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HomeMy WebLinkAbout0264 LAKE SHORE DRIVE - Health 264 Lake Shore Drive Marstons Mills P A = 030 078 7 J��"-1w4deo U. . POSTAGE (� ., CENTERVILLE, MA 2632 J U L 10, 18 R,TEOfT1TEf AM O LINT 4'-�.-: •'- `�� VOSTALfERvICEm O r 7018 0360 ODDD 3917 9934 l000 02601 R2304M110860-04 s.lIl Jill''1l1:i1lli'Ilil')iJJJrfNJ1111.j:llrt i 1 9� 1� 1. y { ! �i {�t i v iili ! 11 vss vsv revvv sss ... E 1 vie• g� 4 A V r an gv `'"`. r - f 48 Woodcrest Road Marstons Mills, MA 02648 July 9, 2018 Gillson LLC TR 389-G West Center Street West Bridgewater MA 02379 Re: 264 Lakeshore Drive Marstons Mills, MA 02648 To Whom it may Concern: My husband and I have lived at the Woodcrest Rd. address for the past 24 years. We were informed after the fact that a group home was residing at this Lakeshore Drive address. We were not happy about the impact on our property investment, but have remained open minded and tolerant over the years. We have expressed our concerns, over the past few years, with Kerrie Finnegan , Director of Services for the May Institute. Kerrie has been cooperative in the past regarding issues concerning noise, horn honking, loud talking, swearing at times as early as 7:30 in the morning to 11:00 at night. This issue was resolved by having the caregivers and occupants using the front door when coming and going. Things are reverting back to using the rear entrance which is a short distance from the property line. My recent complaint is regarding very large trees which came down during the storm back in April. Kerrie came out to take photos and said she forwarded them to her superiors. To date no action has been taken. They attended to trees in their driveway and front area and left those exposed for my viewing in the back yard. Some of the fallen trees have been down for over a year with new ones now on top of them and pushed into my yard causing damage to my trees. My concern is two fold. One there are other trees that are dead/diseased that are leaning toward my property and that of the resident occupants. It is a matter of time before it lands on one of the properties. The other is that is is a fire hazard. Dry tinder,waiting for an errant spark from one of the workers who go outside to smoke. c My husband and I used to groom the edge of that property and pay for the removal of piles of debris collected along the property line. My husband, James Bitner, passed away April 28, 2018. I am turning 75. I do not have the energy to attend to this. I am also having a whole house generator installed this week, at great expense. The gas line is on that side. That places the generator 10 feet from the common property line and a candidate for damage when the inevitable happens. I am serving notice and recording a copy with my lawyer. All damages incurred, and costs to resolve said damages will be the sole responsibility of May Institute. I should not have to pay the deductible through my insurance company and have my rates go up to to the malfeasance of May Institute. Please advise me as to what action will be taken to remedy this problem. I can be reached at 508-4.28-0604 (H) or 508-737-8160 (c). I I am stressed out enough dealing with all the paperwork caused by my husband's passing. I would like this matter resolved as quickly as possible. Thank you for your assistance. Dianne Bitner cc: Town of Barnstable Board of Health/Safety Town of Barnstable Town Manager COMM Fire Dept. COMMONWEALTH OF NLASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION PARCEL O� LOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name: 045 ;,et�,lt s �GO Owner' Address: (X0 Q v Date of Inspection: Name of Inspector• (please p int Company Name: �'Ck G�, ',`':P�. Mailing Address: Telephone Number: /. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information rtported 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: /Passes Conditionally Passes Needs Further Evaluation by the'Local Approving Authority ils Inspector's Signature: Date:Zf �tT� 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM .4 PART A" CERTIFICATION (continued) Property Address: 06o A08- Owner: Date of Inspection: Inspection:Summary: Check.A,B,C,D or E/ALWAYS complete all of Section D A. )ystem Passes: I have not found any information which indicates that any of the failure criteria:described.,in.3.1,0 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not'evaluated are indicated below. Comments: _ M1Yi 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�detetnined(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 breakout-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. 2 Page 3 of 1'] . OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 'A CERTIFICATION(continued) Property Address, JUL kw-14 DdD� Owner: Date of Inspection: MLUA 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-analys s,performed at a DEP ceiiifed laboratory,fo'r coiiform 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 I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: C � :, Date of Inspection: ooV D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N9� _ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding:of effluent to the surface of the ground or surface waters due to an overloaded or / clogged SAS or cesspool V Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or ` cesspool V Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow Required pumping.more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number 11 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 l� water supply. VJ 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. f 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.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a:large:system the system_must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above). yes 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 "y.es"in Section D above the large system has failed..The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: y z e Owner: 7a. Date of I spection: Check if the following have been done.You must indicate`Yes"or"no"as to each of the following-- Yes No t . _ 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 breakout? Were all system components, excluding the SAS, located on site 9. _✓ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The.size and location of the Soil Absorption System(SAS) on the site has been determined based on: Yes no _ VExisting information.For example, a plan.at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIALINSPECTION,FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION Property Address: /21 Owner: Date of I' spection: FLOW CONDITIONS RESIDENTIAL - Number of bedrooms(design): . Number of bedrooms(actual): , DESIGN flow based on 310. 15.203 (for example: 11.0 gpd x#of bedrooms): Number of current residents:L � C " � Does residence have.a garbage grinder(yes or no): A)O - Is laundry on a separate sewage system ( es or no):�.[if yes separate inspection required] Laundry system inspected.(yes or no): 6 Seasonal use: (yes or no):,LZ :.. Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: • COMMERCIAL/INDUSTRIAL- Type of establishment: Design flow(based on 3,10 CM11.15.203): 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 Source of information: , Was system pumped as part of the inspection( s or no): � If yes, volume pumped: gallons--How was quantity.;pumped.de-termined? Reason for pumping: OF SYSTEM T YPT _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: ,z., Were_sewage odors detected when arriving.at the site(yes or no): 6 Page 7 of 11 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Add-ess: A Owner: LC1 �-, -11�- - ' i� � Date ofInspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC other(ekplain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage, etc.): SEPTIC TANK: � locate on site ]an Depth below grade: ��p - (? Off. Material of construction: --,,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: �G° 5 k(v` X S Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 1 Scum thickness: O/ Distance from top of scum to top of outlet tee or baffle: 7- Distance from bottom of scum to bottom of outlet tee Pr baffle: 3 How were dimensions determined: Comments(on pumping recommen ations, i let and outlet tee or baffle condition, structural integrity, liquid levels a related to outlet invert vidence of leakage, etc.): w GREASE TRAP (4ocate 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 outle-invert, evidence of leakage, etc.): y 7 Page 8 of 11 OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS .,.'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: Owner: Date of nspection: Sl TIGHT or HOLDING TANK%//Z&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): y Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present`must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to.outlets equal, any evidence of solids carryover,any evidence of le age into°or out of box, etc.): PUMP CHAMBER:/ o(&Oocate 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.): 8 Page 9.of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAUSYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: -Date of nspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If.SAS not located explain_whv: Type eaching pits,number: 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. CESSPOOLSi ``-esspool must be pumped as part of inspect ion)(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—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.): C� 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACEi SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) Property Address: Owner: (�O Date o�'dnspection: 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. All— v/�.. �a 10 f Pace 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: J A � �Owner: �Q Date old spection: Q(j V SITE EXAM Slope Surface water Check cellar Shallow wells d Estimated depth to ground water,7���y feet Please indicate(heck)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database=explain: You must describe how you established the high ground water elevation: r/ r &o 11 Permit Number: Date: Completed by: 19, HIGH GROUND-WATER LEVEL COMPUTATION Site Location: �� D/ it r(✓C Lot No. Owner: Address: ' /LJ�"—i- d9 Contractor: 0 G®��` =Address Notes: STEP 1 Measure depth to water table ............... .Date to nearest 1/10 ft. ............................................................... month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: A Appropriate index well.................. ................................. © Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 213) determine water-level adjustment ......................... ................................................................ STE P 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water. �? ............................... level at site (STEP 1) .............................................. Figure 13.--Reproducible computation form. 15 i i R_._ fxliil "m(t:!( O`j� _ t_O -A-T-1-O-N ' 5 - C E _a ,E-P_E.R.M T U-O- sly _ - - - - 5-U-1-L D-Et—R 1.1 D A`GE—P—E—RM— 1_S SU .._. � �� // t L; J( � �v { � � � � .,.- J' r. �. �,.,' 1,� �� �S �^ ,.. ---a ' �" _�_ _ ��,�, c -----�: i �J A No................... 'FEE ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE a-;AaH 9t41. ...............0 F.....I................. .............................. Appliration -for Disposal Works Tonstrurtion Prrutit Application is hereby-made for a Permit to Construct or Re air ( kj"`an Individual Sewage Disposal System a �/ ........................... ....... .........ULA). ... .......v............0V....................... ..... ........................................... Location-Address or Lot No. Z ...... --------------------­---------- ----------------------------------------------------**-------------------------------------------- Owner ............ Address ----- ............ - ... ... ................ .............. Installer Address �ype of Building Size Lot----------------------------Sq. feet U Dwelling!"o. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.-______-_-_________--_____- Showers Cafeteria ( ) Otherfixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity------------gallons Length________________ Width....._......._.. Diameter.___--..-..---.- Depth---_-.-._--.__. x Disposal Trench—No_____________________ Width-___------____--_--_ Total Length:................... Total leaching area....................sq. f t. 'Seepage Pit No_____________________ Diameter.-______--___--_-_-_ Depth below inlet__.._____._......... Total leaching area------- ..........sq. f t. Other Distribution box Dosing tank Percolation Test Results Performed by------- ----------------------------------------------------------....... Date........................................ 'Test Pit No. I----------------minutesperinch Depth of Test Pit---_-__--_----__-_-_ Depth to ground water...--__.._--------.--.-. (q Test Pit No. 2----------------minutes per inch Depth Af Test Pit____________________ Depth to ground water.-.--._---_----.---_.--. �10-------- ------------------------------------------------------------------------------------------------------- 0 "", -, -A Description of Soil____jj _4 LY_r.................:-------------------------------------------------------------------------------------------------- x U ----------------­---------- --------------------------------------------------------................................................................................................................ -----------------------------------------------------------------------------------------------------I.......... _- -------- ------------------------ z -4;?q:----------------------------I------- -Zhai Alterations4Answer when applicable........ . ------- e i (� U Nat of P 1 0 -------/ -------- j -------- ------ ------ ------------------ ...................................................................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 be n issued by thqboard of health . ............. ................................ Date ApplicationApproved By---:--- .. ......... -------------------------------------- .... --------- Date Application Disapproved for the following reaso S:--------Y .................................................................................................... ............................................................................................................................................... ............................... ------------ PermitNo......................................................... Issued.... .................................. Date -------- -- r a� F a.. .................. s ? No.._-•-•• .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T ... ...Z ...............---....... ApV irtttiun -fear DhiVoiitt1 Vorkii Tonstrnrtion Vrruift Application is hereby made for a Permit to Construct ( ) or Repair (Z-ean Individual Sewage Disposal System a ._ IVI ............ - .-._-.....••--•--•-••----••---•--•----.•-----.•..-_.__--••-•-•--_______...•.•.•••••-.••••.--.--•- Location-Address or Lot No. -••• .. - ------•------.......... ........... ..........•..... -•------•-•---•-••............••............... Owner Address a _ .-••-- •••• .......................... •••----------•--•--------•-•---••------.... Installer Address Q Type of Building/ Size Lot............................Sq. feet U Dwelling=No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons............................ Showers — Cafeteria Otherfixtures ------------------------------------- -•-•--••.......-•-•--...•---...---•----------------------.._.....-•-•-------------....--- 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. f:. 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 "lest Pit.................... Depth to ground water....___.._.-___-_.__._.- f� Test Pit No. 2________________minutes per inch Depth Test Pit-------------------- Depth to ground water-..._._-___.-__-_-__.-.. ------------ ------ O Description of Soil________ ______ - - ---- - - U --------------------------------------------------------------------------------------------------------------------•-----------•---------------------------------------....................----------- W ------------------------------------------------------------------------------------------------------------ -- - - -- - ---- U Natu e of P. air or Alterations Answer when applicable._.___,'�......___lQ _. ... _.... Ge.. ------------- ---- - - - ------- -----• Gr --------------------------------------------------------------------------------------------------------------------------------.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b tJ board of health. i ��it � tgned----- -•-•----••--• --- ---------------------- ��----•�----•------••--------- �f Date Application Approved B ✓�/ -� Date Application Disapproved for the following reasons----------- --------------•------•---------._--------•.-..-------.......--.-..-•-.-•-•-----••--.-----------____-. ------•-•-----------------------------------•----------------------•----------•--•--------•---------••------------•-•--•--•-.--------•------------------------------------------------•---------------•- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALT .......... :.........OF............. .. . . .. .. ... ...... ..................... 0rrtif iratr of f 11m;dianrr T IS IS T CE TI That the I tvidual Sew e Disposal ystem constructed ( ) or Repaired ( ' staller at... � ' •------•-----------••...............••----•-•-•-•--•------•--•-•_----- has been installed in accordance with the provisions of Apticbc�NI of The State Sanitary Code as described in the application for Disposal Works Construction Permit _______________ dated.-..��..-.,C�-_. �.---......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS �"�'� BOARD F HEALTH��� `� .......OF......... ................ ..��. ........... ....... No......................... FEE......�.............. i >a »r n txnrti>� err Permission is hereby granted .----- ...-- �f... -= - to Construct ( ) r Repair n Individual Se ge Disposal System atNo. .._�tL�._-• -------.- --------••--•--•-- --------------------•-•---•--••-------•------------------------..------ _ Street as shown on the application for Disposal Works Construction Permit No....................-Dated.._. DATE...... 7.5_J.................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No.--. ................. THE COMMONWEALTH OF MASSACHUSETTS I01 BOARD OF HEALTH D-)u ....... ------.OF......� L I T " ..` .............. Appfiration -for Uiipuial Workii Tono#rurtivrt Ppratil Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at Address ................................ .........................................................Lot.ip . ---� S. Owner I" � Address r L e1 �'.✓a •. Installer Address U Type of Buildin ,// Size Lot -��--/---�7.64'.-_-Sq. feet DwellingvNo. of Bedrooms.--__-_-_Y'_____________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures . ----------------------------- W Design Flow.......--.-� -------------------------gallons per person per day. Total daily flow_---__------46®--------------------.gallons. P4 Septic Tank—Liquid capacit/!f4�®_.gallons Length---------------- Width................ Diameter---------....... Depth..-..-.-_-.--... W Disposal Trench—No. ..............®� idth...._.___..._-_.. T al Length-------------------- Total leaching area-.--._--_---...___._sq. ft. x , I.� ���Seepage Pit No________ ___________ amet ....._.____....._._. ep below inlet-------------------- Total leaching area..-__-----.----._.sq. ft. z Other Distribution box ( ) Dosing tank ( ), '—' Percolation Test Results Performed by--------- Date.--...�/. s __--_.. 2e�pth4)to a Test Pit No. 1................minutes per inch Depth of Test Pit.................... ground water_-_--_.-._._--.-._-... fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_---._---_.___.._----.. a et fr �OD I 'escrpton o so ----- .......------ --- . W V Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI of the State Sanitary Code—The undersigned further agrees not to place the system in �n iss b the board o health. operation until a Certificate of Compliance has b ` PY -------------------- Sign � U 7 Da Application Approved BY - � �------ f -- -�----- / a Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------•- ..--•--•••------------------•-------•--------•-......-----------•--...-•----•----------------•--------••-I•-•--•-•-••----•--------------------------•--------------....------------•----•-------------•-- - Date _ 7� Permit No. ` Issued. -.. d- -- -----•-- ` ---------------•--•- Date ' Ozer, No.I_�.---_1...... F>�a�iC/... ................. ... 't THE COMMONWEALTH OF MASSACHUSETTS t _ . . BOARD OF HEALTH ... . ..-------.OF..... f �L�tl � -........ ......... Aliplira$ion -for Uhipviial Works Towitrurtion Vrrmft Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:. -• +�! dress or Lo o. ,0 er Address �. a �tc-fir• , grrF ;----------•• ------ � ---- Installer Address UType of Building 'z Size Lot3__:. .1 IL.....Sq. feet DwellingZ No. of Bedrooms--------- ..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) A, Other.fixtures ....................................................... W Design Flow;;__-__--_40..........................gallons per person per day. Total daily flow----------- ......................gallons. . - _____________ Width_.____.__.-. _- Diameter................ Depth.--_________---WSe tic Ta k Li uid ca aci 4 --gallons Len fi___ x Disposal French—No. _ idtll_ ______________ _ tal Length.................... Total leaching area.....:-.____..._____sq. ft. See a e'Pit No. !AMr. � below inlet.................... Total leaching area....._..------..__S ft. Pg P g 1 Z Other Distribution box ( ) Dosing t k a ercolation Test Results Performed by....... Data l 7 Test Pit No. 1----------------minutes per inch Depth of Test Pit-------_----------- epth to ground water...______________.____.. (Z4 Test Pit No. 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water...____________.__-_-..- . Description of Soil---- "` -/ "'� .""�__ ... . "'... ...... - - ----- ---- ------' ----(�dt� x Vw i '� � �1� y -s----------------------------------------- -------------W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------------------------------------------14--------------- .----------'=---------------------------------------------- ............................................................ 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 b#' enlssWAM by the board o health. Sign - -- ------ --- -- �----R- ----- --------- •-------------- �-- _-Av ..: '¢ D Application Approved BY--- --.- = •-- ` -------- .,..._..--•--•---•- s _ Date Application Disapproved for the•following reasons:............................ ..................................................................................... ..........•---------•----••----••--•-------•--------------•--•--••-•-----------•=-------•--•-••--•-----------•-----•---•--......-••...•.----------------------•-------•----•-------------------------- Date PermitNo. ---------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS V L BOARD OF EALTH .......OF.................. ... ... +!' ''T ` ..................... Trr#ifira#r of uutpliattale , TH S TO C h the Individual Sewage Disposal System constructed (' ) or Repaired ( ) byX d ------------------------ --------------------- a �1�.Cat Installer t Y .Q2. .- _..._...r-----•-•--•-----------------•-------•-•--•----....--------•-•----•---•----•-••---••---•-••--••---- has been 'installed in accordance with the provisions of Article XI of he State Sanitary Co as des ribed in the application for Disposal Works Construction Permit No........ ry'. ................ dated..++.: a ._. : . - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED GUARANTEE THAT THE SYSTEM WILL F• C ION SAT FACTORY. . 9- - • 7 DATE------- -------------------- /....................-•--•• Inspector...17-'------------------ ........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT 5 Q. No3!!.(........ FEE./A�.'.............. BinV as Work 41n s#r, #inat amif Permission is hereby granted to Con�uctt ( Re it ( an Individual Sewage posal Sy, --------- Street at No. ` --- Street as shown on the application for Disposal Works Construction er it No._ _...__..._ ated..f�' __ _ 'fe_.._.. j ^'!� o rd o Health DATE/e." _ � ...................................... - FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS_-- � - t= A , \ ' A t b tJ 8 A. V Ar ' �y • O ; l V A Jy,!' 15c)A w;lU L,EAG+1 '�'t-°'• W `n1 o - 24- —- ----- — 2 5 7 . 7 s? C - � �.�—�]{., �� Y N�Irk 1{.i �T��:1 ����� � ✓ N��•�,e.�y�l�.'�'dy 3...G.'a'��S i". . ._ N, C i O►J 6— 'c�U V;' A'P'—N r > MICHAEL E. JONES ASSOCIATES, INC J'. v'� `ti. �l y1 E.1-� �C.;IGN�R — BUILDER ,� T'G�L� 1 = 30 -r• �vLv' 2,5, I`1 8$ LOCUST STREET OVJ I.1 �. M12S ir11 L £ k'�M.�1. FALMOU lr{. MASS. 02540 I 1