HomeMy WebLinkAbout0022 WIANNO AVENUE - Health l
22 WIANNO AVE9JAC-
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTA,'@AFFAIR �.
DEPARTMENT OF ENVIRONMENTAL PROTECTIOIE �V�® r
ONE WINTER STREET, BOSTON MA 02108(617)292C5500 SEp
18 2OOO
gT�RUDY COXE
Secretary
..
AR GEO PAUL CE �
.LLUCCI DAVID B. STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 22 WIANNO AVE.,OSTERVILLLE,MA. Name of Owner FLEET BANK (NANETTE L.DAVIDSON,MGR)
Date of Inspection:
DULY 26,2000 Address of Owner:
Name of Inspector:(Please Print) LLOYD D. SIME
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name:
Mailing Address: 396 South St.Bridgewater,MA.02324
Telephone Number. 508-697-6663
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:
Passes
Conditionally Passes
NeedslFurthe-E Evaluation By the Local Approving Authority
Fails
inspector's Signature: Date: July 28,2000
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection. If the system is a shared system or has a design flow of 1 0,000 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.
NOTES AND COMMENTS
l.)RECOMMEND A RISER BE INSTALLED TO GRADE, WITH A STEEL COVER,OVER THE OUTLET END OF THE
TANK.
2)RECOMMEND A RISER BE INSTALLED TO GRADE,OVER THE DISTRIBUTION BOX.
3)RECOMMEND THE RISER OVER THE INLET END OF THE TANK BE LEVELED.THE COVER IS UNEVEN.
revised 9/2/98 Page I of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 22 WIANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK
Date of Inspection: JULY 26,2000
INSPECTION SUMMARY: Check A, B, C, or D:
e ,
A. SYSTEM PASSES:
® I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure
criteria note luated are indicated below.
COMMENTS:'
�.+ 2h 7 4 L:4 e- e �
W a
B.SYSTEM 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.
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
Compliance(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 complying septic tank as
approved by the Board of Health.
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 Board of
Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced "
obstruction is removed
revised 9/2/98 Page 2 of I I
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 22 WIANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK
Date of Inspection: JULY 26,2000
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 IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)THAT THE SYSTEM
1 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 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
❑ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a rivate water supplywell.
P
❑ 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
El
revised 9/2/98 Page 3 of 11
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 22 WIANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK
Date of Inspection: JULY 26,2000
D.SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
NO I have determined that one or more of the following failure conditions exist as described 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 into facility or system component due to an overloaded or clogged SAS or cesspool.
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
❑ ❑ �-�tlrle .
atic 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).
Number of times pumped
❑ ® Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
❑ ® Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
An portion of a cesspool or privy is within a Zone I of a public well.
❑ ® Y P P P vY
❑ ® 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 1 00 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"to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 1 0,000 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 m IWPA)or a mapped Zone 11 of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page4ofll
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 22 WIANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK
Date of Inspection: JULY 26,2000
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes 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.
® 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.
® F1 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:
® Existing information.For example,Plan at B.O.H. ; o �irli't?frTi�Yl�
® Determined in the field(if any of the failure criteria related.to Part C is at issue,approximation of distance is unacceptable)
[1 5.302(3)(b)l
® ❑ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2/98 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 22 V►IjANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK
Date of Inspection: DULY 26,2000
FLOW CONDITIONS
RESIDENTIAL:
Design flow: g.p.d./bedroom.
Number of bedrooms(design): Number of bedr s(actual):
Total DESIGN flow
Number of current residents:_
Garbage grinder(yes or no):_
Laundry(separate system)(yes or no If yes,separate inspection required
Laundry system inspected(yes or n
Seasonal use(yes or no):_
Water meter readings,if availa (last two year's usage(gpd):
Sump Pump(yes or no):
Last date of occupancy:
COMMERCIAL/INDUSTRIAL:
Type of establishment:BANK
Design flow: gpd(Based on 15.203)
Basis of design flow
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 no)N
Water meter readings,if available:NOT AVAILABLE
Last date of occupancy:current
OTHER: (Describe)
Last date of occupancy:OCCUPIED
GENERAL INFORMATION
PUMPING RECORDS and source of information:
NOT AVAELABLE,TBE TANK DOES NOT NEED PUMPING AT THIS TIME.
System pumped as part of inspection: (yes or no)NO
If yes,volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
XXX 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)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed(if known)and source of information: December 15, 1987
Sewage odors detected when arriving at the site:(yes or no) NO
revised 9/2/98 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 WIANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK
Date of Inspection: JULY 26,2000
BUILDING SEWER:
(Locate on site plan)
Depth below grade:18-20"
Material of construction:0 cast iron❑40 PVC® other(explain)
COPPER TO CAST IRON,PUMP SYSTEM
Distance from private water supply well or suction line 25'+
Diameter 4"
Comments:(condition of joints,venting,evidence of leakage,etc.)
JOINTS APPEAR TIGHT,NO EVIDENCE OF LEAKAGE ON THE PIPES. PIPES FROM THE PUMP TO THE SEWER PIPE ARE COPPER,ALL JOINTS
ARE SOLDERED.
SEPTIC TANK: DQ
(locate on site plan)
Depth below grade:29"Material of construction: concrete❑metal[:]Fiberglassaolyethylene[:ether(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions:Y X Y X 8'
Sludge depth:0-2"
Distance from top of sludge to bottom of outlet tee or baffle:
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:
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.) THE OUTLET END OF THE TANK IS UNDER THE PARKING LOT.THERE IS NO RISER AND COVER FOR ACCESS TO
THE TANK.THE INLET PIPE HAS A TEE THAT IS 9"ABOVE THE LIQUID AND 18"BELOW THE LIQUID.IT APPEARS THAT FROM THE LIQUID
LEVEL OBSERVED,THE OUTLET IS NOT BLOCKED. RECOMMEND A RISER BE INSTALLED ON THE OUTLET END OF THE TANK,WITH A
COVER TO THE GRADE OF THE PAVEMENT..THE TANK APPEARS TO BE STRUCTURALLY SOUND..
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction:Dconcrete❑metal❑Fiberglass aolyethylene❑ether(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee affle:
Distance from bottom of scum to bottom of tlet tee or baffle:
Date of last pumping:
Comments:
(recommendation for pumping, dition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
revised 9/2/98 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 WIANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK h
Date of Inspection: JULY 26,2000
TIGHT OR HOLDING TANK: (Tank must be pumped prior to,or at time of, inspection)
(locate on site plan)
Depth below grade:
Material of construction:Lj cast iron❑40 PVC❑other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/da;mand
Alarm present
Alarm level: Alarm in w . es❑ No❑
Date of previous pumping:
Comments:
(condition of inlet tee,condition ofloat switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
THE DISTRIBUTION BOX WAS NOT FOUND. DUE TO THE DEPTH BELOW THE PAVEMENT, I RECOMMEND THE BOX HAVE A RISER
INSTALLED, TO BRING IT TO GRADE. I F THERE IS NO DISTRIBUTION BOX,ONE SHOULD BE INSTALLED.
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(Yes or No)YES
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
THE TANK AND PUMPS ARE BUILT INTO THE BASEMENT FLOOR,THE PUMPS APPEAR TO BE FUNCTIONING AS INTENDED.NO EVIDENCE
OF OVERFLOW OR BACKUP.
revised 9/2/98 Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 VI ANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK
Date of Inspection: JULY 26,2000 4
SOIL ABSORPTION SYSTEM(SAS):
(locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods)
If not located,explain:
Type:
leaching pits, number:ONE
leaching chambers,number
leaching galleries, number:
leaching trenches, number, length:
leaching fields, number,dimensions:
overflow cesspool,number.
Alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.)
NO SIGN OF HYDRAULIC FAILURE,SOILS DRY. THE PIT WAS DRY WHEN INSPECTED,(AFTER HOURS).THE TOP OF THE PIT IS 28"BELOW
GRADE,THE BOTTOM OF THE PIT IS ELEVEN(I I-)FEET BELOW GRADE. THERE IS A RISER WITH A STEEL COVER,OVER THE PIT.
CESSPOOLS:
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer.
Depth of scum layer.
Dimensions of cesspool
Materials of construction:
Indication of groundwater.
inflow(cesspool must be pumped XofinspecAtion)
Comments:
(note condition of soil,signs of hydr ulic failure,level of ponding,condition of vegetation,etc.)'
PRIVY:
(locate on site plan)
Materials of construction- Dimensions:
Depth of solids:
Comments:
(note condition of soil,signs of hydraulic failure,Zelofncling,condition of vegetation,etc.)
Ole
revised 9/2/98 Page 9 of 11
I�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 WIANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK
Date of Inspection: JULY 26,2000
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into h
l
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l 36 6
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revised 9/2/98 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 22 WIANNO AVE.,OSTERVILLE,MA.
Owner: FLEET BANK
Date of Inspection: RMY 26,2000
NRCS Report name SOIL SURVEY OF BARNSTABLE COUNTY, USDA SOIL CONSERVATION SERVICE. MARCH 1993
Soil Type CdB CARVER COARSE SAND.
Typical depth to groundwaterOVER 6'
USGS Date website visited JUNE 23rd WATER LEVEL BELOW =24.2P
Observation Wells checked BARNSTABLE(A1W)230 OWmax 20.5F,
Groundwater depth:Shallow Moderate Deep
24.21'
SITE EXAM Slope 3- 8%
Surface water NONE
Check Cellar DRY, NO SUMP PUMP
Shallow wells NONE
Estimated Depth to Groundwater 12+ Feet
Please indicate all the methods used to determine High Groundwater Elevation:
❑ Obtained from Design Plans on record
® Observed Site(Abutting property,observation hole,basement sump etc.)
® Determined from local conditions
❑ Checked with local Board of health
❑ Checked FEMA Maps
❑ Checked pumping records
❑ Checked local excavators,installers
® Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
pit a d qA of 11'l`� � 1-33
a�J U.S S, dlcniler Welts Vine t-401.Jt s ihkr - wTef'oou- /9 f kq (AW
33 On k "�ar�1s7 i��' j,�2 2G�j iU S'YS`t� rSh o r �1�1^ e POP e'
revised 9/2/98 Page 11 of 11
1
TOWN OF BARNSTABLE
LOCATIONSEWAGE # �—�1
VILLAGE ASSESSOR'S MAP CzLOT
INSTALLER'S NAME 6z PHONE NO.
SEPTIC TANK CAPACITY 0-b
LEACHING FACILITY:(type _(size)
NO. OF BEDROOMS L��PRIVATE WELL L�CWA�
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
1 50-b c `
-To
9 V-40-C
p�02 U�l�Yl fl�� G�i/i%Ic
TOWN OF BARNSTABLE
LOCATION a�- �IU��,1 p-v-e._ SEWAGE # W7
VILLAGE �jT �p�\��� ASSESSOR°S MAP Sz LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY j 7:�-Ob Q on'. c-�-a-
LEACHING FACILITY:(type) P��,.G �5 - (size)
NO. OF BEDROOMS Q PRIVATE WELL BL WA
1.
BUILDER OR OWNER ��W� d �.tf0
I "
DATE PERMIT ISSUED: -
1
4f DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �'`
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Saaf C) -� aj � o
Ord oh p �`d� QDC
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THE COMMONWEALTH OF MASSACHUSETTS `
BOARD OF HEALTH
.---.....TOv.-- ........OFF.,}� ..............................
Appliratiun for Disposal Works C.unstrurfiun Frrmi#
•Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
.......................... ................ .T.. v�l� �«...--...................__....._..__....
Location-Address ._. or Lot No.
1h?....F_Ajg1= ...••. .......................... e_i!°�!n"::P........................................
OVAS. Address
sr:....._.u�L... o o 5.............. l` Y:- :P'sv"` ....... ...........-•••-
pq Installer Address
4 Type of Building Size Lot............................Sq. feet
a Dwelling'—No. of Bedrooms........
I.......................Expansion Attic ( ) Garbage Grinder ( . )
p, Other—Type of Building . )A.b LY:......_. No. of persons____________________________ Showers ( ) — Cafeteria ( )
Other fixtures ........... -•-•----•----------•-------------• - _
------------------------------------•-------•-•---------•......•---••-•---•----.------
WW Design Flow....:UfC(.ee....?__5............gallons per person per day. Total daily flow........ ..=........................gallons.
WSeptic Tank—Liquid capacity.15 gallons Length...l_ Width._._(,7_._...... Diameter................ Depth.................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area..:..................sq. ft.
Seepage Pit No.__.___ Diameter.....1_k`:....... Depth below inlet.._%........... Total leaching area ft. '
� P� �------------• P g q•
Z Other Distribution box (9V Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....................
t=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -----------......------------------------...............................
....... - ...... ...-
0 Description of Soil............................................................................................................................................................------•-----
x Nature of Repairs or Alterations-Answer when applicable _ f).N
U eP PP �' �' `�Yc�c9�4..... Q`�-
.........rX.T1-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI'11S 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the bo �1-ekea;Ei ]
Signed - -------- 4------------ ---------- ......... ............
D�Ie
Application Approved By..... -_.. .. ..,�
- --••-----------• •- -•----------•---• -- ---•
Application Disapproved for the following reasons________________•_____._....._-_-____•_________._........_........_..............._....__.........__......._--
...................................... ..... ...................................«_.._--------.»._.......__..__..-----.....-__......:__............._.................:......_................«
Date
PermitNo---------- ----••---I_qj.........._....«.__ Issued._.:.-•--•-------•---•-•-••----........... �--.....-
.
Date
-w...�^."Yr..�_�'..�+-+..'-4.�+.�-Jt:^.'.-w,.�,-._,n.'t«.'_...__..v-'-�.'r.._+..x:se�.�--....'r...t-.-�-r.d - M� �� ....�..�.. ._'_-t1^r�..+.w+. -".. .,-- .. ._-o•.r•w."••^�� r.�._r
NO. . / r Fps_ •--�
THE COMMONWEALTH OF MASSACHUSETTS.
BOARD OF HEALTH .
y F
Appliration for Disposal Works onstr rtiuri,q �erutit
'Application is hereby made for a Permit to Construct ( ) or Repair' ( ) ,an Individual Sewage Disposal
System at:
Location-Address or Lot No.
-------=?,,AMv „._...� ..-- .�.... �,1'�ra!?�V�._...- -•-•--•-----------------�W!�t�:�. ....---------........---......._........
.... ....
/� Ownerfl > l Address
.. \n RV j ............... .... Gc (NYv�
Installer Address
Type of Building Size Lot............................Sq. feet
a Dwelling' No. of Bedrooms........
�Q""e:_._...___Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building :_� h�... ........ No. of persons............................ Showers ( ) — Cafeteria ( )
aOther fixtures ...:........... `---....._.....------------................._........-••-••--•.......••--•......
WW Design Flow....e-?sf'.Es 1......
..?.<..............gallons per person per day. Total daily flow........I..�7E........................gallons.
WSeptic Tank—Liquid capacity.i 5 7-gallons Length._M�...... Width..... Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length............. Total leaching area...................sq. ft.
3 Seepage Pit No.......I............. Diameter....t_:n......... Depth below inlet....!:............. Total leaching area-_-akA.....sq. ft.
Z Other Distribution box (S`) Dosing tank ( )
04 Percolation Test Results Performed by••---•••-•••-------••••...........••-•••••...-•---•-----•--•-••--....... Date........................................
Test Pit No. I................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 ---------------------------------------------------------•-•-----....................
.............................................................a...........
0 Description of Soil..............................................•------•-----------........_......----------------------•-------.` f
V .••-••......••---•-•----------•--•-----------•- - ------------------- ----------
. ._.........----
----------------••---•-••--=---------------------•---------------------•---------------------•---•--------------------------------------•---------------------------._..__..:_.._.....-:
U Nature of Repairs or Alterations—Answer when applicable._.' 4J-__._ _ ?_. Y &I........f�,Z.......................
...
r - s ..,.---�z �,. ---------------------•--
.. a-
Agreement':
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
4 the provisions of TITI.sr 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been Issued by the board-of-health.
.. ..
" 41 Signed.. '` - ............. --------
Application
Approved By....... . . .. ... ...•.. _
to
-Application Disapproved for the following reasons:................ ___
.............................•-------. .....�.__.._..------••---------------....._.._..----------.......--------------•--------•----.:_......._......_.....-•---•--•-----•-•-Date...---•---•—
Perr No...... .�. Issued........................
..
-- ................... .........
Date------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................................. ...............................................................
Trrtifutttr of Toutpliana
THIS IS TO CERTIFY, That:the_Individual Sewage Disposal System constructed ( ) or Repaired
r .
b2 - t .aim .: —� c ...............................................................................
y...........................----•s: .. .....------- - -•...... -
Installer '
at t _ •u v}w c� �_U�. ...............4 ................. iti'C u' r Utz y ` ``�)
--- ---
has been installed in accordance with the provisions of TITLE 5 of�jh State Sanitary Code a e ib in the
application for Disposal Works Construction Permit No...3-7...... -�.---.--.. dated__.. ���.. ................ �
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE HAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................y/ r L�= 1............................... Inspector.............v ................................................
_----------------------------------- ---- --------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD' OF HEALTH
No..----•. V1 Fitz....7,�
Disposal Works Toristrurtion f rrutit
.Permission is hereby granted_...---•� De..e... ....._.._... --------
to _._..
Construct ( ) or Repair ( L)an Individual Sewage Disposal.System
at No.......� r f At. r., ti-�-.�.• aCl v- t.2,Vt w V/_ v 1V-- JZ+z t+✓ l� w� . s
----------------- •--.•--- ......_....-•--•----.....--•----•--•-•--••-.-•.••-- -----------------------------•-•--------..............-- .w_..._..........
z Street Q��-J7 s�
_,O�-
as shown on the application for DisposalVl'orks Constructio rmit NSJ._�.._ D'ated..:_,10�_.: ... .. ........
fffJJJ = -----•-- - -----
--
/ Board of Health
DATE..1_.. / -- ------------------ ----
DESIGN CALCULATION BORING REPORT
Ja KING STREET
ATLANTIC TEST BORING CO . INC. BOSTON, MASS. 02122
DF-SI(iN PER STATE ENVIfiONMENTAL CODE TITLE '51
I ) BUILDING AREA 1700 5Q. FT
! 119 i,, J'HINGPON i':;. I'
y1l, N ';.! .) ' ; r
FLOLJ DC1 1GE aUILoING - 75 Gnu/ DAY/ 1000 SQ. FT. = 1700 SCE. Fi To. X ' ACHU. 02189 Date JURY 21 , 19 8? Job No., _� `JILT' P':ASr�CrIUS_':PT : y
75 GAL/ DAY/ IOUO 5Q. FT = 12?. S (a A L/DAY Location of Borings
DESIoN FOR A MINIMUM FLOW OF 10006AL / DAy VU Br.
� �,IN::D
All borings are plotted to a scale of 1"= ft. using BY OPI-111"? as a fixed datum.
2 ) USI- PFRCULAi ION h.ATE OF 2.0 MIN/INGH
No i va :,�'��?I NG 1 (.o.i vanc e('. )
30Et-'TIC, T/\Ni,C SIZE - 150 "/- OF DESIGN FLOW :- IOOO X1.5 = 15-)o GIALL g • r , I, -
0
• ^ ,5. 4) LEAC, NIN(a PIT 51ZE , FkOiM Llt-j\C HI NGI ARI=A Rf= )UIREMF_ NT5 orS ° =broC11
SIDEWAL-L 2. 50 GAL FV ".".ND little occasional
130T TOM - 1 . 00 GAL FTt fine to cr �;ra el
%. little silt
°' 5) 510FWALL. ARFA = TTc! ( DFPTFI) M16) 0. 67) 4. 51 ( !ry) stone
DEEP ri= f.. P,,.. rloN � �OLE AI� EA -, 385- FTZ 5 . 0 ' ;ee dote
u
s✓
BORIN(, AD. I \ 51DC WALL GAIDA( IT ' = 386 L1L x2.50CaAL/F T 2 =90 GAL i. e(11ium
C7
Some silt u m -
� T) SOT rorl AF�I=A A = TTRj =Ti (6)t = 200 FTt _—
y
0 1 compact N
o
�I BOTTOM ARFN CAPACITY = 200FT I00CyAL / 1=T-= 2000IAL .�
CD �� O( ) p IsTOTAL CAPACITY 11h-S COAL L �
PERCOLATIOIV TFc)T - ��\ �� , �/ � _ 1163 1000 C�ALLOnI (dry) in ra Ln
y U5F_ 51Zt A`� DETAILED to U
DEEP 0R�)FIkVATI,)i 1 � � A 6- � 'n
\ DR W'G
" NO 'TAPER ENCOUNDc': �'!.) Q,HOLE BOkINQ N0.2 LEACHING PIT "OF I;X ' O ' (7,N AT :0.05EE DETAIL THi`� � BOTTOf'; ZC.)
N coarse DA N,'. 7/20/87
\
y F_XIST. ----- A ' P.V. 0 (5 =�N/FT) NOT':: From 4 . 5 ' to .0 ' 0�
CESSPOOL o O' Layer of fine to coarse -ravel
EXIST 'A !COVFK li ht
FO. TANK
PROPERTY r _ 4' PV 5 F T
LINE w E L _ _ J I brown 1y
' r) 'x4'
[)IA
UI<�( I..It i ,r p ! W
4'-0" Cr
W�
Wz
' - z OFFICE y�`o°
E ANKLo
L
EL.FIN IST F 1- 10, 0
V
7
EL. BSMT FL 93 4"1 f' -
12.r, 12 Y
6� Z N
No v o
r .
' DRY
�, Z
40`-0 0 oll :JEt Z N
7 i„ 1J/� ! ,: LINE I , brov;n
?PV�OP F. ; ' LINE trace of fine fry
to: cr ;travel
17 ab -
AI .0 0'. 10, r^1 COIN iiurn compact "
A , 31Mrti EL I(�n
to coarse I LW -
light brown
:>N!� zioccasional W
;tone J V
;ome silt • J
SIT E PLAN (dry) _
SCALE I"= 20'
Wow N
Q �
O W C
O " �
0 � m
~ 7
W �.
� C
N �
rV Q s
` l3RI(.K P15F_p TO .SE PT I(, TANK
_ L)
FRAME COVER ( TYNIC AL FOR 2) V
BP0(,K RISEFZ I FINISHED 6,140NDE — F
1 c _ O:,t 0 L FLO:�A PION AT 25 .0' '
FIN1c,NF0 6I1AOF - FRAME� i To MAN�tIOLE !
C'pVF►1 DATE 8-25 -87
I 7/20/87
2_6 , N
- � o ,- .. rl0;!; No SCALE AS NOTED
— - - 4r, INLEI-
n
_ r • h , c o DRAWN GW
- - _-- ----- - I 65 c O m p.. f-c r
a s r� n I�;,;,`,1 N �)t 1 T t_t_ T 1 L . bro'.•'n
little fine to
n o � n coar:3e :;r•a.vnl
2dY q ] itt;lr' i."I t SITE PLAN
o a o co = o ❑ n ( 1 )
In
rr n o 1=1 C-3 = o ❑ n
r . rr�tvf, l & DETAILS
4` 1 ` -'1 IN
r I o n o r❑ i=] ❑ o DA PE: 7/%'O/fi7
cif
4' Orr
111YO iy/\I I'111 ( /V!t1 ' 111'TI(. it,nl,I,n,l � I ! • I,ft OC'r1 1' nf' I �t':I, ' fttr'
II¢ ' ( I:r ► .Ilr I ' 1.1 ACHIN(I PIT 1ANV, II '() I /�nlrlrl/,
1 i 1 - yir ►ty I,-A' I rrN I )Q Hill) 1,1 11 (, TION 1 I to 11 'N( 4) 1( I'
',I II I I r�l mull It
LFACI JINCI HT F )PTAI1 F I-) T1 I A N K PFTA11
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