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HomeMy WebLinkAbout0028 CRANBERRY RIDGE ROAD - Health 28 Cranberry Ridge Road, Marstons Mills A= 030 060 .I i II _I r V CERTIFIED SEPTIC SYSTEM REPORT LOCATION 28 CRANBERRY RIDGE RD . MARSTONS MILLS, MA 02648 MAP 030 PARCEL 060 PREPARED FOR SELLER MR. & MRS . ROBERT K. LINDSEY 28 CRANBERRY RIDGE RD . MARSTONS MILLS, MA 02648 BUYER MR. & MRS. MICHAEL KELLER 46 RHINE RD . YARMOUTHPORT, MA 02675 PREPARED BY HILLIARD HILLER P :O . BOX 250 CENTERVILLE, MA 02632 508-778-1472 . i a Commonwealth of Massachusetts Executive Office of Environmental Affairs NODepartment of , .Environmental Protection VAIliam F.Weld Gor.mor Trudy Coxe 8.er.tuy,EOEA David B.Struha commbsioner SUBSURFACE SEWAGE_ DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION R0' Address of Owner: Property Address: Date of Inspection: (If different) Name of Inspector: Company Name, Address and Telephone Number: /Op A:;oX Lx�sfl!//GG� 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 _ Needs Further-Evaluation_By the Local Approving Authority Fails 2"&, a 2o�0,,12 Date: Inspector's Signature: The:System Inspector shall submit a:copy of this inspection reportt to the Approving Authority within thirty (30) days of completing this inspection.:If the system is.a.shared.system or has a.design flow:of 10,000 gpd_or greater, the.inspector and the:system owner shall.submit the:reportto-the appropriate regional office of the-Department of'Environmental Protection.. he.-s�system-owner-ano.copies-senrto the.buyer,,if applicable and the approving.authorit�.. The orig inal should.be sent-tot INSPECTION-SUMMARY:: Chec /I�B',C,,or D: A) SYSTEM,PASSESc !/I have-not found:any information which indicatesth at-the:system violates.any of the failure.criteria as defined in 310 CMR'1-5.303.. Any failure:criteria.not evaluated:are;indicated:below: B), SYSTEM CONDITIONALLY PASSES:: One.or more:system components.need io be:replaced.or repaired. The system,upon completion of the replacement or repair, passes.,inspection... Indicate yes,:no;ornot determined (Y;:N; or ND):. Oesuibe:basis:of'determinatiom in all instances:. W'notdetecmined'; explain"why nod The septic tank,is,metal;,cracked;;structurally unsound, shows:substantial infiltration-or exfiltration;.or. s tank.failure-i k imminent: The:system will pass inspection if'the existing septictank is replaced.with a conforming:septic tank.as gN approved'by the.,Board.`of`Health:. k M- }y lzeviaed_elI5y95.1 S One.Wlnter.Streetc a Boston,Marmchuaeft02108 r FAX(617)SS8.1049` a Talep"ns(8/7)"292-6300 pnMed an Recycled•T. I� + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: o?,�' oq /(�,O. ,er�y,�SJo,ccs .rr/G1�s Owner: ,',//i<j �QbB�2T k L��OS/'y Date of Inspection: _711hG B]SYSTEM CONDITIONALLY PASSES(continued) _ 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 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 THAT THE SYSTEM 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 a surface water. _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE-BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER.THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply of itibuiary to a surface water supply. _ The s\-stem has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.- _ The system has a septic tank and soil absorption system and 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 D] SYSTEM FAILS: I have determined that the system violates one.or more of the following failure criteria as defined 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: Backup of sewage into facility or system component due to an overloaded or dogged SAS or Cesspool. Discharge or ponding of effluent:to thea surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: chi 6 G.2�a/��i71 y /Q/rjGi� iPD, h51�.� �/G LJ Owner: Date of Inspection: 3 /A D] SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or dogged 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. 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 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. 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: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 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: 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 (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment.program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. 3. (revised.6/I5/9S) `t. I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 9 Owner: /yi/,y Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. --Fone of the system components have been pumped for at least two weeks and,the system has been receiving normal flow rates Burin of water have not been introduced into the system recently or a5 part of this inspection. � g that period. Large volumes i/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. i/The system does not receive non-sanitary or industrial waste flow 1/The site was inspected for signs of breakout. t/All system components, excluding the Soil Absorption System, have been located on the site. 1,:-Ihe 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 or approximated by non-intrusive methods. _,—he facility o.�ncr (and occupants, if diue-ent 4orn owner) wer.e provided with information on the proper maintenance of Sub- Surface Disposal System. 4' (revised`.8115/957. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: d,? Owner: /h/,* L/,C/05Z7' Date of Inspection: -3-//9G / FLOW CONDITIONS RESIDENTIAL: Design flow: gallons Number of bedrooms: 4/ Number of current residents:.3 Garbage grinder(yes or no):_Ala Laundry connected to system (yes or no): 1015 Seasonal use (yes or no):_&2 Water meter readings, if available: !cJZ LL Last date of occupancy:-2Z"44rL% COMMERCIAUINDUSTRIAL•. Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_. Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy:: GENERAL INFORMATION PUMPING RECORDS'and source of informations ivo R�co/lo /ILT (DPw s><A� System pumped as part of inspection: (yes or no)_A/,:2 If yes,volume pumped Qallons Reason for pumping: TYPE OF SYSTEM.. Septic tank/distribution box/soi 1,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) and source:of information: "o?z pwe 1�D,r/E y/�2Ar Sewage,odors detected when arriving at the,site:(yes:or no)�✓� (revised.8/15/95)" S { SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'C SYSTEM INFORMATION (continued) Property Address: Owner: 1"�/7 iQUL �T /T G1,v�25 Y Date of Inspection: SEPTIC TANK:JL,-" (locate on site plan) Depth below grade:, Material of construction: t-concrete _metal _FRP—other(explain) Dimensions: S'/o" X AL I" V1 Sludge depth: /C3 Distance from top of sludge to bottom of outlet tee or baffler 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:—1L , 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.) ,VO d/G,r/ ale G,PAf flG , T//S T.ie� /fi9.� ,W,A/ &olz� / ol'` �!/o /T Fle4r Ll1c�G TAtZ TT% 4,,e-f /.V Ti/,E ,eo1Taat b T' 'e isa?!IS fAv� FAAL 7" 7'A.r//' AC .dv4ze-, GREASE TRAP:_ (locate on site plan) Depth below-grade: Material of:construction: _concrete: metal _FRP` other(explain) Dimensions: Scum.thickness. Distance from top of'scum to top of outlet tee or baffle: Distance from bottom nt Yum t^bonom or outtettee or oatfte 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.)' (revised 8/15/95) z, 6. �F -SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 99 Owner: Date of Inspection: 311i ly` Y TIGHT OR HOLDING TANK:_ , (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP—other(explain) Dimensions: Capacity: Gallons Design flow: Gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:—O- Comments: (note if level and&stributicn i; cq:c!, cadence':of solids carryover, evidence-of leakage into or out of box, etcJ :!{�O 10/BLS LOO/',EZ;) e-,,5;WQ f/oG0-'VM0W 7'112/7iz' 4i�/I� soGi.Os G.�1Ti.r� /.U�o PUMP CHAMBER:_ (locate on site plan) - Pumps.in working order•.(yes or no) Comments:. (note condition of pump chamber, condition of pumps and appurtenances, etc.) !revised-`6/15/951 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /Q 106-4 AD Owner: A-i1,y A- LC,ri05.2Y Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):v (locate.on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: c leaching chambers, number:_ leaching galleries, 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,etc.) ,Uo /o i F�:6 � Y /9x5- ,v 2,o >T Tr> 72tZ T�vo ,XZG RL S %if /fr eWI-WI , lif TftA y F/1'/[ TEE' O.�/Git/�9G P/T� Gv/GG 6A—T Ttt� FGov' F/lo�, Tfte ud'' 60,�; 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) li failure level of ponding, condition of vegetation, etc.) Comments: (note condition of soil, signs of hydraulic Po 8 PRIVY: (locate:on site plan) Materials,of'construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 8 (revised.B/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: .7 S G.OffvGLllQ Y 19/4t;-X RD lyi�25?�,vs ,/�GS Owner: 1,-71 Date of Inspection: 311/y- SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' s � I U� A -,6 =6s' I. I t. DEPTH TO GROUNDWATER" Depth to groundwater: 3/3 feet, method of determination°or approximation: 13Aed. 5rzfiee z es/5 Aj //�j %�f� �!/1r.0 Uii9� 7'�3L.� ,%yr/i�•�� .f7i?Ar.�//.riG 4fyr��iS Tiy� l�P� .�� T i 611-1 G.- r O l�vE f1 E °/S ;S,dc.",;�5r3 0 is Y,71 313 (revised 8/15195) 9` TOWN OF BARNSTABLE II�S •k' CAi'ION SEWAGE # 9 —/If9 V LLAGE yV1 . /VI /Ul4S ASSESSOR'S MAP & LOT d670 — OG 0 INSTALLER'S NAME & PHONE NO. ;2d/tT_d.U-7 Cto,4S--- V,2r_ppL g SEPTIC TANK CAPACITY loon LEACHING FACILITY:(type)/ /,y �,�.�-�✓C� (size) NO. OF BEDROOMS PRIVATE WELL PUBLI BUILDER O OW � Gt JCS DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes R0q, . .� 3s b3 c� (� Vq V ' r r i . TOWN OF BARNSTABLE UkATION 2 S e—AlUld"WY #"iZ,0,w Z /2 SEWAGE IALLAGE NAZ-?5;22� 4144J ASSESSOR'S MAP &LOT 4,%0 o60 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I � LEACHING FACILITY: (type)��' /NFIGT.�fIS s (size) NO.OF BEDROOMS V OR OWNER PERMIT DATE: 7//3�.5; COMPLIANCE DATE:9 2 ZAC Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 lea hi n faci ' ) Feet Furnished by ,1� / %� - l'/ � �Ro�► To Bois 0 6 i © 76 16 ay' 741 7P No----7"5-----Id? Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Mi ntittl Works Tomitrurtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair (b- an Individual Sewage Disposal System at: ............ •-•----•---- anon 1 W�eJ IS 1Z �1�/ CtT1 Owner 7( Address .....__.' • t �........ Installer Address go UType of Building ,,/ Size Lot............................Sq. feet Dwelling— No. of Bedrooms_________________!- -----------------.-----Expansion Attic ( ) Garbage Grinder ( ) `44 4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures -------------------------------- • . .. . w Design Flow................ 71—-------------gallons per person per day. Total daily flow..............V..(10.................gallons. 04 W Septic Tank—Liquid capacity/09..O---gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. --------/..___._. Width..... Total Length. Total leaching area....................sq. ft. Seepage Pit No--------_-_-------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 444 Test Pit No.-2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •-•--••••••.................••-•-•••----••-•-------•------•••-••-•-------•----------•••-•-•---------......................................................... ODescription of Soil........................................................................................................................................................................ x U w Nature of Repairs or Alterations—Answer when applicable.-._-. �...._._.lQ...___.// �-�i_ ...................................... LU U P i ... .. �-- ..--- --J%b.•o: ------..-�l�V•..---•---...7.V_........ 13' ..... ......'' aL Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een ' sued by e rd of health. Signed ................ .................... ....... ....... .........................r,_,,------ ----------------- .... Dare C Application Approved By ........ ----- v` _..� --`-t�-- e Application Disapproved for the following reasons: .... .... ......__....-----------------------------------------------------------------------------......- --- ........ ........................... ... .......................... .......................... . ............................................................ .......................... Permit No. -------- ------ 9 ......... - Issued . - - D--- -- - e.... I ace 03o F ©60 r Fps.............. ... THE COMMONWEALTH OF-MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApVftration for Bi-nVosttl Wor1w Tontitrnrtion Prrmit Application is hereby;made for a Permit to`Corist:uct ( ) or Repair ('� an Individual Sewage Disposal System at: y ..�'E Gr ►.�G �JZ2�9 ...................•---.......-----------------------------.��................------. -•---•----- 'l --------------------------•--------------------- L ation- •."duress or Lot No. lC� Z> X r C: <_ /�� /_,y - --------------------------••--.....-•------•--•--•--------•-•-•----............_. Owner Address W s Z ---- -- ��� -ff3 ,�---= =............. s:. Installer Address UType of Building / Size Lot............................Sq. feet .. Dwelling— No. of Bedrooms................:1 ......_..-------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -------------------------_- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- w Design Flow................. %`...............gallons per person per day. Total daily flow..............V .................gallons. W Septic Tank—Liquid capacityZVW----Lallons Length-----------..... Width---------------- Diameter................ Depth--------.----_ x Disposal Trench—No. ...-_.-.1.....-_._ Width..... ............ Total Length.�Z<a� Total leeaching areaa..._......_...____sq ft.Seepage Pit No--------_..-_---.-- Diameter-------------------- Depth below inlet.............. g q. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......... ...................................................... Date........................................ Test Pit No. I----------------minutes,per inch Depth of Test Pit......-.--__-..-.._. Depth to ground water.......--......... fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ............................................................................................................................................................ 0 Description of Soil........................................................................................................................................................................ w V Nature of Repairs or Alterations—Answer when applicable.......A91)--------- .N' - �/&'")Tj/Z ---------------...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een ' sued by ohe Jioard of health. l'k >Ln (~ � �. l Signed ........ - Dare ApplicationApproved By .............V�.�::�.�.... - �ra.� ............................................................. Dare Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------- ......... . ............................................................. .... ........: ............................ . . . ........................................ Permit No. -------- ................ Issued ........................................................ Dare------ Dare •-'—_.------------------.----- - ---.---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (ILErtifirate of 0:11ontplianCE THIS IS TO CERTIFY,Th•a the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by --�w.-'' ....... s'-- ...-.�J------------- ............................................. Instakr at ------------------------------------------------ �.....C`-�Z/---�B..t/LI--l._----��---�--��---_-------------�-- --------_-..4.t------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....— ------10...?........-.. dated ._.---------_..--------------------__..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE 'y ------------ , - ---- ------------------------------------ ------------------------�—-- -------- )4" _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q� TOWN OF BARNSTABLE �G io �t1 u�r� Tonitrurtin frrntit 1� � �-W�- � � GPermission is hereby granted............ _--..-sG - -- - ------------ -- -- � to Construct ( ) or Repair O an Individual Sewage Di osal System at No. .. -----C-'1..-�..1� - .+ C° -.. =- � 1 (U................ Street as shown on the application for Disposal Works Construction Permit No ------ Dated....... _.. ..................................... =X_ .................................................. Board of Health DATE................ -- , FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS ll= CATION SEWAGE PERMIT NO. �t`, LLAGE INSTA LLER'S NAM i � AIVDRESS ' ,.-.BUILDER OR O NE s D A T E PERMIT ISSUED DAT E -COMPLIANCE ISSUED' � � � i 7/ P,-;q t �` J yz . F M. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH OIX ........7 --oF.....-.. ✓� il.STi9/3L �7 . Appliration for Bispao ai Works Tonstrurtion ranfit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ............<!3_f r� � ...IE1 E;.r............ ....Z27. l .z...-------•---............-----------..........---....---- Locat' n-Address '� r Lot N �_^ JC W r,„,_ Address /J ` ,� ��� �.: ►............................ ...................... . . ....v'f.l.f_" ....... ............ Installer Address U Type of Building Size Lot... .....__9 ..?sq. feet .-� Dwelling—No: of Bedrooms............ ............................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building- ersons____________________________ Showers —p., yp g. No. of •-•-•-•••----• p ( ) Cafeteria ( ) Other fixtures .. \- :::: .....- ,gEt7/Lod�ri'-- W Design Flow.............Ila.....................gallons per 4wirson per day. Total daily flow..____.____45�_o...................gallons. WSeptic Tank—Liquid capacity��'-d�gallons Length.,c9.-_O_ Width_4_=/Q_ Diameter________________ Depth__5_'_ - x Disposal Trench—No. .................... Width.................. Total Length.....................Total leaching area_._.................sq. ft. Seepage Pit No.._..__._Z_._._.._. Diameter... ---FT._. Depth below inlet.... Total leaching area__.L...sq. ft. Z Otlier Distribution box (,x) Dosing tank ( ) / Percolation Test Results Performed by_.l�_s1__ ,�z. A.l�/�t_..lw ................ Date.... mlj;6z.......... ..___Test Pit No. 1. ___._minutes per inch. Depth of Test Pit_.__/_ __.. Depth to grown water_________________. Is, Test Pit No. 2...155�.Z....minutes per inch Depth of Test Pit---/44<:'.. Depth to ground water........................ 0 Description of Soil...0/_......... f�..�---•---�'o�sri/L_._...�_....-S.(//3so-iC=.......................................................----•- fig_ c.9N.....IYJ�j?...._ro 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 hafibn issue by he boar halt .Signed �< __._. � Application Approved By.......... �` ✓X1 Date Application Disapproved for the following reasons:--••----•------•-•--.-..---••----...----•-------••••--•---••--•----------------••--•-----••-----•---...__.....-- --.................................................................................................................................................................. ................................... Date PermitNo......................................................... Issued....................................................... Date No. 8!. '.'f' S Fss.... . ?.....�_ ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w� Appliration for DiopooFal Works Tomitrnrlion Prratit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at -•-•- __.. ev ... - ------•----------•-------------•.....- --••. -----•--•-•----•---•••----............... c tion-A •� Lot No. .VS.L.._..... .L ... ...... 1/ 'S', ............. -•---- 1� J.F?X......A ............ �l. Owner Address ................. ------- -- --------------- ---------•-------.. ................................... .� -------_____--------- Installer Address Type of Building Size Lot...�_7___G"5___�-�_..�q. feet V Dwelling—No. of Bedrooms........... ___________________________Expansion Attic 4 ) Garbage Grinder ( ) '4 Other—T e of Building _______________ No. of ersons._________.________.: __ Showers — Cafeteria a YP g P ( ) ( ) Other fixtures -----------------------------••--- ,h, "= W Design Flow______________________.............._______gallons per perso per day. Total daily flow____.__.._.4505 .j ..................gallons. WSeptic Tank—Liquid capacity-4 Length�a_ .___ Width_4:/Q_. Diameter________________ Depth___4_' x Disposal Trench—No_____________________ Width.....................Total Length.................... Total leaching area..... .:....sq. ft. Seepage Pit No...._---------------- Diameter.__. --- Depth below inlet.... Total leaching area__.-00J..:sq. ft. Z Other Distribution box (/) Dosing tank ( .) Percolation Test Results Performed by.X__d..< �Yc'_.Z42Z1%4...f!!!C............... Date___`__Z ....��'_� Test Pit No. L_ _ ____.minutes per inch Depth of Test Pit____ ��/�.�r_ Depth to grouri water_________:"'"'"_____--- (i, Test Pit No. 2..." __._minutes per inch Depth of Test Pit... Depth to ground water........................ PI' P-501 Description of Soil - --------- f--••---- --------------- -....... ...... •---------------- V _____-•--•----••------ ..�'t ���~--- G /fin/--------'J,E17--- --`----- •+ w 2-----------------------•------...----- 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 TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issue ,y th boar o /hlealt di • •- -.. Application Approved BY ------------------------------------ ---------------- Date, Application Disapproved for the following reasons: .......... - Date w PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD E ..........................................OF..................................................................................... �ntifiratr of Tomphaurr ✓ THIS,,,Ap.��, TIJ��the Individual Sewage Disposal System constructed ( ) or Repaired ( ) at...............................................•--------------------------•----------------•-•------•'---- has been installed in accordance with the provisions of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........................ _______ dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - DATE. .�' /ef._..... Inspector— /y THE COMMONWEALTH OF MASSACHUSETTS 8> /sYCA_ d�t.a-,., BOARD •mod ...............I.........OF....................................... J No......................... FEE........................ �to�oo�� � �tr�ton rrntt� , Permission ta'Kereby granted...........----•-----._...--•--"-----•--•--...-----....................................................../.............................. to Construr,df,7) 5> pair ( Ln Se System 1% atNo....................................................................... ................................................................................................................. Street as shown on the application for Disposal Works Constr ,';rated.......................................... DATE.......................... /._....---------.._.._.__.....__...•----.....-•- Board of Health e FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ' t� 4 � d tItIItI t e S 1y 111 ,��.S�.qn>;+ +{"� r t• I } r t u g2Y lR Y y�+d.. 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Aye' � � w r rt I ��`ZN Or,per �p`�►���M9� i �XI,S�TING SPOT ELEVATIONS' 0„0 �'stJ1R�� ANFrl14�� -�: x `" 4EX`ISTIN`G � CONTOUR - 0 1 � FII�IISHEDI SPOT ELEVATIONS 0.0 '. CONTOUR 0 1; `, PROPOSED PLAT rPLAN� , r ' APPROVED= BOARD OF HEALTH �;:-�. j� F < _ � > T% 1 ; t- �.,' ,. =,AG'ENT'> �' aY i CERTIFIY THAT THE PROPOSED R. ✓. O�hvEARN INC RLS, I�1 BUIL,DING ' bSHOWN`� Q'N .` THIS PLAN 1348 'ROUT'E t34 # � ,EAST �DEN(v'IS ,� MASS bd fl t �4 C 0.QN�ORM$, TO THE ' ZONING , L.AWS' � - DATE EGISnU� L AND StJ:RVEYQR DR. E3Y RE OF 7 4. + t-+.P.a-R� A W Z7 c 'ALL:4. VO ­-"INVE RKI E,VA.fy N NOT uT� a U rtbl 440:ik" A ONSH ­-S -If FT ,.TITLE: 5 S E�D-- RY ""j k Al NK SHALL �CONF NL] A 6 R -TAN 446 - tkt-"--,t bw FT , k�_. S D REGULATI' ' AT, -AN do -PERCOLAT MI'N p Y. 7 V To �R �E 1 N L E-T T I'0 N _ON:- " I k , 6 S4, 6 i§'Yk f U, 0 :/41L D I�EVATION.1E t�E, CHING, 9��,s FT. Pl T BOX.P.-08�S'ER6-VA.�-T,.d]ON�....�;�HOL-:E-�,".',"I-�.�;;�-�"", OBSERVATT] 6T ONO., OUTLET N L LEACH DIESIGN." IONS �DIROO;MS N MBE -,OF� BE GARBAGE; ' DISPOSAL -UNIT... r✓y -DAY TOTAL` FLOW - GAL./BR./`DAY x BRA GAL./ �ESTIMATE,D 'SEPTIC T� GAL. R.EfQUI'RE,D-­� TANK :'-CAPACITY�:-.._...—� .o.l. T K: 'ACTUAL -TAN t I N TA L L Z G OF`- SEPT It��f�,'T S11 Z,E-', t) _�..LEACHI N REMENTS-� .: AREA R Ei�Q 1r, SI.DE- WALL- AREA:2,_-_'9GALdS-F AREA 60 GAL./S.F.BOTTOM LEACH-ING CAPACITY ( BOTTOM BOTTOM SIDEWALL .. ... . C . . . . 4- _7,o :'GAL. RESERVE LEACHING CAPACITY.-O. . Al :TOP OF FOUND. 4" SCH. . 40 ELEV. CONCRETE CLEAN . SAND PVC - PI-PE COVERS CONCRETE MINf PITCH COVER 1/8 PER. FT: 2% :MI.N. PITCH �vk OF 41, .MAX: 12 OF C7 Z —4 2 LAYER OF 1/8"- 1/?- KXNAW C, LINE R,CHARD Gam; FLOW I - ­� J 1. ,I I - A WASHED STONEti oliw#4 1%&#94 -1 van 5/4'!_' 1 1/2" 41 4" CAST IRON WASHED STONE PI PE - MIN. PITCH 0 1 4 P -FT..-. . / " ER Di ST, :PRECAST LEACHING BA BOX wc) $IN OR EQUIV. z� U4 sx. )7 L -SEP Tit':, -G MASS N 110-R. 'LS RS 4 R INC TANK . ,.R. J� 0­H E'A 15 4 [3 4 8 'S -MAS S. ULE E _ DENNI AR R _W-A TE P 66ILE__ GROUND .10 s JOB' N IEWr_ 4 ev _:S WA G E D1, E 0 A P L� YSTE� 8 0-s SHEET 2--OF -TE .- NOT TO.,� 1.�Ckl.E D _-, I