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HomeMy WebLinkAbout0185 MISTIC DRIVE - Health 185 Mistic Drive Marstons Mills A= 079-053 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 186 MISTIC DRIVE Property Address RILEY Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for - every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important: A. General Information �I When filling out forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA State 02632 Zip Code r Cityr town 508-420-4534 S14297 Telephone Number License Number B. Certification 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: .s ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10-23-14 ISignature 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. lll� l � VU( y t5ins•3113 Title 5 official Ins orm:Subsurface Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE Property Address RILEY Owner Owners Name information is required for MARSTONS MILLS MA 02648 10-23-14 -- every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which,indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: AT TIME OF INSPECTION SYSTEM MET ALL PASSING REQUIREMENTS. FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE CAN NOT BE DETERMINED _ 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. Check the box for"yes", "no"or",pot determined"(Y, N, ND)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 infiltration or exfiltration or tank failure is imminent. S structurally unsound, exhibits substantialY 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 } . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form:Not for Voluntary Assessments 185 MISTIC DRIVE Property Address — RILEY Owner 4umer's Name information is MARSTONS MILLS required for MA 02648 10-23-14 every page. CrtytTown State Zip Code Date of lnsper�ion B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 ❑ Y ❑ N ❑ ND(Explain below): r ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ - distribution box is leveled or replaced P ❑ Y ❑ N ❑ ND(Explain below): ❑ 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 ❑ Y ❑ N ❑ ND(Explain below). ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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. i-t 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE Property Address RILEY _ Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for every page. Citylrown - State Zip Code Date of Inspection B. Certification (cont.) 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 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: ._ 'Y This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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: D)' System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool a ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow 157ins•3113 Title 5 Official Inspe0on Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE Property Address RILEY _.. Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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 16,000 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 ❑ El Area 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 16.304. The system owner should contact the appropriate regional office of the Department. (Sins•3l13 Title 5 Official Inspection form:subsurface Sewage Disposal system•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE Property Address RILEY Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10-23-14 _ every page. Cityfrown State Zip Code Date of Inspection C. Checklist 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 ❑ ® 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. in he field if an of the failure criteria related to Part C is at issue ❑ ® Determined t ( y approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 16.203(for example: 110 gpd x#of bedrooms): 330 i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 �• Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE — Property Address RILEY Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information . Description: ACCORDING TO DESIGN PLAN SYSTEM CONSISTS OF A 1000 GALLON SEPTIC TANK D-BOX AND A 6X1 OX 8FT LEACH PIT _ Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ❑ No Water meter readings,if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): 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: t5ins•3113 Title 6 Official Impaction Form:Subsurface Sewage Disposal system-Page 7 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE Property Address RILEY Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for State Zip Code Date of Inscn every page. Citylrown petio D. System Information (cost.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Priv � El 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3M3 Title 6 official Inspection forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 185 MISTIC DRIVE Property Address RILEY Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE Property Address RILEY Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for State Zip Code Date of Inspection every page. CitylTown D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): Pump Chamber.(locate on site plan): Dumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): •If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: tsins•its rite 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ti 185 MISTIC DRIVE Property Address RILEY ...... Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: 1 ® leaching pits number. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: - ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): PIT WAS FAIRLY DEEP WITH AROUND 1 FT OF LIQUID IN THE BOTTOM WITH NO EVIDENT SIGNS OF FAILURE OR SURCHARGE STAIN LINE WAS AROUND 2 FT FROM BOTTOM OF PIT 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 13 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE Property Address RILEY — Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 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.): tSins•3/1 s Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE Property Address RILEY Owner Owners Name information is MARSTONS MILLS MA 02648 10-23-14 required for State Zip Code Date of Inspection every page. CitylTtiwn D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately • Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 15 of 17 tSinS 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 MISTIC DRIVE — Property Address RILEY Owner Owner's Name information is MARSTONS MILLS MA 02648 10-23-14 required for — every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: SEE ATTACHED DESIGN PLAN feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If 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: ATTACHED DESIGN PLAN Before filing this Inspection Report,please see Report Completeness Checklist on next page. 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 46 of 17 • THE COMMONWEALTH OF.MASSACHUSI-I4S 'BOARD OF HEALTH �}� Ilutttiun fur Bispos l 3lurku (numtrurfiun Permit Application is hereby made for a Permit to Construct X) or Repair ( ) an IInndividuja�l� Sewage Disposal System at: _....�� ._...� .�-. s..G/%`-t-- /%%c��i"���J! !Lip• I �. ._ �jJ� //�� •-,�C� /I� dress— __ I- -�L!__f,�:_.73_--�t L.6M�.'-.aL�L�_�/L��--L-r-�`` ....L_:l 1,.tKl.:.L:b]-- ..�> '— a..........-•__� Address d T'ppe of Building Garbage Grinder Size Lot. 3` feet - __Expansion Attic ( ) G ( ) Dwelling—No. of Bedrooms -fj,�-•-- - N P (` Other—Type of Building �s'�. � No. of ersons..—._.__—_._---_-•- Showers ( ) — Cafeteria ( ) Other fixtures .------_---...- —_ -------------- ................—.............:_....... ... — -:�..�-- - _ _ Design Flow--_--------_�,° f �..._......_...gallons per person per day. Total daily flow---------_--- W _.._._..Width._______..Diameter...............•Depth-............ r4 Septic Tank—Liquid'capacity._.--..-.--gallons Length Total leaching area-----•-----sq•ft. MDisposal Trench—No.-..-____--••_-••Width-_---.-._....._--Total Length.-____._.-___ Seepage Pit No._.--•- --- Diameter_-----:._---•-- Depth below inlet.-__..-..---.Total leaching area_---._._—_sq.ft. z Other Distribution box (/) Dosing tank ( ) ---..._---.. Date____.. __.__.____.. Percolation Test Results Performed bY...........____.___.-----—.-__.._..._-._---_ ground '--�--- Test Pit No. 1.---------_---minutes per inch Depth of Test Pit.--.---------_--- Depth to .. Test Pit No. 2_.__-._.minutesper inch Depth of Test Pit___..___.....;-Depth to ground r' o _ .--�----__..... _ DescnpuonofSoil--- U ----...._..- U• -- 3 I? - -----•---- _.1- -•--... -S�s4t_�- -- W — ........- w -•----•-----.••--_—..•--_..•-----------------------------_..--...... 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Coinpliance has been issued by the board of health. rcation Approved B Date -------------_------- Appi pP Y--•-.•- -eil- 1 .................... ____----- -anon Disapproved for a I.otuing reasons:------_•----•-•-- _---------�...__ ...------------- ._...._..__..___..._._.__....._..______.__--_____—_...—_.__..___..-.._.--._. Date Permit No.__ Issued....-.--- ----- --•-----'—_---'_—._'----__._•— Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, g. f rrfifir�e of Tamptittrirr THIS IS TO CERTIFY.—That the Individual Sewage Disposal System constructed {. or Repaired has been instilled in accordance with the provisions of TI LZ 5 of The State Sanitary /(�Ic as nbed in the application for Disposal Works Construction Permit No_....l.._._7,e . ------_....... dated._.d___..__l - -----------•--•------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. n DATE -— --- _--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �i-�1 oF..................---...._........._.._........-- f Map unufrudivu permit Permission is hereby granted.._.i. _.e�.r:_.. ........_.---_____-......-._...............___.................__ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No ---------- --------- ---------------------•----._X-L __ st:ee: as shown on the appli tion for Disposal Works Construction Permit No:_ Dated...l ._:_ ..-._ _ Bwrd of ealth__...._H..------•--•------ / �._••— FORM 1251s A.M.SUL.KIN•7Nt«.BOSTON r o rn s 7T QL ac 4t-A CH too t 14 �, �� 1 i � �� � ' �� �_• _03�� °_.-.� dux _ �1 t ; C( �0 \ 'i? rn 2 1 c3 HMO oSEo. v, Of T ONAL y 95 3 0/i s s'� LEGEND ' EXISTING SPOT ELEVATION Ox0 CERTIFIED PLOT PLAN . EX1 STING CONTOUR O ��c, Lq T 47 Al�_y FINISHED SPOT ELEVATION -Q0- F ,+ J P.CIB FINISHED CONTOUR -- 0 I:A..25 ' ELcREQ - I N APPROVED BOARD ..OF HEALTH ' :. « .� DATE AGENT SCALE: / "- 0 DATE : DEL D RED GE- ENGINEER_1 G CO. I—IVG7 CLIENT i CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB N0. 8UlLDING SHOWN ON THIS ELAN CCVIL LAND + ,• CONFORMS TO THE ZONING LAWS' DR.BY .�___ -___ .ENGINEER SURVEYOR. OF BARNS.TABLE , MASS,. A I N' ? Tt E ET' C H. 8Y ��' { 7 HYANNf �' MASS. V:.EYOR— OF DATESHEET: REG. LANQ SUR i IVO•'rE 20 FT. M//V. /0,4CN1lVGlie P1T AIIE MORE TN.a9N /2"9ELL1A riR/1 OEM c';1 "l//•a�-1 ETER CONCH" T� COYEl► !ca ,FT. jvM!n/. cc'� I .S/•/�1 L L �6r ®•if'OuG N T TC) G/�.4[7.E.�fi N EXTif"A •.-� F�-- i 4"PVC P'/PE 1 jiE,.�vy CAS-r /,?ONSfdAL.L DE uS5.D ICONCR&rle /y/�/- p/TCN I 1 F I N ,ORI V—=.kVA Y FZ- �p 4-7 COVERS �g PFR % CONGRE'TE , �.f _o. �! • . BAChfF/LL .lieL/QU/D LEVEL .>:• c, 2+LAYER va, RON p/ tS U l;1 GAL. ° , e • • . • . • •• + a a„Q WASHED SM-PIE 'Qr MJN.P/TCh! D/ST• o • • • . , '• • • • •e° 4-4 PAR r'r: SEJ�T/C TANf� BOX o b . • • 8 . . . •• 1 p Ir • D n • •EJ`fEG7"�VG • p 1'V,43J•!E4> STaNE • i • • DLPTt1 � s 4 7 D � • •e • • • • • • •• i ' a p p PRECAS T S,EE/�AG£ j n z,s /NYe+t"�' G°LE�AT>ONS PI T �.ja,�C_.l�Y // • CsF�T INYERT AT dU/LD/NG p FT. /D FT OJAM. �, C V�TJON� /NC ET .SEPTIC T.4NK F r �-- OUTLET SEPTIC TANK g 3 FT. _ GROVND tt0=1TEw TABLE - lNL.E7"D/STR/�!//TJON B©X � SECT1aN O F auTL�TDISTRIA&MION®ox �'.8;5 FT S ffWA4 aE O/„$'P03A L SY.S'.rCM ... /N[.ET LEACH/NG PIT 7��•. FrTi,dl1Lse`T1DN LEACHI/VG P/T D/MEN.9/oNl A JCALE %4" _ / —G OJ+MENSIuN A_��FT. DESl61V C /T/ER/A o/MaENS/oN G _p-r NL/JNQER OF®EDROOMS 3 GAROAG.Eo/5,P05AL.41NIr TOTAL E3TI/r1A7'EG' SO/L TESTo 2 FLOW 33 n OAL.IDAy SOIL TEST d+/ W" =V to U 7- AMAFI/. 1 DA TE OF SOJ L. TEST NUMBER O r L,6�ACXd Vd P/TS f , /-p r—7 Aw RESULTS ,,VJTN&SSED SIDE LEACHING PER P/T Sf� FT. 0- 3 U; ,, PCPRCOLAT/O!Y RRTaFi1�� / LC—s S /►�JIbSf1 NCH. BOTTOM.LF�CH/NG PER e M7p PIE�tCOLA+77/0/V RATE*2 MI>y.�IIV:Cf! TOTAL LEACHING ARBA s'4. FT �.= � �" ,., 2_.,U .aESERVELEACNJNGAREJ► S4. FT. , / 3 Sc/; 4- 7 SST ML:17� 7 �ISTlC_. 7>iz1 %L t At r lv LO 'T .7 A ASS DF 69� ''' ` S 4e �^ a`.. r.; ,�, rsTJ/v > /1., 1 C S RODERT p2� AL r1pj�4 -Sr L. ELDREDG > r^ ttiM6R v, h v'E^L" N R/�6 CO INC • ` �' ti EL DREDGE E AW AV , , ! , r .:: 'A pNo.1095i�4 7t2 MAlN ST. HYA,vN/9, MASS G`ST�+ �y�� � GfST� �4' GL. g7.Z UN7 �2EL% CL/.ENT:y„14D/7A6C�� DATE' /,l£s��'`� 0. ,—�� SSIONA� NG GROCJND YY�1 TE''� E`NCO 1 GAO UVO wATE`R AT Ed•.Es! JU® No. 22 f 3 o SPIEE7'?�OI• �" AsBuilt Page 1"of 1 LO AT ION - SEWAGE PERMIT AD. V I L L A G t d? 3 IMST t R'S N ME A ADDRESS Ocbsco-- �1 BUILDER OR OWNER )CNA 4 DATE P R 1 15SUED �� $ DATE COMPLIANCE ISSUED http://issgl2/intranet/propdata/prebuilt.aspx?mappar=079053&seq=1 10/23/2014 _ w LO ATION _ SEWAGE PERMIT N0. C q `Z As+I c1 zud- 91 VILLAGE w a-7 ilos-3 I N S T L R'S TE i ADDRESS 6 5 S U I L D E R OR OWNER A l�ryA ffy DATE ffiffilf ISSUED DATE COMPLIANCE ISSUED < '� � `�. �}x i�� l � � � `� �. 1,`` '' �� ��,� s;'� ' -- ,� '� � . �{--- m..�.--,.�._ ---- , �� .. � � j� No.w2.. .......... Fmc.....`sL............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '" ,�C1Cf✓!'w.............OF.......,/��1✓l/L ` `- :--------.........---•-------.......... ;Appliration for Uiipniittl Works Tonotrnrtiun JIrrmit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System ... .........1..!�il.l �C.r..._1 '?.f.C!�-�' fie ../.!� !�.. ........................ ... / 1L'U,J ./. ' Loct'/fdress, � r , Lt Address .... ....................................... W Installer Address ��//��ff d rypeofrBuilding Size Lot...l75p_ �............Sq. feet Dwelling—No. of Bedrooms. ....._ .....Expansion ttrc ( ) Garbage Grinder ( ) Other—Type of Building [ No. of persons---•------------------------ Showers ( ) — Cafeteria ( ) dOther fixtures ............... -----•---•----•---.......•••----•••--..............••--------•-•-•----- ............................................................. W Design Flow................. ................--gallons per person per day. Total daily flow.............. . !................gallons. WSeptic Tank—Liquid capacity----------..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box (i ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.........I........... Depth to ground water..-.7.0.. ...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.'..0 .----. ----•--•--••............•----•......-- . . •-•-•• --..... ...... .--••--••-•---•--•-••---••--••----- O Description of Soil....0- .......,� .f � ......... --------------•- ' x •-•-------------------------•--•-----•----••-•----------•---------•--•... -•------••••--••-•-------------•-•••---•---•-•---•------••-•-•••--•------••--•-•••••-••---------..................--......... 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 iITLL .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 health. agne .........-•-•-••••--•--......-•----•-•.............•.•-•--•..................-•-•••• .... • •... .............. ApplicationApproved By...........•• . -•••••-•--••••----•--•-•...-•--•-------•-••-••-•-----•-•----•-- ----�c. Date Application Disapproved for: a ollowing reasons----------------------------••---.....--•-•--•-•----.....---•------------------- - -•--------•-....----•----•----------- -------------------------:------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued_........................................................ Date Na-�:�.?y---..._-. � Fss....-��............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 111n ............OF........ �y�`� AVVIiraffon for Diiipoiial Workii Tonstrurtton Prrmit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: , - Locat' -Address +Lot { /J Owne� r"" za e.s ._..... ...-trc.F-�.cca✓lr6d�.c �.. _._..._. 1 j.... .............•--•---------........._..... Installer f C € +' Add I' Q Type of Building Size Lot...Y-V S feet U 4 --- q Dwelling—No. of Bedrooms............3........ ...__._...Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building f �// ' �"" No: of persons.......... ............. Showers a g N f --- ..........................................................( — Cafeteria d Other fixtures -------------------------- W Design Flow.................�,''�---..............gallons per person per day. Total daily flow......,........3-3-0................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................. W Disposal Trench—No. .................... Width.................... Total Length................. Total leaching area....................sq. ft. x Seepage Pit No------------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) 4 Percolation Test Results Performed by-------- ••••••••--•-•-•--•------•-•-•....•-•••---•..................••--- Date........................................ Test Pit No. 1...........:....minutes per inch Depth of Test Pit.................... Depth to ground water...._.._''............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.—_.C'--___- f� ----------••--- ------•--•••--•••-•-•••..... ......- Description of Soil....�'-'<........ �-`� �!x / .:_•--•h's '��' --............................. .... U ._.. .......... = + (!�._... !Clef j`! - W -- -----------------------------------------------------------------------------------•-------------------------------------------------------------------------...............----••---.........••••-- 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 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 board of health. Zellowin ne ......•-------•--••...............................•---•••---•-----••--•....--•-----•- ---- . . . ............... Application Approved By.. :................... -•------•-----......-•------....._••-- ---• I t/•••-------••-- Date Application Disapproved for reasons-------------•-•------------•----•---------------------........----------------....-------- ...........- - .•....••.•.•.••••••••.•.....•.••••.•.•.••••.••••••...•••........•...•.•..•••..••••..--.•.•......•--..............•...••...•....•.....••.••.•••......••.••••.•.•..•.•.•.••..•..•.•..••...••••..•....--•••- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 40 .......... ........... Terfifiratr of Tootphaurr THIS IS�-�TLO-CERTIFY,/That the Individual Sewage Disposal System constructed (A' or Repaired byj�._ .,'u��:�.�----------------------------------------------------------------••--------....------.. ......-•----------•--.......-•----.......... - .. �}/ / at........-��y N /(iC /.��� Installer ./1%�'liSt. ................ allf ,: .. .1 • ---- ---- ------ has been installed in accordance with the provisions ZTITLB 5 of The State Sanitary e as ibed in th'e-- application for Disposal Works Construction Permit No.__C 1..................... dated__..._..'l THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE®_AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. d O ........................... DATE .... Inspector............. '..�a-.......................................................... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � .........OF.......................... Iry .// `` ...................... No......................... FEE- ................... �i��to - oa����r#ion rrotit Permission is hereby granted..._. s I�t-_.-t � -. �---- ----------------------- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System-'-- . atNo........................................................................................................St-•--................. ••-•••..................• •- -•-............. Street as shown on the appli t, for Disposal Works Construction Permit No..�_ ........ Dated.._ .. r'... j............. ----....- --------------------------------•- Board of Health DATE----------------------- -------•--•-----••-------••----.....--------------..... , FORM 1255 A. M. SULKIN, INC., BOSTON ' - - f..a .._�.�__.._� - �wwv .�asw'<♦ .. �.—pus........+.�re.sur�> Of 6-3 0 � r �3 p 17 2 o A 9 IK MORSE' \� ` No..10951 p y EN. d yy NN III h k tt LEGEND -EXISTING SPOT ELEVATION OxQf ", CERTIFIED PLOT PLAN EXISTING CONTOUR — 0 � % r;..-- . >��t c « . FINISHED SPOT ELEVATIONR0..0 / ;Rfl�3FFT FINISHED CONTOUR ,� r I /� �, 7�';� .. Are ELDR I `APPROVED : BOARD OF. HEALTH . ` a DATE AGENT + - SCALEt' j „ DATE G8'/ y !hA P t N,� DEL DREDGE ENGINEERING CO IN CGtENT I . CERTIFY THAT .THE PROPOSED fW EGIS7ERE REGISTERED „' JOe NO I�'a_...;, BUILDING' SHOWN ON THIS. E'L AN CIVIL LAND CONFORMS TO THE ZONING. LAWS` DR.BY '� �'� ENGINEER SURVEYORS BARNS.TABL-F ; MASS- - OF YFI YA�II IN M "EET ICH, BY. N N I ASS . SHEETS O.F - ._.A _ �% D TE, REG. . LAND SURVEYOR /YOTP /F E/TNER TH,E.SEPTIC TAMAC OR 20 I-I/N. LE.4CHlwG P/T ARE MORE. TNA,,V /Z"EAr40JV •, /O 7 1W1A1. GRADES A c'4 IJ%AM,TER CONC,-, C- COYE.P' SHALL BE BRouGNT TO 4�TAOE.64/✓ AsXrR'A 4 PVC P/Pl CONCJ�t'TL M/N. AITCN ( h+EAvy CAST /RO/Y CO//�R S/s+,4LL L3E G O Y o¢ COYE/4'S �'PF.P FT OR/✓AFWA Y �. f� 2 MiN. G'D/VCRLrTE 1 �A► _ c3 .►oE Co✓ER CLEAN -TA YY O &ACxF'I LL z' LAYER 4 RDNP// UC�O - <,o. -Qo ' o•`ov QF �8�-3�e. di MlN:P/TCN GAG. • e . . . . • • • D 040 %4 Peet f'T SEPTIC TA/VK d/sT • s • • • • • ♦ • a e a WA SHPO 57i�NE BOX a • I ® ♦ • • 006 ,•a • �'• � . • D • • •EFFECT%VE � . • .r 3 4 — � �2 • e •• pEPTH • • • • o WASH,ED STONE 470 7 Fs /'v 7 i Oi a • • • • • • • • • y PRECAST SEEA4G0" NIiPRT C'LF.1/AT/OHS j�/T ,G�4.�• G.4L/D,4� l a a e • • • • • • • • • • o P/7 DR E-QU/V, • ♦ Ar IMMERT.AT Ot//"/NG ��d•p " FT - 6 fT D/AM. . /NL ET .SEPTIC :Ti4/VK `��.5 FT, . y FT. pm C CSFE TiBt/L.4TIOiV� OUTLET SEPT/C rANK:. ` 3•FT:` INLET D/STR/ovnoN BOX �� FT SECT"/ON OF GROUND it�1TER TABLE OVTLETDlSTRlB(!T/ON BOX f3 FT INLET cF.oCNiwG oiT' :2- FT -: SEh/AGE Ol.SPO�SA t SYSTEM TAB!lL.4TlON LRACH1'VeW P!T SCALE D/PIE/V.S/ON A DES/GNI: CR/TERIA /aN 8'-AFT. N!lMdER OF®Et�ie00MS 3 D/MENS/ON. C' FT, /►?a^/' (y4I?Or4GED/SP0S41-UNIT v^/E �O/L. LOG' SOIL TEST TQ rA4 Aff— ►'HTEO FYOH/ 330 G.4L.DAY' -SO'/Lb TEST#/ SOIL TEST 2 iVUMBER QIF LOACN/ND PITS f`FLL=✓. /OY�Z ELIFY. �O UZ -�-� GA TE OF SO/L TEST S/OE L1'ACHING PER P/7' SQ FT. U_ 3 v G d���7 �L RESULTS Av17-"ESSE4D L cs s Pvc. BOT7`OM L6ACN/NG PER P/T �' $Q. FT SG��� PERCOLAT/ON �IRTa� / MI/V•IINCH TO?AL LEACHING A TEA ' 2-6 b SQ.SQ. FT. ��' t �r/> 7a 's 7-[w Off ' � �^ FII.C�ICOLi4T/GN RATE 1W2 a RRS,ERNE LEAC*Nl NCG AREA: Z_l�. SQ FT , , /F/�rz; . %fir' •_ y,tl 7�57` 21 �OF -(H OF Al 5 .,;� ' LOT x P S ROBERT ; ram. . ! L c 3 BRUCE. . o� ALR71j14 ELDRE to f 4SE J No.10951 O EL DREDGE ENG INEER/NG W. �GISTE� � , .g7;z 7t2 MAIN ST.1 NYANNIS, MASS'. NAL NO G/QOUNp Ye/i4TE`R,EJVCOV,VTF�EQ CL/ENT:M,4 DPaq dtsNA! DATE: / /Fs. y GRO ji v,0 Lv.4 TE•P AT ✓OB NO. g 3 f 3 O z SHE.�T Z•-OF