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HomeMy WebLinkAbout0070 EMERALD LANE - Health 70 Emerald Lane, Marstons Mills A=046-045 Mon TOWN OF BARNSTABLE LOCATION �, i'r"f��=: A r SEWAGE # VILLAGE 01 aw.'4 ,=1-i MIMS ASSESSOR'S MAP & LOT I G ()�► INSTALLER'S NAME&PHONE NO. rn+ Ck C ,"p-12+C M� -t)64ki SEPTIC TANK CAPACITY LEACHING FACILITY: (type) el inI g ze) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: - Y COMPLIANCE DATE: a - -�?9 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.leaching facility) Feet Furnished by v -13 a w�� 31 �32 ' e 1 Lla No. v �� Fee �.5 01 G>` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppliCotion for Migo!ml *pgtem Congtruction Permit Application for a Permit to Construct( )Repair('V)Upgrade( )Abandon( ) komplete System E)Individual Components Location Address or Lot No. —7 b Ye rc,1kL Loav-Q_ Owner's Name,Address and Tel.No. N MAfSiZ? am. 1M��IS Assessor's Map/Parcel r —Xd eN� here lIc., C Kv �`� 2) Installer's Name,Address,and Tel.No. J Designer's Name,Address and Tel.No. C91=1?)-7 7�p— 04?4y Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 O gallons per day. Calculated daily flow 3 '49 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I Type of S.A.S. Uttjft Cr. T Ttv ELT �`ry Description of Soil VA,\ Nature of Repairs or Alterations(Answer when applicable) S W 5Tal voS-e M1 L K— Y c. L.v 1 i fi it Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental ode a to place the system in operation until a Certifi- cate of Compliance has been issued b this d of p Q Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. "' Date Issued 4--' 6�' ....... TOWN OF BARNSTABLE o�b `.`LOCATION 7 o reo,1 A r& SEWAGE# ': :.VILLAGE 01ar`4e,-)S' ASSESSOR'S MAP & LOT 0Y6 . 4y b INSTALLER'S NAME&PHONE NO. rv% ck C.: +;c O 69'J .......:::'SEPTIC TANK CAPACITY / t� I• LEACHING FACILITY: (type) NO.OF BEDROOMS_ i BUII DER OR OWNER Q � -'�— `:.PERMIT DATE: COMPLIANCE DATE: a - -J, 3 -`l 9 Separation Distance Between the: j IGiaximum 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 leaching facility) Feet Furnished by ,`�� �: L o-J No. ! 4 7,0 k` r Fee .` THE COMMONWEALTHJ0F M SSACHUSETTS w," Entered in computer: PUBLIC HEALTH DIVISION -TOWN-OF•B RNSTABLE., MASSACHUSETTS Yes Z[pprication for Migoml *pgtent Congtruction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) YcompleteSystem El Individual Components Location Address or Lot No.",b S Owner's Name,Address and Tel.No. tAw 5rnov5, I `` Assessor's Map/Parcel -Toe`�� 'pe y- 11�.(\K\c I l q Installer's Name,Address,and Tel:No. Designer's Name,Address and Tel.No. flvcylc- .S CSC ) 77Y' 0(oc��r. �aJer >-6 ' ti' !M Type of Building: Dwelling No.of Bedrooms �J Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 O gallons per day. Calculated daily flow _3 q I gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. <q�Ci T _T1vC,L7vk'to S Description of Soil IM F_ 14► .b '° t Nature of Repairs or Alterations(Answer when applicable) M W S-T14` Se Z 1 L 7- µ-K i L o. C.v f I -1- Il Date last inspected: " Agreement:- 11 The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental qode an n t to place the system in operation until a Certifi- cate of Compliance has been i�bvth�isar of Signed Date Application Approved by Date lyl ' 5pf" Application Disapproved for the following-reasons 44 Permit No. —7,o Date Issued'" --------�'-------- Y----- ----"--- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System.Constructed( )Repaired ( )Upgraded(✓� Abandoned( )by i-:� -C to PC 51✓;P z i Le .P V+ c at a tvc•-I,A Lc.o\j, a.,c s4oh M V has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. "7a dated Installer Designer ' The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector Q\ --------------------------------------- No. / 4! 74 t Feed 1 I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(Upgrade Abandon( ) System located at '7 u V-1(\N Al S and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date off this it. Date: O '� '� e Approved - 10/9N7 i i i NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT-(WITHOUT ENGINEERED PLANS) - i { hereby certify that the application for disposal works } construction permit signed by me dated l=�—� —��, : concerning the property located a t Lc, �_OA- a 1`s meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed There are no variances requested or needed. i a �If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the { proposed leaching facility, will W be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. 1 Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) _ S SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER tAttach a sketch plan of the proposed system.Also If the licensed installer posesses a certified plot plan, this plan should be submitted). q:health folder:cert s i 3 ���� � �� 0 �Pi i Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 .Jolut Grad � � E.P. Title V Septic hispector ASSESSORS MAP NO. Y.O. Box 2119 PARCEL N0: — Teaticket, MA 02536 WILLIAM F.WELD (50 13 Governor 11 j2 ARGEO PAUL CELLUCCI p Lt.Governor ti 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOW PART A CERTIFICATION t�/�•v � L Property Address: 70 Emerald Ln.Marstons Mills Address of Owner: sfA, f9 ,q Date of Inspection: IM2/98 (If different) '`' ry v Name of Inspector: John Graci Parilta elF cp I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: 9 �r 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 This Inspection Is based on criteria defined In Title V Conditionally Passes code 310 CMR 16,303.My findings are of how the system is performing at the time of the inspection.My Inspection does _ NeedsFu her valuation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the X Falls septic system and any of Its components useful life. Inspector's Signature: Date: 1114198 The System Inspector shall s mit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. 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 Co7hpliance(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 exfillration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 007f97) One Winter Streat • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 70 Emerald Ln.Marstons Mills Owner: Parilla Date of Inspection:1112199 — Sew.ane backup or.hreakout.or hiah.static water level observed.in.the distrihution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply 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 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: x 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. Yes No x — Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. x_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. x_ — SAS is in hydraulic failure. (revlaed 0627)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 70 Emerald Ln.Marstons Mills Owner: Parilla Date of Inspection:hues D]SYSTEM FAILS(continued) Yes No x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. x Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s). — Numbers of times pumped x Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. —x: Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. —X. Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 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: Yes No x the system is within 400 feet of a surface drinking water supply x the system is within 200 feet of a tributary to a surface drinking water supply x 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. (reyleed 04127197) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: TO Emerald Ln.Marstons Mills Owner: Panlla Date of Inspection:1112QB i Check if the following have been done:YOU must indicate either'Yes"or"No"as to each of the following: _X_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. —X_ The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x 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. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] (revleed 0412757) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Add res s: 70 Emerald Ln.Marstons Mills Owner: Parilla Date of Inspection:1112198 FLOW CONDITIONS RESIDENTIAL: Design flow: 3w g•p•d./bedroom for S.A.S. Number of bedrooms: 9 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Ye: Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day 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) No Water meter readings,if available: nra Last date of occupancy: n1a OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: nla System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other APPROXIMATE AGE of all components,date Installed(if known)and source Information: 1992 Sewage odors detected when arriving at the site: (yes or no) No (reylaed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 70 Emerald Ln.Marstons Mills Owner: Parilla Date of Inspection:t12f98 SEPTIC TANK: x (locate on site plan) Depth below grade: 4" Material of construction:x concreate metal FRP Polyethylene_other(explaln) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Les^H57-4410^ Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 24" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: te" 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.) Septic tank Is structurally sound.Septic tank needs a new Tee.Recommend pumping every two years. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rya Scum thickness:rJa Distance from top of scum to top of outlet tee or baffle:nfa Distance from bottom of scum to bottom of outlet tee or baffle: Na Date of last pumping, 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.) Ma BUILDING SEWER: (Locate on site plan) Depth below grade: v Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line?o- Diameter: V Qmments: (conditions of joints,venting,evidence of leakage, etc.) (rsvlssd 04fl7)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 70 Emerald Ln.Marstons Mills Owner: Parilla Date of Inspection:7112l98 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nra Capacity: rda gallons Design flow: rda gallons/day Alarm level:_w4 Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Na DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nla Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)Ye: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) nfa (revised 04117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 70 Emerald Ln.Marstons Mills Owner: Parilla Date of Inspection:1112l98 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,'explain:. rda .Type: leaching pits,number: 1PW gallon leach pit leaching chambers, number:nla leaching galleries, number: nla leaching trenches, number,length: nla leaching fields,number, dimensions:rda overflow cesspool,number:nia Alternate system: rda Name of Technology:_wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) SAS la In hydrautle failure.The aoll In peat the eRective depth of leaching,ph was full. CESSPOOLS: (locate on site plan) Number and configuration: nla Depth-top of liquid to inlet invert: rda Depth of solids layer: nia Depth of scum layer: rda Dimensions of cesspool: rda Materials of construction: nla Indication of groundwater: nia inflow(cesspool must be pumped as part of inspection) rda Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda PRIVY: (locate on site plan) Materials of construction: nla Dimensions: rda Depth of solids: nla Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda (revised 04127)9T1 f s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 70 Emerald Ln.Marstons Mills Parilla 1112198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) �- V� 17 (rtvlud042T197) Pay ! of to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 70 Emerald Ln.Marstons Mills Parilla 1/12/98 Depth of groundwater 12r, Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts (revised0027197) page 10 of 10 PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 046 045- - Account No: 27688 Parent : Location: 70 EMERALD LANE MM Neighborhood: 12CC Fire Dist : CO Devel Lot : 418 Lot Size : .47 Acres Current Own: PARILLA, JOSEPH A & ROBERTA State Class : 101 BOX 522 70 EMERALD LANE No. Bldgs : 1 Area: 1636 Year Added: MARSTONS MILLS MA 2648 Deed Date : Reference : C78143 January 1st : PARILLA, JOSEPH A & ROBERTA Deed MMDD: 0000 Deed Ref : C78143 Comments : Values : Land: 22100 Buildings : 74900 Extra Features : 1000 Road System: 70 Index: 501 (EMERALD LANE ) Frntg: 125 Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 112988 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [046] [046] [ ] [ ] [ ] r �o t LQXAT1�0 SEWAGE PERMIT NO. _'' 01' �K <p zaHit 17 - 111 VILLAGE M �IiLL INSTAnLLER'S NAME ADDRESS 14 O U11DE R OR OWNER' G. !2 N/ ' e - ry t S 2 G DA T E PERMIT. USS U E D 5„, 7 7 DAT E COMPLIANCE ISSUED ', , ��� s 7e' . � ��` � ° \ i 1 ray � .� �::_ -_ __ _ � \ �l�..-- ._---___---___..� -___.�.�_ S3�' -� �, �v !��'1'f Sl �� �n,N�u �.µ i r�1 19 No............ .. 1. Fss.... 5.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _..._... . _......-.OF.......-. .. ---------------------------------------- 6,Appliratiuu -fur 43iupuuttl Worko Tonotrurtion Vrrmft Application is hereby'made for a Permit to Construct (WOr or Repair ( ) an Individual Sewage Disposal System at: ------------- -----------------------4.4.............................................................. Loc ion-Address or Lot No. 1�.( l�.P.---------------- ---- ------T-n....-- --------............................ Owner Address a ----••---- -----------------------------------------------•-----•---•--------- ..................... !. ............................................................... Installer Address d Type of Building Co A-A fit 4 e#%I Size Lot404..4 A.Jr-_------Sq. feet Dwelling—No. of Bedrooms------------3.............................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ---------------------------- No. of persons-..._-__-_-__-_-__-_--_-_.-- Showers ( ) — Cafeteria ( ) Q, Other fixtures --------------- ------------- - -- ----------------------------- W Design Flow..................P.Q..................gallons per person per day. Total daily flow._.............7_Q..4__-__-___-_-------..gallons. WSeptic Tank i--Liquid capacity/O$_>1•-gallons Length-__--I--------- Width----- Diameter------ - ------- Deptli.-S-------I - x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No......4------------- Diameter-------4......... Depth below 'nlet......G....._..... Total leaching area_/10-P--_-__sq. ft. Z Other Distribution box ( ) Dosing tank ( ) U - /V Z" - 7 aPercolation Test Results Performed by--------------------------------------------------------------------•----- Date-----_------------------- ----------- Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water....-..---_-.._..-.----- f� Test Pit No. 2......_---------minutes per inch Depth of Test Pit._--_---_-_-----_- Depth to ground water.-.-.--..--._-_.-------. l� - ------ --------------- �+ Descriptio f oil----------77--- fs-•�O--p 1`� L�" °t - . 1- -------- - ---- - e U �' ?z ---------------------------------------- ----------------------------------------------------------------- W I., ..................------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ VNature'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 Article XI 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 ---. ............Da................ _ Date Application Approved B . ------. y- 77 PP PP y----- - - ---- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------•--••-- -------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued....................................................... Date ' � _ . .. No............ ...XA FEE.... ' .................. yt THE COMMONWEALTH OF. MASSACHUSETTS BOARD OF HEALTH m �G /y�i...._....OF.......... �. -----01--------................ 1�yvl alien -for Diripasttl Workii Cnotuarnr#ion Wrnift Application is hereby'made for a Permit to Construct O or Repair ( ) an Individual 'Sewage D`fsposal System at: ...................... Location-Address or Lot No. ' =---------------- _-j ¢ ----� l------N+f A tv.Aj�!........................................ Owner Address p� 1144 ........................... t i W1 .........l3,-,,. ?�.J� ..............•---.. ....---••; "� e -k...... ... ---•-- -------•_......._......•-----••••--•--- Installer Address U Type of Building C.A.1314 S atNf Size Lot-Zdzkk$7......Sq. feet Dwelling—No. of Bedrooms..__---_..-_------------------------------Expansion Attic ( ) Garbage Grinder Other—Type T e of Building T 0.1 � YP g -----------•-•-------------- =`o. of persons--.----•-.------------_--.-- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------------------------------------------------------ I- ...................... W Design Flow__________________ ..................gallons per person per day. Total daily flow......--------2;9_a_------_-------- ---gallons. PSeptic Tcuik#—Liquid capacity C;4-0--gallons Length_-_--9....._... Width__---�_*......._ Diameter_---- ....... Depth-5---__.-.._. xDisposal Trench—No- -------------------- Width......._------------ Total Length------------------.. Total leaching area--------------------sq. ft. r� Seepage Pit No..____T............. Diameter.......?;--------- Depth below inlet....._ ............ Total leaching area.,(AA-4------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ;. �Gs "�` 1 77 Percolation Test Results Performed by----------_------- -•--------------------------------------------------- Date---•----------------- -- ra a Test Pit No. I----------------minutes per inch Depth of Test Pit.........._......... Depth to ground water._.---_____.-.--... w Test Pit No.-2<...•..._...__..minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.-.--.._-._-..--_----- � �,s ----- ---- --------- _ - _._.O n / �.... Description f Soil: 40._4 hI .~-{ " �t---- I ef. --------------------- IU /+ - ------------ ....>� t _aos 4• 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 Article \I 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. Signed_. ` i ,�!" j-------------------------- Da------. .-------------- • � Date e Application Approved BY----- t .+%- =Ap-$.1- ----------------------- -------- I Date Application Disapproved for the following reasons:---•-•-•---•-------- '...-... •---------------------------------------------------------•--------------•------------•----------------------------------•---------------------------------•-•------•--------------------------•-.----- ,� Date PermitNo__.................................................... Issued------------ - ....i,:tl................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEA TH - ;. ........ L:...............OF......fl� . '. . .. . :. . .......... ................................... x1rr#if iratr of fI'loutplittgtre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or,Repaired_( , ), bY------------------------------------1--° = "r`............................... Installer at. 0_iR-•••F"•,a16 . tl--- A �!.K----------- - 1 .. P-I1 � k ---- ---------........................................................................... has been installed in accordance with the provisions of : I XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ ___./AZ'..................... dated.."..: " ......................... .41 THE ISSUANCE, OF THIS 10ERTIFECATE SHALL,NOT BE CONSTRUE© AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. / ................... Inspector------ THE COMMONWEALTH OF MASSACHU TS a° BOARD/APF HE LT No......................... FEE---- ----•--•------- �i����ttl Permission is hereby granted.......... __ A_�?.!/_.................... to Construct ( v) or Repair ( ) an Individual Sewage Disposal System at No.......4J_4_!?--------- ?1."►:_A..Lis ------- .1►_ 1-- ------------------•-- Street �r sti as shown on the application for Disposal Works Construction Permi __o.____ . ated-_--_-_7.. ............................... 77 Board of Health x. DATE.......... .�`------ ------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -