Loading...
HomeMy WebLinkAbout0043 MARQUAND DRIVE - Health L433- d.-Drivels� P F i • ¢ ^Y TOWN OF BARNSTABLE LOCr+:�IOt a SEWAGE # VILLAGE �'� t — -�%����ASSESSOR'S MAP & LOT � INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �d LEACHING FACILITY: (type) ,aelo—. 0,0 ie� (size) NO. OF BEDROOMS BUILDER OR OWNER PERMT,TDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching FactLty (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 fee Ao ac g facili ) Feet Furnished by y 20 � 3J 30'R 3 � t7 z 4 DATE:_1 /1 7/02 --- PROPERTY ADDRESS: 43 Marauand_Dri_ve__--__ NMarstons Mills,Mass__-- 02648 ------------------------ On the above date, I Inspected the septic system at the above address. This system consists of the following: _Ca3 73 1 . 1 -1500 gallon septic tank. 2. 1 -Distribution box. 3 . 1 -1000 gallon precast leaching pit packed in stone. 6 ' X9 ' Based on my Inspection, I certify the following conditions: 4 . This is a title five septic system. (. 78 Code ) 5, The septic system is in proper working order at the present time. 6. The waste water is 17" below the invert pipe of the leaching pit. SIGNATURE:s Name:_ ber Jr-_-_--_ Company: Joseph—P. Macomber &. Son , Inc . Addrgss:_ Box-66 Centerville , Ma . 02632--0066 JAN -------------------- TOWH�A�ND�EPT EtE Phone: 508_775_3338____-__ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY (JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 COMMONWEALTH OF MASSACHUSE"YTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL, PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 43 Marguan(I nr; va MArRtnnc Mi 1 1 c tvt-)&S. Owner's Name:Nlatthpta J. McNamara Owner's Address: e,mo Date of Inspection: 1117.1o2 Name of Inspector: (please print) Joseph P.Macomber Jr. Company Name: J.P.Macomber & San Inc. Mailing Address:Box 66 Cpntpruj i l e, Magg■ 02632 Telephone Number: 5027;75 3�3p CERTIFICATION STATEMENT I cenify 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 tion 15.340 of Title 5(310 CMR 15.000). The system: !/ Passes _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: t Date: 2X>77d:Z The system inspector shall mit a copy of this inspection report Zoe 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. Notes and Comments ""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. Title 5 Inspection Form 6/15/2000 page I Paee 2 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 43 Marquand Drive Marstins Mills,Mass. Owner: Matthew J. McNamara Date of Inspection: 1 /1 7/0 2 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: V60 I have not found any information hick indicates that any of the failure criteria described in 310 CMR 15.303 or in--TTULMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time 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: WO 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: ,r/ 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: 2 Page 3 of I l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:43 Marquand Drive Marstons Mills,Mass. Owner: Matthew J. McNamara Date of Inspection: 1 /1 7/0 2 C. Further Evaluation is Required by the Board of Health: 4/d 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: 4b 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 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. ,00 The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ,(j� The system has a septic tank and SAS and the SAS is less than feet but Y 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: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 43 Marquand Drive Marstons Mills,Mass. Owner: Matthew J. McNamara Date of Inspection: 1 /1 7/02 D. System Failure Criteria applicable to all systems: You must indicate 'yes" or"no" to each of the following for all inspections: Yes No _ ✓ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool �ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or Zstoaggcd SAS or cesspool tic liquid level in Ihe distribution box above outlet invert due to an overloaded or clogged SAS or cesspool I Aid—1 I7 / ig-5pr iquid depth in ca4epoe4 is less than 6"below invert or available volume is less than 1/7day flow _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number �of times pumped Q. 9rty portion of the SAS, cesspool or privy is below high ground water elevation. -Le- Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface Jwater supply. Pny ponion of a cesspool or privy is within a Zone 1 of a public well. 1/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.) .! V (Yes/No)The system fails. 1 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. 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 ! 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—1WPA)or a mapped Zone 11 of a public water supply well T 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. 4 Page 5 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFA--E SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 43 Marauand Drive Marszons Mi11G,Ma s. Owner: Matthew J. McNanara Date of Inspection: 1 1 7/fl9 Check if the following have been done. You trust 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 ? 4- _ Has the system received normal flows in the previous two week period ? 4/Have large volumes of water been introduced to the system recently or as part of this inspection ? ZWere as built plants of the system obtained and examined?(If they were not available note as N/A) r/ 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,r:Kluding the SAS, located on site ? _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition f th oe 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 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: Yes no / Existing information. For example, a plan at the Board of Health. Y _ 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)) 5 Page 6 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 43 Marquand Drive Marstons Mills,Mass. Owner: Matthew J. McNamara Date of Inspection: 1 /17/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): � DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): .c�6J; Number of current residents:_ Does residence have a garbage grinder(yes or no):y© Is laundry on a separate sewage system (yes or no);dP [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):M Water meter readings, if available (last 2 years usage(gpd)):2 0 00—117, 000 gal lons=320. 55 GPD Sump pump(yes or no): yd — —gallons=1 09 . 59—GPD Last date of occupancy, COMMERCIALd"USTRIAL Type of establishment: A�/Q Design flow(based on 310 CMR 15.203): j1A _gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): e,4 Industrial waste holding tank present (yes or no);OJe Non-sanitary waste discharged to the Title 5 system (yes or no):, Water meter readings, if available: IA Last date of occupancy/use: 41A OTHER(describe): 'V14 GENERAL INFORMATION Pumping Records Source of in formation:,&Ve, Was system pumped as part of the inspection(yes or no): If yes, volume pumped: allons- How was quantity pumped determined?�U Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system Single cesspool .U�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): Mto ate of all components, date installed (if known)and source of information: 2i Were sewage odors detected when arriving at the site(yes or no): 6 Page• • g • OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address:43 Marquand Drive Marstons Mi11s,Mass. Owner: Matthew J. McNamara Date of Inspection: 1 /1 7102 BUILDING SEWER (locate on site plan) Depth below grade: /X ."atenals of consrruction.",a-4! .:on 4,40 PVCd/aother(explain): .414 Distance bom private wa+er supply well or suction line: 4,4 if Comments (on condition ofjotn,4, venting, evidence of leakage, etc.): Joints appear tight No evidence of leakage The septic system is vented through the house vents. SEPTIC TANK: Y(lo:a!e on s:te plan) Depth below glade: vtaicrial of construction: concrete,If metal.l&fiberglass polyethylene �dother(explain) ,{/� If tznk is metal list age:,yfj Is age confirmed by a Certificate of Compliance (yes or no);o (attach a copy of certificate) >> �/ Dimcnsions: .�J� f%1112 � � Sludge depth Distance bom op off lucre to 'ooc!orr. of outlet tee or baflle:1 Scum thickness: Distance bom top of scum to !cp of outlet tee or baffle: D,sunce bom bonom of Scum to bonom of outlet,tee,o�j baffle: _ How were dimensions determ ned: /sue Comments (on pumping recoTmendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inven, cvicence of leakage, etc.): Pump the SPz]1'lr tank PvPrCy 2-1 Parg,Tn1P+- R nl]t1Pt t-PPc; a r o _i n p l a n c T h e tank i s c?o-i,ate � --s8 ta- E�-a-nd--S 6lGT S n8 evidence of leakage.The liquid level at the outlet invert is 51 " GREASE TRAP�locatc on site pl2n) Depth below grade: VY Material of construction4Aconcrete44f metal fiberglass fApolyethyleneA4?_other (explain): .414 Dimensions: Scum thickness: Distance from !op of scum to top of outlet tee or baffle: Distance bom bonom of sea:.^. :o bonom of outlet tee or baffle: 4 Dale of last pumping: 4-1)w Comments (on pumping recornme:.dations, inlet and outlet tee or baffle condition, structural integriry, liquid levels as related to outlet invert. evi'cn.ce of leakage, etc.): Grease trap is not J�resent. 7 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:43 Marquand Drive Ma-stons Mills,Mass. Owner: M;;H-haw „T McNamara Date of Inspection: 1 /1 7/n 2 TIGHT or HOLDING TANKS /�(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: 10,1 Material of construction: concrete Wmetal&4fiberglass /Apolyethylene Nother(explain): Dimensions: AIA Capaciry: A)14 gallons Design Flo A: ��{ gallons/day Alarm present (yes or no): A44 Alarm level: A14 Alarm in working order(yes or no):,,12 Date of last pumping: A44 Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not presen . DISTRIBUTION BOX. _L/of present must be.opened)(locate on site plan) Depth of liquid level above outlet invert: Ala 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.): Distribution box has one lateral.No evidence of solids carry ov r No evidence of leakage into or out or t e PUMP CHAMBERi(&&(locate on site plan) Pumps in working order(yes or no): Allf Alarms in working order. (yes or no): 40 Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Dmmp_ chamh r is not present 8 Page 9 of I I o 1 � OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 43 Marguand Drive Marstons Millc _Mass. Owner: Matthew J.-McNamara Date of Inspection: 1111 7/0 9 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) 1 -1 00 2 stone. 6 ' X1 0 ' If SAS not located explai.-t why: Located; See F-age ! E) Type leaching pits, number: leaching chambers,number leaching galleries,number: leaching trenches,number, length: d leaching fields,number, dimensions: 41 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.): Loamy sand to fine enargin sand ai ure or ponding Soils are dryl7_onotata6n-3a--"*- - Waste water -s 17" below the invert pipe. CESSPOOLSJ�(cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: 0 Depth—top of liquid to inlet invert: -40 Depth of solids layer: X)A Depth of scum laver: IVA Dimensions of cesspool: A Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Cesspools are not- jorp�zsnn_ PRIVYAA&e(locate on site plan) Materials of construction: 160 Dimensions: r9 Depth of solids: .Qf Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Privy 9 f Page 10 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAdd:ess: 43 Marquand Drive Marstons Mills_,Mass. Owoer: Matthew J. McNamara Date of Inspectioo: 1 /1 7/02 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. 43 Vyna(-c a l7r rnacs�-o,5 Vet;« S I Ga ra C A I Al - tZ4 j " 16 �„ 2, 20 ;� 0 t 3 - Z`1 3� 301 L ,t 0 a- q0 3 3 10 •, a Page l I of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:43 Marquand Drive Marstons Mills,Mass. Owner: Matthew J. McNamara Date of Inspection: 1 /1 7%o2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: 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: Used. Gahrety & Miller Model 12/16/94 Ground water elevation above sea level. Used, USGS Observatian wPl1 riata JtlA2 1999 92— — to 2 Leaching >f Pit 14101� Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom Of the leaching pit and the adjusted groundwater table is feet. 11 `a nrnr�.—nrsr-.n—arn. mrnn*rrs-�ertr.nrs.*.m.�r+tasrr�rrnnrmtser+ttin�'�nvew"r �7 TOWN OF Barnstable BOARD OF HEALTH SUIISUItFACF SF,WAGF DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •••T•��T••. :: —T.,11.�.�aTlSTTI"ITr1 TIlr.TTT/l.TTT't�.'I r111TTt1R1.TTl1TRAr 7 fI11 J -TYPE OR PRINT CI•EARL1'- PROPERTY INSPEC7'ED STREET ADDRESS 43 Marquand Drive Marstons Mills,Mass. ASSESSORS MAP , BLOCK AND PARCEL # OWNER Is NAME Matthew J. •McNamara PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME Joseph P. Macomber & Svn Inc COMPANY ADDRESS P.O. Box 66 Centerville Ma 02632 Street Town or City state ZIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT - I certify that I have personally inspected the sewage disposaj system at this address and that t)le information reported is true , accurate , and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check / ne ; . I/ System PASSED The inspection trhich I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or Lhe environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated Are as stated in the FAILURE CRITERIA sectio►) of this form , System FAILED* \ The inspection which I have con i►cted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signatur v Date One copy of this certificatio t b the IIUYER here applicable ) and the BOARD OF HHALZ'iI, * If the inspection FAILED, the owner or•".operator shall u d within one year of the dnte of the inspection , unless allowed ortrequiredm otherwise as provided in 310 cFIR 16 , 305 , partd . doc says— L0SkTION SEWAGE PERMIT NOA,� L" LC)7-5 F-6 jc;� M/�W _� VI L L A G E % � I rr i INSTA LLER'S NAME B ADDRESS i L/ f2/x-d 151tv_s -zti Ce BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 12-- y �8 � �� !' �d .s �' ,��.�i Q �p o� 0� _ �� �� 1 N Fizz- THE COMMONWEALTH-OF MASSACHUSETTS BOAR® OF HEALTH ...........................................OF.......................................................................................... Appliration for Disposal Works Tunstrnrtiun ramit � Application is hereby Moor a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: 1 P �13 ar u I 3- .......h�l_. .. ..._.............................................. _ ..o .... -- ---------- 1- Locatio.j Address ner Address Installer f Address Type of Building Size Lot. ` ..Lf .Sq. feet Dwelling—No. of Bedrooms....... ................................Expansion Attic ( ) Garbage Grinder ( S Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Q' Other fixtures ...................................................... ••-•---•-•-------------•-----... ------ W Design Flow.............................................gallons per person per day. Total daily flow............................................ WSeptic Tank—Liquid'capacity............gallons. Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.........,.c...... sq. ft. z Other Distribution box ( ) Dosingtank ( ) i VV-r1 ?�1 d �t a Percolation Test Results Performed by--- t__' .1�11L..___.._...�........................ Date._..��Z . ._.--------.-----.. Test Pit No. 1...;L7.....minutes per inch Depth of Test PitAA?..r-------- Depth to ground water.._ P de..___. 44 Test Pit No. 2....a.:'.....minutes per inch Depth of Test Pit---Ll........... Depth to ground water.....I'l_�.h�. RS ......................... ....... ---• .----- O Description of Soil....... 1 ._..C'......�19 .... Vi....._. .� --------- ---% c 1 \- x I< V U -...--•-------------------------------altw 1 ,tit+ .... a °h? ------------------------•------------------------------- 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 iITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in- operation until a Certificate of Com iance has be i ue the b f health. Sign: •. • ------------------------------••-- .........................._.... l D to Application Approved By........... .... •-------. . Via ) 3 n� Z � Date Application Disapproved for the following reasons:................................................................................................................ ---------------------••---------------.....----------------.....-•-----------------•-------•--------...--•--------------------•-•------------------------------•----------------•••--------•-------••--- Date PermitNo......................................................... Issued....................................................... Date Z-:5- FiD No. A. . ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................OF.......................................................... Xplifiration for Uhqvasal Works Tonstrurtion Famit Application is hereb made V, 'r _ -,.frg a Permit to Construct or Repair an Individual Sewage Disposal 4zimt t: L-,:)� e�11A.r&UOL Ir v 'U t-A 5 ...........................................;1'..........1. .......L....... es V 107 , F&rrq e_6ty�4 tuti-63)1�1-41 .............I .......L............................................................... f........... ... ........... ............ -4. 43 Address ................................................ --............... ---......................... ................................................................... -­---------- -----Installer Address kf i f rzg� Type of Building Size Lot............................Sq. feetj, Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ....................1........ No. of persons............................ Showers Cafeteria Otherfixtures ....................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width....__.__._.___. Diameter._._.._......._. Depth_...._..._..._.. Disposal Trench—No..................... Width..._............._.. Total Length...._.............._ Total leaching area....................sq. f t. Seepage Pit No..................... Diameter...._....___.__..... Depth below inlet................._.. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - _%Percolation Test Results Performed by........................ .. V'1-1..... Dl� e_69p" 1.4 - At I....................... Test Pit No. I................minutes per in f0h qfii��Pit......* ............ Depth to grou er, I ----------- Test Pit No. 2. ............minutes per inMepth of Test PiV-!.-.,,----------- Depth to ground water.-rJ-0-r-re----- ......................................................................w.Ll I................................................................................ 0 Description of Soil...A........................................................... --­--­---- ........ ................. ...... ......... IV3. --- .......12.3e-------------------------- --- ------ ------ .. ................................................................. ...................................... ........... - -- ------ .......... ..2bL--------- U Nature of Repairs or A l:!;�A"io s Answer when applicable............................................................ ................................... ...................................................................0.................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with r A the provisions of TLITU 5 of the State Sanitary A,-olh 4,-:;—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has s e �y Siglie ...................................................................................... ................................ 2D t Application Approved By...... ............ .•.................. n) .........(a. ­Da(----.Date ...... • Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date has 4b *s Le ................ PermitNo........................................................ Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR-Q OF HEALTH 0 Fz5i_Z�3_'ned-ce .................................................................................... Tntifiratr of Tourplinurr THIS,ISJO. ..... CER.TVFY, 'f hat the Individual Sewage Disposal System constructed or Repaired i by ' " ' P .......... 2, . ..... 1 .a............................... ..................... .. .................................................................. Insla at............ .. .................... . ......... ...... ... ........................................................................................................... has been instilled in accordance with the provisions of TITLI� r,of The State Sanitary Code as described in the S application for Disposal Works Construction Permit No----------- ----------------------- dated-_ ....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNSI" SATISFACTORY. DATE.......................... C..................... .... ........1-1-Vi Inspector........ .................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH ........ ....................... ..............0F.. ....... ............. FEE rks rutit b Permission is hereby grXied........... X_ n A............. ...................................................................................... to Construct, or Replr,,\ an Indjvi�u Se aq_p isposal System at No.-------- 4 L,� '-'w C., ..... . .......0................t.................................................. ........................................................................................ Street as shown on the a'-lip'li-cati n for Disposal Works Construction--PErmit jX� Dated.... ............................. 3 ............................... ..................... -6f7joe ------------------- DATE..............................)------ ----------------------------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 'A w 'E S/Gib/ 1D/�T,4 "! �S�//G L L CAM/L�' ^ .3 ,S E/�,�ox�• � J /irk r 6,E- - DA/L Y FGpW //oX 3 = 33a 6.Pa _�/ may. ,3,30/� Zoo U " 6 66. . q4—rlz, E Y U�E /mecca G,4 L.. • � •. S�oE. WA LE, AR,6, /88 5..=. Stft' T"Zo r LES It OF /�ESiG.�/�E,PGo/r4.Tia.✓2.ct i PETER- 8 U L L I VAIN I: RICHHARD. �4 No 29783 j r3 yIl No.240"; ; I i , Tom. �q INV `� -- I j _.. _ _..... . Tc.Sr' oG E P- 4-¢IG 1�='YoV(,D u u sv�T�Bctr/y9TL�Ttr/at. S8 .0/577 /A/✓. 3.3 G4L.. Z /�N-1 �X /nil/ 6�tL. t , Clcq� - , W K i S�Np 674 ,8 a 41,9' CE,2T J z No / c'E'2T/,=y T;UA7 TIV� 7 o DWe,Zi-/Aj G. ,C aG,4T/O.t/ M4)Z AJ S Hi � S W122 CA L �j/ O� �,�� Ait/O SETBA C/G E"V ��2./II S A/o T' 2 c�o To C �40C.4 �'r� !.y/Ty/mot/ T.YE FLoavPG4/y, 7- /0 1-c-C. 23/// C i- . e.QsEo av,ar/ .eEG/sTE.eEo .two su�i�Ey�r //V.ST.2lfi�1.�NT CST /N�,S �4Pi�,L /C.�i�T /J�UG,y la- �.4 itl GLC� n:.enuE;w. :.:.•iC.e t-Irvr 10.--,(i4 f tt3 21 s9 �2ry V � SNt=CT Z�=Z PETER yJ SULLIVAN V NO. 29733 �f �'IST£f' cv�cQ J , / � L_.GC. Z o 0 70 C' n LoT I0 LCG 23 1 1 1 C'. �1{ f h!q Lo-r � •�` RiCHARD „r�» 9° ��'t- b!J L-GC 2 3 111 G A. r� 13AXTER u No.24048� h. 4, �/STEM �# � 7 ' \ r TIA o s4 --1 T N 0.•S3. o,� : \ 5 S-:PPOP. Zoe PT i ) J J St 56 � Sa•o a � J -.� ' : LCC. 2 007OG S 4o' ySi IJo TE 1 CLEVAT"i o Q S gAS(`D o►J N- G.V. D. TAY-CL) FR-AM A pIAV,J aY 6ae��cs ������-L-rznvG Co.Tvc nl,l �1 v1 snQ.,. 19 85 4-� I : K �I 3 13 Go.e15)OM OA/G'y "=!.'nW ytc)5 G. O. � FA C14 ,o/SPOSgGJPi. (J 5 E / c� G 4 L. S Alte Z-77 jA OR LESS ZH OF �llgss9 I ati�� •°� PETER saA� c _ RICHARD. o _ SULIIVAN d .�+ A. �A No 29733 y 1i� TER H pp No.24048 ; STEM 41 r4oL.E' P 4.¢lC QL-"lYovLD UA)sviT98e ly97t---/v4L. l`'14Y: 2,.l98s � : 412o b SySrLAj , T o � ` CAA r►� g'; . y,S 33 G 4L.. IAIYJ /nit/ GAL. . /hdU,FPi S3.g S4,¢ ScPT/ 154.L W z 3�tl _ �K S`14N , G2:41 j �Z No wa f�2'aPodEO. / CE2T/,=Y. T,UAT T�� DLVc:c���G. �oGAT/O�c/ M4A.S7A1S HI/IS rr 4//,4LEis-/E�t/7'�S' Off" T,y Totsi�t/OF (• 9QNs T�9 Q'CE :4.vo /s ;X/o T LoT 8 uC. 2 0 7o G ,C o c.4 T,Ev ly/Ty/�t/ T;YE T / L o C. .�3� p OATS:T=B� +" Q ARA X7�=-26�t/yE /it/C. ::::%oV A,{/ �eEG/sTE.2E� L /!O SU.eYEyb, O�►SSE'TS,Shnvu/.Y S.�ovt.a ,%7- g� U,SE ) Tom'06'72FP- WE '.�-OT /N6,S A I zI-/G,4iV7- /-/vG-,4/ 4r. :(!', _' AI.F•n NE,a, ;..t•Ir,e L,,F, 1 Q.56 J. ���P• qs�9 � �2�v v � s�-/t=CT Z�=� Oki O� PETER yc 0 SULLIVAN No. 29733 `�I i .t` STEP• �� � FfslON J , Lzc. 2007o Lo-F 10 LCC 23 I I.I C' RiCHARD rG^�1� CL L-GC 2 3 ll.f:C* s � A. � uI BAXTER \ / No.24048 1-14 \.. . `I '/... 40.� \ ` \ 54 PIS qj / \ I 4 W / -� L.C.C. 2 CO _ a . j\)o TE G-LLVATt o 1J S gA S GZ7D OW 4.4 �... - YmB............?v.......... THE COMMONWEALTH OF MASSACHUSETTS EBOARD ?F E*AtTH.............OF........ ................................................................. Appliratiou for Disposal Works Toustrurtiou Prrutit Application is hereby made for a Permit to onstruct or Repair an Individual Sewage Disposal System,��t: ................................14)..........;.......�1��Gt� ..... .... " *Location- 0. Lot 0 ............. ...... ............. ........... 4M.................. .... ................................................ . ....... .. or_ ft�, ............ n 0, d s Installer Addres s Type of Building Size Lot......... U s.........3..............................Expansion Attic ( ) .G .....Sq. feet Dwelling—No. of Bedroom Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) <P4Other fixture�...................................................................................................................................................... Design Flow......................WQr............gallons per person per day. Total daily flow..._... 33-.D.....................gallons. WSeptic Tank—Liquid capacity/ .gallons Length----9.....Width----�=x....... Diameter________________ Depth...._........... Disposal Trench—No..................... Width_. .____....__._... Total Length___....._........... Total leaching area_._.._ . ' sq ft. Seepage Pit No---------4........ Diameter......IR....... Depth below inlet.............. Total leaching area.. . --....sq ft. Z Other Distribution box Dosing tank Percolation Test Result Performed by.......................................................................... Date........................................ Test Pit No. I._-_.� ...minutes per inch Depth of Test Pit.................... Depth to ground water_____.__.............__. Test Pit No. 2..............:.minutes per inch Depth of Test Pit.._................. Depth to ground water---­---------­-­---- P4 ..........; ............. . ...... ----- .. 0 Description of Soil...... _4- --------- ------------------�4 ----------------------------------------------- ................................. ......... . . ........... ------------------------------------------------------------------------------------------- U -------------------------------------------------------------------- ------- .............. --------------------------------I..........................I.......I.............................. U Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------.................. ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the proviKieka f'I'LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation n Cdr�tificate of Compliance has been iss y the board of health. Siled...... ... ...... ..... ... .. ............................................ ----- ................... D t P E� ............... Application Approved By......- ............... ............ ...................... ................q.7................ Date Application Disapproved for the following reasons:................................................................................................................ .........................................................................................................I............................................................................................... Daft Permit No........ ................................................ Issued....................................................... Date ---------------- ------- ------- 00L.. 1/ mac•^•-�—_�=.+_,; S:. � ,,..,-____. THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH z 11............OF......... ,1',.•;' Appliration for Dispnsttl Works Tontitrurtiun ami# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at r s,.�y Location-,tTddress q or Lot No. ---.. -�: r ... ! : ............../ /`.° .. - .......-•............. / Owner .� � A ss ................�. .d�.... r ...__ Y............................ .............. ........................................... Installer Address w-: d Type of Building , Size Lot..., .Cj ---,.Sq. feet U ,..,, Dwelling—No. of Bedrooms___.....,,............ ............Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons ........................ Showers W YP g -------------•-•--•.•---••-• P ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------------------... W Design Flow..................... ...............gallons per person per day. Total daily flow........ 1--_-----------• _gallons. WSeptic Tank—Liquid capacity'�-€,..gallons Length .... Width-_.f ........ Diameter__ ............. Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area___.;_._............sq. ft. Seepage Pit No---------/---------- Diameter......yf--�......... Depth below inlet...47........... Total leaching area.0"V-6.......sq. ft. . .. Z Other Distribution box ( ) Dosing tank,( ) _ Percolation Test Results Performed by--•-•---•-•-•--•----•-----•--•---•------••••-----------------••--•--•.... Date........................................ aTest Pit No. 1.. ." ._-_minutes per inch Depth of Test Pit.................... Depth to gro-.ind water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... .., - ._.. , ........O Description of Soil----- . . . % t-2: t. --------•------------------------ U .________________________________ .L_.__._w�-=------_.,___�J_______________.................._.'._--_---_---•-•-----------._ ---_-_.-- --------- --------------..._---____-_--•- •- �ts .............. ,� ---- 6__ ✓<......................................................:.......................................... W a,r._._ UNature of Repairs or Alterations—Answer when applicable.................................................:._:_........................................ ------------------------------------------------------------------------------------------------------------------------------------------- ............................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the prow on f TITLE 5 of the.State Sanitary Code— The undersigned further agrees not to place the system in operation tjfiltiNa Certificate of Compliance has been iss dby the board of health. Signed. -! �• �� l �------------------------ F ........ ........ .......... .._..._ Date Application Approved By............ .. ..... -"�--�.... sc�........--•-•-•----•------ .�. ........ :.. Date Application Disapproved for the following reasons---------------------------------------------------------------•-----------------------....................... -•-------------------------------------------------------------------------••----•-----.......--------------•----•-------------------•---------•--------=---•---------•--•--------••------••-----._..... Date Permit No--------- Yam. — _ = ................ Issued--------------------------------------------- ------ Dace THE COMMONWEALTH OF MASSACHUSETTS f BOARD�F HE LTtK r' ......... f. ..........OF....... % .....:......U........ Trrtifiratr of Toutplianrr , THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Wj'or Repaired ( ) ` r , 1 { by-------••-------------------•--------• es. I ................................................ ..... .at.................... .. ---. _ ��� � Installer � at-•••........................ ::�--- •Z!_ �!°G! .� , Vj----------_-- � ........................................................ has been installed in accordance with the provisions of TITLE_5 of The State Sanitary Gj�le csd in the application for Disposal Works Construction Permit No------ ------ L....... dated_-..._--...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT ON ATISFACTORY. � 2 DATE... Jl . -� Q�-: •------------•---•-------- Inspector ......--•--- -� -------------•--- THE COMMONWEALTH OF MASSACHUSETTS } BOARD (?,F HEALTH y(J ...rf.. :;�.. .....OF..........�� v ....1 C�!.-' _--:..r�?.......................... No.�....... ...:...... ✓ FEE........................ Disposal sal Works TUoustr tin ramit Permission is her y granted............. • �' to Construct ( ,,of Repair ( ) an I,ndwi a wage sposal � V4j ° •:�' 1��'rJ� t�/'� ` F---------------- . as shown on the application for Disposal Works Construction Permit No-._.=_ _��____ Dated. ��,,t_ .•_--_--•----------------- K 4 Z, �1 i Board of health DATE................................................................................ FORM 1255 A. M- SULKIN• INC., BOSTON /t/o �54,Q gAGE G,e%uoE.e r I� /o z • Z /v/ • (o ,s/OEW,GLG ,G,2�Q = ��p S,c /o/• Z tv TOTAL. Rp, /o/ c � S.4w \i I i.„e�IiaMa: OE,S/G•S/ �E.2COL4T/aN 4 .' PETER A. %�ivK�'� ��3 y'��� ���,�,jH QF•�i;pq�,s �f Q I1� f 7 /a/ v SAXTER �;• �, SULLIVAN /n Nc).240"8 No. 29733 / le ir•; vRV Fs ONAI �MaVE•�JLL.C�/Sv/Ti.�'T3L.L�' 46 TEST f/acE lY1/,LTG-'�"�/.�l-L �-c� Icy FG S IcZ.S .i `� Ta�fivQn/a3.Z ,a BOX VV Z- LEA--&P/! ,Z 71'$ :. !�✓`AtHE17 :� /N✓. /NV i' ro �3 Z r3v2.�/ST�Y�•L -�/'�-- c '- /•�»-- LOG,�T/O.y Ste/7-v /7- 7 7;/.47-TNT" �•c.�/��4�'icn,Sh�aWiv �,�E.�� /a •/3• '7� A.V-9�L="Tl/aG,� .e�4/J/,eE�1�NTS Of 7y� �2.EGisTE.EcIJ,G4rvo.Sli.2riEya,Ps �-/a. CSC' it���1 �'� � C� �� t�.a,� -���......✓ T//G��L,.e�V /.s �VoT a.4SE�G�v,4�V i�Y.ST,2- -�/�IE�YT..SU.ec/EYsIN.O T//E aaFS�Ts S�LOGf/i!/h�E.��4r✓.5,4/4UG��/aT�E USEp