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HomeMy WebLinkAbout0167 LOVELL'S LANE - Health Lovel srL;ane ` I. Marstons Mills A= 078- 071 - 001 j '� �t 4/28/22, 1:35 PM First Property Management of Cape Cod Residential & Commercial Condominium Management Specialist on Cape Cod I� home page about us services maintenance communites forms faq con"tact affilliations insurance First Property Management 167 Lovells Lane Marstons Mills, MA 02648 (508)420-0299 office (508)420-0789 fax President: Andrew Witter andy@fpmcapecod.com Administrative Manager: Audrey Nielsen audrey@fpmcapecod.com Administrative Assistant: Nancy Greenberg nancy@fpmcapecod.com Accounting: Shelder Carvalho shelder@fpmcapecod.com Stella Dias stella@fpmcapecod.com Assistant Property Manager: Devir.Witter devin@fpmcapecod.com First Property Management 167 Lovells Lane Marstons M Ils, MA 02648 (508) 420-0299 office (508) 420-0789 fax President: Andrew Witter andy@fpmcapecod_com Administrat've Manager: Audrey Nielsen audrey@fpmcapecod.com Administrative Assistant: Nancy Greenberg nancy@fpmcapecod.com Accounting: Shelder Carvalho shelder@fpmcapecod.com Accounting: Stella Diaz sdiaz@fpmcapecod.com Assistant Property Manager: Devin Witter devin@fpmcapecod.com Content copyright 2021.First Property Management of Cape Ccd.All rights reserved. https://fpmcapecod.com/Contact.html 1/1 BENNETT ENGINEERING PO BOX 297 SAGAMORE BEACH,MA 02562 LAND SURVEYING,ENGINEERING,&DEVELOPMENTSERVICES TEL(508)88&4868 FAX(508)888-4867 November 22,2005 Town of Barnstable Public Health Division 200 Main St Hyannis, Ma. 02601 Dear Sir: Bennett Engineering was asked to perform a Title 5 inspection at 167 Lovell's Lane in Marstons Mills. The inspection was conducted on November 9, 2005. The site passed inspection upon completion of the minor repairs discussed the day of the inspection. On November 17, 2005 1 met with a licensed installer onsite. The installer replaced both septic tank covers, and thoroughly cleaned the roots out of the D-box. The system then passed the Title 5 inspection. A copy of the report is included for your records. Sincerely, Thomas Roux ro e C) fn Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 611512000. Inspection forms may not be altered in any way. A. Certification Important: When filling out 1. Property Information: forms on the computer,use 167 Lovell's Lane only the tab key Property Address to move your Wechter East LP cursor-do not Owner's Name use the return key. 65 Red Barn Rd. Owner's Address Monroe CT 06468 City/Town State Zip Code Date of Inspection: November 9,2005 Date 2. Inspector: Thomas Roux Name of Inspector Bennett Engineering Company Name P.O. Box 297 Company Address Sagamore Beach Ma. 02562 Cityrrown State Zip Code (508)888-4868 Telephone Number 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 and 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: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation y the Local Approving Authon a Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 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. 'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y Subsurface Sewage Disposal System Form A. Certification (cont.) 167 Lovell's Lane Property Address Barnstable Ma. 02648 city/rown State Tip Code Wechter East LP November 9, 2005 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass"section need 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 determined (Y, N, ND)in the❑for the following statements. If"not determined,"please explain. ❑ 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 than 20 years old is available. ND Explain: t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y Subsurface Sewage Disposal System Form A. Certification (cunt.) 167 Lovells Lane Property Address Barnstable Ma. 02648 Cityrrown State Zip Code Wechter East LP November 9,2005 Owner's Name Date of Inspection B) System Conditionally Passes(cont.): ❑ 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 broken, settled or 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: ❑ The system required pumping more than 4 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 ND Explain: 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 environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, 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 t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification(cunt.) 167 lovells Lane Property Address Barnstable Ma. 02648 Cityrrown State Zip Code Wechter East LP November 9, 2005 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health(cont.): 2. System will fail unless the Board of Health(and Public Water Supplier,N 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 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory,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, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 4 of 16 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form k Certification (cont.) 167 Lovells Lane Property Address BVamstable Ma 02M Citylrown State ZipCode Wechter East LP November 9,2005 Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow El ® 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of 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 1 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,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, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] 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 be necessary to correct the failure. t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) 167 Lovells Lane Property Address Barnstable Ma. 02648 Cityrrown State Zip Code Wechter East LP November9, 2005 Owner's Name Date of Inspection E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. YES NO ❑ ❑ 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 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 system 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. t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form y Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 167 Lovells Lane Property Address Barnstable Barnstable 02648 Cityrrown State Zip Code Wechter East LP November 9, 2005 Owner's Name Date of Inspection Check if the following have been done.You must indicate"yes"or"no"as to each of the following: YES NO ❑ ® Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ 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? Was the facility owner(and occupants if different from owner)provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. El ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 167 Lovells Lane Property Address Barnstable Ma. 02648 Cityrrown State Zip Code Wechter East LP November 9, 2005 Owners Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ❑ No Last date of occupancy. Date Commercial/Industrial Flow Conditions: Type of Establishment: Office Building Design flow(based on 310 CMR 15.203): 200 Min. Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Sq. Ft. Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp.doc.d'oc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 167 Lovells Lane Property Address Barnstable Ma. 02648 City/Town State Zip Code Wechter East LP November 9,2005 Owners Name Date of Inspection General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes,volume pumped: 1,000 gallons How was quantity pumped determined? Pumper truck reading Reason for pumping: To inspect the structural integrity of the tank. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ 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 approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: Building was constructed circa 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 167 Lovells Lane Property Address Barnstable Ma 02648 City/Town State Zip Code Wechter East LP November 9,2005 Owner's Name Date of inspection Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): 75 Depth belowgrade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No certificate) Dimensions: Sludge depth: None all liquid Distance from top of sludge to bottom of outlet tee or baffle N/A Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 0" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? direct measurement t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cunt.) 167 Lovells Lane Property Address Barnstable Ma. 02648 Cityrrown State Zip Code Wechter East LP November 9, 2005 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Structural integrity of tank was O.K. Inlet and outlet baffles were made of concrete and were intact. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: 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 Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): The tank itself was in very good condition. One cover was cracked approximately half way around the entire cover. Both covers were replaced on November 17,2005. 1 returned to the site on November 17, 2005 to ensure that the repairs were made to my satisfaction. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): t5insp.doc:doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 167 Lovells Lane Property Address Barnstable Ma. 02648 Cityrrown state Zip Code Wechter East LP November 9,2005 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: 8.01 X 5.2'W X 5.3'D 1,000 Capacity: gallons 200 Design Flow: gallons per day Alarm present: ❑ Yes ® No Alarm level: Alarm in working order: ❑ Yes❑ No No records available Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert •25 in. 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.): There was some evidence of root infiltration.The D-Box was been thoroughly cleaned on November 17, 2005. 1 returned to the site on November 17, 2005 to ensure that the repairs were made to my, satisfaction. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 167 Lovells Lane Property Address Barnstable Ma. 02648 Cityrrown State Zip Code Wechter East LP November 9, 2005 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: The soil absorption was located under the parking area. Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): An as-built was not available from the Town Hall.The type of S.A.S. is therefore unknown. During the excavation of the D-Box,There was a medium sand encountered below the A&B layers.This is confirmed by the Soil Survey Book which indicates that there is Carver Coarse Sand in the area. t5insp.doc..doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cunt.) 167 Lovells Lane Property Address Barnstable Ma. 02648 Cityrrown State Zip Code Wechter East LP November 9, 2005 Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(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 ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5insp.doc.,doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 167 Lovells Lane Property Address Barnstable Ma. 02648 City/Town State Zip Code Wechter East LP November 9,2005 Owner's Name Date of Inspection 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. /V f �O ` o t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 r' Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments V•. Subsurface Sewage Disposal System Form C. System Information (cunt.) 167 Lovells Lane Property Address Barnstable Ma. 02648 Cityrrown State Zip Code Wechter East LP November 9, 2005 Owner's Name Date of Inspection Site Exam: Slope = 3 — Y° Surface water /V1 j'k e (j '/ 1 CFF1�� � Al- So,�•�7 �j�`' ( nr 4ev ' 2� c1 wclt Zr r�t��`'(? �rc Check cellar _ ��� 1 Shallow wells ale Estimated depth to groundwater: K M�Lfe y S e f cri ' Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record ff checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: The Groundwater Contour map indicates that the depth to groundwater in this area is 30 feet.The Groundwater contour map was obtained from the town of Barnstable web site.A check of the Soil Survey of Barnstable County indicates that there is Carver Coarse Sand in this geographic area which supports the groundwater map because this soil is excessively drained. Permeability is very rapid in the subsoil and substratum of the Carver Coarse Sand. t5insp.doe.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 AsBuilt Page 1 of 1 .�✓"+^ TOWN OF $ARNSTABLE LOCATION �d SEWAGE # 9`1-2o7 VILLAGE ��rs/dys /Y/i//3 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NOJOL�+ �u I�o Z; �: SEPTIC TANK CAPACITY /000 ol LEACHING FACILITY:(rype) /00 0 P w�S�'(Size) b Il��n �pNO. OF BEDROOMS PR/IVATE /WELL OR PUBLIC WATER 4. e-BUILDER OR OWNER ,Y,c��GH COh DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED; -77— VARIANCE GRANTED: Yes No v 1 lk. ti http://issgl2/intranet/propdata/prebuilt.aspx?mappar=078071001&seq=1 5/13/2019 '7,r3 0'7f —j:�o Yui& THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct (41�or Repair an Individual Sewage Disposal System at: Location-Address or Lot 0' Installer Address PQ Type of Building Size .......Sq. feet Other—Type of Building ... No. of persons............................ Showers Cafeteria Z Other Distribution box (4 Dosing tank ( ) . 4 Test Pit No. L.A��..;�=..minutes per inch Depth of Test Pit---- .... Depth to ground . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLIT= 5 of the State Sqnitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isMed by the bD rd of health. Date Date Application Disapproved for the following reasons:..................... '--'—'-------- � ~^~ Permit Date �z o........................ FRs.................... .�....... THE COMMONWEALTH OF MASSACHUSETTS R BOARD OF HEALTH - r? t _Ise.................OF...-R lv.. _tA.11'---r...................................... ApplirFatiOn for Dispaii ai Works (futuIrair#iOn Prrutit Application is hereby made for a Permit to Construct k) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ......................__........................................................................ -------------•-•-••----•---..........-----------..........--•--------.......................------ Owner Address W Installer Address Type of Building Size Lot/C}_____ '____........Sq. feet Dwelling—No. of Bedrooms.___.._...NIA_______________________Expansion Attic ( ) Garbage Grinder (14o) Other—Type of Building __O.jFAeC.e__.. No. of persons____________________________ Showers ( ) — Cafeteria ( ) Otherfixtures ----------•----................................ ..._----------------------------•-----------------.._...---•--------_--••-- d -••------•-•------/600 41 WDesign Flow................. .. ...................gallons per person per day. Total daily flow..............7>3.......................gallons. WSeptic Tank—Liquid capacity/A??Qt___gallons Length_�_''�_"___ Width rY."!A"_. Diameter................ Depth__$_""I.. x Disposal Trench—No..................... Vidth.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../........... Diameter. ............ Depth below inlet•a..'........... Total leaching area_P..<50...sq. ft. Z Other Distribution box ( Dosing tank ( ) 4 Percolation Test Results Performed by...19......Pk!N!_A.L45...................................... Date__7-.'>FC t__.__Z�___:228 aTest Pit No. L _Zr_._minutes per inch Depth of Test Pit...f_'4__-__...____ Depth to ground water_A,:taev.45.__.__. L% Test Pit NO. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------- -------•---------•----•-_ __---------_------ -------...--....... _---------.---- -------------- ----------•---__---- ODescription of Soil................`-_�=•-� '-° •------ ---------- 1./' / ..................................................... "4 ' V ........................................."" 'l ........ ............ ---------------•------------•----.....------......_.........------•---•----- W -----••----•-----------------------•---•---••-•-----•--•---•--------•----------•----•-•._..___..---•----------••--------------••-----•-------------•..__...------.....__........._..-•---•-----•-•-•---- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... _....---•-------------------•---•----------•-----•------•---------------•------•----........------------•-------------------------------------------------------•------•_._..._..........--••...--••---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the;bo r of health. Signed •-__-• -- ' --------------•-•----- - f ApplicationApproved By............'...........-.__.....--••......................................•-••................-- l������`�--------•--- Date Application Disapproved for the following reasons:................................................................................................................ --...--•---•--•-•---•-------...-•----•-----------------------------------•-----------•----...---------------•--•---••---•-------•-------...-•-•-...---••--•-•-------•----•-------•-•-----------._....... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF.... ................................. Trriifiratr Of TOutpfiaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( ) by...-A., DC.fli9 _ --------------------------------------------------------------------------•-----------------...-------------------------------------------------------_••- Installer I�.� at.-.....................----------- .T..__ t/47 C4 4r!?t.!�`e.�_='x.. 4� '-1 41?_S_� has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit V'ol__. 3______________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �^ DATE.................!,!_ . . ..7. .. Inspectoy. 'r ,-•.....---------------•---._....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH •``� �5�... FEE...)��� Disposal Vorkg TOno#.rur#iOn unlit Permission is hereby granted......4•......... --.---....•-•-•••----•-•.............................•------------..........._..----.....--------- to Construct K) or Repair ( ) an Individual Sewage Disposal System at No.__4vT.....P�.............. = '` .` ..._ !?.s! .. -- ` • !� --------- t7+.`.i10Aj_57 �A Street as shown on the application for Disposal Works Construction Permit No..................... _D ted__............. ..___..--------- .---------- '- / / Boap: yHealth DATE-----. � ;'--•-_. ;-------------------------------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS I R I EST HOLt- 12 �.<T �O\�� �.�. a-17 rp i a ' L.a A M A N O ' �� ,Ioi. •" \\�/C DIST. „mot, �La �' r 5�if3�Gt� aox Q:r C;�. 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