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HomeMy WebLinkAbout0153 BRIDLE PATH - Health 153 BRIDLE PATH, MARSTONS MILLS A = 125 057 - } SA TOWN OF BARNSTABLE ` LOCATION 1,53 16rill le / a SEWAGE # /VII LAGS �YI/1!S T©nSi+��S ASSESSOR'S MAP & LOT fa,5 a�(9 9 � —9 3 NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 0) (size) /'ap° 9a-001. NO.OF BEDROOMS .3 BUILDER O WNER e� 1k401) PERMTTDATE: 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 C4 Nam i 3g tee, a I vG BOR'I'OL'O'I'TI`CUNSTRUCTION,DNCi, 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 SUS-771-9399 508-428-8926 FAX: .5084.28;9399 rd� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 1 CERTIFICATION efi a Property Address:" Date of Inspection: / y k Inspector's Name: Owner's Name and Address: eat a ,n Z"/na f�D /�►-era .73:8 ` !y'�a� May o 7 oCERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal:systemrat.ttlQs„ ddress,antd�hatthe informs tion1coorted below is true;accurate and complete as of the-time of inspection;, per- formedlbased"on my:training and experience in the proper function and,ni itrtenst�Dfonslte;sewage disposal systems. The System: ``_ `„ " xr ' ✓ Passes CondilionallyPs Wes' rNeeds``FurtMasput' B he'Local'ApravingAuthority. , . ,`;: ` °$Fails' Inspeclor's`Signamre: Date. , `,,The.System'Inspect0shall submit a copy of this inspection report to,tte rriT,10vu, aptithor ty within thin- ty(30)'days of completing this inspection. of thesystcm is a shareglks a t�prr�hasi��lesigailtow,of 10,000 ` gpdor�greateri,the inspector and the system owneushall submit:the;,repo4, 1p:theyappropriate regional,r' office of the Department of Environniental Protection. The original,,shvulq@ be Sept to the system owner zand�oopies,sent to the buyer,if applicable,and;(lie approying euthority,. ttr; ;F,s K�. 'e s K* INSPECTION SUMMARY: a A).SY5 M PASSES: have not found any imforniation:which.indicates that:tUo syslcln yiolalge any of the:failure criteria as def ncd im 310 CMR 15.303. Any failure ca pated are indicated below. - ,:.B),SY�STZM CONDITIONALLY PASSES#,- �- ,� ,� : One ournore system components need to;be replaced or repairs >The;system,upon eomple tionof the replacement or repair,passes inspection, ,,,_ ;n.Jndicate:yes,:nor,or not determined(Y,.N,OR ND).Describe basis.of detertaiMtion in all instances. If "not dete[ttined",explain why not. The septic tank is metal,,cracked,structurally,unsowid,.shows substerttial infilttation'or ,. . exfiitration,or lank failure is imminent. The system w _Wilt,passfitis on if the pApting,sep- ' ' ,-tic tank is�replaced with a confonnin < tic tank as�.a provx, -byr Boar of Health: P g p p �: Sewage backkup or breakout or high static water level obsersedxn,thedistribution bok is due to;broken or obstructed pipes)or due3to a broken,settled por�uiieyen,..-I ribution box.'The system will pass inspection if(with approval off Eoard,of Health): - 1 - e ar F� ,�'` j�l" .:C•' .�i �rcCktLL,�,+��'try�T{d �+'- . � rx,z �t�i-', r�'t''a �..i �s,a d?r`j .. -.; r 'F Alt!", ' o '}3��i yt- +..� }`� �""T's•y bz ip. 6:b;n„+„'7+ i .asxha',' ' 'Sx1ir �x h, h l 2'5rAtt' �x:.;it ix� "1e t r.k•yu ,K t, ;?i+! �Wln.\'> .. l y: W..3' a3 7 Y++ f lzz ' •, VP,'T,d,°, '�,_ 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSFEC7;ION,FORM r PARCA CERTIFICATION (continued) Broken pipe(s)replaced , Obstruction is removed Distribution Box is levelled or'replaced The System required pumping more than four times a year due to btoken or obstructed pipe(s). The'system.will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced " Obstruction is removed . -- C)FURTHER EVALUATION IS REQUIRED BY TIIE BOARD OF HEALTH: - Conditions exist which require further evaluation by The Board of Health ire order lo'detelmine if ttre{system is failing to protect the public health; safety and the environrKlent: `1 '1)'SYS'I'EMWILL PASS UNLESS BOARD OF IIEALTH,DETERMINES THATTHE"'ni,o `SYSTEWII&NOT FUNCTIONING IN A MANNER WHICH WILL PROTECToTHE•ti l PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:, Cesspool or privy is within 50 Feet of a surface water M Cesspool or privy is within 50 Feet of a bordering vegetated wetland-or a,salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD'QF HEALTH. (AND VUB14C WAT*R SUPPL1E IF APPROPRIATE)DETERMINES TIIAT,THE SYSTIiaYI'•LS;FUNCTIO � N- INC,IN WMANNER THAT PROTECT THE PUBLIC lHEALTH-AND SgETY ANID�,TIHE' ENVIRONMENT: ;w. rThe?system has a septic-tank and soi[absorption system and is hvilhi►•i 109IFeefto"a"surface ,_;:, water.supply.or tributary, n �rface water supply. I` 'The system has a septic tank and soil absorption system and 4s QOlh a Zone i ota public } 77water supply well. The system has a septic tank and soil absorption system and is evitltin 50'Fee6f a private water supply well. The stem has a septic tank and soil absorption stem and is leis tltanj r OO Feet but" 0 system P p Y a' ! Feet or more from a private water supply well, unless a well iwaler analysis for coliform bacteria a!asl volatile organic compounds indicates that the weld'is ftee'from}pollution from the facility and the presence of ammonin`nitrogen and niteate•ltht^ogenfls equaiao or on :, 1. than 5 pp:n: .. ,>. 1 t 'j, a i+ia,T n•. D)SYSTEM FAILS: I have determinedahat the system violates one or more of the follo�^ping r�ilure jcrileria as defined . in 310 CMR 15.303. The basis for this determination is identifiedlielow `I'1}e°'Board of Heahh should be contacted to determine what will be necessary to correct the-failure ..o.,,.,., Backup of sewage into facility or system component due to4i overloaded or clogged SAS s or cesspool. Discharge or ponding of efluent to the surface of the'ground ole surface`waters,due�toryan overloaded or clogged SAS or cesspool.Static�liquid-level in the.distribution box above outlet invert dice w an,gk'ierloaded.or clog- • .;... +. r r{ 't �-.- - ., .. .Alt}31. M- ,.] + t'1 t���,, s. gedSAS;or�jcesspool. ^ ` & { ` Liquid depth in cesspool a�le 5.than 6"belo*invert or availWe!volul�e is less than 1/2 ' day flow. Required pumping more than'4 times in the last year dtae'.to clog ed or obstructed pipe(s), Number of times pumped 3 -2- 4- YE � � y,� ,�r:y.;° ;.�;is"`}'��,N+ yw q -��^G4:i`� S•:f:`;4}1 ..._,y.�, . ,f 's §TP ', ,:.;-, ti:, r t ��> j`jJ' .(• , 1 �,a'�'` w;'. +, YW µ ` :pt g ,, �.." �d�:y.i 'i' y.5 §o . .:r �' ' 1' ,��,:;}i r- '' F'.q'��r 'rF �': �'S�`Y' �s �r t .{•�..-. � `5 f e ,.. »y'!:.,s--� ;.�,. �' Y'. ? ' ;r'#d1t',ea - = SUBSURFACE SEWAGE DISPOSAL$.YS'1'EM INSPECTION FORM Ili PART B ., t' , CiIECK LIST-(continued) r k°✓The facility!owner(and occupants, if diE'erent front owner)were provided with:Information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION YORM PART C SYSTEM INFORMATION; : z , FLOW CONDITIONS. RENiDELW : q,ra d Design Flow: 3y� o gallons Number of Bedrooms:� 3 Number of Current�Residmnts: Garbage Grinder: n D Laundry Connected To System: s Seat8081 Use Water°MeterReadings,.if ay.,ailable: Last Date1of 0=pancy: COMMERCIAL/LNDUST IAA• Type_of Establishment s } Des1gnF.Io*4 ttellons/day„,Grease Trap Present: (yes or no sd Industrial Waste Holding Tank.Present: Non=Sanitary Waste:Discharged To The Title V Systeut: Water,Meter.Readings,.If'Available: Last Date of Occupgncy OTHER: Describe) p ,x —r Last Date of,,Occupancy: a� GENERAL INFORMATION) PUMPINGRECORDS and source of information: System Pumped as part of inspection: A10 If ycs,volume pum► ds,� gallons ,,Reason forpwnping: � # ... i .F.+4 %e t -'#� xr:'� '�a `�•;F;A;,�. TIT SYSTEM:.,. N f Septic Tank/Distribution Box/Soil Absorption System Single Cesspool # jOv erflow Cesspool + Priv y , Shared System(If yes,attach previous inspection iecords;if any), Other(explain): ' . ... ^Cs i ` . AEPROXIMATE AGE of all.components,date installed(if known)<and soused ofminibrmations r,Xk .>",,.-.s? se ge odors detected-when arriving at the site: fY .. .... -•� , :�: ft'. , is :qt S° is +h''Y ,. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) I , Any portion of the Soil Absorption System,cesspool or privy4 is bel�w"the ltighsgroundwater elevation. 3 tAny portion o(a cesspool or privy is within 100 Feet of a surface;water supply or tributary to 'r a surface.mater supply. !Any portion of a cesspool or privy is within a Zone I of a public well:=`''` Any portion of a cesspool or privy is within SO,Feet of a private water supply well. Any portion of-a cesspool or privy is less than 100 Feet but greater than SO Feet from a private . water.supply well with no acceptable;rater,quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for colifonn bacteria,volatile organic compoi.nds,;ammonia nitrogen and nitrate nitrogen. x E)1LAItGE SYSTEM FAILS: < , The'following criteria apply to a large system in addition to the criteria above as}y f IT r 7+t Yi. Fi ,• 3 The.design flow:of,a system is 10,000 gpd or greater(Large System)send ihe4system is atsigniflcnt threat to public:hea1t4 and safety,and the environment because one'or•more o the followlag ,; conditions�exlst ; rinking watersupply 11 •iM1�}"s'� a rj �'� s$.��a ��s #alp d Th6s rystgm ithin 400 Feet of a surfaced The system is within 200 Feet of aacrbutary to asurface.drmkmg wates"supply' % , ( . The�system-I locate en sensitive- Protection�Area ` .., d in a nitro la area interim,,, e Y4 3 ;•+ '�s�����i�t"r�� :kfi$�+0.�rF���SrS'� (IWPAj,or'a mapped Zonal of arpublic iy iersuppl}+Weil N K L ,z 04 '}The owner or.operator of;any such system shall bring'tile system and factiit tntbul�om lianoe vlth groundwater lreatment,peogram requirements of 314 CMR 5.00 and 6.OQ 1?le�se eohsult the local regional,office of the Department for further information. , :,a4}�? ; +rwssW,- ., * ykE�.imGyih3a SUBSURFACE SEWAGE.,DISpUSAL SYSTEM INSPECTION FORM PART B CII,ECKLIST 1 i v o• } YYa 11 "' ` Sri$$., ti'y4rr��'+t1b'tyf +92k .� Check if�the.following"have been done: ;_Pumping information was requested of the owner,occupant;and,Uoard of ealth ✓None of the stem components have:been pu.,mped for atleast two weeks#ad.thas sten ° system r �i d tt+ been receiving;normal flow rates during that period. Large;volumes of jar., notbeen introduced into the system recently or as part of this inspection. As-built plans have been obtained and examined. Note if they are not av�ilabie wilt N/A • t/.The facility or dwellingmas inspectodFforssigns:of,sewage back-up.. Y,� F , , t sa r I The system does not receive non-sanity or industrial waste flow. non-sanitary sale,wasj i petted for signs of breakout _ All oomponente,;excluding the Soil Absorption System,7lu±vepbeep loealed on site __The septic tank;manholes were uncovered,opened;and theanterior,of thq septic tapk'waFia- 4 depth fll�tlid, spected for condition of battles or tees, material}of e1onstr�uctioitg�dimensoo deptihof sludge,depth of scum. ' c%The size and locatiotr of the Soil Absorption Systeni on the"site Bias been determined based pri existing information or approximated by non-intrusive methods. -3 j j F ,SUBSURFACE SEWAGE.UISI'USAL SYSTX11a,INSPECTION FORM PART C I s GENERAL INFORMATION (continued) SEPTICTANIKsell ;M elow.. de:+ /8" Material of Construction: ✓conc rete metal FRP Other; Depthb.. . gra., Dimisions: S s'x c, x ,j" Sludge Depth:" 3 Scum Thickness 1rI017 Q Distancefrom top`of sludge to bottom of outlet tee or baffle: Distancg form bottom of scum to botto in of outlet tee or baffle: Comments;.(recommendation foi pumping,.conditiona,,gf inlet and outlet tees os t a[[ 1 p depth of liquid level in relation t9 outlet invert,structural integrity,evidence of,leakage,telc.) n..�� ` x2 GREA3E`TRAP: n'lO. � DepthEelow Grade:- Material of Construction: concrete meta }FttP Other (explai . Dimensions Scum Thickness: _ Distance from top of scum to top of outlet tee or baffle _ Comments:.(recommends_tion for um in condition of,inlet and outlet C )r battles, th of ligtitd -- level inrelation to.outlet invert,structural integrity,evidence#of leakage, lVit P{ {d64P? � iFa .'yt !}.•t°` i!'17!'t . « I! L 4 ,:r t;7fl� uu43.Yy,FS�3Ri ". TIGHT OR HOLDING TANK:_ Depth Below Grade: Material of Construction: concrete meta. F"' 0thor•(explain) Dimensions: Capacity: gallons Design Flow:_ __T gaUons/day " Alarm Level: ' ,f t,Comments:(condition of inlet tee,conditiongUalarm and float switches,e1c,) .DISTRIBUTION BOX: ��Ft Depth of liquid level above outlet invert: jm lhcros .L� Comments:(note if level and distribution is equal,evideWce or solids carryover,evidence of go;in, or out of box,etc.) Pump is in working order: Comments:_(note cofiditioft of pump chamber,'conditioh of pymps'and alp itenances,etc.) trP f t' x2 in« t.�:o,•,� 'Y^`` 'da'9ir %.'.. t�1 Y.`' '+ratt 4.i t-2r em tl,.;dP, �'3.,y. Ett,� <c / }. tNt ' I. jJ pt },. i rdt 7 '- i �. "'��b ttm%' <Y.. ° '., rfre w.,e,} ey +`&k��r^vv"drxx. S rx t € *4 a rr x tlS 4�u x \v.. i':4 � .,mot. :1"t•A# IS!'b , e SUBSURFACE�SEWAGE DISPOSAL,SYSTEM INSPE��T10N FORM PART C SYSTEM INFORMATION (coWi»ued) SOIL,ABSORPTION SYSTEM(SAS): (Locate on site plan;if possible;excavation not required,but may be approximated by non-intrusivek' methods) If not.deternuned to be present, explain: r r�'' rY L�eacWng pits,number: / Leaching chambers, number: "Leaching galleries,number°' :" Leaching trenches,number,length: Leaching fields,number,dimensions: `Overflow cesspool,number: " Comments Inote condition of soil signs of hydraulic failure level of ponding,conditipn,of vegetation, etc.) .c, 1L11�- i-lop 'CESSPOOLS: , Number and configuration: Depth-top of liquid to inlet invert Depth of solids layer. Depth of scum layer. D»aeersiani�of Cesspool '# ` !F ` �1Vlaterials of construction: Indication of groundE,vatpr.:_ Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of poriding,'cond don of vegetation, , t ' r r IVlaterials!ofconstruction: Dimensions: Depth of Solids: _ `(note condition of soil,signs of hydraulic failure, level of po»ding,.wadi'on of vegetation,Cokinents: etc•),• ti0 r -6- I i a.�.8,UB.SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAK'1'C SYSTEM INFORMATION (conlitaucd) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties:to atleast two permanent reFereuccs, laudmarks or bcochonarks. Locate all wells_ _wthin lQO meet. i _ . i . Nawox a _ jq a DEFM TO GROUNDWATER: / Depth to groundwater: Feet Method of Determination or App oximaUon: . t -7- L,,JCATION R7 SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME & ADDRESS t B UILDER OR OWNER DATE PERMIT ISSUED 61 20 DAT E COMPLIANCE ISSUED O ,g 3 rY No........:3.:5........ .r f Fxs.... : . ............ 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH OF............. . .....'.....--------•-•---•---------- Appliration for Dhipaii al Vorkg Towitxnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at �... /8 Locat Address or Lot I _ i �L..r:../rL/./��rr ne ....... ---------- ddress. .!........................... Installer Address U Type of Building Size Lot.._.__..�� ,:..................Sq. feet Dwelling—No. of Bedrooms............. ---- -------------------Expansion Attic ( ) Garbage Grinder N).O Other—T e of Building ............................. No. of persons............................ Showers — Cafeteria Q' Other fixtures .................................:..................................................................................................................... W Design Flow._.....................6.=.5_ .._.._-gallons per person per day. Total daily flow_-r._-� ./-.....................gallons. WSeptic Tank Liquid capacity.� gallons Length................ Width................ Diameter._.............. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...... ............ Diameter-------- -------- Depth belo inlet....:.. Total leaching area....R.U./....sq. ft. Z Other Distribution box ( ) Dosing to ( ) - e —A $' 7f'� ~' Percolation Test Results Performed by---------X_ .. ............... Date.--a-_k-n7�:............ -'.minutes per inch Depth of Test Pit............. p g Test Pit No. 1... ....._.._._ Depth to round water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p+' -- . ---------...•-- Description of Soil '1' � ` ..........-----------�Z- ---------- Qj 1 ... 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 iITT:;,:. p 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. - ignedem-U-4 �- a Date ------ �APPlication Approved By......... Date ' cr• Application Disapproved for the following reasons:---------------------------------------------------------------------------------••--------••-•--•-••----------- ...........................................---•-•----•-----------••------••--•-•-----------------•--•-=•---•----------• --•----•••-•------••-•--. ......-------•-----•••--------•-•••----------- �� Date PermitNo-----------------------------------------------------.... Issued--- ! ........................... Date .f .i No.......... . ..... r FEB.............................. { THE COMMONWEALTH O MASSACHUSETTS A R D ® LT H OF..................... ......i&k............................ ..._...__...----•- y iration for Dippniial Works Tnnitrurtiun anti# Application is hereby made for a Permit to Construct (' ) or Repair ( )" an Individual Sewage, Disposal S stem at . 1 k.-w................................ - 11J?" , ?. Locat A�ddd ess or Lot No. s< d Owner rAd3reSs « . Installer A ress Y �2 4.1) Q `* Type of Building Size LotTT ......Sq. feet aDwelling—No. of Bedrooms..... .......................Expansion Attic ( ) (G)rbage Grinder pl $' Other Type Building ............................ No. of ersons............................ .Showers — Cafeteria Other fixtures ,. ----------------------------- ------------------------------------ --------- 4 Design Flow-_.f______________________!S �j allons per person per day. Total daily flow---_................... ................gallons. 111:4 Septic Tank—Liquid capacity ........gallons Length................ Width..........,...... Diameter ___ -- Depth....._....�. Disposal Trenc)i—N ........... Width___ ______________ Total Length............... ... Total leaching area.......... sq.-ft. 'Seepage Pit No.... �. ..Diameter.._..._.:_.._.. Depth belo inlet._ ___. Total leachin area..................s ft. Other Distribution box ( ) Dosing to !` ) '" —A ��" z° Percolation Test Results/ Performed by......... . .. . - e - _._ Date.... "? .� - -- . ............. ._... >_. Test Pit No. 1................minutes per inch Depth of Test Pit..................... Depth to ground water------------------------ GT, Test Pit No. 2................minutes per inch Depth of Test Pit------.............."Depth to,ground water------------------------ ------- Description of Soil__.._.._' _ _�_ � � ............. V ------------------------•--------------•------.,..-------------- ------------------------------- •-------------------------- ------------------- -•------------- ,... W ----------------------- -------•-••-••• --•---......•--•----- --------------•-- -•--••-----------•..... ------------------------.------.••--• •. --- ---•- UNature of Repairs or Alterations—Answer when applicable---------------------------------------_-------------------- ..: .:__ ..... ------------------------------------------•---=`---•-------••---•--------------------•----........................--•---------------------------------------=---....................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TME 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: Signe ._ U...... ..... ..... - ..................... ------ �3te7►A✓ @ Application Approved B -��� {''t''q'� k Date Application Disapproved for the following reasons:-------•------------------------------------------------------------------------------------------------------- ----------------•------------------------------•--•-----------------------------•---------------------------------------------------------------------------------------------------------------------_--------------------------------••-•----------------------------------------------------------------------------- Date i PermitNo......................................................... Issued.................. ................................... Date THE"COMMONWEALTH OF MASSACHUSETTS BOARD Of2HEALTH OF.............IV..................................................................... Tatifiratr of Toutplittn>rr T�„ $=�1 ER -1 , That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by �Lx --- ---- ...........................•---...-------------- -- ... 7 r d - y� � Inst- le at r`C•- ------ -------------------------------------------- ................................ has been installed in accordance with the provisions of,T 5 f<V�rhe State Sanitary Ode.Vsod-es ed in the 11 application for Disposal.Works Construction Permit No......................................... dated----............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE .SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................................----...-•••••...-•-...... =ns ector....._.._._......... -----------•------------•---------.---••-.---.-----.--- THE COMMONWEALTH OF MASSACHUSETTS, BOARD O HEALTH O F..... 4 - •s.. -�i F No......................... EE . Mops6(4-1rh n� ilan rt`uti# "t Permission 'sereby granted__..: .... y. '' to Con u t or Repair ( ) I al evi Dlsp #'� �. d - �� �y '! at No.•-- . -•---• . . • •• --•-•-••-•---•-.. ...._ �... ._ as shown on the application for Disposal Vhorks" Constructions Permit ". ..... Dated.... ............. Board ot Ha th DATE FORM 1255 -HOBBS & WARREN, INC.. PUBLISHERSyy f' .., No......... d. _.._ FEs.......a ... .. THE COMMONWEALTH OF`-MASSACHUSETTS BOARD OF FJEALTH ..6 �... OF..... dd. 1.�9.."*---------------------------------------- Appliratiun for Biupuual arks Tonutrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ................_._ _ .., .... , � .-•-- ...................-•---• Locat' Address No` or t •�o . ! .3-�. .t .._ !C/. Lam... / T)t --------ss....... ..... ................ Owner dre W ��11'f- D/3 �!..... . .............................................. Installer Address h - UType of BuildingSize Lot..-__(Jt-------`---------_Sq. feet �-, Dwelling 2No. of Bedrooms.....13.......................................Expansion Attic ( ) Garbage Grinder QVI Other—Type of Building ............................. No. of persons............................ Showers ( f) — Cafeteria ( ) P4 Other fixtures W Design Flow............==..................... per person per day. Total daily flow......0_30._........._.:........gallons. WSeptic Tank 4Liquid'capacity/lf�.gallons Length................ Width................ Diameter................ Depth... x Disposal Trench—No..................... Width_..___...._........ Total Length...___..__.___._... Total leaching area................-_._sq. Seepage Pit No..._li__G''�.--•- Diameter------ Depth below inlet C Total leaching area_ d- ..sq. Z Other Distribution box ( ) Dosing to ( ) 4 lf Percolation Test Result Performed by..._.....X t:... �. .............�:_S_..._.. te__�.`'z_.. ..�........__. 04 a Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to and ter. . ................ 1­4 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to gro nd wat .. .................. ............................................................... •--• --•---•------ ... 14 Description of Soil..------••---------------.a---- tE!._.._._ f�`1_..- � `" ...._.... . w T. .l. •P....._.0 i -�IVn--f...... ----------- •---------- ------------------------•--•------••-•-•--------•-••----------------•--•--•---....----•--------•--••-••-•-----------------•-------------------------•. ................................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------•-----•----------------------------•---------------....-------•-•------•----------------------------------...------------------------------------------...----•-------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions Of TITI.L 5 of the State Sanitary I e—The under igned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the b rd of h lth. igne ._ �_. ... ------- ............. Date Application Approved By........ r- ............ .:_a .�_. Date Application Disapproved for the following reasons:-------•-•-----•----•----------- ------•----------•---••••---•-------•-•-----------•---•-•--•......•-•---•---- .......................................•--------------------•--------------•--•--•------•--------••-----•---•-------------•-------•-...-------•----.................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH OF............ . . .... .......................................................... Tnrtifirate of Tompliunrr THIS CE TIFY, hat the0Individual Sewage Disposal System constructedA___or Repaired ( ) by-- - ----- 1 -------------------- staller at- ._.a- _ ... :. has been installed in accordance with the provisions of T of The State Sanitary Code as described in the application for Disposal Works Construction Permit N ��'_..._ .-1.............. dated - ........... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE.................................. .............----............................ Inspector....................................................... .............. .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7� v .......... .. - ................®F........... _ N ........................`� .... FEE..!2-T�.... �i��d1' � bar n��rl�r�i�lt rrll�t� Permission, iss reby granted.-- . •-•-- -- --..; -- -------• .................... to Constru (V or Re it n vi Sev,.a ispo System at No.---- . . --••--2- ---•- Street as shown on the application for Disposal Works Construction PerLM* o..._ ed..:._/ ..._........ .....-•(:�--- -- - -lr� •-------------•---....__... DATE................................................................................ a Board of Health // FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS THE COMMONWEALf7H'OF"MASSACHUSETTS BOARD OF H ALTH ........ ........OF....6a4ft7a. � Appliration for Bigpnlial Workii Tomitxnrtiun Vamit f: Application is hereby made for a Permit to_Construct j ) or Repair ( ) an Individual Sewage'Disposal System at .__ .. !_. __..... �A!K .. 0.. ...*. ` ............... .............. Locat Address r t No. OwnerLaze ........ _......... � r 0--��ass.....•.--• i Installer Address 2® j `-- _Sq. feet � Type of,Bu>ldin� +;t Size Lot____ __ ______ ________ '� Y w� Expansion Attic Garbage Grinder Dwelling—No. of Bedrooms ---------•-•••--•••-•---•--•------ P ( )" g ) Other—type T e of Building Gi YP g --•----...-•--------....... No. of persons............................ Showers Cafeteria ( ) < Other es -----------------------••------•-••••-•••-•••••---••---•---•---•---------•-•--------------------• ••-•••-------•---••-•--••••_•---- W Design Flow__. -. ........................gallons per person per day. Total daily flow............................................_______________________gallons. WSeptic Tank Liquid capacitN a'Q_gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No........:.:..:.._.= Width_ Total Length.......... _._.. Total leaching area....................sq. ft. �' -- Seepage Pit No.__t>r '_...__:_ Diameter____.Sr--•______ Depth belo T inle otal leaching area_.?..47.1..sq. ft. .._. Z Other Distribution box ( ) Dosing t ( ) g {� Percolation Test Resul Performed by-.-.-•- 1�._. ?: ____________�3_t._J-c______ Date__".4r ' _��_4!"'"±_...... 14 Test Pit No. 1----_•-._:_-----minutes per inch Depth of Test Pit____________________ Depth to ground water........................ Test'Pit No. 2................minutes per inch Depthof Test Pit..................._ Depth to ground water........................ ._....•--•--------------••-• - '-• -----................................................................ z, G W O Description of Soil Q_ 3............... - ` wcc 1"a ----------------- ------------------------------ ------------------------------------------------------------------------------------=----------------------------------------------------------------- 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 TITTIE 5 of the State Sanitary C —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued by th oar• f health. Sign _ Date Application Approved By...... t-- --•-- ...-•-- = �„► i n" " Date Application Disapproved for the,G f allowing,reasons---------=....................... -------------•----------- =- •• •••-•---• ........................•-•------------•---•----••------••-•----------•----•-------•-......... Date Permit No .... Issued -Date THE COMMONWEALTH OF MASSACHUSETTS {J i F BOARD OF EALTH - . . k OF Trdifirate of Tompf ai u'a THI C TIFY .h hat`th$Individual Sewage Disposal System constructed ' or Repaired ( ) .. tit nstaller at.._...s_. _. .._ __.....__ .._... d •, - `- .....--••--•---------------------------------- has been installed in accordance with the provisions of r ` of The State Sanitary Code as described in the P e-� Y application for-Disposal Works Construction Permit'1 �'____ �_�_______________ datedt__--�/R �r THE"ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector...............................................::...................................... THE COMMONWEALTH OF MASSACHUSETTS ya••. BQ �RD OF HEALT ` `!................�F ...........; ..`....,1 FE s oni#rn lion amit Permission ereby granted ............................................ -•---------------._..__. ........ ________ to Constr t ) or R aiL a di v . 1 Sew Dlsp System ,. at 'No• .Z .. treet • as hyo6vn on the applicat4on for Disposal �lTorks Construction Pe it NO.. ated_lyJ,.'_ ,, ' ...... r �'C'• 4'Board'�ot'z a ; DATE---- --- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS V` t � &0 �3 oX. C o.vrFr',S Ale 4 20, /vo 1 ' TE57T NoLE T- SL 1 Z-3/9C/< :<_,i Ui E%'?EAj �- ��./ S i L %`.i !_-(? f---,> /�L.�,l� ;`.� ,!i ✓ DO L N f J� �i IC4L= F� 'G..�s�.% Y.?^ •. !- r J if 1 T n T � r� -T J• !/' OX >i N? !!v 1r —Y � , 12 %-OOT h:f) S/ .57 Li -- /._./IL.� /t/ ,n! .cam y/�► "}jyt , SOU , r i l ,tii��T .!�� %� ,`-)'T �_ I i/1, r c,2� :';l,' ✓E�T ^ _ t- /-7,2 _�-, � -� ��- ' !•'V ,14- -041 PLtA9 AJ PLO7 %` �17�7. �U / j / NAL. \cr /`'z Fyn/ 3-1 ?;2 Qe ®rye o(::Aj _ ._ .. 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O /� ' G�3.4�i✓-s Ti9 SL E o cy _ � RONALD v >:3 T 08, /l`'7.6 o ARTHUR 2 7 f i O Gv/�/ " GIFFORD n r f tir- No.603 L F�Al o. b '` 7 H E '�F60STER�� U /V T.`` E'E;G i' h-r."e O Z7 E c D's TAR Co , C,o ciR T /"�L�/�/ 38 32.5'B COn� .�c�/�� y ,D,E s/G/�✓,E'RS, iNc, / O,AJ /`/,D t 1-/ a r T 7-0 �-� < +.I j J . `, /Q + .�ti F 1 `-4 1`�-�b..t-� 1..I/,GEO f:U Low .z. T AL AMA Cn i � '_7 1Y•4T�f� /-�Yl���.gn/T ELEr/ _ 9583 .LOAM Sv,�sOiL 7s� Uis�; P,2ao 43ox• /oo�; CogRsE /ooa�r. N EXjP004151 SAn/p Go7 27 , BGOc�. Z� GRr9 VE,L So't Q� Z�X8 wo {Ti.9TE�? NcoU�tl7Fo 7.. .E 5 7T 3 t p_ 93 A J' U �'.. 1 6 - 9Z• kllX, :J T E R ul4- U1 /1r 6E7 ticK 0u% eEi� A.11T 7— .3ca' _ -' < i _ ;r�� J G'- �✓ �)C:i L;_ `�v `� 7 i'� v:A yI.t_ C:r n: i�, 1r- c > �. T 9 I 7 /)A2L 70J--11',1 OF Z 09RNs'7,Aq, 44- f--/f: -) I- t-1 A? T /n sc < '�' -7'v i ' WITHIN I OF F/,V1,5 E'L) �/eyDc= - ` M/N/MU 61 1 <- T ID/ST ox•U -� ---.-._ . L✓ L I N E /`?/A/. 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