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Home My WebLink About0067 HIGHPOINT ROAD - Health 67 HIGHPOINT ROAD,MARSTON MILL A= 028 046 POY No.-------------------- Fee------_-- ---- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVe[C Con0ruction3permit Application is hereby made-for a permit to Construct ( ), Alter ( ), or Repair K'-)an individual Well at: J L cation — Address Assessors Map and Parcel Owner Address - ---------------------------------------------------------------------------------------- Installer — Driller Address Type of Building � / Dwelling----lC� ��si4 1---------------------------- Other - Type of Building ------ No. of Persons----------------------------_—______-______ Type of Well 1-e- --- -- - Capacity--------------------------------------------- ---------- Purpose of Well----go- -4. 6_-�---------------------------= Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed Lf-."d Application Approved By ---------------_ — -____-- date Application Disapproved for the following reasons: ------------- ------------------------------ ---------------------- -------------------------------------------------- -------------------------------- � �"�' date Permit No. -- o�/T/ ---0 - ---------------- Issued----- --�— - - - ------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS TO CERTIFY, That the/Individual,Well Constructed ( ), Altered ( ), or Repaired ( ) by- '�� - g --- -- - - - -- 1 dt+'staller at- / _-1-1%,f��!_ Qlt�L1 f ------ — ------ — ------------------------ ------------------ --------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------------------Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. -------- DATE-- -- ------------ -------------------- ----- -- Inspector---------------------------------------------- - ------------ � v o�--D ------ Fee-----------}---- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Congtruct ion Permit Application is hereby madejor a permit to Construct ( ), Alter ( ), or Repair (P�Jan individual Well at: Location — Address Assessors Map and Parcel Owner ----------------Address -------------------- �� Installer.— Driller Address Type of Building / Dwelling---r --------------------------- Other - Type off Building---------------------------- No. of Persons------------------------ Type of Well -------------------- - - Capacity Purpose of Well---- � f ,)- ---------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed -LX'dC�' —�� 1 �;�' ° ' y' dixe Application Approved By-- --- -------------- -----------------_-- ------- ------- date Application Disapproved for the following reasons:------------------_----_----------------_--------_------------______________--________ ---------------------------------------- ------------------------------------------------------------------------------------------ g ^� v date i Permit No. ---� -- O' ---- -- Issued ---- --L o-A ------- - - -- --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE C ertif sate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) // (D'Aaller —,,.at------- — � ih�� - ---- ------------------------------------------------------------------------------------ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------------Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL-FUNCTION SATISFACTORY., DATE-------------------------------------------------------- - -- Inspector----------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH A TOWN OF BARNSTABLE Well Construction-permit Lf No. - -ol Fee--------------- Permission is hereby granted _------ -_ to Construct ( ), Alter ( ), or Repair (li�-an Individual Well at: ---------------------------------------------------------------------- street as shown on the application for a Well Construction Permit No. -------------------------- -- --- Dated-- ----- ------------- ----------------------------------------- g.� Board of ealth DATE-- -- --�- --- - TOWN OF BARNSTABLE t� L( C :100 2 /ri n o- )&ad SEWAGE # � AGE GI flb 'XI l Z/s, 12)A- ASS OR'S MAP&LOT O V(, MN-c.P&70R SHAME&PHONE N , ) , d SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 2 VL (size) NO.OF BEDROO 3 BUILDER O OWNER ' Q PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 y wetlands exist within 300 feet of 1 c 'ng fa ility Feet Furnished by o �., 35�'` i ' 5 0 Od - �� fE � BORTOLOTTI CONSTRUCTION, INC. r Z 765 WAKEBY ROAD, MARSTONS MILLS,MA 02648 �d 508-77.1-9399 508-428-8926 FAX: 508-428-9399 Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'q,, PART A ; CERTIFICATION Property Address- /� A / / w*-/ _ Date of Inspection: - Inspect is Name: Owner's Name and Address: cStUl CERTLFICATION STAT MENT• I certify that I have personally inspected the sewage disposal system at this address and that the inforrna- tion reported below is true, accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The System: 1/ Passes Conditionally Passes Needs Further Ev tion ByFthis cal Aproving Authority Fails Inspector's Signature: Dale: `��0(o The System Inspector shall submit a pyinspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the systems 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUM ARY• A)SYSTEM PASSES: I have not found any infornsation which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system, upon comple- tion of the replacement or repair, passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND).Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfrltration, or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four 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 C)FURTHER EVALUATION IS REQUIRED BV 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 the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONM ENT: rf within 100 Feet to a su ace . The system has a septic tank and soil absorption system and is� water supply or l tributaryto a surface water supply. n i with a Zone I of a public h septic tank and soil absorption stem and s P The stem as a p Y system P water supply 1 well. The system has aseptic tank and soil absorption system and is within 50 Feet of a private water supply well The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NDI due to clogged or obstructed pipe(s). Number of tittles pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feel.of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for colifonn bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design low of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 Interior Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: L- -Pumping information was requested of the owner,occupant,and Board of Health. __None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓As-built plans have been obtained and examined. Note if they are not available with N/A. Me facility or dwelling was inspected for signs of sewage back-up. _��e system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. (,—All system components,excluding the Soil Absorption System, have been located on site. //''The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees, material of construction,dimensions,depth of liquid, de h of sludge,depth of scum. to size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CIIF.,CKLIST(continued) V The facility owner(and occupants, if different front owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION— FLOW CONDITIONS RFCLDENTLAi.• Design Flow: 3 gallons Number of Bedrooms: Number of Current Residents: Garbage Grinder: U Laundry Connected'fo System: Seasonal Use:47J _ Water Meter Readings, tf ilable- Last Date of Occupancy COMMFrtC U/INDUSTRIAL: //0 Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings, If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informat' u: System Pumped as part of inspection: If yes,volume pumped: gallons Reason for pumping: TYPF.OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): 4AponW_a_�r�ivin AGEents,date ii Called if known)and source of information: �- do'ed. e odors detected he site: -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: Material of Construction: tl concrete metal FRP Other (explain) Dimisions: ' Sludge Depth: y" Scum Thickness: 6 ' Distance from top of sludge to bottom of outlet tee or baffle: 31/ Distance from bottom of scum to bottom of outlet tee or baffle: " Comments: (recommendation for pumping;"condition of inlet and outlet tees or baffles,depth of liquid level in relatio to outlet invert,structural integrity,evidence of leakage.etc.��C�Q.iOao_C�`�OlJ p[ C� /i GREASE TRAP: Depth Below Grade: Material of Construction: concrete metal FRP Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments:(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:—concrete rnetal_FRP_Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box, etc.) PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) . -5- SUBSURFACE SEWAGE DISPOSAL SYSTEM EM INSPECTION FORM PART C SYSTEM INFORMATION (conlinued) i SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits, number: Leaching chambers, number: Leaching galleries,number: Leaching trenches, number, length: Leaching fields,number,dimensions: Overflow cesspool, number: Comme ts: (note condition of soil, signs of hydraulic failure level of pondin j�condition of vegetation, U Q� / '— "S C G t3 2 q e to etc.) � a*v - / _le.�_.�S._J�_� al 2 v �Oyh, el lh (�CLP CESSPOOLS: Number and configuration: Depth-lop of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: /l U . Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (cowimied) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. G CeAr �s%Ole jk n id ►g l 0 DEPTH TO GROUNDWATER: Depth to groundwater: 2, Feet \ Me of Determination or Approximation: K / i'�z'G�" �/^ty/�i Gl Jam, �C � ��? ��r/ r � .S itva - 7- 1 r,h { s TOWN-OF BARNSTABLE LOG'ATION t SEWAGE # U VILLAGE . ASSESSOR'S MAP LOT 4&(,� INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY .LEACHING•FACILITY:(ty pl+ (size) PL NO. OF BEDROOMS y . PRIVATE WELL OR PUBLIC WATER )P, J — BUILDER OR OWNER DATE PERMIT ISSUED:- 25 - DATE COMPLIANCE ISSUED: - E 2 VARIANCE GRANTED: Yes No �,/ L3 J z �_ a THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........T.own- ------------------OF...........Barns t able .................... ApplirFation for Bispvii al Works Cnomitrurtion rumit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ...6.7:..Hi h.Point.•-Road_.Mars..ons Mills. .................................................................................................. --- ns - Location-Address or Lot No. Owner Address a J..P�Ma�9r ber..---•-••...._.--_.. Installer Address Type of Building Size Lot............................Sq. feet U U Dwelling No. of Bedrooms.........3................................Expansion Attic ( ) Garbage Grinder ( ) aOther—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 ( .) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. 1----------------minutes per inch Depth of Test Pit...........:,_.,..... Depth to ground water-.--_.-._-___-__---__.-. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.......:............ Depth to ground water-..__.__-______----.._.. a' -•------•-----•.••--- -•......................•••-•---..._...--•-._...-----.....--------•-••---_._.......-•-------•-..........._.__.....-•---.........-•-•-- 0 Description of Soil...................................... and ...... x -------................................ U •••••---------••--•----••••--•---•-•-•......................•••-----••-•-•---------••------------------••-------------•-••-••--•...--------•--•-----•---•-•-•............_-•-••-------....._......---••- W U Nature of Repairs or Alterations—Answer when applicable....1`"l ......... a,1103 _ pit v.it h a 2 9 h 1T11 ...... ............................. _.--•--••---••-•-•-••-•--•----••--....--•-•--••-------•••-•-•--•-••--•...-----••-•-----------•---•-----••-•-•---•--•---•----------•--••-•------•--------.•-------------•-••••----------••--------__.---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i T l.a. 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 t e A of health. / Si ned.- ... . .............•.!..- 9�3/87•...----- ------------- D e Application Approved B / Date Application Disapproved for the following reasons:................................................................................................................ ....--••--•-••••••-••.......................•---•-•---•--•-••-----•.---•-..._----•--_._......._ Date Permit No. - v Issued---•------ �0 ci -------------------------- Date THE COFCMONWEALTH OF..MASSACHU TS THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH OF.....--..... '....� ,.. ...... ..A.,...J Appliratiott for Disposal Works Tonstrurtion Vrrmff Application is hereby made for a Permit to Construct ( ) or Repair (`4 ) an Individual Sewage Disposal System at: ..................... �. 1.:•............................................................... .... . ..,:. .. Location-Address or Lot No. ....!.x.. ..... ...................=3: -.............................................. --•-------•-............------............ ----...--•---------........................-•- }*, Owner - Address W � i•p-fe.r.J�4� !y... Ins'aLer Address d Type_of Building Size Lot____________________________Sq. feet Dwelling`4-No. of Bedrooms.........;..............___________.........Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building __________:_________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _---- -------------•-----•------------------------------------------------------------------•------------------------- WDesign Flow............................................gallons per person per day. Total daily flow-_:____-______________._____................gallons. WSeptic Tank—Liquid capacity............gallons, Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No__________ _________ Diameter.................... Depth below inlet.................... Total leaching area................_.sq. it. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................................... =--•................................. Date........................................ W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------__. Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----- -------------------I------------------------------- ---------------•--------------•---------- •------------------------ •-------------------- D Description of Soil____________________________________ Pr-, - x W' VNature of Repairs or Alterations—Answer when applicable.____ ... :::'� � < �� € �_____.. .��€. .. I S b 1°�` .............................................-...............................................................................................................-..------------•----••--------------•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T 11 T LE 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. Signed,,"' I 4f 17 _� fi..:,. .. k -----• [ r Earc D to Application Approved B .. ' j �� -�'`"'-�---, ..... -!__--''.l``�s Date Application Disapproved for the following reasons:-•-•---•---------•-------------------------------------••--•--------------------------------------------------- -------------------------:-...---•------------� .........^.....----i---•---....-------------•---------------------•-------------------•----------------------•------------------•----------------------- � Date �Permit No. ----------------------------- --------------- Issued._._...... =- / -� Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF........f......... ' ..-:..i:°:..:......................................_.._.._.__ (Irtif iratr of Tompliattre THIS IS�TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired �' } ;.I ti by.......... ' --` .............................................................----•-------•---...........---------------------------•-•-•----.........---------•---------_..._ installer-- at......... __ ______ _ _________ _________ _________ _________ ________.................. _____ ______________________________________________________________________________________ has been installed in accordance with the provisions of T!TIE of The-State Sanitary Cpde as described in the application for Disposal Works Construction Permit No.__.�______________-��'1� dated__ f— ----- __�_______________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................- —Io....... '... ...................... Inspector.................. ----- --- ----------------------------------_____-- THE COMMONWEALTH OF MASSACHUSETTS ~� BOARD OF HEALTH ..................................O F................_....-.._..__..._-_._....._._........•__..--.-....._._.._.._................ No.•U. _. ....._ FEE.__,.... Disposal Works Tonstrt iota rrxtii c1 • • � - '� I1L� r Permission is hereby granted ===`"........................•---•---•--------------------.:._..----------•----•-••--•---•--•••-- to Construct( la)i or Repair`s( an Individual Sewage Disposal System t r _ Street as shown on the application for Disposal Works Construction Permit No_�_=�✓� Dated__.( _... .....2................ --� ........................a.:----- ---=� --------------- ------ `^ Board of Health �.. DATEJ�— �--7----••---••-•-•-•------•......--` FORM 1255 H4B S�°& WARREN, INC., PUBLISHERS {'� L Ci�T10N 5EWIS,64E PERMIT 1-J0. VILLAGE • IW57,&L R SS IJD,NhE,� ADDRESS BUILDER 5 Q A,DDR -55 DNTE PERMIT ISSUED "- D ATE COMPLI &&ACE ISSUED : ._. ,. ��'_� � , �; ��..� �, 1� ET+ �� - �6��'7` �� . � No.---------`--...-71. .... ....�C� ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT OF rOL-1 r- ................... ApV trtttinn -for UWVoiittl Workii Tontitrurtinn Vrruid Application is hereby made for a Permit to Construct ( ) or Repair ( )" an Individual Sewage Disposal System at* ---- ....... -•-•---- ---•tea .A-Vt.......... a ......4-4.1 ?�S s � c n-.Qrttdress or Lot No. -------- ---- .......-- .....c...�- �------ ---.......... ......... ..------------------•-----------------....-----------...._-.._.._..--._..-.•--------.-...--...--- can Address wrier ---------- ------------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............................. ............Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ___________________________ No.,of persons.........------------------- Showers ( ) — Cafeteria ( ) a Other fixtures --------------•--------------- d ---------------------------------------------------•--------------------•---•-----------------------•---- 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 ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date_.______-_----.---------------------._.. Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water-..------.--_- LT, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..._-.------._-.----.._. �+ ------•---------------------------•------ I-----------•----•---------•-------------------------•-----------•--------------•--------------------------•----- ODescription of Soil----------- ----------------•---•-----._...---...----------------------------•----•---....-------------------•--- ----•---•--•----------------------------------------- V = M .............................................................................................................. ...4._._. --- -L.u_.Qd_ _ __P.. _ _.�. Q� �... -•----•----------•---------------------------------------------------------------------•-•---_--•---------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e issued y the boar f alth. g Qj Date Application Approved By----- V-- -- --7--- � ----------------•--- -- = % .... Date Application Disapproved for the following reasons----------------•---------•---------•--••-------•-------------------------------------------------------•-------- -----------------•-•-•----------•----......_....._....------•-----------------------------------------._.._.__.-----••----...------------_----••--•.-..._._.._._......-..._..........._..•---•----_----- Date Permit No. Issued. .`---�v--- Date 71, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTu OF,7? .................. .. ......... Application is hereby made Disposal System at* ~~ Address ��tv. Address Installer Dwelling--No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other-Type of Building ---------------------------- No. of persous-----.---- Sbo`vcry ( ) -- Cafeteria ( ) � Other fixtures.� ------------------------------------------------------------.------.----.---------.----.--- Denigu Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. Septic Tank-Liquid capacity--_.�zDnoa Length................ �Vi�h----_ Diameter Depth------ D�yonz Trench--No-----.-'-- Width-------------------- Total Length.................. Total leaching area------.-sq. 6. Seepage Pit 0u--_--.- .................... Depth below inlet.................... Total leuc i xrea------sq. h. Z Other Distribution box ( ) Dosing tank ( ) '- Percolation Test Results Performed by---------------------.------' Date.---------.---' 1 Test Pit No. L.----..m�utey�er inch Depth of TestPit.................... Depth to -round water -------- �14 Test Pit No 2...............minutes per inch Depth of Test Pb----.-- Doytbtogrouod water-------' - �� -.-'-_--_'--'--.-_.---------.-'---.__-.__--'_..__-_--_--_-- Dcscr�t�uofSoJ'---------_-.-----._-_-----_''__.-_.--__---------------_--- -----'--'---'--'-'---'' --'------'---------'''''--- ' Agreement:r." Answer when applicable._:,�e-", _P.......04---------�_UzIT . The undersigned agrees to install the aforcdescribed Individual Sewage Disposal System io accordance with the provisions of Article XI of the State Sanitary Code- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has eil issue y the b ar of hu4lth. Date Date _---_-----_-----_----_-------_--_'----_.----.--------.--'----.--.--_--_-------- Date PeruzitNo......................................................... Issued......................Date .................................. THE COMMONWEALTH opwAsexo*ussTrs � BOARD / �� .'_---_--�/-`.--------- ~-r------~--- of --`---~v-~------~ THTS IS TO ERINQIFY TohhWrthe Inidual Sewage Disposal System constructed or Repaired ---------------------------------------------------------------------------------------- bas been install in accorda ce with the provisions of A 11i/ State Sanit-ary Code as described in the &IC THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BECONST 'RED AS A GUARANTEE THAT THE SYSTEM/)�.,ILL FUNCTION SATISFACTORY. ua/��-,«-'��-��.��--�I'��'�----l'1^--- luspr��or--.-��---��-.�-'�---�---------.--------- THE COMMONWEALTH oFmAssAo*ussrrs BOARD HEALTH l�*.-_-7'�-'�-- p--z°--------' - ^ -----`----'ur-~'----------' Foo-'5................. applicationto Construct or Repair ( 4.<a'n__'1ndividual Sewagc�_Disfosal System treet as shown on the ~ sal Works Construction ^/ ^' ' ' - o�� o"a� DATE ^�=^��----'------ - "� ^ w" *^ --_--..�.�---.��----------.-_---'-- popw 1255 xooasaWARREN. INC.. puousHcno V9% OF C7,J / 1 k- ; .� �or� ROBERT 9c�N No:.- �7 F �:......... �a �IACGLONE v, THE COMMONWEALTH OF MASSACHUSETTS ,fyNo.11944 O j� �L�`N 4" BOAR® OF HEALTH �� S*18T V _T0.1rJIvT._ _ ._..... o F........................B.ARnTSTABI,E.. ------------........--- �� Appliration -fear Ditipuittl Workii Tontitrurtimn Vrrmit 4 Application is hereby made for a Permit to Construct (X ) or pair ( ) an Individual Sewage Disposal Sys n . Location-Address or Lot No. ................................. a��a__8e 7. ---Truest--•-•----------------- ----•-------•--�"`"---------1--$� .�tj ])"bu � fir.. �------ 3r_...-•----------•---- jamr. Owner Address 1�J ......._... t`!_.0 Installer Address dType of Building Size Lot---2CL7GOG----------Sq. feet U Dwelling—No. of Bedrooms----_......tWO..........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building --------------------------- No. of persons.--____-__-..__________--.-. Showers ( ) — Cafeteria ( ) Q+ Other fixtures ------ -------- ------------- W Design Flow............50...........................gallons per person per day. Total daily flow-------------200------------------------gallons. WSeptic Tank-x-Liquid capacitylQ04_.gallons Length---------------- Width.........._..... Diameter_------------- Depth---.---_.._.... x Disposal Trench—No--------------------- Width-------------------- Total Length------- ------------- Total leaching area-----:--------------sq. ft. Seepage Pit No.-_-._-__1--------- Diameter..... Q---------- Depth below inlet____62........... Total leaching area.26-7__-------- ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by---------Rob art---G,_-_Xc j4Dn.9-_R P_._E......... Date.4/4/73.----------------------- Test Pit No. 1-----2---------minutes per inch Depth of Test Pit......9........... Depth to ground waterAlOrle-----.-..._. Gi Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------- Existing-.Surface--Mev.----1-00-..00-M-ev.---98b-7--5--Lnam75- 0 Description of Soil-----KLeVa._9_..s00_.Madi um...COarae..Sand..-F2ey.---9.1.00--.Bot-tom..of--Pit-----Nei_ zater----- Ufound_.4/4/73----.Pere.•_Rate @nave S6��Q !!�2 Ml s�-'------'----•-----------•---•------------------------------------------ W - --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ 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 Article \I of the State Sanitary Cod The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be is by the oar of healt _ 1z -/,7 7 J� .............................. D Date Application Approved By------ zi --- •.......... =/7 7 Date Application Disapproved for the following reasons------------------------•-•--------------------------------.-----•----------------------------------.------------ -------•.........................•-------••••----------------•--'••-•.......••-••-•'--------------•-••--...---••------------------------------•---•------•-----------------••--•----- -------------- Date fog .0 Permit No_...................................................... Issued....... .'-!t- •V` Date ROBERT G. NO...................... o E CGLON........W4, THE COMMONWEALTH OF MASSACHUSETTS .e .p No.11944 BOARD OF HEALTH ��IsY,r��, �SS�ONAL ENG� Apphration -for Ditipoottf Workii (owitrurtion Vrrmit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at ••-------•---=---------------jitgbpo .yak.mad.--------•---------....-------- --•--•----------------- t--�`....---•---------------------•-•-------....-•------ r' Location-Address or Lot No. •-------•` ---------------------��enno.-.I�calty!_.�$716tit---------------------- -------------•-•---------1-rda""flea.....LNIXbkkry--------------------- r: Owner Address -------------------------------- ---------------------------------------------------------- Installer Address UType of Building Size Lot..-90.rQ -----------Sq. feet Dwelling—No. of Bedrooms--------:.tX0--------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e yP of Building ............................ No. of persons............................ Showers ( ") — Cafeteria ( ) Q, Other fixtures ------------------- W Design Flow.........._.5.0---------------------------gallons per person per day. Total daily flow-------------1an------------------------gallons. P; Septic Tank v Liquid capacitv!Q -gallons Length---------------- Width.----..-....._: Diameter---------------- Depth.---_-._.-._. W Disposal Trench—No- -------------------- Width.=:.........:------ Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No---------1--------- Diameter----1W--------- Depth below inlet_--_-6------------- Total leaching area-267----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- V_.^,__?.� 3gip._ .n. �.......---- Date 1a a 01tf --- ---------------------_.. Test Pit No., 1____2--___-_-_minutes per inch Depth of "Pest Pit......9........... Depth to ground water.. one------------- Gr~ Test Pit No. 2................minutes per inch Depth of Test Pit.---__-__--_..--_-_- Depth to ground water...................... �i W5t?ZtFs Sil1T'f Ac -xr s0 r*?i E?X3!r 98 v TOz?M..F3Ild2_.:�:2 !? = �__T� fit• -V �7,�R+• D Description of Soil-----R7-f'Va--- 1...cta fir'i.R `` tt7 ------ found--• --V.-3 rc.- hate ® Flom. ��,f)c) 11=2__Nir V - W -------------=--------------••---•-------.-----------------------------------.-----------•--••----------------------------------------------------------------------------------------•---------------- UNature,of Repairs or Alterations—Answer when applicable..-------------------------------------------------------------------...--.-.-.---.---.----_-.. --•---------------- Agreement: - � 1 The undersigned agrees to install "the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Co The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bWiby,th oa of healt . J -------- ----- ........................ -------------------------------- Date Application Approved By `: -- -- --- �--- ......-••-•--•--•----•--•---- - -------------------- Date Application Disapproved for the following reasons.----••-•--- •--•--- ..-•----••--••---•-•-•---•--•..............•--------•------••---........----••---•-•-•-----------------••..•---•----•-----•-•-----••----------------•-----------------------------------...•----•-•••---- Date Permit No........................-................................ _ Issued-- ---------+----------- - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, . T01-01 .............. o F.......... ..:.:.....]IM. TI�?��..................:.................. Qlrrtifiratr of 6m0inurr THIS IS TO CERTIFY That the Inddi}v'dual Sewage Disposal System constructed (X or Repaired ( ) by------------- ,�l-J/�- /C.s_.. ------------------------------------- Installer at................... Fi gbP0j_rt__Rotad------•---•---- ...... - -------•.............•----•-•-----•-•----._........•--•-•--•-•-•---•--------..... ` has been installed in accordance with the provisions of _ e o The State Sanitary Code as describe l�„yi the application for Disposal Works Construction Permit No. ------------- dated..../A.-- --- --_!-.�._............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....-.-.- " ------------ --- Inspector ;�V .__,= - _ ___;// tt,. �' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A 'l r [.....:.............OF....................... tIINSTAM //� t r O._ 5..._�'/� FEE.I.(1.-----•......... ��• ;�i��ttl �rk,� Cn�rt�trttrti�t��rriatit Permission is hereby granted........-•-.............--..... ! / `C-- .._. to Construct ( X) or Repair ( ) an Individual Sewage Disposal System atNo------------- _r1t__Raasi-----•-------------------------------- -------------------------•-.--------------------------------------------------- Street as shown on the application for Disposal Works Construction P t No. ___. _. Dated- ............................ -- --" --•------- ' -•-- -- -1• _ Bo rd Health DATE...............----------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .i L c:>-r 2 Al K� . OF i�t ATCJ I�a ! t 1 l.t tSS • c==vim Qom}� �� s� vp,� "►; .