HomeMy WebLinkAbout0024 CARDINAL LANE - Health 24 Cardinal Lane, Marstons Mills
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LO CAT SON / SEWAGE PERMIT NO.
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IN.STA LL7EVS NAME & ADDRESS
B U I'l D E R OR OW-NI
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED �t-=-tc --�'s 7�
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APR-01-99 THU 04:32 PM DONALD HENDERSON ATTY FAX NO, 508 775 1952 P. 02
. LOT 64
LOT 32
rs
LOT 3
�56�0 SHED L
LOT 66 LOT 65
PopcH 30:
�- _-__ �; -
LOT 67
2A 00 � t
REJ. ZO1VZ i'. This MORTGAGE IVSP�CTIO� PtBn ;s For F
Sank Use 17niv FLOOD ZONE. •,C
-IQ �yR� �:� i11�,L� _ REGISTRY OF�IivER: C'42OILE,Y _✓ :� v ERG
DEED REF: _ ����.49�---, � � L �..����_ ��•_
DATE: e� -BUYER 1 _! �f?f_',401aL7L�C �'.YEfI.� -- - -
,� �� --- -- T FLAN FREF: ?B- iQ _ SCALE:1 30 �FT.
I HEREBY CZiT' 'Y TO B.3v -(LN1 .iZ9F �: -~ -�T� ���� _- YANKEIJ SURVEY
_dc_fT_S SCiC.�3�J?S_.4jVD/O.a_AS_S_!G_2VS TFAT THE BUILDING tx of a•4
SHOWN' ON T; IS PL�.N IS LOCATEI? Ov THE GROUND AS sy COV ULT_`-,'vTS
SI- OMN AND TEAT ITS POSITION DOES _ CONFORM( � ��`�� °�
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TO THE ZONING LAW SET9aCK REQUIREMENTS OF THE 2 — 408 (SUITE 1)
2 l�AE.4I7H�1N
TOWN OF E,49'V�Z.3,_I�---------W_�,ANt} THAT No. szt1S8 � INDUSTRY ROAD
IT DOE5,sv0 LIE WITHIN THE SPECIAL FLOOD HAZARD
4 MARSTONS MILLS. MA. 0264,8
AREA AS SHOSN Ov THE H. U,D. MAP D T1=D��02 sr,�fJIST�A��v¢4 TEL 428-0055
Cam*- i*v—Panel 4 250001 0015 C °'y.11AK4 ' FAX 420-5555
�:� 4 bl• „�•�, --,__�� T1I9 PLAx NOT .HADE FRO&{ TRUMENT
—
• � a S4RVZY. NOT TO 8%� L'S':D FOP. FENCES, ETC. 169�26 �fS
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK
Address of property �241 Card ► k,C, I L, . M cars -/v s M l l s
owner's name
Date of Inspection C ar° 'j o t- CA CA�j
'1` ,2 e /9 5 PART A
CHECKLIST
Check if the following have been done:
V/ Pumping information was requested of the owner, occupant, and 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.
V/ The facility or dwelling was inspected for signs of sewage back-up.
VThe site was inspected for signs of breakout.
All system components, excluding the SAS,, , have been located on the
site.
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 SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
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SUBSURFACE SEWAGE DISPOSAL SYSTEM 'INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
If residential
3 number of bedrooms
O number of current residents
Nu garbage grinder, yes or no
DES laundry connected to system, yes or no
Flo seasonal use, yes or no
If nonresidential, calculated flow:
Water meter readings, if available: 9y - 25/ 00 U
e6 . 015 Last date of occupancy
GENERAL INFORMATION
Pumping records and source of information:
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a u i .a a. c a ors
�r ems.�' nn G✓t � �cx v�'f"
NO System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
Type of system
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection
records, if any)
Other (explain)
Approximate age of all components. Date installed, if known. Source of
informal: � � S�s 7 �. .� I 11 I
YI � T 43 c� c c� G _
�d Sewage odors detected when arriving at the site, yes or no
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9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
f SYSTEM INFORMATION continued
SEPTIC TANK:
(locate on site plan)
depth below grade:
1 �
material of construction: concrete metal FRP other(explain)
dimensions: 5 /Do 6 90, 1
sludge depth
4 " distance from top of sludge to bottom of outlet tee or baffle
NoN E scum thickness
6*" distance from top of scum to top of outlet tee or baffle
/ ,6 " distance from bottom of scum to bottom of outlet tee or baffle
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, recommendations for repairs, etc. )
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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, recommendation for repairs, etc. )
Tz),J 0, d Alo -s !i a, s
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PUMP CHAMBER: �I
(locate on site plan)
pumps in working order, yes or no
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs,etc. )
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1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) :��
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods)
If not determined to be present, explain:
leaching pits and number 11 H c �� ��4C'
leaching chambers and number
leaching galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool, number
Comments:
(note condition of soil , signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
o a A rovK dra� I
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 as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
PRIVY: lA/%
(locate on site plan)
materials of construction
dimensions
depth of solids
Comments: i
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
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11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE L:SPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100 '
53' ss
DEPTH TO GROUNDWATER
S« hzlc�w depth to groundwater
method of determination or approximation:
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined" , explain why not)
N Backup of sewage into facility?
N Discharge or ponding of effluent to the surface of the ground or
surface waters?
N Static liquid level in the distribution box above outlet invert?
ff 9 Liquid depth in cesspool <6" below invert or available volume< 1/2 da
flow?
Required pumping 4 times or more in the last year?
number of times pumped
N Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent?
Is any portion of the SAS, cesspool or privy:
below the high groundwater elevation?
within 50 feet of a surface water?
Nwithin 100 feet of a surface water supply or tributary to a surface
water supply?
/ Y within a Zone I of a public well?
within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the SAS) ?
within 50 feet of a private water supply well?
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 analy(
. for coliform bacteria, volatile organic compounds, ammonia nitrogen'
and nitrate nitrogen.
13
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
Name of Inspector rp W : UvL► S _
p � e' I i cn c r., s �/J �
Company Name �� (� � �C/
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Company Address /
SOS
Certification Statement
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true, accurate and
complete as of the time of inspection. The inspection was performed and
any recommendations regarding upgrade, maintenance and repair are
consistent with my training and experience in the proper function and
manitenance of on-site sewage disposal systems.
Che k one:
I have not four_d any information which indicates that the system fails
to adequately protect public health or the environment as defined in
310 CMR 15. 303 . Any failure criteria not evaluated are as stated in
the FAILURE CRITERIA section of this form.
I have determined that the system fails to protect public health and
the environment as defined in 310 CMR 15. 303 . The basis for this
determination is provided in the' FAILURE CRITERIA section of this
form.
Inspector' s Signat
S
Date
Original to system owner
Copies to:
Buyer (if applicable)
Approving authority
3
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No..............°�.. ..,
THE COMMONWEALT \MASSACHUSETTS
Ljj (D�s BOARD OF' `l�iEA.LTH
.. ?.a. .....................OF....4Fa
ApplirFation for Bispoii ai Works Tow3trns#ion Vamit
Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
Sys �a��! ................................................ /c3 4_ ...... fvi� T'm _1..:.. 5 ....
/ Lo ion-Address
C/ 5 r 1014 mac . . ......................c �(� E `� v✓mot N ..._....
..................•-.._.... -- ... .._......
Owner _ Ad r ss
.. ............
...........................
...................•-----.
. Installer Address .�
UType of Building Size Lot_ ____ ____._Sq. feet
Dwelling—No. of Bedrooms ----.A-�............•--------•-••...Expansion Attic Garbage Grinder
Other—Type of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures ...................................
W Design Flow.....A�s. .......................gallons per person per day. Total daily flow.........._... �1.__.._..____.________..gallons.
WSeptic Tank—Liquid capacity/iMP..gallons Length--_.. Width...6..._..... Diameter---------------- Depth_..-.........
x Disposal Trench—No..................... Width....................... Total Length........;.............. Total leaching area....................sq. ft.
Seepage Pit No._Y................ Diameter----e�.......... Depth below inlet.._. ..._.._..... Total leaching area.�Q.�_....sq. ft.
Z Other Distribution box (®) Dosing tank) _
eve /1
W Percolation Test Results performed by.__._..%' r_.s� _ .____ .............. Date.._..__. .______1-
a Test Pit No. 1....�.......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........................
•---•---•----------------------------------------------••-------------•.._..........-•---••......---.........................................................
O Description of Soil............... .______._
x ..........................................
. -------•----•••--...:•---•------•-•••---•-------- ---------•-•••-
----------
U ----------------
•---------------------------------------------
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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 TITLij 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issuedSoard of health.
Signe . ..-• ------ -•----- - -----•-.
............•-------------- J
Date
Application Approved BY ........� - -7�-
Date
Application Disapproved for the following reasons:................................................................................................................
.....................................................----------••--------...-•--•---------------•-------•------------------•-------•-•••---•-----•-•-•--•--•-------•--•-•---•--------•-•••-------------
Permit No.......................................................... Issued------. ...... :.. -ate......
Date
lee 1W%Ilk
.................... Fizz..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEP)LTH
-- ---------....................OF_4�.............................................................................
Appliration for 11W#osa1 Works Tonotruition thrmit
"Application is herebyma& for a Permit to Construct or Repair an Individual Sewage Disposal
Systm at
7.2 e I VS
1/...........................................
/a— .... /0 ...........
jc dres;,
or Lot No. , $_j ),, N
................ ................................. ........................ ..........I..........................................
Owner Add
A.-A............................................................ ........... ...Ga ........ ................................
Installer ress
A dress
Type of Build J* — .701 04,
Building Size Lot..............1�---I------Sq. fee
Dwelling—No. of Bedrooms___..._.13............................Expansion Attic/% Garbage Grinder
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
PL4Other. fix_Wres .....................................................................................................
tl�SV4�--------7- gallons per personper ;ay. Total daily flow...........V _1io----
Design Flow...-. ns
P4 Septic Tank—Liquid capacitV �::gallons Length . C... Width--Ak.......... Diameter________-____- Depth....4.........
Disposal Trench—No...................o. Width-7V-------------., Total Length... ....... Total leaching area..__ ..............sq. f t.
Seepage Pit Nol................ Diamel De t1i below inlet. Total leaching area_.... .....sq. ft.
Z Other Distribution box Dosing t, k,
Percolation Test Result Performed by........------- -- ------ .....A .............. Date----_._- -----------
Test Pit No. 1...0(...._._minutes per inch Depth of Test Pit..................... Depth to ground water.......................
44 Test Pit No. 2................minutes per inch Depth of Test Pit............_....... Depth to ground water....................
.............................................................................................................................................................
0 Description of Soil.............. P............... .................................................................................
-------------------------------------------------------- ............. ..................................................................................................
-------------------------------------------------------------------I.....................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned.agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b en issued board of health.
Sign
..fix----------------------------.. . .............................
Date
...... ............. 7,7
Application Approved By. ................ ...................................................... ...Da.t-e..............
01
Application Disapproved for t� ollowing reasons:...............................................................................................................
.......................................................................................................................................................................................................
Pate
PermitNo........................................................ Issued------ .................
Date
THiic
' ro OMMONWEALTH OF MASSACHUSETTS
T
BOARDOF HEALTH
....... ...............OF............... ......**...................................Tatifiratr of Tompliaurr
rutted
R That th Ind co ted Individual Sewage Dispe ystem 5p, Repaired
b3f*-** 9 .................... ........
-11 .. -----------------------
. ....... ...... ................. ............ ..................
--------------------------------------- ----------*------I
has been installed in accordance with the provisions of -�he State'Sanitarykode as described in the
application for Disposal Works Construction.Permit No......................................... dated_--...__-_._________-:._.._._....___........_...
THE. ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM MILL F"CUQN SATISFACTORY. T
'OP61!a
DATE.............................. S.........7d2 •............................. •Inspector..................................................................................
..THE COMMONWEALTH OF MASSACHUSETTS
4 BOAR ��F ALTH
rr ....................................0 F....................................................................................
................ FEE........................
Ain 7it
DisposalAhr trlu n rrr
Permission �eby gravted....F------------4 ---------- .......... ............................................
to ConstXy Reptrd ewage
0��Io�l sw V . 4 1 - /w 7[-,@
atNo.. ...................................... ....................................Street
--- ----------- .............
Disposal Works Construction Permit
as shown on the application for V OaFA*.".
.___!. ........................ ............................................................................
Board of Health
DATE.......... r.............................................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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3.Z . /3 /03. .27 ' PLAN LAN® �
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O.sE/pN �lP� E N
i g AUK eOMERY s TRENTON ST.
! t" Of '�'�,�, 1 3' H OF A14 : VANNIS. LASS. 02691
/� / / C'y �•� S'r lkPE A A Q LAND S�,MMYOR
3 S/7 o ic9 77 �+r7 ct 77 i It�F t�tire1 i 0�3 �y�
.�'. '. J. 00AC .284 �� /. COMERY o CONE FRANKul
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