Loading...
HomeMy WebLinkAbout0330 STARBOARD LANE - Health 7=4 arboard Lane, Osterville _ A66--113----i I n COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 .1,997 ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 V \ V WILLIAM F.WELD TRUDY COXE Governor Secretary ARGEO PAUL CELLUCCI DAVID B_STRUMS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Cammisskxw PART A `:ANC CERTIFICATION Property Address: 3 3 O ( D S `r d S�yt,�C Address of Owner: � Date of Inspection: 3� µL4y/ 1447 (if different) Name of Inspector: room e S �v am a DEP aqprove4 system inspecior pursuant to Section 15.340.of Title 5 (310 CMR 15.000) Company Name: `m- Mailing Address: Telephone Number. (0]-7_ ML93 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 funetkm.and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: , Id. Date:NJ The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing 11Mr 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 shatl,sr omit 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: _ 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15303- Any failure criten not evaluated are indicated belo;;�� /1 COMMENTS: s is 15 i.J >°kt5r 6Le� eo�+.,bl."4.ly,_ B] SYS ONDITIONALLY PASSES: !� One or more m components as described in t onal Pass" section need to be replaced or repaired. The system, upon completion of the rep nt or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND. cribe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the ow r operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank nsta"ecl within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, stru unsound, shows substantial infiltration or exfiltration, or.tm*. failure is imminent. The system will pass inspection if the exis' septic tank is replaced with a conforming septic tank as approved by the Board of Health. (zaviaad 04/25/67) Pago 1 of 10 y DEP on the World Wide Web: http://www.magnet.state.nia.us/dep Printed on Recycled Paper c it SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) P perty Address: 330 SvaQ•� �'�• O S�-eQ���l�� Ow r: y{Q. w(. Peet^.) Date Inspection: 3 1 µ .ye g-7 6 SYSTE ONDITIONALLY !PASSES (continued) 1 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval,of.the and of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The syste required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection i with approval of the Board of Health): broken:pipe(s)are replaced obstruction is removed 1 /J Cl FURTHER EVALUATION IS REQUIR BY THE BOARD OF HEALTH: Conditions exist which require furt r evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environ ent. 1) SYSTEM WILL PASS UNLESS BOARD HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC H LTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet o a surface water Cesspool or privy is within 50.feet of bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEA TH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER TH T PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption stem (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption cyst and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption syste nd the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system d.,the SAS is less than 100 feet but 50 feet or more from a. private water supply well, unless a well water analysis for liform bacteria and volatile organic compounds:indicates that the well is free from pollution from that facility and the pre ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 3 30 $i#-6p 41 L� " 0 Owner: rrt R, Nf., D ea.J ate of Inspection: 31 Pt7 4-7 D] YSTEM FAILS: You ust indicate ei;r:er "Yes" or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis r this determination is identified below. The Board of should be contacted to determine what will be necessary to correct t failure. Yes No Backup of sewage into facility or stem n�1 due to overloaded or clogged SAS or cesspool. ischarge or ponding of effluent to a surf o ground or surface waters due to an overloaded or clogged SAS or ce pool. - - Static iquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid d th in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pu ping more than 4 times.in the last year NOT due to clogged or obstructed pipe(s). . Number of ti s pumped _. Any portion of th Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cess ool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspo or privy is within a Zone I of a public well. Any portion of a cesspool o rivy is within 50 feet of a private water supply well. Any portion of a cesspool or pr 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 mpounds, ammonia.nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: R You must indicate either "Yes" or"No" as to each of the foll ing: The following criteria apply to large systems in additi to the criteria above: The system serves a'facility with a design flow of 10,000 pd or greater'(Large System)and the system is a significant threat to public health and safety and the environment because one r more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water pply the system is within 200 feet of a tributary to a surface drinks water supply _ the system is located in a nitrogen sensitive area(Interim Wellhe Protection Area-IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full co fiance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the D artment for further information. (reviled 04/45/97) Page 7 of 10 t , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ` Property Address: 3.3 D 54+rQ.6o-it c�s2-�'Yl.e- wlr4 Owner: µI. Wl. L">eqN_) Date of Inspection: 31 wtq.( 911 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Ye No _ Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. JL_ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout.. All system components, excluding the Soil Absorption System, have been located on the site. )AC _ 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. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex: Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) (seviz*Q 04/25/97) Pag* { of 10 r r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM AINFORMATION Property Address: 3Sa Owner: W(Ej, 04. pNfto Date of Inspection: -3 FLOW CONDITIONS RESIDENTIAL: Design flow: t 1 O g p. /bedroom for S.A.S. Number of bedrooms: `V Number of current residents: Garbage grinder (yes or no): &S Laundry connected to system (yes or no): Seasonal use (yes or no):,Ojo — ��"`edw► rr II // �� Water meter readings, if available (last two (2)year usage (gpd): �7 ee �t'�T cJti Ce3Q 0 Sump Pump(yes or no,. Last date of occupancy- CDQ P COMMEIZISI L/INDUSTRIAL: Type of estab ment: Design flow: Ilons/day Grease trap present: (yes no)_ Industrial Waste Holding Tan sent: (yes or no)_ Non-sanitary waste discharged to th le 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS nd source f information: boJ� System pumped as part of ins pe ion: (yes or no) p If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM ,%e 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) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) f (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C _ n SYSTEM INFORMATION (continued) Property Address: 3 30 5 4 LL,Kd/ Owner: 0►(,f2.. W(, pea,,.) Date of Inspection: —S( v4 9 11 SOIL ABSORPTION SYSTEM (SAS): St 4e P( (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) 4-mer-determined to be present, explain: _ LnAe4 Type: leaching pits;number: a-- leaching chambers, number: A. leaching galleries, number: leaching trenches, number,length: A..) A- leaching fields, number, dimensions: overflow cesspool, number:AVAJ Alternative system: Name of Technology: AF Comments: (note conditio of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) � Q c C SPOOLS: _ (loca on site plan) Number a configuration: Depth-top o uid to inlet invert: Depth of solids er: Depth of scum.laye Dimensions of cesspo I Materials of construction: Indication of groundwater: inflow(cesspool must pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, vel of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, conditi\ofetiation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3 O S+gQlegfA W Owner: w(R. M. DeqJ Date of Inspection: 31 04 T7 BUILDING SEWE . (Locate on site plan) Depth below grade: Material of construction: _cast iro 40 PVC_other (explain) Distance from private water supply well or su n line Diameter Comments: (condition of joints, venting, evidence of lea e, etc.) SEPTIC TANK: 1< �� n (locate on site plan) S 4 q X Depth below grade: R I aJ C`GS Material of construction. concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: 16, k 1 Sludge depth: LI%C 4 y JJ&%'c ✓e Distance from top of sludge to bottom of outlet tqv or baffle:-4/� Scum thickness: L'V1t4 A%V4e AJO-4 Xse i& X&C4- Distance from top of scum to top of outlet tee or baffle: MA Distance from bottom of scum to bottom off outlet tee affle: tJ How dimensions were determined: pepbr 0 Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles depth of liquid level in relation to outlpl invert, structural integrity, evidence of leakage, gtc.) AJ Lr 2 � a--- S ✓G�.1 �— GREASE TRAP (locate ite plan) Depth below gr e: Material of constru n. _concrete _metal Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top f outlet tee or baffle: Distance from bottom of scum to bo of outlet tee or baffle: --, 1 Date of last pumping: �CJ Comments: (recommendation for pumping, condition of inlet an utlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n SYSTEM INFORMATION (continued) Property Addre ss: 330 Owner: ^A Date of Inspection: 3' t,,.< g 7 TIGHT HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on s plan) Depth below grade: Material of construction. concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons ^ Design.flow: gallons/day /r Alarm level: Alarm in working>float ; No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm hes, etc. DISTRIBUTION BOX:k (locate on site plan) Depth of liquid level above outlet invert:/�aJJ t Comments: (note if level and distribution is equal, evidence of solids rryover, evidence of leakage into or out of box, tc.) C l�c�. v L. + 0o a Lev PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or 1 Alarms in working order(Yes or No) J��J Comments: (note condition of pump chamber, condition of ps and appurtenances, etc.) (revised 04/25/97) Page 7 of 1.0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM` INFORMATION (continued) Property Address: 330 S fQP a"j a wL4 Owner: 04 L. AA, D�a Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) P See so.T-Ct � (revised 04/25/97) Peg* 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ' Property Address: 330 54(Z V'*0.iCn Owner: M its w(. oeoq . Date of Inspection: 3 I t44%y t-7 Depth to Groundwater _ Feet Qf l t4410 0 v1 O �'f' Sr o••• G I• 4 bear ' Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record YObservation of Site (Abutting property, observation hole, basement sump etc.) Qc,�le Determine it from local conditions " Check with local Board of health Check FEMA Maps Check pumping records 6.�,jLe �,,f I�vr►1 (,.��o �� �� R t Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) IT.fr y-E�C A$e-Q"'eo 7>e&"� 1 Wd 4 er4•S 40 a 5 y (revised 04/2S/97) Page 10 of 10 01/01/1994 02:25 5084201154 MARK AND RENEE DEAN PAGE 02 L0CAT10N SEWAGE PERMIT NO. vl CLAC-E ;. INST ' A LLER S MRMf i ADDRESS .. l VILD-E R O# OWNER Tod c%4 No DATE PERMIT I S S 9 ED OAT E COMPLIANCE ISSUED t II cn ^{ Y THE COMMONWEALTH OF ,MASSACHUSETTS T,AL PROTECTION DEPARTMENT OF ENVIROI��VIEN BE IT KNOWN THAT `R James Ke11y { q atisfied the De P artment's ualifications as re `wired and is hereby Has s authorized to use the: title - CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21 A of the r General Laws. Issued by The Department:`of Environmental Protection. j I o-Cif April 2 ,1996 y1rd or of the i sion of Wa Pollution Control `. r RETAIN THIS PORTION FOR YOUR RECORDS SERVICE ADDRESS ,, ACCOUNT,NO PREVIOUS a._..... � .' �i BALANCE WATER BILLS UNPAID AFTER(30)DAYS FROM DATE OF ISSUE ARE SUBJECT PAYMENTS TO INTEREST CHARGES,AND TERMINATION OF SERVICE FOR ACCOUNTS &CREDITS PAST DUE (120) DAYS. ALL IN ACCORDANCE WITH CENTERVILLE- OSTERVILLE-MARSTONS MILLS WATER DEPT.RULES AND REGULATIONS. INTEREST TELEPHONE:(508)428-6691. CHARGE PERIOD COVERED; PREVIOUS.METER CURRENT METER CONSUMPTION, CURRENT FROM TO ;READING„., z� READING°�f _ae .,1000's=.OF,.GAL.;? CHARGES 1=�a=;'(•i::::: F'f::a��: 14-4t:?tJ`::�i`•,iti)' F'cl' EXCESS CHARGE Mili''•1t. "I1..iPERIOD COVERED MINIMUM . )o4. t 11 ;j( i tr.1.,....1. ...1 ... CHARGE '• DATE OF.ISSUE ,TOTAL ,;:• ..'.L . AMOUNT:D.UE. I.•.. : ';''i;' No ... ... Fps. r THE COMMONWEALTH OF MASSACHUSETfS BOARD OF HEALTH . /....�7..i <./ I--.---------OF......1.ti1..�'�.1' U. Appliration for Dii�rnsal nrkii Tomitrnrtion Prrutit Application is hereby made for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal System at: .. Lo.c.a�o_n-AddressTt0 ............................................ t.... wed f Owner Address cc---------------------------------------------- ------•--------••-••. --.....----•---•---•----------•......----•- Installer Address // Type of Building Size Lot... _.Jj_20 9..Sq. feet U Dwelling—No. of Bedrooms.................. .......................Expansion Attic ( ) Garbage Grinder 0<) Other—Type T e of Building No. of persons......................... Showers � YP g --------------------------•• P --- ( ) — Cafeteria ( ) Otherfixtures ..-•••••------- -------------••-•---------•••---•-•--••-----••-•--•-----•--•-----•-•---••-••--••----•----- W Desi n Flow........._' ©g ,��.�'�A_:�'_____________gallons per person per day. Total daily flow.__...._.__.._.___._.._....__..._..____.__.gallons. tic Disposal Trench—No capacity.lS W Width LengthTotal Lengthidth................. . . Total leaching area._-Depth................ Seepage Pit No........... ........ Diameter.......1Y...... Depth below inlet.......6......... Total leaching area.4./.,)..../a..sq. ft. z Other Distribution box ( () Dosing tank ( ) Percolation Test Results c� Performed by............................................... ------ Date........................................ Test Pit No. I____.-----4-minutes per inch Depth of Test j ..---- Depth to ground water-60.17-<1_.__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' - -------- �t y .:C------.... Qr O Description of Soil... - -y__.. c?_9G1y--1 �a _.__ _ _� s�` -L______________i --•• . (� - drsk ;. x 1!� '�+iis>� .. �' '------------ - - 1 -� ------.M ....... 0 Nature of Repairs or Alterations—Answer when applicable.____........................................................................................... Agreement: The undersigned agrees to install the aforedesdribed Individual Sewage Disposal System in accordance with the provisions of TITi M 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i by th and of health. 4 Si n . -- -- ..-- .............................................. .../. • - . U� Date Application Approved By................ ••••• = --••----- '-�, Date/ APPlication Disapproved for the following reasons-------------------------•--•----•---------------------------..•..-•---------•------------------•-----•-•-------- ........•-•-----•-••----------------•----..........--•••----•-----•-••-----•--•----...-----•---•••-•----.--•-------------•••-•--•---•--•--------•-•-•-•------••-•••--•---•-•-••-----•-••------•---•----- Date PermitNo......................................................... Issued_....................................................... Date No „l ...j.� A Fim _.............. _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7. ...........OF...... ... _,�. ................................. Appliration for Disposal Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct k) or Repair ( ) an Individual Sewage Disposal System at: ............... ..... -aka ...........artek- 111. ......................................................#./.-:......------------........ ..... ----------- --_-_----.��. Location-Address or Lot No. .- �en� y -.... ! ..�_ Owner Address ° `. ✓ s a . ._....� ------------------------------------------------ -------------------------------------------------•------------------------------------------------ Installer Address Type of Building Size Lot.4_ ___Sq. feet Dwelling—No. of Bedrooms................. ........................Expansion Attic ( ) Garbage Grinder ) '4 Other—T e of Building ..... No. of persons................-_.......--- Showers — Cafeteria al Other fixtures -----•-------- --------------------------- Design Flow..........��.�.. _.__/.............gallons per person per day. Total daily flow................. ................gallons. Septic Tank—Liquid capacity/_,5�Sagallons Length................ Width................ Diameter---------------- Depth............ x Disposal Trench—No. .................... Width.................... Total Length,.................... Total,leaching area....................sq. ft. Seepage Pit No.......-_ol-------. Diameter....../'_I........ Depth below inlet......4......... Total leaching area�_,/J" .,6..sq. ft. z Other Distribution box k ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1 .... ,_..minutes per inch Depth of Test Pita - Depth to ground water_,q_,C,_,q�.._._-. fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .......................-------•--- --- . ............-----.......---•-•-•----.....------..... ;........................................ O Description of Soil. .(.?..- :'....3�',r'���f• � ----•--•-------------- U ................. � A4.....V1.e_�-p _ ..__.../lC6 -C 4'fi V ..__... 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 TITIS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' s ed by the board of health. ....... Application Approved B '� ?0_.4"0.,k................................... ...• ------ ..... �e:.l PP PP Y---..._-•--.-- .................... Application Disapproved for the following reasons-------------•-•--...--------------------------------•---------------------------------------------......•----- -••--•••---••-••-•••--•--••.............................••-•-----•--••••--........-•----........_..•--...._......_...._........._..•-------------•-••-----••---------•---•-----••------------•---•-•----- Date PermitNo..................................................._.... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Irr ifiratr of Gontpliatta THIS IS-TO_CERT1-k'Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......... n..... =------------------------------------------- --------------------------------------------------------------------------------------------- Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.• _:~�.C,.=~�„__••-••-- dated. .._� �_1 ------------------•--••- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C STRUED AS A UARA(NTEE THAT THE SYSTEM WILL FU TI N SATISFACTORY. DATE.............. ........ ............................ Inspector------. -•. . •-----..... . -•.... THE COMMONWEALTH OF MASSA USETTS BOARD OF HEALTH ......OF...................................................................•--•....:......... �i��o�ttl ork� �on��tion rrntit Permission is hereby granted................... C2.............................................................................................................. to Constrµct�S( ) or Repair ( ) an Individual Sewage Disposal System at No....1 -•---- t-cl Street as shown on the application for Disposal Works Construction Permit NOo'S f ........... Dated->- ......................... Board of Health DATE................................................................................. FORM 1255 A. M. SULKIN, INC.. BOSTON LOCATION 44 f SEWAGE PERMIT NO. VILLAGE / J�� 1416- 1t � or-b;--i j / � I N S T A LLER'S NAME i ADDRESS e U1`LDE R O-R OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � g ,�/� ��� /� �'� �- ` � ��� �I I L �.z o 0 TOP OF FOUNDATION CONCRETE COVER CONCRETE COVE?`' IQ1�/ti� • 4"CAST IRON 12 MAX MAX'•' SCHEDULEOr 40 PIPE SCHEDULE 40 PVC (ONLY) - PV.0 PIPE LEACH - — PITCH 1/4 PER FT PITCH 1/4--PER FT PIT PRECAST LEACHING INVERRT_ < PIT OR 48.E INVERT / • EL. I SEPTIC TANK E INVERT DI ST. EL -7 44 �j EQUIV. • INVERT J GAL INVERT BOX ` - o ; El -z: L - -- EL. 1.83 INVERT W �. 3/4"TOIV2' 4i ►� - 'NP�� 1 - -- - -- EL - LIL WASHED + STONE `k� i�/� • , '� - ` - -- 6 PIA -+�• N. f v • PROF. LF OF ;POUND WATER TABLE SEWAGE DISPOSAL_ SYSTEM I NO St,ALE SOIL LOG WITNESSED BY : / DATE A&V Z /9164 TIME 1o .34> ,AM . Cif BOARD OF HEALTH `EST HOLE I TEST HOLE 2IVAf� EE1/ ENGINEER y/ ELEV s' -�� ELEV. / M *77 ` DESIGN DATA e4 47 ti / Lgyc-s of NUMBER OF BEDROOMS Za,T" 'r/ Dw,.•st /hurt:. SAwo TOTAL ESTIMATED FLOW GALLONS/DAY �• �3 RtKGZ j i -- e2.4S*74 ;n �'' �.v,, • ri� r, BOTTOM LEACHING AREA SO FT / PIT/C.Pa. 77Yr�� SIDE LEACHING AREA �7S / SO FT / PIT/43�F.8+:�-p - �� GARBAGE DISPOSAL Y6 s (50 % AREA INCREASE ) TOTAL LEACHING AREA ll. SO FT PERCOLATION RATE ZI .77IA07✓ JAlS MIN / 'NCH 9 1l7;o_ - � LEACHING AREA PER PERCOLATION RATE ,fib J,q SC FT/�'..I? `� 'yam WATER ENCOUNTERED 'Y NUMBER OF LEACHING PITS /'iT� .s �o ''1' /' FftT &o 72-.v4 G„✓ iYlL. :`I.P4 s APPROVED BOARD OF HEALTH n:'E 0 ��� \ wi~ � D' CO11j� AGENT OR INSPECTOR — 0 ryM / / �� AGOF 4ftEINV ; t •`''� -yam G N / ( t J �'c, ED1J�,RJ .� s--Tso As,* HA E. 0.5 / /' ST�kb'o�t�. L.sh!✓E . . 4 " �� ^,7 �:�;, ��� TV- ' 4e / l Gam $ ,a, xffi sANffR0.lP� 1t, PETITIONER l l/i✓ S L�+rytr•9 TP . •f .`.. : : `', 73 i ,vfj /�/ T� 5G C o STZ�T VlG G�' �/� "Ira- aP � ag.o -', B,Rc,9 7,e . TaE M,l3 G_X /Z /rj8¢ .5�h►l E` ��= '40 ' led-c �,�•..D .� .,�✓ yae B, LE�/62 f E L '.K-,2•o TOP OF FOUNDATION CONCRETE COVER CONCRETE COVER" i 4'CAST IRON FT IL ' AX"'OR SCHEDUI.E 44 SCHEDULE 40 PVC (ONLY) PV C PIPE __— PIPE MIN. LEACH PITCH 1/4'PER F C-- PITCH /4"PER FT 1 PIT PRECAST \—INVE�T_ C LEACHING YL. � ° EL..� INVERT INVERT c ~ `� 0 1 SEPTIC TANK EL DIST. EL r •,, PIT OR INVERT - BOX I',• > EOUIV Z — ------- -` 3/4„TO I I/2 r EL G AL INVERT. ~a ..', �• - - - --- cL�r I INVERT ww .�. EL_ �o '� WASHED i w� STONE 4 DIA \ PROF1 LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SUI l_ LOG WITNESSED BY "OV Z 0 :3o qy .rC'oI� �i/fJ�G�LJ Al � DATE TIME . . , BOARD OF HEALTH TEST HOLE I TEST HOLE 2 �! ENGINEER Y/ EIEV -��•..� ELEV. Jh Woo pGo/r►-1 d DESIGN DATA . c�z�47.9 7 i I.-7 t-rye'As of NUMBER OF BEDROOMS �. 9cctls s t 7w: -5w^'z' TOTAL ESTIMATED FLOW GALLONS/DAY ez.¢,7 . � �r SJMoo � Z. /,. � "' �e*�r, 04 s". BOTTOM LEACHING AREA S0 FT. / PITIG. 3` SIDE LEACHING AREA /7S SO FT / PIT/4-*.v-,k-t., GARBAGE DISPOSAL Yes (50 ",, AREA INCREASE ) 01 v TOTAL LEACHING AREA $p FT 7 PERCOLATION RATE !E %5. � � 7Z'Vc MIN ":Cr �,• �• Jib~ ?v LEACHING AREA PER PERCOLATION RATE Sp FT;1C o0_--) �- i ' WATER ENCOUNTERED r � f V � � NUMBER OF LEACH NG PITS 7Wo Pi73 I+Virj,• a /O f2T GEC J7PAl Gyil/ .�. APPROVED BOARD OF HEALTH v � 51. -�.An IN /Jc- T°Nt o , ATE Cae„Z 1 3p AGENT OR INSPECTOR 41, C. 7 7 Ati� / J�•- ,J T�;�v ��9nI,E 6; � k.�L,_GY �">`�� "c N o 2 1 J' � Gj // �` �✓��V�L: f�,la.' i a f w`_�,,�k., , ,?>.n STD� PETITIONER a. `.r-'�A - SANITAA',P„/. ' � `` '"may '7 �I / � / :�• � `�``;� Ae a / � J of ek / v 1 /i ti.`� C.�JTR'�$� ,N ' PL107'+/ ,G'�,�?/ -s/ 9�3c� ��5771m v.E.4 -ram 2 I I ISLE`G / i 1vo"a - G>Nf- f s