HomeMy WebLinkAbout0056 LONG POND ROAD - Health 56 Long Pond Road
Marstons Mills P
A = 014
T
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED
' 5FP 1 0 2002
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,W TOWN OF BARNSTABLE
SYlb
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE,SEWAGE DISPOSAL SYSTEM FORM
PART A
r CERTIFICATION
Property Address: 56 LONG POND RD MARSTONS MILLS, MA 02648 C)1
Owner's Name: NUGENT
Owner's Address: 56 LONG POND RD MARSTONS MILLS, MA 02648
4
Date of Inspection: 8/19/02
Name of inspector: lease 'r )
'int JOHN GRACI
Company Name: (P print),ti SEPTIC INSPECTIONS InG
Mailing Address: APO. BOX 2119 TEATICKET,MA.02536
Telephone Number: 508-564-6813'FAX 508-564-7270
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 the inspection.The inspection was performed based on my training and
experience in the proper function acid maintenance of on site sewage disposal systems. I am a DEP approved system
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
_ Conditionally sses
_ Needs Furth valuation by the Local Approving Authority
Fails
Inspector's Signature: Date: 8/19/02
The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspectio . 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 DEP. The original should be
sent to the system owner and copies sent to the"buyer, if applicable,and the approving authority.
Notes and Comments '
SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
""This report only describes.conditions at the time of inspection and under the conditions of use 11t that lime-This
inspection does not address how,the,system,,will perform in the future under the same or different conditions of use.
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Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 56 LONG POND.RD MARSTONS MILLS, MA 02648
Owner: NUGENT
Date of Inspection: 8!19/02
Inspection Summary: Check A,13,C,D or E/ALWAYS complete all of Sectio► D
A. System Passes:
4r
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist. Anv failure criteria not evaluated are indicated below.
Comments:
SYSTEM PASSED TITTLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG
THE SYSTEM'S USEFUL LIFE.
B. System Conditionally Passes:
_ One or more system component§as described in the"Conditional Pass"section -r<;ed to be replaced or repaired. The system,
upon completion of the replacement.or,repair,as approved by the Board of Health,will pass.
Answer yes,no or not eetermined(Y,N,ND; in,the for the following statements. If"not determined"please explain.
n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits
substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced
with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating
that the tank is less that, 20 years'old is available.
ND explain: n/a
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a brok:n, settl4or uneven distribution box. System will pass inspection if(with approval of Board of
Health):
broken pipe(s)are replaced
_ obstruction is removed
' distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping'i»ore tlian 4 times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of-Iealth):
_broken pipe(s)are replaced
_obstruction is removed
ND explain: n/a
Page 3 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
'CERTIFICATION(continued)
Property Address 56 LONG.POND RD MARSTONS MILLS, MA 02648
Owner: NUGENT
Date of Inspection: 8/19/02
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 public health,safety or the 66'iror,ment.
.fib i
1. System will pass unless.Board.o,f Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a mannerohich will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet ofia surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water
supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
_ The system has a septi6iank'and SAS�and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tatik and SAS'and the SAS is less than 100 feet but 50 feet or more from a private water
supply well". Method used to detetmme distance n/a
"This system passes if the-wel`l'water analysis, performed at a DEP certified laboratory, for coliform bacteria and
volatile organic compounds indicat.--s`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, provided that no other failure criteria are triggered.A copy
of the analysis must be attached"to this form.
3. Other:
n/a
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Page 4 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 56 LONG POND RD.MARSTONS MILLS,MA 02648
Owner: NUGENT
Date of Inspection: 8/19/02
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for alLinspections:
Yes No
X Backup of sewage into facility or system component due to 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
SAS or cesspool
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 'h day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped nLa.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool+`or privy is,within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspooJ;o,r•,privy 54Within a Zone I 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
if the well water analysis,performed at a DEP
le water quality,anal sis. This system passes y ,p
no acceptable q ty.. Y I Y
certified laboratory,for,Ecoliform bacteria and volatile organic compounds indicat
es that the wel
l is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this forma
_ (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310
CMR 15.303,therefore the system fails; The system owner should contact the Board of Health to determine what will e
necessary to correct the failure. `
E. Large Systems:
To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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
If you have answered"yes"to any;question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large systeni has'failed.The owner or operator of any large system considered a significant threat
under Section E or failed under Section D'shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
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Page 5 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE;SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 56 LONG POND RD MARSTONS MILLS, MA 02648
Owner: NUGENT
Date of Inspection: 8/19/02
Check if the following have beewdone. You must indicate "yes" or"no" as to each of the following:
Yes No
X _ Pumping information.was provided by the owner, occupant,or Board of Health
�4
X Were any of the system components pumped out in the previous two weel,:.s?
X _ Has the system received normal flows in the previous two week period `?
_ X Have large volumes of water been introduced to the system recently or as part of this inspection '?
X _ Were as built plans of the system obtained and examined?(if they were riot available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up`'
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS, located on site
X _ Were the septic tank'manholes uncovered,opened, and the interior of the tank inspected for the condition of the
baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems'?..
�S
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
X _ Existing information. For example,a plan at the Board of Health.
X _ Determined in the field(if'any of:tne failure criteria related to Part C is at issue approximation of distance is
unacceptable) [310 CMR 15.302(3)(b)]
t
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Page 6 of 1 I "
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 56 LONG POND RD MARSTONS MILLS,MA 02648
Owner: NUGENT ;
Date of Inspection: 8/19/62
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x t#of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last2 years usage(gpd)): now oO --i Jj ow
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a _;
Design flow(based on 310 CMR 15:203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no) 'NO.,'
Industrial waste holding tank present(yesor no): NO
Non-sanitary waste discharged to tile Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe):n/a
t <
GENERAL INFORMATION
Pumping Records
Source of information: n/a
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallobs-- How was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box `soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,,att,ach previous inspection records, if any)
_ Innovative/Alternative technology.Attach,a copy of the current operation and maintenance contract(to be obtained from
system owner)
_Tight tank Attach a copy of the DEP appr oval
Other(describe): n/a
Approximate age of all components,date installed(if known)and source of information:
1978 BY OWNER
Were sewage odors detected when arriving at the site(yes or no): NO
Page 7 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 56 LONG POND RD MARSTONS MILLS,MA 02648
Owner: NUGENT
Date of Inspection: 8/19/02
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction:_cast iron _40 PVC Xother(explain): 20 PVC
Distance from private water supply well or suction line: n/a
Comments(on condition of joints, venting, evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 12"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: IOOOG L 8' 6" H 5' 7" W'4' 10""
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 32"
Scum thickness: 2"
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: 16"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.
RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP: _(locate on site plan) .
Depth below grade: n/a
Material of construction:_con`crete_ineial—fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a ,
Comments(on pumping recommcndaiions,.inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage;etc,, ,
n/a
}
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Page 8 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 56 LONG POND RP MARSTONS MILLS, MA 02648
Owner: NUGENT
Date of Inspection: 8/19/02
TIGHT or HOLDING TANK: (tank nest be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working ord-.r(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
g
DISTRIBUTION BOX: X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into
or out of box,etc.):
D-BOX IS STRUCTURALLY SND.
PUMP CHAMBER: _(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump cham':,er,,condition of pumps and appurtenances,etc.):
n/a
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Wage 9 of 1 I i
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 56 LONG POND RD MARSTONS MILLS,MA 02648
Owner: NUGENT
Date of Inspection: 8/19/02
ABSORPTION SYSTEM (SAS): XC locate on site Ian,excavation not required)
SOIL ( ) ( P
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 1
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
3 w 3 Type/name of technology: n/a
Comments(note condition of soil;signs of hydraulic failure, level of ponding,darnp soil,condition of vegetation,etc.):
LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF
FAILURE. PIT HAD 1' OF LIQUID IN IT AT TIME OF INSPECTION.STAIN LINES INDICATE PIT HAS
NEVER BEEN MORE THAN HALF FULL. BOTTOM IS AT 11'.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a ,
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a S;
oy
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Page 10 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 56 LONG POND RD MARSTONS MILLS,MA 02648
Owner: NUGENT
Date of Inspection: 8/19/02
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet. Locate where public water supply enters the building.
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Page I I of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM :INSPECTION FORM
PART C
SYSTEM INFORMATION(cont;na-M)
Property Address: 56 LONG POND RD MARSTONS MILLS,MA 02648
Owner: NUGENT
Date of Inspection: 8/19/02
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 12+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavatorF,j nstallers-(attach documentation)
NO Accessed USGS database-explain:,n/a
You must describe how you established th.? high ground water elevation:
HAND AUGER- 12+ FT.
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No..�------. ., �, - Fk39 ...............
t% THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
CSC.c�N.............OF........ AR.I\J..S.TICCI'4. ........
App iration for Divp.aiial Works Tnnitrnrtinn ranfit
Application is hereby made for a Permit to Construct (V ) or Repair ( ) an Individual Sewage Disposal
System at: M ��
..... a10.D..... .14ARSra.1t.1....M&1.5....---•-----------------L Q.T....----..d...Z.L.........------.....--
.Location-Address or No.
............. ::x_ ......... :. �' /„5----------s ........
Owner Address
Installer Address
U Type of Building Size Lot.o,/450-,5--Sq. feet
�-, Dwelling—No. of Bedrooms............................................Expansion Attic (NO) Garbage Grinder (NO)
`
�4 Other—Type of Building
yp g .."VA........... No. of persons....................:....... Showers ( ) — Cafeteria ( )
Other fixtures -----------------_----........ 2W�+ ----------------------
W Design Flow...........//.0.....................gallons per per day. Total daily flow-----------3.3,0..................gallon.
WSeptic Tank—Liquid capacity/_Og0gallons Length�_..�.._.. Width _/Q...: Diameter................ Depth.5._8211
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.....................sq. ft.
Seepage Pit No........./....... Diameter.....C_._...... Depth below inlet......6--1...... Total leaching area..Z.0.0..sq. ft.
Z Other Distribution box Dosing tank ( )
aPercolation Test Results Performed by.._ s�_i�l4_��_...._�Q..... dFFGil�t?/_R- Date.....Ci_�71—I. 8...--....
Test Pit No. 1...4.i;;-_.minutes per inch Depth of Test Pit.....AA.."_._. Depth to ground water........................
(i, Test_ Pit No. 2_..4-;.Lminutes per inch Depth of Test Pit------ ....... Depth to ground water........................
Ix •-•-••••. -•••------••••••••............••-•-•••--•••-•.....---•••...............• -••--••.._...-••----•-•-...-•••-............--•......-••••••.
------- -----
.04
O Description of Soil.....C.-.3Q........ Q/�? Q ..- (,1,, COf4 �:..__�' ..
Iir?iIT !G' '�----------------•-.........
------------
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 iITLE 5 of the State Sanitary Code—The undersigned fu ther agrees not to place the system in
operation until a Certificate of Compliance has been issued by board of lth.
- - - ed ,r.r_. . -•� �--=-�--- = .......�........--
y
Dat
Application Approved By-• � ..c -- .'.._....
Date
Application Disapproved for the following reasons:...............................................................................................................
-•--------------------------------------------------
Date---------------
Permit No......................................................... Issued-.......................................................
Date
C7Z
NO.............. ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD . OF HEALTH
N.............OF....,-...RA.Rj8j..!.S ....R-1_41!!�.......................
Allpfiration for U44poiial 10orkfi Tomitrurtion ramit
Application is hereby made,for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
......xjr!-... ........................L-O.-T......... ......................
Location,Address or Lot No
........ .... --------- ......
Z�... ..........
Owner
Addr ss
.......... ......................... .... 2 ........... .
Installer Address
Type of Building s�a I�e r Size Lotx' .450, -.-Sq. feet
U 3 _Z 5
Dwelling—No. of Bedrooms______________________________ Expansion Attic (NO) Garbage Grinder (NO)
�4
P4 Other—Type of Building ........... No. of persons...._.....__._.____.__.__.._ Showers Cafeteria
Other fixtures .................................. ......................................................
------------------------------7------------------
�r-gon ..................gallons.
Design Flow...........//jO ______..gallons............. per day. Total daily flow.._....._
9 Septic Tank—Liquid capacit�y/Aafl.gallons Width1q..**/,-).-. Diameter................ Depth..S ._".*
Disposal Trench—No..................... Width_._._..._...._...___ Total Length...___._..______.... Total leaching area....................sq. f t.
Seepage Pit No........./........ Diameter..... Depth below inlet......6.......... Total leaching area..9-0-0..sq. ft.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by.... ...... Date----. .........
Test Pit No. .__.minutes per inch Depth of Test Pit.___.IA ----- Depth to ground water------------------------
Test Pit No. 2---<—.".x2...minutes per inch Depth of Test Pit.._.. Z........ Depth to ground water........................
.............................................................................................................................................................
0 Description of Soil--- ....... $Atu.'b 4
........................................................ ...............
.......C .137�QA.s...... A 4..-4-10.rA rv7s;?� A04_4�.0..........................................
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 TLITILZ 5 of the State Sanitary Code—The undersigned, rther agrees not to placd the system in
operation until a Certificate of Compliance has been,i sued by board Y Xealth.
S"ged.... ......... ...... .. .................. ........
Zr
ApplicationApproved By...... ............... ................�.Z........... ........................................
Date
Application Disapproved for the following reasons:................................ ............................................................................
.......................................................................................................................................................................................................
Date
PermitNo........................................................ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS y/v li2G��/ C
BOARD OF/�iEALTH
......... ...OF............... ...................................
005,rdifiratr of Tomptlaurr
T �IJIS ,TO CE TIFY,Irhat the Individual Sewage Disposal System constructed or Repaired
by....... .�tl... ........ ---- a----------------------------------------------....... ............ ...............................
7 V..... Insi'
at..... ....................1_w.........�/...is, YT
;;2 2
rov
has been installed in accordance with the ions of TI 5 of The State Sanitary Co e qesc+ib6d ip the
application for Disposal Works Construction Permit No----- ...... .. dated-...... -----------r / d,
..........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
. ...........................
DATE......---__ .................................... Inspector-.-.�Pc�*..........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF F�EALTH
.......... ........OF.................. 2..z, i.................................
No.............3•'�.. FEE........................
Roposa rho Tomitnifiion ramit
Permission is W-eby granted.......... zl..le............... ....... ...... 7..........***........."........
to Construct or Repair an Ind*vi'du/al e � ge Disposal SOtem
at No...... .......
(..................
..........!n.�......; ..... ................... .............................................. .
Street �— 3— 7'—'
as shown on the application for Disposal Works Construction Permit No.................../,./Dated..........................................
......... . .......
Board of Health
DATE......... s ..... .................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
LET 30 :STD AssrUM,, TEST HOLE S
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.. I S.o' , �. PAUL MUt`RAY- .ZNl, €CTC�f.'�
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PLAN15 'PPSD .. D1v.TNE Gf? C/NG ASa�° �y. +
GE OR E G
ShOU)N `AND lT DOES .CONFORM .TCC) T
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THE .TO(A-)N 0F. 13ARNS 7APL ." y�`c,sT 9, Q
4 p�sn m4to 9��Ey
7 0 ��g.a�3�og9
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ao a
' I-I O">4'-B'>I O"Poursd 1—In.twll new"Vilco"G"aixo bulkhawd Q
Donor«a atwir foernq.� � I �,
C
UP 4'>4'P.r.C n}rY deck
--__- y-eopa,ii.i}nq door /�—w/»tap.t L.00wl'e nwwy IL Q
undar a}wiralf po<a;bla. from lwwn aprinklcr hcwd � � O
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w/m'-O">e•-ra•cwacd apaninq.ma+roll
�_ - Oft new daublc 2>I O hcwdcr. � ry-:'
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/� ...troll new�a'-O">m'-!a" _iv:NGp•oott - ,—. � m w
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Ncw cntry roof w:column•.—� ... :�_ ...._.........
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v° /�; FIg�hT FLOOD PLAN
t '—O"
J^Y Gan+rac+a-c F.lai'¢: n 01`u 9�'9.4 a c d
+ q•-I O^ All¢xi4+iny window are io
�`-----_ Narv¢y doubt¢hung window.,ar¢1-u b¢ins♦•ait¢d. n��� �n Z ��
All n¢w windawa ar¢+o b¢n¢w construa+fan+yp.r.. °u am m O
/"') Wwlla+a be rcmeucd �N O v°
V/ r l../ ./)/S.
�.J V� --.-••r--••-ram Naw w,Jla
Note:
all r;oaurc�nan+-.�o;m<n}iona rota to DRAWING TYPE:
be a;tc vcriFied by Ganerwl Gon}trot+or Flrs+Floor Plan
' w}}imo or Lona+rue},on
1
SHEET NUMBER:
2 OO
N o`e my3 RY
a
3"" € Imo q �e aE_
Q 7 o y�man3�6o3
E-em
I i--}ered to ar t g 2 G Gi hnq Jmi<ta' I f1
1 .I II N nm7T2oo/gbh qe mlm' I Q 1,`
1 i i I I I l I I � 1 LLJ
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1 i I III II I i i jl I � [ C
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I 1 11 I / I 2wIOFwf Ceram lld'o.L. � m..n'�n�� SOS
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DRAWING TYP€
7ceoncl Ploor Framing flan
p-ooF Framing plan
SHEET NLJM13ER:
GOOF
lA 1
a
I^i'-G%/4• 9'-10 1/2• 20'-.i" 9'-'a l/4' 4'-B I:Y." p o Ems°�E E2yI c o 0 0
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————————————
.p�_y Hnrvavm 2 9 4 Y � "'�� 19"�molntu6?am cc}in hnllwnY calling. _,Q_ V.•—._r.�.
WaL�-INGLOoi�T ° a LIVING�OON ,_ .. f..c-v..n v
19•_Inx 1 %'_®„
1 o"x 10'-9"
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A � Gan}rnc+ors No}e: j.�'n.y o
O1 0 Al(aeistinq window are to be remo�ad and new m '�
Harvey double hung windows mre to be installed. `=Y°'��`� ��_
rt p
All r.ew windows are to be new aanstr.trction type. Y a <'
th
x N i N .................................... C.i.Ynq wall. O°._m a a Q '¢
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0
3
• G_1. ` 1�..gi IF I G'-B" 9'-1 O" Notm: V J n L d
y�l� 1�--- All lyasuramcn}.;1rJlman}ian�ara}m
I ,I La ci+a vorificd Vey Ganarnl C.an trnctor
n}}imc d can.truction
° " s DRAAING TYPE:
1/2" 12'_5» 19'-G 9/9" q•.0
�`-- ------ - -'-"— ew h.6vnJ Ploor Flan
SH V JET N/UUM�B ER:
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p�o"E£ v 00
g ssn
aeo��a �• �
S m 9„r-okR�
Goo}inJOtls fidg6 Ven} "Q Z d ;�SDa 30� kn
mHurA°"
I1rLhl+BL+IIfa{AsphPt}shmglas � �' ti � � '�
15•Fa1+Pap r .
I/2"APp
2 0 Goll r-t wa 1!n o c v'
2 xe R"affiers 0 1!o"o.t.� 1..
♦'' . I I S �
k
1lJ
L
Ice and wP}er shield � / .'\•�' � ," I
�>
.0 t ....
Aluminum drip
q-jo +s.�® 1!A
lvminum qu++ere to drywalls - j .�—
AsPk.Trimbnardsm f
e o +inuaus—H)4'van+ C
—
0
x HP PP k q 0
a —
11..
n f n n w.n rn+onl .W.G shi Ies
Y 9 `7 T�
III
on atI other walls. � C
Fel+pPper®Trim and windows t 0 �-
M O .I
L�
Tyvekm Housewrap ! i ` J 1A` L�p
V
e
d Q
T
d1
y
P e he hm q
r
2 x 4 wall suds® I!n"a.c.
9 1/2"H.O.Insulw}ion•�15 ' V
red ubffdr
C glued d u-aw d 1 Q
I Q/
1 I/B" -------__ _ _______ _ _ _ ___ - __ _
(xZ
L`xis}Inq 2 x!o Gc'dinq.foie+s a I 1p"n.a. 0"N.O.Insvla+inn 0 ! !
1p
n .
CM
c :
4 h W v
Existing framing ,_ ..QL-Ui q"
..fr�•� � L O 3
E.I....L..h —. m
�xis+inq 2 x I O Jois}s e I!o"o.c. 6._ -.� �• J m
i � t
w
Existing 9-2 x I O's—� •
Exis}inq I O"x 7'-Co"Poured` k 4'' n ESE".
Existing% I/2"O�ifiael/concre}m LolUmn r `u�o q�� O S
1v" 0 s
YL O$
On m�J'aE to 9 C
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�n
�� �!!�i!%!�•i!�/rf��lf�/!!���•••w �!% i!�i�!iF/Ji!�!�/�.!%!r�!/!/f! � v� � d d.�
�a \` 13Ull,r I �LVTIf "A"
DRAdln,) -M-
�� I 7� f�ulfdlnq he�l'lon"p."
SHEET NUMBER:
A400
C o a`YrsoS�pg.��
z v &D-ER9II3
< 7 0 5 13 !H
1 `�E pO o�o
Gon+i nuous ridge en+
Archi+ec+oral asphalt shinplas S-
I y•Falt paper ` .y r 2 xa Faf+ars® 1 el"o.c.
I/Y"APA rat¢d shoo+hlnq—�. �
.. - F ,1,
� � � � —� Proper vcm+s®moo"mc. 11J
'� i Y IF.CI Inqu� +v %8 I"rigid foaim inwla+ipn® ICo"o.c. V•
m 1 A(ummum dr dqa
/ `:, C P a "l `f
a<<�.x C q Atummum gut+ors to drywalls O <
��� �� r I � I Acak T'rimboards� Q
:� Gon+inuous svff+van+ i
1 2 t �� I x!o Nardi Plankm clapboard sid'nq o 9"t.w. t
I 2 1 oon frog+only.W.G.shingles a 5"+.w. •L �7
lq-
44,
� 1�•Pal+pap¢r®Trim and V,(mdows � � � `f
i f ` Tyvckm Hovsawrap t ,�
o
po,
1/Y"APA rat¢d shea+hlnq ^
a"N.D.Insula+ion•p-%O
2*A W all s+uds a 14e a.c.
% 1/2"HX7.ins Wjon-F-I y
�. %/4•liPA r +ad sulaftgor f qlv d and bra d 1 �
exist4nq 2 x�o Geilinq joists® I Co"o.c. B"H.O.}nsuL.+ion �.%O
_�eplaba axis+inq haadar New y/a"TYPa"X„Mracoda
w/2-I %/4"x 9 1/2"VersaLam's drywall an wall and ceiling.
I xlo Hardi-Plank'O clapboard 4id nq e 4"+.w.
on fran+only.W.G.�,h ogles®5"+.w Q E..
}
on Al o+har waifs.
ti'a.w s+airs
EXIh'rit.1G GARAGE
O 3
Existing framing ^ N •�, c y
to
4 #
A'
cL-
a
6
4"GNU blocking o floor—� 1 I I ;- .... ...:...........�a..
f�f f� jJfjf *;
------------
if
L )
ov
o�J1 0 S r
f� t�UtLtall.�lG �GGTIlON „�,� A�k�v sus m
DRAWING TYPE:
P�ulldlnq vieGi-ion"P�"
SHEET NUM6ER:
A40I
I O 3eW °
p• 3°°°
ig
;• ee�11 � ��sa`�a�i`�y'3 E�
/ a 7 a y«swo�eg3
EMILLJO
90
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L-7 L-0
I I I I i I
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L _________ --------- ____^_____________________ __________________J DRAWING 7YPE:
�/ �� 1 LEFT• ELi:�/�TION Pron+�levai'lan
4' SEA.- ELE\/AT►oN
5HEET NUMOFF-I
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