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HomeMy WebLinkAbout0092 PALOMINO DRIVE - Health f 92 PALOMINO DRIVE,BARNSTABLE A= 316 094 u M o ' o a T a .,Zt- � .,., v'F•� -. ._-.a _ ... ., ,��-'._� ;:,. _z. ..na.:.,a:.n-. r.> .:,�- .a..au „ .. _ aa:s..�y-.a - $- a.. _ uy:a_ ._ _: �;uv'...,,_s .y.�- ,,..-_.:a .�-Yr.•_ --- -- -�i., =-.m ♦ u _ �,.F'- F. o a s a + o , �\ COMMONWEALTH OF NIASSACHLSETTS i EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION y ONE WINTER STREET.. BOSTON. NIA-0_108 617•292•500 �g➢l �� �. I NILLIAV F WELD �� ^p�`'Ol C- , coxi= Govemo Se.retar\ .aRGEO PALL CELLUCCI "^' ' Cj �1�AVID B. TRIUHS Lt Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM m issiurier' PART A ©T Al cc CERTIFICATION , 1 / Property Address:'Pb1QPPrLomirro 17r. i�>RrJhT le-rrtq,oab"30 Address of Owner: Date of Inspection:-4/ Y-1.5 (If different) Nane of Inspector: Re,lLC. � I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: r r Mailing Address: Q3 Tri�c': IRA, U ht�os►t�1�orT.MA. Telephone Number: J.SL) y) 3V2— 623'1 v CERTIFICATION STATEMENT `. I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate -�T, and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-soe sewage disposal systems. The system: it �C Passes `, Conditionallv Passes 'Feeds Further Evaluation By the Local Approving Authority Fads gk Inspector's Signature: Date: 4Z`"--G 5 The System Inspector shall submit a"eopy of this inspection report to the Approving Authority within 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 (he appropriate regional office of the Department of Environmental Protection. The original should be sent to the system.owner and copies sent to (he buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, �B, C, or D: t A.) SYSTEM PASSES: Ll I have not found any information which indicates that the system violates any of the failu%e criteria as defined in 310 CMR: 15,303. Any fail evaluated_ore iridi�ted low. COMMENTS _ .ter �51 7- lev 3] SYSTEM CONDITIONALLY PASSES: � One or more system components as described in the "Con itional Pass" section need to be replaced or'repaired.r The system, upon completion of the replacement or repair, as approved by t e Board of Health, will pass. ,. Indicate ves, no, or not determined (Y, N, or ND). Describe basis determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or ope ator has provided the system inspector with a copy of a Certificate of t Compliance (attached) indicating that the tank wis installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspect on if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (r*%*;s•d 04/25/97) Pag• l of 10 DEP on the World Wide Web http:Nwww.magnet state.ma.usroep Printed on Recycied Paper ! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM + PART A ' CERTIFICATION (continued) Address:ya 1�Lum11W Property �chr, c�itj�Rn1 Ohner. Date of Inspection: -9 +. ��/ r ObsiruCted BJ SYSTEM CONDITIONALLY PASSES (continued) royal of the in the distribution box is due to broken o will ass inspection if (with approval sewage backup or breakout or high static wat r level observed pipets) or due to.a broken, settled or uneven istribution box. The system P £ Describe observations: Board of Health)• broken pipe(s) are replaced obstruction is removed r replaced distribution box is levelled The system will pass The system required pumping more than four imes a y ear due to broken or obstructed pipe(s). ` nspection Ii (with approval of the Board of H alth): broken pipe(s) are replace obstruction is removed EALTH: CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF project the re further evaluation by the oard of Health in order to determine if the system is failingto _ Conditions exist which requ n1NER public health, safety and the environment. INES THAT THE SYSTEM IS NOT FUNCTIONING IN A MA WILL PASS UNLESS BOARD OF HEALTH D FM THE ENVIRONMENT' tl SYSTEh1 y WHICH WILL PROTECT THE PUBLIC HEALTH AND SFM ater _ Cesspool or privy Is within 50 feet of a surface g vegetated wetland or a salt marsh. Cesspool or privy is within 50 feet of a borders HEALTH ND PUBLIC WATER SUPPLIER, AND APPROPRIATE) AND D ETERMINES THAT 2) SYSTEM THE SYSTEM LI FAIL UNLESS THE S FUNCTIONING NOARD OfA MANNER THAT ROTECTS THE PUBLIC HEA ENVIRONMENT: k and soil absorptio system (SAS) and the SAS is within 100 feet to a surface water supply or The system has a septic tan public water supn'Y well. — tributary to a surface water supplysystem withih 50 feet off private water supPIY well. The system has a septic tank and soil absofptii system and the SAS is within 50fee feet b 50 feet or more from a that The system has a septic tank and soil ab p and the SAS is less thancompounds indicates The system has a septic tank and soil absorpti n systemual to or to water supply presence of ammonia nitrogen and nitrate nitrogen is eq va I well, unless a well water nalysis for co bacteria and volatile organic Phi (approximation not valid). the well is free from pollution from that facili and the less than 5 ppm• Method used to determine istance �-- 3) OTHER p�q• 2 of 10 (r-vised 04/25/91) • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM j PART A 11 CERTIFICATION (continued) Property Address: PALmtn-o �Y, Q�rnSTAble IYl[3 Owner: ,Soy rt C�-ez T�,lktvl Date of Inspection: y 4 96`' + D) SYSTEM FAILS: t You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the (lowing failure criteria as defined in 310 CMR 15.303, The basis for this determination is identified below. The Board of Healt should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component ue to an 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 Static liquid level in the distribution box above outle invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day floe: Required pumping more than 4 times in the last yea NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the. Soil Absorption System, cesspool r privy is below the high groundwater elevation Am" portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a sunace water supply. Any portion of a cesspool or privy fs within a Zone of a public well Any portion of a cesspool or privy is within 50 feet f a private water supply well. .-Nny portion of a cesspool or privy is less than 100 f t but greater than 50 feet from a private water supply well with no acceptable water quality analysis If,the well has n analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, am nia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: {' You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition t the criteria above: The system serves a facility with a design flow of 10,000 pd or greater (Large System) and the system is a significant threat.to public health and-safety and the environment because on or more of the following conditions exist Yes No the system is within 400 feet'of;a surface drink' g water supply _ the system is within 200 feet of a tributary to a urface drinking water supply- _ the system is located in a nitrogen sensitive are (Interim 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 d facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the Iota regional office,of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST r mrylti �'�. �rar�lSTa'b�e_('f`nt'-i-' Property Address: lI Owner: So1,✓1 Ch��Th h1 Date of Inspection:y Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes _ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least 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 pan of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. ` The system does not receive non-sanitary or industrial waste flow. _ The site �%as inspected for signs of breakout. _ All system components, eNcluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based information on the proper maintenance of The facility owner land occupants, if different from owner) were provided with Sub-Surface Disposal System. . Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) page { of 10 (revised 04/25/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM'' PART C SYSTEM INFORMATION Property Address:q5- PRLorntn() 0'r-, [>r}rnsTA-We-jy l— Owner: �ohn L�1zeT1�lkW\ Date of Inspection: l FLOW CONDITIONS RESIDENTIAL: - Design flow -3 t .P.d./bedroom for S.A.S. Number of bedrooms. r ~'umber of current residents:_2 �f/'n✓!�' l S Garbage gr,: der (yes or no?: Laundry cor•pected to sy ste yes or no): Seasonal use (yes or no): � Water meter readings, if available (last two (2) year usage (gpd): ..� /L- Sump Pump (yes or no) j Las: date of occupancy: (_; l/Z,,�'/'1'�/ COMMERCIAU'IN'DUSTRIAL: Type of establishment. Design floe Qallons/day Grease trap present. (yes or no)_ Industrial Waste Holding Tank present: Ives or no)_ tion-sanitary waste discharged to the Title S system: (yes or no)_ \%ater meter readings, if available Last date of o.cupanc-� OTHER: ;Describe: Lasc date of occuoancl GENERAL INFORMATION PUMPING RECORDS and source of information- System pumped as part of inspection: (yes or no) If yes, volume pumped: Z gallons Reason for pumping TYPE F SYSTEM Septic tank/distribution boi/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? ` Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 67 Sewage odors detected when arriving at the site: (yes or no) � (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION, (continued) Property Address:`- a plpLo mn4 fir• 13t�trnSTA'��z rnf+ Owner: j o� \ Date of Inspection: y BUILDING SEWER: (Locate on site plan) Depth below grade: Material of consvuoion: _cast iron _ 40 PVC _ other (explain) Distance from private water supply well or suction hie Diameter Comments (condition of joints, venting, evidence of leakage, etc.) SEPTIC.TANK:'( JJ Uocate on site pan) _-7 Depth below grade ot-��u etal _Fiberglass _Polyethylene _other(explain) Material of construction: jCconcrete ,_m If tank is metal, list age — Is.age confirmed by Cenificate of Compliance _(Yes./No" Dimensions Sludge depth �G Disidnce from top of sludge to bottom of outlet tee or baffle: Scum thickness Distance from top o scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffler Ho,w dimensions were determined. Comments: (recommendation for pumping, condition of inlet air d outle tees or affle depth f liq id level in relation to ou let str aura C� ntegri , e"Kidenc oe f leak?$e, etc.) �, S GREASE TRAP: (locate on site plan) Depth below grade: Material of construoion: _concrete _metal _Fiberglass _FDlyethylene _,•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: (recommendation for pumping, condition of inlet and outlet tee or baffles, depth of liquid level in relation to outlet invert, struoura integrit),, evidence of leakage, etc.) Page 6 of 10 (revised 04/75/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C I ,SYSTEM INFORMATION (continued) Property Address c f1(+)�mt"l% �r a ispo �STI'�-! OHner: 1o1�v\ C�Zz �1 Date of Inspection: Lj_q TIGHT OR HOLDING TANK: (Tank must be pumped prior to, o at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethyl ne _other(explain) Dimensions: Capacm gallons Design floe gallons/da Alarm level Alarm in working order_Yes, _ No s Date of previous pumping: - Comments. (condition of inlet tee. condition of alarm and float switches, etc.) DISTRIBUTION BOXim ~ (locate on site plant Depth of liquid level above outlet invert: Comments (no(e le yovvel and distribution is a al, evi ence-of solids carr ,r, evide ce of ) age into or out of x, etc.) _ ' " p PUMP CHAMBER:_ (locate on site plant ` Pumps in working order: (Yes or No) Alarms in working order (Yes or No) 0 Comments: . (note condition of pump chamber, condition of pumps and appurtenant , etc.) (raviaed 04/25/97) Page 7 of 10 a ry SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:Ll-�, 1)A� WCm Or. j3�rn�lf�,�< .TYIA Owner: Jot , C hte- t�rvl Date of Inspection: y.c) _qg SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excav tion 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: Alternative system: Name of Technology: Comments: i t .) l� note condition f soil, sig s of hydra I fajlt9re, le I o> n ing, cortpdyt(on of v gam'etation, e V v No J �' _212 — CESSPOOLS: (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 (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, cond ion 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, condit on of vegetation, etc.) (revised 04/25/97) Pag• a of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (conJinued) ^ / :. Property Address:�� �i��msr p �(, g�t�Yr1ST-r,4C rnp � v �. Owner: ���h CeeT�Rm Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) i • � I Jam/ l � thy ' (revised 04/25/91) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: _q_1?6 Deptl- to Groundwater' eet Please indicate all the methods used to determine High Groundwater.Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check "ith local Board of health Check FEMA neaps heck pumping records Check local excavators, installers Us6 USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) 76-- Z�e IW�1 / 4 a.4 l � (revimad 04/25/97) Page 10 of 10 LO AT ION SEWAGE PERMIT NO. VILLAGE T INSTA LLER'S NAME i ADDRESS h rV 77 02AR57aru s r3,;11.i-es o 0 U I L 0 E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 0 1� 1� f (. No....-------. .... rFi ,,,,........................... THE COMMONWEALTH OF MASSACHUSETTS .BOAR® OF" HEALTH ~ I .........OF........ .......................... for Uh4pniia1 Works Towitrnrtiun ramit Application is hereby made for a Permit to Construct ('✓) or Repair ( ) an Individual Sewage Disposal System at: . �, llot;5i5 .......----.�T -- `� Locati n- ddress or Lot N --------------- ------l56..` , A1. ec�..... r -- ......-- y� ,[� p Addr�ee`'s`sss �� lY......[..{ 1 ................ ............... .A K�!7 QA d ......Address �./A. ................-•--^._... nsLaller d Type of Building ' " Size Lot__'} /-___.C.-O-.Sq. feet UDwelling—No. of Bedrooms............�..........................Expansion Attic ( ) Garbage Grinder ( } Other—T e of Building • No. of persons............................ Showers ( ) .— Cafeteria ( ) a Other fixtures ••-------------------------------- W Design Flow..................�1�_ --.--__-•---__gallons per person per day. Total daily flow_............. 4..C)-----.----------gallons. WSeptic Tank—Liquid-capacity./dZ@Vgallons Length-----f"4_._ Width-_-.V_'l.�. Diameter________________ Depth....S-.$- 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 t nk ) f '—' Percolation Test Results Performed b �. � ---•/� --7�6 Date..__ - - -f--�_ Y--••- aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - ------- ----------------� �V L� S�'�L--------a-"- 49---------�/QC.___5A�----------------- V ....•••••••-••••••••.....•••••---•••-•--•-•-••--•••••••-•--•-•-•••-•-•••-•--•-••........•----•-•••••.....•--•--•-•••---••••••-•••••-•---•--••---•---------------------•..._......---•-••••...---------- 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 TIT�:a. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in p Certificate of Compliance has&beesuedbby the board of health. o erarion until aDatedApplication Approved BY•--••• -+( ` — •_�'- /--�1- ��• Date Application Disapproved for the following reasons---------------------------------------------------------------•-•-••----•-••••--••-•--•••- -•-------•--•-----. •-••........•---•--••-•-•-•-•••--•-•-••----•-•-•.....•••-----•-•--••••••-•----•-----••-•---•-••-•-•••••.....••-•-----•••••-----••••••----•-•••---••-----•••--••----•-•----••-••--•----•.••-•------------- Date PermitNo......................................................... Issued........................................................ Date (-I THE COMMONWEALTH OF MASSACH-USETTS BOARD OF HEALTH . 8 Appliration for Uii#woal orkfi: Con riir#ion • prnti# Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal System at ��� Location-Address R r� . e" .... �e � fit:: .1.�i�L„iS.�:.--• �--r� •---.����-t.�r.��f.F.°i:Y.�&��----3 �_19:t .a^�.:�!...........-•--•-----...._ �Address� or Lot No �3-^ , a ss •---._...--=v��l e�- .,..:�`: f� yy�_•�=.:+m....-•--•-•---------•---•......... ...:.........,�-f �'�5-`rr�:�Add� �-{9',�F'"`• . •---•--.........---•---- ngtaller Address 44 Q Type of Building �, Size Lot__ y :2...Sq. feet Dwelling—No. of Bedrooms._... ......'.............................Expansion .Attic ( )• Garbage Grinder ( ) . Showers _ Cafeteria p•, Other—Type of Building ............................. No. of persons............................. ( ) (. ) dOther fixtures.............. ........................................ .............................................. = Design Flow............... - �__.. ..._gallons per person per day. Total daily flow__._._. - 4�' __ _..__.....:.....gallons. W ...._....... WSeptic Tank—Liquid capacityl_.j _.gallons Length.... _ .__ Width.... _ ?:,Diameter..:.:..:...:.... llepth_.,. ._�.�.. xDisposal 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.... u��✓�-_.: r11 r_+ +� Date._. . __ Test Pit No. 1................minutes per inch .'Depth of Test Pit..................... Depth to ground water........................... Test Pit No. 2................minutes per,inch. Depth of Test Pit.................... Depth to ground water.......................... t� •--------- •----------------------------------------------- O Description of Soil....... ...... a •Y 2_ .._ta , f._.:3= ?!_ ------. l .......... r. ` -! '................. x U -----•-•----------••-•-...------•-----. -•- . --- ............ 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 TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued by the board of health. g ' Tl �° .�� 7b✓r'� a'`ao'ef Datea / Application Approved BY t * /� •------•----••----• -•-A �` Date Application Disapproved for the following reasons................................................................................................................... - •-----•....................•----=--•----•...---------•-------.:.••---•---•-•-••--••......--•••--•------•----•-----••---------•-----•-•----•-----••-•--••--•-•---•--•••-------•---------•--•----•-•-•--- Dat- PermitNo.......................................................... Issued.......................................--.............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....%�.1. . .. .O F..... . "..........................::.. 9n ifiratr of Tontplianrr ; THIS I. TO f1RTIF/�, That the Individual Sewage Disposal System constructed ( �q ) or Repaired byQ / '�-�!�?.�. .:r... :.. y R ................. - -- • ................................. y f / d I stalle? has been insta led in accordance with the provisions of TI� � 5 of The State Sanitary de as described in the application for Disposal Works Construction Permit No."�. _-- .•w............... dated__� 1" ✓_ ._...... 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 OF HEALTH 1 ................... . ..... -r ......OF....r�{' t .5. . 4. �que No._......: -•--••--- FEE........................ Disposal orkv (toustrttr#ion ramit Permission Is herebyranted----- _? �f// g • ..... v ..........................................•-----•---•--•------........--•-.......••••••-•- to Constr�c�( or Repair ( ) a Indivl.ualjSevc�age sppsal System IZat No..--••= i... � -,milc.� -.._..✓ i::P?. :�- P- 'gl------------------- Street as shown on the application for Disposal Works Construction Permit NZ �.__�______ Dated_ T "7 f ! ', L.� Board of Health7 DATE................................................................................ .=4 FORK 1255 HOBBS & WARREN, INC.. PUBLISHERS L,10 �-,A28.oGf� C�Rt+•.1DE-.fZ _• ;;��'.' _ � _- - - t�al 33O G•pt?. C 3So.r (So % - d-9ra E.P0. USi✓- l OC PCb EsQ•L•.• ' _ PDr Ad.. 'PIT • USE I Dorn GAL., (j7GUTALL A EA. = 150 1c� SF 2.s . 377S 6 P.r). q) SxP Aes�d So ToTA L 'p ES 6kl = 42S 6-.i?t-->. � • i�f -rc>T&t- �,tai t_�t' F'L.a w = 330 b R D. pup. Pir tmfzc•OL&nOL.I Z&-rE : t"Iy 2mtu'orz GAS• 3�� 4 Tor Fw =ioo.o 96-0 .. � .. ..�.��.• ^ v �Y tuv.• 9;o LoQM Q.�P� locb ItN• SvI� ou., 4'Pp� aKT urd. GAS. 9d 5 94.2 Z• 'box Sc-pnc l o iwv. Ct3 • , tCO00 te�V. IW. t• GAL. �- Lea , C�L1E PIT v s• �,�HLJ '� w /w w• I8l�-��IZ WASN3t� Vrowr= S LSCTIV=%atD PLOT PLAN Przp "1L LoGATI.o" L 0 WA'TEW-- pt .�6►i.1 ' Rom ' QE►jcF-- 1 GGtzTiF,q Tt4A-r TPr-- UN Ttbi� SU4�V�l tt nn�� t•1�:i'( aaa GcaMPt,�lS W tTK TW yl D�.L.11.3� t...��" c�c:� A1J� SC-Tt3.AttC V:r--4U1CeAAE- 1Te, Ot= -r"e PA.'tG ' B A 7CTCtZ t;. u�� I"G_ i tZEGISi'c--iZED Lh.►JG SUZv�=Y��S T(-115 h L A►-1 i� u oT �.AS cv v k..s p..•.i 05TE�V1t._l.0 a MASS• NJ�t'C:JMG I�1 i /��JI,�JI��{ • TtIL: C�Ft=�rT'�, it•IUWLD AP t_(CA.!-J_T_ I I:>t" �,'Ci tJr.c��� r� l7C'1'G['.Mtw11~ 1..o,C` t_I W�.�� _ I �`i�2 Vf•����.�./ ��_�—