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HomeMy WebLinkAbout0032 MOCKINGBIRD LANE - Health 32 MOCKINGBIRD LANE, M.MILLS A=vo - i S - BORTOLOTTI CONSTRUCTION' INC 45 INDUSTRY ROAD, MARSTONS MII..LS; MA OY,V-08 508-771-9399 508-428-8926 FAX: 508-42.8-9399 _. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTJ;ON'PO'ftM PART A CERTIFICATION Property Address: 30 Date Of Inspection 3 II for's Name: Owner's Name and Address: CERTIFICATION STATEMENT: I Certify that I have personally Inspected the Sewage Disposal System at this address and that the infornia- tion reported below is true,accurate and complete as of the time of Inspection. The Inspection was perform- ed based on my Training and Experience in the Proper Function and Maintenance of On-Site Sewage Dis- posal Systems.The stem: Passes Conditionally'r.a s Needs Furth6r alua 'oP(B the Local Approving Authority Failure Inspector's Signature Date: 0 The System Inspector shall submit a copy of this Inspection Report to the Approving Authority with Thirty (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 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 SUMMARY: A) SYST PASSES: I/ l have not found any Information which indicates that the System violates any of the fail- ure criteria as defined in 310 CMR 15.303. Any Failure Criteria not evaluated are indi- cated below. B) SYSTEM CONDITIONALLY PASSES: One or more System Components need to be Replaced or Repaired. The System,upon completion of the Replacement or Repair,Passes Inspection. Indicate yes,nor,or not determined(Y,N,OR ND). Describe bases of determination in all instances. 11 "not determined";explain why not. The Septic Tank is Metal,Cracked,Structurally Unsound,shows Substantial Infiltration or exfil- tration,or Tank Failure is imminent. The System will Pass Inspection if Existing Septic Tank .is Replaced with a conforming Septic Tank as Approved by the Board Of Health. Sewage Backup 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 - r I S,URSURFACE$SEWAGE' DISPOSAL SYSTEM! • INSPECTION .FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is leveled 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 µ Obstruction is removed. C) FARTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board Of Health in order to determine it' the System is failing to protect the Public Health,Safety and the Environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HELATH 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 IIE SYSTEM IS FUNCTION- ING:IN-A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND TI-I f; ' ENVIRONMENT: The system has a Septic Tank and Soil Absorption System-and-is within 100.Feet to a Surface Water Supply or Tributary to a Surface Water Supply. The System has a Septic Tank and Soil Absorption System and is with a Zone 1 of a Public Water Supply Well. The System has a Septic 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 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: 1 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 overload 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. ° _4 :. Static liquid level in the distribution box above outlet invert.due to,an overloaded or clog- ged vSAS or cesspool.,,„. ;t t. ,:t^., . .,.. 1 ... i .•. ,n ;s+'..,...5 4:s `"' f* + ::_•t ;,Liquid depth in cesspool is less:than 6'-below inver:t'o'r+available.volume is less than 1/2 day flow. Req .I,uired pumping more,than 4 times in the last'year NO due to.clogged or obstructed pipe(s). Number of times pumped - 2 .- i SUBSURFACE DISPOSAL SYSTEM INSPECTION'FORM PA11T A CF11TIFICATION (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 Feet 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 coliform 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 flow of a system is 10,000 ggd 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: I he system is within 400 Feetof a surface drinking water si►pply The system is within 200 Feet of a tributary'to a`surface'd-inking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)"or a mapped'Zone 11 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 315 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: Pumping information was requested of the owner,occupant,and Board of Health. t/ 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 it'they are not available with N/A. _ l The facility or dwelling was inspected for signs of sewage back-up. _V'rhe system does not receive non-sanitary or industrial waste flow. _LThe site was inspected for signs of breakout. V/:All system.components,excluding the Soil Absorption System,have been located on site. �v'rhe septic tank manholes were uncovered,opened,and the interior of the septic tank was in- ";' .apected for,condition.of baffles or tees,'material of construction;:dimensions,depth of liquid, / depth of sludge,depth of scum. 1/ 'rhe 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 - t L' SUIISIAIFAC'E SEWAGE'DISPOSAL :SYSTEM; INSPECTION FORM PAIIT B /I'he CHECKLIST(continued) facility owner(and occupants,if different from owner)were provided with i►aorluation on the proper maintenance of Subsurface Disposal System. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM,INFORMATION rt / FLOW CONDITIONS RESIDENTIAL• t/ Design Flow:^_ 3y gallons Number of Bedrooms:_�,�Number of Current Residents: 11` Garbage Grinder: 001.0r Laundry Connected To System: 616d_ Seasonal Use:cly_,7 Water Meter Readings,if available: �J Last Date of Occupancy: Type of.,Establishment: s Design Flow: gallons/day; Grease Trap Present:, (.yes or.np) ; Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last llate of Occupancy: OTHER: (Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS any source of-information: System Pumped as part of inspection:,( If yes, volume pumped: gallons Reason for Pumping: FYI,OF SYSTEM: w/ Septic'I'ank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records,if any) Other(explain): PROXIMATE GE of all compollents,jdate iipstalled(if known) and source.ofinforniahon:. Se- age odors detected when arriving at the site: / -4- '-SIIIiSI.IIIFA('E SN:WAGE' DISPOSA1, SVSTl,M INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grad Material of Construction: ✓ concrete metal FRP Other (explain) Dimensionss,�.,S Y ta's` Sludge Depth: A0 ` Scum Thickness: Distance from N►p of sludge to bottom of outlet tee or baffle: Z$ Distance from bottom of scum to bottom of outlet tee or baffle: 9 Comments: (recommendation for pumping,conditioin of inlet and outlet tees or baffles,depth of liquid level in relation to outl t invert,structural integrity,evidence of akage,etc. �t 3 MOO GREASE'rRAP 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: (r..ecou neudation.for pumping,condition of-inlet and outlet tees or baffles;depth ofliquid level in relation to outlet invert,.structural integrity,evidence of leakage,etc.)` TIGHT OR HOLDING TANK:-� Depth Below Grade: Material of Construction: concrete metal 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: Commebonts: (note if level and distribution is equal,evi nce of solids carryover:evil Tice of leakage into or out of x,etc. PUMP CHAMBER'. -Pump is m working order. t ` Comments: (note condition of pump chamber,condition of,pinnps and appurtenances,etc.) - 5 - SUBSURFACE SEWAGE. DISPOSAL SYSTEM INSPE('`I'ION FORM PART C SYSTEM 'INFORMATION(continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if possible; excavation not required,but may be approximately by non-intrusive methods) If not determined to be present,explain: Type: yl e: Leaching pits,number: Leaching cliambers,number: Leaching galleries,number: Leacahing trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: mmnents: (note couidtion of soil,signs of hydraulic fai ire level of onding,conditigryof vegetation,etc.)_ a. 1 OW T / CESSPOOLS:dLfr Number andconfiguration: Depth-top-of liquid to inlet invert: Depth of solids layer: Depth of scum layer:" '-Dimensions of Cesspool: Materials of construction: Indication of"grow�dwater: Inflow(cesspool must be pumped as part of inspection) Continents: (note condition of soil,signs of hydraulic failure,level.of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hyddraulic failure,level of ponding,condition of vegetation, etc.) �Y1 y `i. .Y.�. ,�.,\ s�. 'r. w yi i.,e.:��,�. iF.. n �s I:7.7' 1 . � 1 •y �'rjs; - 6 SUBSURFACE SEWA(::L. DISPOSAL'SYSTEM ,INSI'E(C'fION' DORM PART C SYSTEM INFORMATION (continued) SKETC11 OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references,landmarks or benclunarks. Locate 11 wells within 100 Feet. yt'o CCIIJJ 7 ^•t: r k DEPTH TO GROUNDWATER: / Depth to groundwater: 17 Feet Method oa'Determination or Approximation: IrGt-rh ® ,0, 7 _ LOCATION 3 SEWAGE PERMIT NO✓ VILLAGE Q i3 pZ h) &44-ZF v INSTALLER'S NAME&ADDRESS CPW..( c I BUILDER OR OWNER h2a DATE PERMIT ISSUED g_ - T6 -$� DATE COMPLIANCE ISSUED t3 aS 3S" ` o itOCATION L SEWAGE PERMIT NO. .PILLAGE I N S T A LLER'S NAME i ADDRESS E S U I L D'E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED a g5 1 ^J 9� „ 9� r No.592..... � FEB' .............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -77 /:o w1'4.------...-.OF......-....3 ........................... ApplirFation for Dhipoii al Workii Tnnitrnrtiun ranat Application is hereby made for a Permit to Construct ( J� or Repair ( ) an Individual Sewage Disposal System at: ...1. � /.r.? .._. NOE........� r _. lL�. ........... ...................... . -• L i n- ddress �Q�(r `/ } f. .U_/. __.._...._.. �. 'llY.�C ! O.. M ......... a I /t M nstaller Address U Type of Building / Size Lot_�o ��- " S feet Dwelling—No. of Bedrooms__ ...,• l1.�'I__K,_).....Expansion Attic (✓) Garbage Grinder (/�✓ a aOther—Type of Building ___,/1 ,�__._... . No. of persons-./4":74............. Showers ( ) — Cafeteria ( ) Otherfixtures -° ------------------------------------------------- ------- W Design C� Flow.......... ____________gallons per person per day. Total daily flow.._.��ZZ........................... _ lons. Septic Tank—Liquid ca acit �8W.. allons Len th_ --G__._ Width.%.'Z�_ Diameter________________ De _ .__-_r. Disposal Trench—No. .. .... Width.__/.............. Total Length.................... Total leaching area.____________.......sq. ft. Seepage Pit No----1-__-____ ___ Diameter_,1�2----- Depth below inlet....$`._.._______ Total leaching area��_�_......sq. ft. z Other Distribution box Dosing tankk (�/ '-' Percolation Test Results Performed by.,6�(, '_!A.'p�-__Pes�t :-_____.___J,62 �__.._._..__ Date_,9. Y�'�______________. . Test Pit No. 1L`'' minutes per inch Depth of Pit,/ __........ Depth to ground water./V°V -._._.- Gz, Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -• ----- ------ --- ------------- • �.Description of Soil.. • --V. -- x ....................... ••••-••••••-•••..............••--•• ••••••--•-•-•••-•---•--•-•--••-•-•-••-•--• --•••-•---•---•---••••••-•..__._._...•••-•-•--•-••••••••....-•••--•-•••-•••-•-...•-•-•••••- VW ---•-----------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------•-•-•- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------•-----------------------.._..------•---------------------------.....----.._..---------------------------------•---------=-----------•-------....•••••-••••---•-•--•••••- Agreement: E The and si ed agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisioi o TITLE of the State Sanitary Code—The undersigned further agrees not to place t/hes,em in Operation nti rt•• e liance has been iss d b the board of health. Si ned......... ���� ; S5 -----••-- ...••••-_.... Aplicatio oved By--------------------••----' -••- _ • ••••---_--•-••_-•.•-•••••••-•--•------...._..-- ---•---...�_:"_.. _ Date Appli io Disapproved for the followin easons__________________________________________________________________ ----------••-- -••-••--•..................•••---....•••••••••••••••••••••--- _..---•••-•-•-------••--••••---•-----•••---- ................. Date PermitNo.___4?_CJ__........:3__1_-•--------------------•--. Issued....................................................... Date c6- �/(� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................I.....................OF.................................................................................... (Infifgratr of Tuutpltattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed rr� ) or Repaired ( ) ------ — ---------------------------------•----------------------------------•--------------- .------ Installer has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for I)isposal Works Construction Permit No.-<3.`,--•-.L-3.--�................ dated---..----'7--..:�- gs............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................1Q.:._ Q "� -.- Inspector......... ---- No------------------------- Fzx.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........F0..VQj1J............OF......... ---------------------------- Appliration for 14sposal Iforks Tutuitrurtion 'phrmit Application is hereby made for a Permit to Construct (7\) or Repair an Individual Sewage Disposal System at: ---------------------------------!;&�.......................................... ddre;; or Lo No. ............................... ......q ZA. " -�....... ........ .&.....-------- ........CIP...................... .............t.. Installer Address Type of Building Size Lot,,.,�GKZX:�.......Sq. feet Dwelling—No. of Bedrooms_ ...�. U Expansion Attic Garbage Grinder,, .. ------ Other—Type of Building ........... No. of persons... ----_-------- Showers Cafeteria Otherfixtures ..................... -111�,44----------------------------------------------------------------------------------------------------------------- Design Flow............f-,f........................gallons per person per day. Total daily ...........................gallons. 9 Septic Tank'— Liquid capacity/e1&,0..gallons Length.�f_.-__.0..... Width.__'-/,6.. Diameter................ Depthy Disposal Trench—No..�_-4.... Width:I.................. Total Length.................... Total leaching area_._.._._._...._____sq. ft. Seepage Pit No.--,/............. Diameter.�.oZ.......... Depth below inlet....,4............. Total leaching areaMk.......sq. ft. Other Distribution box (,v) Dosing tank Percolation Test Results Performed Test Pit No. 1"'minutes per inch Depth of Me'st Pit/ .......... Depth to ground water.A.j�q&.�........ Test Pit No. 2...............minutes per inch Depth of Test Pit..............._.... Depth to ground water..____.................. 0 Description of Soil.r aa... ------r.*....a...'r"* -)...cz�eam.... ................. .......................................................................................................7 .......................................................................................... U W .............................................................................................................................................. ......................................................... Z 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 I IT ILj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation nt*,-a er /061f C nipliance has been isped y the board of health. S* ned......... Y-S ........................................................ .........7ij............... /D/t;e Aplica ................. ............................. ............)...... Date Applica�ti Z proved By........ Disapproved for the followi reasons:................................................................................................................ .......... .......................................................... ................................................................................................................................ Date PermitNo... ........................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................-OF..................................................................................... THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by-----------------------------------------------P-MliCA±........P-V..k............................................................................................................. Installer .......C, VZ...C.1 ................... at..................................................9..-a......... .... .................................................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.Z;.7:_J6'.3_4................. dated----------- ------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .. ............................ DATE................... Inspector.... 7 ------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT . ..................OF...........A"V2041)ZA............................................. .................. ..... No...... FEE..., .:5................. uiapvs orka Tonstrurlian Errant- mo C 0 Permission is hereby granted.....Z i f e...7.......................O/Z-................................................................................................. to Constr ct (X,) or Repair ( ) an Individual Sewage Disposall-System at No....... 1*4 0 B1 ................... .......................................................... A Street as shown on the application for Disposal Works Construction Permit --- Dated-------)-------1- ......... �1 1 ........................... &- --A------------------------------------- Board of Health DATE.. 416 ................ ............. FORK 1255 A. M. SULKIN, INC.. BOSTON y +; -,g Se�✓az f' r 8-vim) Ltd T R w f' Io 53 L7IA � � 1 h r �• JeES���E �` NYC '� (5A:�12- SEw.:>- �F .. N 00 w «Ay F AcH,PIT v Itt o ;V � C �a , Or 01 >(4)' P.w�osm p o w✓ wq7�� Q e6�*IA17 Far; 15 C. 2 r , 0 �'��/u T st 5 r1M p LO T plc©T c�ry peg RT.: H OF °�/Q�S Sv try/ ,fir `" A�" •`Y —� . t7 q� PA✓��7L-NT q FtgS..�T 5 N ALBERT � i' U /� A. A,� -x P, `�zn MORSE Q C/</,V 0.8 fe �a� ' No. 1G951 a,A'yi S `'fir+ /♦ `V 816 ! i �A. 'O t �, � .i� LEGEND ' <EXI.S'TINA lIPOT ELEVATION 0%0 CERTIFIED PLOT PLAN ' ':EXISTING' CONTOUR --- 0 �} �.FINIGNED SPOT ELEVATION L o T Z ar\.n ,v� #° 'rFINISHED CONTOUR 0 v rtld0'1'E` :_:The location of any existing" un_ dergrOU d sewerage, y ael:ls,.'or other utilities shown on this plan is approx- IN Axwte.only "as determined from records and/or verbal gA g h S• A-9 L A,.W ASS* Information ;The contractor .is responsible for the x _.T..Oi.cation ::of..the existing locations in the field. SCALE, / 30 DATE , G 4/f REOGE ENGINEER/NO Ca-INC) CLIENT.,._...:.._ I CERTIFY THAT THE PROPOSED '�" 5o9S BUILDING SHOWN ON THIS PLAN � }�� MIGTERE REOISTeREO JOB N0. CIVIL LAND CONFORMS TO THE ZONING LAWS , Y OF BARNSTABLE , MASS . . T 12 .M A I N STREET CN,'By 7 ��.-_ x I MA S. NYANN s 9 Y REG. L ANO SURVE OR..._. F ODA E 9 HEFT 0 NOTE /F1 EZ7,VG&* 7"NESFPT/C TANK OR 20 FT. H/N LE,•rcx/wG PiT A/tE l`fORE TNA1V /2~aFtOI�V /G FT /rf/N. 1R^OEM 24'p/AW F74-e CONCRETE COYE.r f, S/,+A L L eF B RO SIGN T TO { CO/VC�tCTE �' IOVC.P/pE ( h'EAVY'CA ST lRO/Y Co�/ER S//AL 1- BE USED ' MlN. PlTCJ•1 1 /F/N OR/VEJ�t/�Q y COVERS - r y �- C"OnrCRt-7 A r ' _ i d1tAoE GO YER CLEAN SA V.0 1 i - - - .- - Ll3UJD LEVEL r� _ ' "�••t, :` ;� � E e � • iJ"O1/1. - � .. •.J c" Z SLAY t �.• C. P PE • • t.: �IIv. �►/Tc�► OAL. + • t • . . • • • i WA SHEO STr'rE D/ST. + • . • • • • • • • . • SEPTIC TANK oX ` + « . . • . • .'• 14'- :..; r,wST • • + + • OL'PTtI • • • • : WASXEO STONE 41 x /•v = ! �3 ' ` � • • . • • • . . • j��� PREC,/tS T SEEA4G£ a. . p/7'DR E4u/V- • • . • • • • • • • o• ` 1AeV,CRT CL EYA77ONS ./--I T CA I-AvrY ..459 v GAP �DA r ► . Fr D/AM. t 1NYZAT AT OU/LD/IVG 9 G Fr. ` C CSFE T�8uL4 TJONJ PIAW. IA/LET .SEPT'K' TiF/VK 9-57-18 40r Ou7LET SEPTIC TANX .95-6 PT. /INLET D/STR/Bl?/ON.6®X 9S 4-F7► SECT/ON OF GRO/JND H t CA7,F TAAL€ C z' 7vTtETo/STRIAOrION BOX9 S z F r, /NLFr IXACNINrr P/T ' FT. SEN�AGE O/SPO�Sf4 L SYSTEM 'rAW"TIO/Y LEACH/NG P/T Sew : �4 a /:o• DINIF10"IOIV A_ &ESI SAI CNN TERIA DItIENS/o N 1� �-fT• NutldER aF. BELaROOMS 3 ytRd.<GED/SPO,S�SL�/IY/T /von�e SO/L LOG SD/L TEST TaTAL EST//�'TED FLodS/ 33 O G.4L.1DAY SOIL TEST Al SO/L TL�ST P 5K/MaER OF L.-ACKINZ; PJTS reLEK 10,01' . -ELE3! OAT& OF SOIL TEST SIDE L eACHI JVG PER.P/T RESULTS WJTNESSFD dY JoTTOM La-4c,,/IN L/G P--R P/T 3 -sq. A - y�f/j •Sd3- �RCOLA-r10N /GATE.0/ 707,44 L EACHJh'G AREf47-4 Q,HCH '. 7-47-4¢ .S'Q • T. )� i� 4 y )cwxcOL ArIDN , . . ' ; RESERVE LEACNIN5 r4REA ib4- SG. F T. p=Z5ao. .95.8 .S �� �S1• CSG9/LL ?E�'T/�. NOT /9'(3tLs or+Gf�Y'� OF,y� � cL'c-f1 /� GDT 8Z-Moc�tin��43�,e.o L �/E MA4175 7 alVS 3 . .ALBERT s� Q ROBERT A. S. MORSE vi)F " E1 DR s GA2 `�f No. 2 / . � i,, r�3 a � € �LOREDGE io95i o EJ�4G/NEAR/NL � • s''-;'fi r"�• ` i, ,3vo �'- 4 <t t ;7f2__ .STj .'!'+iA - s� _ � s { F EZ!' ENCOIJNTEREO r �e�'EO/✓ _ o =x, .., ..Z ;• CIO GtJNO--YY4.T _h L✓A!7`ER F � x..- o L :a,s -'.+, x'. a�. �` y "�,n. '� c�' rt�rr .�3 .,-•� • 'r -i+s,•�"°` + a� � n..3'�• a �.',�=:,Y a i .�. .- ;..-,.: :.�. . ..t ,1., w.:. ,�. < 1. , ,.,3..y,�....,. p,�. „„c.., :•, erg- �...:�, .rx�...'�^ .. -;,•r. .s�.s;me� Fx��., .�s�?r-' t ,..._.a, =,,i sr .:•. ,:, °s n ;" w. ta. .x` .f 8.s.4, x..:a-.. - ri<+"..;x.+r� :?H�wY,.,. },.. _ rM- ..Y.,i k' .'i.G,,.�"«:tM:..w...:.-w«. ^r.-= ....��..'^'_�. ,:-.� ._"' tcaw.4.Cux.':t:�.�:+5='i.':•�k�Y 2r:#,s .•.-..�.;-,..+e..•C..'fs+s�• r_"�n3� -,w+', +�.F.�e.�b+% .-a�^,.dF•.^.i�..:_n •'!4��^'�'�.".15�h•d`rti�". � ;`,�+i-� '"q .,•�#�"�� �i�`��'_-_- ,�. ,a n'�:S� No....21:e®.F'.-.... F�$y ................ THE COMMONWEALTH OF MASSACHUOETTS BOAR® OF HEALTH ................. ........................O F...............I........................ Appliratiun for UigpuuFa1 Works Tunitrurtiun ramit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: Lot #112, Mockingbird Lane, Marstons Mills, MA ...• - - ......_. ..................... --•. ...............----• ---------------•- •-•-- ....... George BiSs�°�'�°;-Addre:s 0 . Box 667, Sandwich, MA °r I,ot N°' -• _ -------------------------------t...--•---........._..........-•-------•- •.........•----•----------....-•-•--••------••-•----•----•----.......-----.....................--- w Owner Address a ............./•_c ------Tll ttd!1 .................................................... .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........... ..............................:Expansion Attic ( ) Garbage Grinder (no) PL4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures -------------•••••............•• .._ Design Flow...........55.............. .............gallons per person per day. Total daily flow.............330......................gallons. w W Septic Tank—Liquid capacity1__...__..._000 .gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____ _____________ Diameter.__.$............ Depth below inlet................... Total leaching area....200......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by--- tel5s n..,R.....Kall............................. Date....2/28/83.....--...--.... 4 Test Pit No. 1.X.....X......minutes per inch Depth of Test Pit..... ........ Depth to ground water........................ f=, Test Pit No. 2....2......_._minutes per inch Depth of Test Pit----- 2.......... Depth to ground water........................ -------------•----•---------------- O Description of Soil......Pl _._.._�_'._ _._. loam & topsoil, 3-4____._clay.,__.4_ -__ 12' medium- x coarse sand:•; Pit #2 1 ' 2' loam & topsoil, , -' ..12' __ ---....- -••••••••-- •••- ......................................mecTium-coarse sand. 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 TITLE 5 of the State Sanitary Code' The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by the board of h th. - •- - . Signed -Date y Application Approved B •••• - � ------------ -•--•--------------....------------ Date Application Disapproved for the following reasons:................................................................................................................ ---------------------•------••---•-•--•------•--•-•---------....---...-----------•-•-•--•--••----.....:--.......---......----------......-------------------------•-------------------------•--•••_-•--- Date PermitNo......................................................... Issued-....................................................... Date L No.....$.3:efl— Fmc.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF....................................................................... Appliraation for Dispaii al Works Tontrnrtion ramit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: `,ot 112, iiockin bird Lane, Marstons i4ills, b1A •--•---------•-•--......•................................•---............----...-•-......•--••-•-• -•---..................---...-----....•••------•-----•.............--•--•......--•---......_.••--- v o ton-Ad gss or Lot No. 'eorr e Bins $® . 0. i3ox 667, Sandwich, VIA-_ ......................-----............................----..........-•----•--••---•--••-•---••.. ..........-•••••......--•-...........•--------•-•--••-•._.......................................-- Owner Address a ..............7-.........r�..................................................... ................. w. Installer Address Q Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms........... ..............................Expansion Attic ( ) Garbage Grinder (nq aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. Q Design q 55_ .. yl Ci.. p - pe o pe day. y - t daily --- 330 - ..gallons. W Desi n Flow...........:......................... allons er erson er da . Total dall flow......._..__.._-•-•----•••-----._______............ WSe tic Tank—Liquid uId ca acit _........... allons Length................ Width................ Diameter________.____._. Depth................ x Disposal Trench—No..................... Width-_........._.._._.. Total Length............0....... Total leachingarea_._........._.......s . ft. q Seepage Pit No......�_------------ Diameter.....` .......____ Depth below inlet.......... .._..... Total leaching area_.___�00.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Result Performed by....Slelso-n.._R......I all... ......................� Date._...�_..�` _.��............... Test Pit No. 1_.:-............minutes per inch Depth of Test Pit...... ....... Depth to ground water________________•-___-_. (z, Test Pit No. 2......?........minutes per inch Depth of Test Pit------ ......... Depth to ground water........................ p Pat h: 3"' �o:am..�..�opso il.�...1_�-L-r_..c��y®::��.�__. �� ....izd°?lam-...._. Description of Soil._._.._. a_._ r x coarse sand e, yat---# Y rs� �o so i , ,� v to a 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 TITS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iWued by the oar, of h , h. Signed. -- - -- ---- ---------------•-•-•--- ................................ Date Application Approved By........ ........................................ Date Application Disapproved for the following reasons:-----•---------•-------•--------------------------------------------------------•-----.......•-••••-•-------•- ...............••............._......----------•••-•-----•------•---••-••••••-----••--•--------•-•-•-•---••-•-•...-•--•-••••-----••---- -•-••---•-•-----•-•------------•-------••---••--•-••--•--------- Date PermitNo....................•--•-•-•........----•-..........._.... Issued........................................................ r Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................. .................................................................. (Inrtifiratr of Tontplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) 41 by................... �.--------------------------------I..........--................................................ In gal y, at............. .. _..h.- -------------------------•--..........---------------- has been installed in accordance with the provisions of TIT R 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__: ... .......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU S A GUARANTEE T14AT THE SYSTEM WIL FU CTION SATISFACTORY. DATE...... . .7..�f�...................................................... Inspector........ .... -•-•------------------------.......:.----..............--••--.....-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.---................................................................................. o%' No._$3-=�Q> FEE........................ Disposal Nq4 . w trndilan unfit Permission is hereby granted........-.................lel ` "" ----•------------.....----•-----•------------....-•----........---.................... to Construct ( �or Re air ( an Individu l S _*ag ispos System atNo.......... /'� ..... >• •--•------------------------------------------ Street as shown;on/appli.ation for Disposal Works Construction P r t No.................. Dated.._....................................... ••---• ard of HealthDATE-•-- - �.---------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LO CAT IO SEiNAGE PERMIT NO. VILLAGE INSTALLER'S NAME & ADDRESS . � rcl1 d UILDE R OR OWN' use Il l DATI PEItMIT . ISSUED jr 23 — DATE COMPLIANCE ISSUED _ �3 _ J Y � � ��� w 3 �., �� i� �� �o ty ,l- r"i. t `L ,`,4' „t.rsti4 s r 't,+l' 4:!` - t„ < ';+w' . ;.d'/ r ti I, fir. ,y I. v T`&P Ff.: :±' s a5,? r y' < ,, d. k ,' .{:' Y _,.5, �4 fr, s S�{ •-, • ' ', o v 1 y Y #_ 1 F ti <ti 'S• 1• : s a rS :.: .' a .S rr' u .l a 1 `j rI . v . . r - I � ,. 'J�L�EY c I � � . - y /F r: cif IIN) R x ! J/+�` TM y F�, - S . ro'. ff (,yam//[/ ,ml �, ,j �z. .S P.Y•LC `P. S TaaV �ti- 8 �► �N z;r E A Y E 8 Y ! �2. GZ,4' r �: . 4rI .S,EhI:E , -, PV.C _6�f X+ ;, y•: - (�,,4 p. y. 12 x: t 4: I l 1 ASH;, wr°, w �., f ; s0 - E` C P c E: t 4 T If ., r. >- I E .S T'O N E .ALL � � r `y, r n.l R U U.� - _ - 1 a e .�"I.7 s (�t F. j . s .,t,..-- i • I`1. A . , q R UN ` ,�.E C 4 ] . 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