$, .� :, -� .3{7 te�,.!O.�e. `!T•��-Ty' �1 f� � 111�. \� Y � y:.`-,n .R-ri ti: .. � _ � � 1. ,_.;,. .' 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