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Home My WebLink About1363 OLD POST ROAD (CT & MM) - Health y 1363 Old Post Road Marstons Mills / l A= 017021 OWN BAINSTABLE ,OCATION � SEWAGE# VILLAGE, S` WS AS SSOR'S MAP&PARCEL 1.14S ",T;�S NAME&PHONE NO. SEPTIC TANK CAPACITY SOD LEACHING FACILITY:(type) (size) �C NO.OF BE 00 S l� _ OWNER to + � V u F PERMIT DATE: C E: p� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(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 feet of leaching facility) Feet FURNISHED BY i > S iS .:::...:.. �. i ...::.::......::::::::..:.::::::::..:.:...... 48 . 27 56 Driveway w. I Old Post Road r COMMONWEALTH OF MASSACHUSETTS JD EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION h �Y `t V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 1-39 9 / Property Address: 1363 Old Post Road Marstons Mills MA 02648 Owner's Name: Herbert Gilbert Owner's Address: PO Box 1025 Marstons Mills MA 02648 Date of Inspection: September 27,2006 Job#06-257 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: \0,�F'1i1)Yiil OO Q�� •• S '�. _X_ Passes �G Conditionally Passes = ; p Tnl" W Needs Further Evaluation by the Local Approving Authority _ : M. CID Fails V• CiA9/27/06 Date: ', Inspectors Signature: 0q1 �F5INSPEG�� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea 6k� 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:Tank is not in need of pumping at this time,leaching pit has 18-24"of effective leaching. k ""This report only describes conditions at the time of inspection and under the conditions of use at that fl time.This inspection does not address how the system will perform in the future under the sam4di different-4 ! � w conditions of use. to cv �— M Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1363 Old Post Road,Marstons Mills Owner: Herbert Gilbert Date of Inspection: September 27,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: 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: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: r Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1363 Old Post Road,Marstons Mills Owner: Herbert Gilbert Date of Inspection: September 27,2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 "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: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1363 Old Post Road,Marston Mills Owner: Herbert Gilbert Date of Inspection: September 27,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow —X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with 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.] _No_(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 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—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1363 Old Post Road,Marstons Mills Owner: Herbert Gilbert Date of Inspection: September 27,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X _ Pumping:information was provided by the owner,occupant,or Board of Health X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS,located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1363 Old Post Road,Marstons Mills Owner: Herbert Gilbert Date of Inspection: 'September 27,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents:2 Does residence have a garbage grinder(yes or no):Yes Is laundry on a separate sewage system(yes or no):No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):No Water meter readings,if available(last 2 years usage(gpd)): Two years total: 133,000 gal.=182 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/IN'DUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ 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: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank has never been pumped Source of information: Owner Was system pumped as part of the inspection(yes or no): 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 Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Compliance date:9/27/83 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1363 Old Post Road,Marstons Mills Owner: Herbert Gilbert Date of Inspection: September 27,2006 BUILDING SEWER:XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 1' Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5'long x 5.2'wide—1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:28" Scum thickness: trace Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees are intact and clear,liquid level at bottom of outlet invert. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1363 Old Post Road,Marstons Mills Owner: Herbert Gilbert Date of Inspection: September 27,2006 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (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.): No solids or high stains present,liquid level at bottom of single outlet pipe. PUMP CHAMBER: No (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.): Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1363 Old Post Road,Marstons Mills Owner: Herbert Gilbert Date of Inspection: September 27,2006 SOIL ABSORPTION SYSTEM(SAS):XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: One 6x6 pit. leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Observed 18-24"of effective leaching in 6' pit. CESSPOOLS: No (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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1363 Old Post Road,Marstons Mills Owner: Herbert Gilbert Date of Inspection: September 27,2006 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 6 ........................................................... 27 - _ = 41 ........................ ............. _._...._.._.._.._....:.........::......... ... :. :.. .. 56....... ...:...:.::::.... ... ......... ............... :: . ;: ............... ....................................................................................... ....................._::::: ..............._.... .............. ... ........................................... Old Post Road Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1363 Old Post Road,Marstons Mills Owner: Herbert Gilbert Date of Inspection: September 27,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 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) _X Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.20 and topo map shows property above el.40. I AT ION °7�`�-7 SEWAGE PERMIT NO. t �o� tf2�1 �- VIJLLAGE INSTA LLER'S NAME A ADDRESS R UILDER OR OWNER -164 S' W NA� *DA T E PERMIT I S S U E D r DATE COMPLIANCE ISSUED sG i No.V�6�v FES D ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ..................OF......................................................................................... Appliration for Diipooal Works Tonitrnr#ion Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual,Sewage Disposal System at� g �4_A : .. ...... ... -------------------- .... 1.. - ----------..... ------------•• - --.. ... ocati - ••.•ess- ,`C I �t No. 1PC!!� j v Y` z..... ..... .. s... --. 9t4"!)....................... Ow er Address °...........................•.dL[:.:`... !.. -1........................................................ Installer Address Q Type of Building Size Lot k alfl t......-__.Sq. fe t Dwelling—No. of Bedrooms ...�. . :..................Expansion Attic ( ) Garbage Grinder ( � per, Other—Type of Building . . .. No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ....................... _.._.....- W Design Flow..........S.3D........................gallons per person per day. Total daily flow........3 ........................gallons. Gd Septic Tank—Liquid capacity.&64�gallons Length................. Width................ Diameter---------.-_--. Depth................ W Disposal Trench—No......... .......... Width.................... Total Length.................... Total leaching area....................sq. ft. x ,.p Seepage Pit No..�� f. Diameter.................... Depth below inlet.................... Total leaching area..................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 ground water........--.............. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--. a -•-••••--•-•••---•---•-•••-•-••••-••................••••••-••-•-.....................----------••---.......................................................... 0 Description of Soil........................................................................................................................................................................ W ...-•-••-•------------------•---•-•-•••-•••••••---••--••-•-•-------•-•-•---•••...•-••-••-•----••...----••--•--••••---------••--•-•-•-•------••••••-•-••••-•--•••-•-•••••••••.................-•----••••- f 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 iITLi� 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the boa o ealth. �� ned........ . •..... .... .......`_..... ................... ......... .1..... ............ PPlicationApproved By= f ••• •••••••-•-••••......... ................................•-•-........•--- •---•_... ... .............. Date Application Disapproved r the 1lowing reasons:............................................................................................................... _...•••••••-•••••••••-•••••...............•••••---.......................--••••-•-•-••----------•-•-•---•.........................-•-•-.......•-•-••• .............................................. Date Permit No......Q _...-�� ..-.... Issued.. .... ..... ............. Date THE COMMONWEALTH OF MASSACHUSETTS'`_ BOARD OF HEALTH ..................... ....................OF.......................................... ....._...... Appliration for Diipoiial Workii Tonitrurtion Upprutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst ®�at6? ':`...... .. s ...... .......'�'! ..i .1.. ..._t:.'ex1 �alj _ j... ocati ess E q�•�,o: No.� ...........4�n.A ..---•-•--••-•-• --..�........----•---•----•---•.=-- ................•VC --.....: - ........ Ow er --`Y) 1 Address Installer Address 2a 6 O Type of Building Size'.Lot______E.:.:.................Sq. felt Dwelling—No. of Bedrooms. Expansion Attic ,( )f Garbage Grinder a "• Other—Type of Building _ tt: _ No. of persons____________________________ Showers ( ) Cafeteria ( ) d Other fixtures._.__.---------- --------------------------••-•----•--.___•---------= w Design Flow..........3_ '4_____________ __________gallons per person per day. 'Total daily flow-------- ?b gal WSeptic Tank—Liquid capacity.l!-' gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ _______ __________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_�o Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 -----------------------------------•-- .............................................................----••--•--••-•-----------.....-------•-•••--•----_----- 0 Description of Soil........................................................................................................................................................................ 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 TITL L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the boa a of ealth. W/ PpIicat/io�nAApproved BY ! .......... ..... .................. ..... � ......... Date ApplicationDisapproved or th .........................................................'__...________________..._______-•................... ----------------------------------•--•---•------•-•--- -------....._._...-----------------•-•-------......_ Date Permit No....... 2................ Issued_...... _ !�_._. . ---. }........... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Tatifiratr of Tompliatur TIMS IS 'O CERTIFY, That the I vidu 1 Sewz e Disposal S'`ystem constructed ( 'y�Repaired ( ) by...... .......:.- >=p . ..... -- -- ... _.., ......----•------•------------------•-----------------••-.....--••-----••-••- nstaller at.•--•-------------------------•-/-' •---...........y'--•--•---------•-- --•-------------•-------------------------------•-----•------------------- yam.._......_..... has been installed in accordance with the provisions of TIT .E 5 of,yl� tate Sanitary C e s de Erib in the application for Dlspos 1 Works Construction Permit No.__...._..._�_____ _ ........ dated......r=..._ ._...___.___. THE ISSUANelE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE / SYSTEM WIL UNC N SATISFACTORY. 2 DATE. ................J........................................... Inspector...--f- - ----- :.. ............................................... .2 7 THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ...........................................OF..................................................................................... ! .. FEE.. ............. Ito Toms ' n rnti#, Permission is eby gran*d.......... :__. .................... _ to Construct ( r( )-an In 'vi ual e age Di al Sy 7 Street ZY as shown on the plicat•on for Disposal Works Construction Permit No_____________ _______ ate'd.......... ....... �3 ---------------------- ------- DATE_ _______________________________ Board of Health r ` FORM 1255 A. M. SULKIN, INC., BOSTON `. -_ �� / Jr �/ i � .. `► y 51Q6tL- FAM%L%Y - BEORo M z !JO GAV-5AG6 Gcz.INDE2 6 • 27 L�hl l-'{ F .:u0w • IIGlX 3 - 7306.PP ZG 5EPT1G TAtiK = 330x15c>% = 149 /r" G.P. R ' u5c- I000 GAL. y 67.49 01'5P05AL P17 v5E 1000 C�A�-. /o rOZ.Z 5%pC-WALL A2EA. - 15 o 5.>= X i 50TTOM AREA= 5F•- 5� $.rr X 1• o -IOTA 1- C>V-51 GN -- 42 5 6.P D. /uD. 9 �3- 97 L 1 9y- o -TOTAL AA 1►-Y Fl-OVA( - 330 G.PD, j PE2GOLATION GZATE ; I 1N 2MIN o�La55 9 0 o 9S / s-r ?�r\ 7 21/ Of EyP Pi�- I1 � tN o��rAs kv� •9 N JF RICHARD A. BAXTER �4I� no. S1G0 C 1' No.2 048 I SURq -rop FWD -r 5Ti� I . 9 7 Y �-�.'C Af- 10 ovPi6T INV Q�x q S'PTI 9 �✓n I00P INge 9C.G TANK C3Ar LEAGW INV. INV. PIT yo.Z 9,. Y GLEAi✓ ,WITH 6TON� f3�.o GE2TlF1CD PLOT PLAN PRUFILt- L04A-T ►oN r _. .cr�A,es-�•v_ ✓I WO SCALE �jGALE /�-Sp .. SATE G�3oZ5, REF6ZEN GE ` GE czT1t+Y TNAT TH1~Pl�..o+vscD��5No4YtJ i HEREOPI GOMPLY5 WITH-THE A►.1D 56Te%&.GK fL6QV►2�MEN7"� DF 'TI�� -To W N p BA�rI�TAB1-E ,�N� I S I.lo'� 8.L! Z�Z PG 29-3v LOGfaTE0 WIT T 6 GL 4D P 11�1 D AT 1r Se=�: RE6IS�EQ6� LANO5u PLY E'Y�i�'S Tu15 Pt_Qti 1 � ►JOT t3n5c n ob ArJ v3TE2.vILLJr - MASS• IN'jTRUMENT ;QQVC-Y i� 'rHE Opr5eT5 SWou 3) No't DE u550'TO OETE-F INS L.oT �INE.'S APPLIGA►-1T