HomeMy WebLinkAbout0077 MARQUAND DRIVE - Health A =�U10
"U`Si5
77 MARQUAND 5\k, MARSTONS MILLS
A = 098
SATE ; 10/5/01
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77 Marquand Drive
PROPERTY A O O R t? S S: ----------------
`Marstons Mi_1.1s4Mass
02648
-----------------
On Iho above dote, I inapooted the aeptfo ayite'rb at the aboyo addre s s
This systom conslata of the following;
1 . 1 -1500 Gallon septic tank.
m 2. 1 -Distribution box.
2-1000 gallon precast leaching pits. � 'X10 ' effch
Based on my Inspec o 0ert (y the (o owing oondltloni:
4 . This is a title five septic system. ( 78 Code )
5 . The septic system is in proper working order
at the present time.
6. Pumped the septic tank at time of inspection.
Heavy scum & solids layers were present.
SIGNATURE.
name : ,,d .3.�.Tt,ssQa�tC.yU�___www
Company: Jo, •�h_P . _N+comber-& Son , Inc ,
Addle 55 :_ Box- 66-__-_________
-� C,n � , rYille � Ne-- 026�2�0066
Phone : 508- 17_S- 7 > >8-w_THIS CCRTIfICATION OOES NOT CONSTITUTE A OVARANTY OR WARRANTY
JOSEPH P. WOMBER & SON, INC,
T+nki0�i iPooltl,e+chll+ld+
Pvmp�d 4 Init+Ilid
Town Sjwi! Connootlonl
P,O, 8ox 66 Cinorrlllo, MA 02637-0066
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COMMONWEALTH OF MASS9CHU9'ETTS
EXECUTIVE OFFICE OF ENVIRONMENT FAIR� AL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Propert)• Address:77 Marquand Drive
ars ons Mi1l_s�Mass.
Owner's Name: David Clarke
Owner's Address:Same
Date of Inspection: 01
Name of Inspector: (please print) J.P. Macomber Jr.
Company Name:Joseph P. Macomber & Son Inc
Mailing Address: P,O. Box 66
C'ani-i—ri7i1 1 e Ma 02632
Telephone Number: 508-775-3338
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 10,
o ection 15.340 of Title 5(310 CMR 15.000). The system:
Passes
_ Conditionally Passes
_ Needs Further Evaluation by the Local Approving Authoriry
F it
Inspector's Signature: W a I/
Date:
The system inspector shall mit 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.
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
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 77 Marquand Drive
Mars o;.M"irrs., ass.
Owner:David Her t7 e
Date of Inspection: 1 0 5 01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A.Gstem Passes-
.� I hav�O �304
inform�Anyy
hich indicates that any of the failure criteria described in 310 CMR
15.303 or in existailure criteria not evaluated are indicated below.
Comments:
The septic system is in proper working order at the
present time.
B. System Conditionally Passes:
.fed 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.
VQ 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:
_0 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:
,0 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
I
Y Page 3 of l I i_ y
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 77 Marquand Drive
P
ars ons i s, a s.
Owner: David H. Ciarke
Date of Inspection:
C. Further Evaluation is Required by the Board of Health:
4 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.
I. 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:
0 Cesspool or privy is within 50 feet of a surface water
Ale 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:
/0 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.
No The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
/I The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
/V,�o 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-yell". Method used to determine distance 1 �
"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 I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 77 Marquand Drive
Mars tons MillsMass.
Owner:David H. Clarke
Date of Inspection: 1 0 5 01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No/
_ i/ ackup 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
L/ Static liquid level in t e distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Riquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow
equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
/ of times pumped
f� 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.
y portion of a cesspool or privy is within 50 feet of a private water supply well.
�y portion of a cesspool or privy is less than 100 feet but eater 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.]
A/2) (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.
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•
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 whe system is within 400 feet of a surface drinking water supply
'" the ystem 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
Y g mapped
Zone I1 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.
4
Page 5 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 77 Marquand Drive
Mars tons Mllls,Mass.
Owner: David H. Clarke
Date of Inspection; 1 07-57T1
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No,
l/ Pumping information was provided by the owner, occupant, or Board of Health
ere 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,,e'/cluding 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 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.
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))
I
5
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DATE P44110111 ISSUED
i DATE COMPLIANCE ISSUED
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Page 6 of 1 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 77 Marquand Drive
Mars tons mlils,ffass.
Owner: David H. Clarke
Date of Inspection: 10 0
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):I- 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 or no):
Is laundry on a separate sewage system(yes or no):.VI? [if yes separate inspection required]
Laundry system inspected(yes or no)-Ai
Seasonal use: (yes or no):4,J2
Water meter readings, if available(last 2 years usage(gpd)): ����
Sump pump(yes or no): /0 �S
Last date of occupancy:
COMM ERCIAL/1NDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): dlj gpd
Basis of design flow(seats/persons/sgft,etc.): iJi9
Grease trap present(yes or no):.,40
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use: Zl,,4_
OTHER(describe):
Pumping Records GENERAL INFORMATION
Source of information: ZAeL
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: /dad gallocns-- How was quan try pu ped determined?
Reason for pumping: G�¢!�> clG/J�l"2 XWL �s'
TYP OF SYSTEM
Septic tank,distribution box,soil absorption system
!� Single cesspool
,Vg) Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records, if any)
/U Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system own
/U�Tight tank�Attaph a copy of the DEP approval
,61)Other(describe):
Apmxirnare ageof alllcomponents,date installed (if known)and so'ur e of information:
Were sewage odors detected when arriving at the site(yes or no):111/
6
► Page 7 of 1 1 ,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 77 Marqugnd Drive
ars ons i s,Mass.
Owner: David ar e
Date of Inspection: I TTV0-1
BUILDING SEWER(locate on site plan)
Depth below grade: -V —
Materials of construction:/4cast iron 4k)40 PVC_Pother(explain): Te r�
Distance from private water supply well or suction line: /0'f
Comments(on condition ofjoints, venting, evidence of leakage, etc.):
Joints appear tight. No evidence of leakage. System is
vented through the house vents.
SEPTIC TANK: Y (locate on site plan) 1��,414�3
Depth below grade: 1�
Material of construction: !/concrete metal fiberglass I.LVpolyethylene
�11Qother(explain) /1l
If tank is metal list age:Al Is age confirmed by a Certificate of Compliance(yes or no):yo (attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:e
Scum thickness: _(L_
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bolt m of outlet tee or baffle:
How were dimensions determined: � �%Ji�tlG d' /llS9N,GJJacJ
Comments(on pumping recommendations, Inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of-leakage, etc.):
Pump the septic tank annually Garbage disposal is present
Inlet & outlet tees are in plane The t-ank is structurallz
sound and shows no evidence of leakage.
GREASE TRAP: locate on site plan)
Depth below grade:A)Y
Material of construction:.!/,I concrete,4metal I/ fiberglasWolyethylene/il other
(explain): .,)/9
Dimensions: AX
Scum thickness: 4M
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: 11�w_
Date of last pumping: A1�4
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Grease trap is not present
7
Page 8 of I I
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 77 Marquand Drive
ars ons 1 s,Mass.
Owner:David H. Clarke
Date of Inspection: 10/5 01
TIGHT or HOLDING TANKAW (tank must be pumped at time of inspect ion)(locate on site plan)
Depth below grade:
Material of construction: concrete 40 metal fiberglass ___polyethylene dA other(explain):
1 Dimensions. ,{
Capacity: %—_gallons
Design Flow: gallons/day - f
Alarm present(yes or no): A),4
Alarm level: ,IA Alarm in working order(yes or no):
Date of last pumping: AA —-�
Comments(condition of alarm and float switches, etc.):
Ti.aht nr hn1 rij nQ tanks are not present
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: t16
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 two laterals.No evidence of solids
_carry over No evidence of leakage into or out .
PUMP CHAMBER ,(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pnm�_hamber is not present
8
Page 9 of 1 I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 77 Marquand Drive
Marstons Mills,Mass.
Owner:David H. Clarke
Date of Inspection: 1 0/5/01
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
2— 6 ' X10 ' leach'incr pits.
If SAS not located explain why:
Located
Teaching pits, number: oL
_dLa leaching chambers, number:
A)'b leaching galleries,number:
leaching trenches, number, length: d
leaching fields,number, dimensions:
_overflow cesspool, number: D
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 boney fine sand.No signs of hydraulic failure
or ponding-Soils are dry Vegetation is normal
CESSPOOLS64/G (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: Q
Depth—top of liquid to inlet invert:
Depth of solids layer: ,'
Depth of scum laver: AVIV
Dimensions of cesspool:
Materials of construction: /U/
Indication of groundwater inflow(yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
Cesspools a Q- nGt present
PRIVY(locate on site plan)
Materials of construction:
Dimensions: A14
Depth of solids: I
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Privy is not present.
9
I
Page 10 of 1 1 t ,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:77 Marquand Drive
Mars tons Mi s,Mass.
Owner: David H. Clarke
Date of Inspection: 10 5 01
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.
-7 7 W arq o Avid Dr, *Kamto s 04. S
`, vsar�R
lo
100,
10
Page I I of I 1
a
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 77 Marquand Drive
Marstons Mills,Mass.
Owner: David H. Clarke
Date of Inspection: .10 5 01
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.Groundwater above Sea level
USGS 92-0001 Plate# 2
Usgs Observationwell data ,Tune 1992
Top of Ground
Leaching
Pit 'eet
Groundwater: Feet Below Bottom of Pit
Therefore, the vertical separation distance between the bottom
of the leaching pit and the ad'
feet. ustcd groundwater table is A�
11
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TOWN OF Barnstable WARD OF IIEALTII
SUIISURFACE SEWA(;E I1ISPOSAL ,SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
•••T•'1�T•'.••.' -T.t1I.�.�1T1.rITT1'n.'TrI TIT IRnftRT1"11-!.'1 '11T117IR1R�T��RnIN.�R�^At7 iRn li ..ter T'�•�. -. .
` -TYPE OR PRIHT CI.EARL1'-
P/IOPERTY INSPECTED
STREET ADDRESS 77 Marquand Drive Marstons Mills,Mass
ASSESSORS MAP , BLOCK AND PARCEL # 098 239Y
OWNER' S NAME David H. Clarke
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P. Macomber Jr.
COMPANY NAME Joseph P. Macomber & Swn Inc
COMPANY ADDRESS P.O. Box 66 Centerville Ma 02632
Strvvt Town or CJty Staty IIP
COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 1 790 - 1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposaj system at
this address rand that t)Ie 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 .
Chec one :
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or, the environment as defined in 310 CMR 15 , 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED* \
The inspection which I have con ircted has found that the system fails to
Protect the Ptiblic health and the environment in accordance with Title
6 ) 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
e
Inspector Signature AO Date e�5��d1
On e copy of this cer fication must be provided to the OWNER, the BUYER
here applicable ) and the D0ARD OF HEAL1'Jr,
* If the inspection FAILED, the owner or"'*operator shall u d
within one ,year of the date of the inspection, unless allowed ortrequiredm
otherwise as provided in 3.10 CMR 16 , 305 .
partd .doc
" A 2
,9 AT16 � �SEWACE PERMIT NO. �
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diLLAGE _ f1SF, '7�
INSTALLER'S YE 4 ,ADDRESS
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0 U L of R OR O W N S ��,a-tin
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DATE P&MIAIT ISSUED
DATE COMPLIANCE ISSUED
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P.9alf
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......�................._
o� ✓ �q�� T E COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
���H .............0 F.........:........ ... ....
ppliratinti for Uiipnsa1 Workii Tilu trnrtinn Vamit
Application is hereby made for a P it'io Construct or Repair ( ) an Individual Sewage Disposal
System at: 7 1
............ .__.. ...._........ "1....------ :....t►.04.. ;...i .�dr,.. - 2 ._ .......
Location-Address or Lot No.
................. .�-"--M-----.5 �!t au`. r -:....�.N.e.j.-.............--••----------.............._.....
Owner Address
a � ....:................. :........ -.......... ?fly b_wte ,.r.......... ..._.....
Installer Address
Type of Building AA Size Lot.2 66_.�.__._.Sq. feet
Dwelling—No. of Bedrooms...........Y
............................Expansion Attic ( ) Garbage Grinder (V/)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures --___-----_•---------------- -
W Design Flow..................S- --:--------....gallons per person per day. Total daily flow_....�I0..........................gallons.
WSeptic Tank—Liquid'capacity/�PPgallons Length 1 � r. Width._. . r Diameter________________ Depth.... .1._..
x Disposal Trench—No. ........ ..... Width•- 0 .--. ..._._ Total Length. ._._. Total leaching area........... .......sq. ft.
Seepage Pit No..�_.�.. __.. Diameter.___...__.____ Depth below inlet__...__________ Total leaching area_ .. ..sq. ft.
Z Other Distribution box ( v/) Dosing tank ( )
'—' Percolation Test Results Performed by. - �?fz:_5r�'J �ate...._J2.��7 -��
Test Pit No. 1.G._3n._minutes per
inch Depth of Test Pit--- Z�...__._ Depth to ground wate . �.
GL, Test Pit No. 2..._.__..Z_._minutes inch Depth
of Test Pit----I ..__..__.. Depth to round wates:r�__ �F
Description of Soil--- ------. Q �
O Q..3� Goan. S Solt - at
x •--•••-•--.-- <<= " C- s y ------- wry_ i r�.......-----•-----------------------------
U ) rr / Ir 9
W ...........•-------------- .5S, ............. -0..
VNature of Repairs or Alterations .—Answer when applicable......................... ............... _.._.__....................._.............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLij 5 of the State Sanitary Code—The undersigned furth grees t to place the system in
operation until a Certificate of Compliance has(�e. n issued by the'board of heSigned ___
...... .
Dat
Application Approved By________ ::<: �_.��� ...........
..................
ate
Application Disapproved for the following reasons---------------••------••----•-------------------•-------------------------------•---------..._......--•---------
...................••-•------•-----•-•-......-----•••--•-•-••-----------•-------------......_..---------..__.._.._..••--•-----•••----••-----------------•-•-•---••-------•----- .........................
Date
PermitNo......................................................... Issued.......................................................
Date
rX r
�i
NO..P� C/7 ' Fps.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....-.
....... ................OF........... ................._......._..---.............._...............
Appliration for Disposal Works Toustrurtinn rrmi#
Application is hereby made for a Permit to Construct ( 4`) or Repair ( ) an Individual Sewage Disposal
System at:
_...
A ..• Location-Address or Lot No.
............................................ ...................................L AL r._... ._.._.........
Owner / Address
WZ.3a��.a;�� .4.. .........................................
Installer Address �yC
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a'4 Other—T e of Building ............... No. of persons............................ Showers
YP g ----•--------------------------------------P ( ) — Cafeteria ( )
04 Other fixtures ---•-•......•----• •---•-----••-•--••-•--•---•--•----------•-----•-•-
Design Flow....................�ac'..,��.................gal lons per person per day. Total dailyflow.._.......'7�`.�_-............._........_gallons.
WSeptic Tank—Liquid capacityZ���gallons en th_t .�� � Width....S' Diameter................ Depth.....
x Disposal Trench—No..................... Width. . .__._..._`�*Total Length-__.._..::_`:___..._ Total leaching area.._....___:.._....Sq. ft.
Seepage Pit No..f...��__�_... Diameter.._._. �._.... Depth below inlet--___ ...._... Total leaching area.'..' p.._sq. ft. .r
Z Other Distribution box ( ✓) Dosing tank ( ) �11 1 -
'-' Percolation Test Results Performed by........ ............. ................... `' ��}?7.�'!��.Date........................................
2. P P / r p ground lV,6�F
Test Pit No. 1________________minutes per inch Depth of Test Pit___.__. Depth to ound water......_____._.__..._._..
f3. Test Pit No. 2__'- ... ..minutes per inch Depth of Test Pit....7 _...____. Depth to ground water ^R: i4 C_ �f b
_� L O a�rz+t i S G r?�rG7/G. � �w —��-------------•-------......
O Description of Soil•--•-/•--•------• --•••-----......................................-•------=---•••....%. ....-• -- ---- ...
x ---•----••-•--•--••----••................. ttr� 11•- c ,. ....................................` �' ......................................................�' 'U
007-0 7—
r zr ;
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 TITHE 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 board of heea1lt
Signed...........................................
...............•-_::__ .--...........................
Date
Application Approved BY :_ ... y .-•-•-•-•---•......----••---•- _D '..:......
ate
Application Disapproved for the following reasons:...................................................................................--------------•-----------•-
-••-----•--------------•-•--•--•-•-•--------•-•-------•---....--------•---•-••-----•----•--•-------•-•-•-•-•-••-•---------•-•-----•-------••-------•-••-••------......................................
Date
PermitNo.......................................................- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Tntifiratr of Tompliattrr
THIS IS TO CER IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-----------_--- .•- ------•:�._.......... -----------------------------------------------------------------------•.•..........------------------------------...._--•.--
Installer -----------------•-•---- -
at.. ° •----•-----• 0 ....
has been installed in accorce ith the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal
osal Works Construction Permit
•--•-•------ dated----------------•...--------•---•-•-••-•---
THE --•--
ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................•-----------•-•--......-•---•-•--•-••-••-......---_..... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
QG✓1I/ /)
................O F.---...:............. N t c•- �✓
No. .....::....... FEE.. 5.............
Diupnuat Iforks Tonutrurtion rrutit
Permissionereby gran ted-...... --• = rr' .. "
to Construe I or Repair C ) an Individual Sewage Disposal SS stem
U Street
• as shown on the application for Disposal Works Construction Permit No...................... D ted.---••------------------•-•------_-------.
DATE............................ L.�l_ . /'�'-v-•..................... Boar of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
'7� �v10►t7�/GnC� o�
oV- Oa3-07Y
LCP. 231119 ASSESSORS MAP 98
LOT 8
PARCEL 23-073 \\
J AMEWS MAP 98
PARCEL 23:074 `
/ sl
\ / 4' GATE I
\\ IMPOSED TREE ( x49.8 x48.3 / r
! LINE ( �'
PROPOSED 41 � I
?/ I 15 WALL /
x53.3 BENCHMARK RODCAP x48s 1 7
M. = 49.8t -
POOL x43.6 /
( 4 .5 / x41.2 /
hti ELEV..=45.5 /
\ V\` ; i�`\ � x51. /' / x45 IE
.7 / 4�
a
RCH � GA
47.
GALE '� . �# e�°3 A 18' WIDE STONE WALL
APPROK. LOCATION TOP WALL ELEV.=48.0
SEWAGE DISPOSAL /, �i"� �� t � p �' � / l '/ 1
EEN SYSTEM / !,! IRRPOSED CHAIN
/ ' YGAZ 0 of r' i ,R_ O�
r SE. — - —, . �.\ � r, / 5 t11 h i _ / I LINK FENCE _ �6.0
/ �
_._ � .s3,�,t,+y /
136.1
BRICK STEPS � �z � / ��� / / ' GA� I /
/ BRICK PAi10 / Ile
/ /
s
45
/ WEBO TO BE / )LID / J
/ REMOVED
--y w / / /
/ � x38 /
X d // TOP OF WALL =EL 48 x45.5 / / // // / x39:4
/ TOP OF SLOPE loll Ile
/ 48.0 / / / xZ4
EQUIP X /TREELINE/El?!r 0 CLEARIN
(`
BOTTOM F SLOPE�'f""`
........... 39.5 . ( SOTTO 0P�LOPE — — — — — — — -
" =
TOP OF SLOPE
622.00'
f N 13'47'26" W
ASSESSORS MAP 98
PARCEL 37-007
RECEIVED
AUG 16 '82
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OMAN CONST.
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a
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f• 1%L. ' re i-,1 , 7 - Ol yt�t 8tl ftorl \ z OF MA S TO 1*1 E F•�
iL ' 1 M P1GF�V I Ov S C:OV 42 7b i
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pit- ?' d _ ....
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CA
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Y s _ E4
r�'¢ ?i Ems_,-,�'�. �'°_• �E P 1 G �TTNJ K �i"r v��T 4 OtP�. Q�IC.
$ i► 't' .._WATERTf BHT)i-
1 I� yEs e,ARBACaE GRWvER 1
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5,N ALL CONFORA'\ TO THE MASS.
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o.v .�ss�-•.r.�v -Q > . .i• AND LE NAG tNU "T TO 59 OF
{2E1(J F•ofr�C�17 GON C.RT''T'E , �
- - - -- - ` NA1N , GONC.9FXS �5'�WATk 03000f5l 1 PROPOSED LEAGt CAP�cl1y --✓-- — — --
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