245 Title 5 Application/Permits 1986, Inspection 2002 OMESTEAD INC .
March 12, 2003
John Hunter
12 Long Plane Road
Amherst, MA 01002
Dear Mr. Hunter,
1664 Cape Street
Williamsburg MA 01096
413 628-4533
Here is a summary of the additional observations conducted today at the property at 245
North Ring Street in Northampton. I have revised the plan of the system, as attached,based on this
new information.
1. The man hole in the parking lot leads to an oll-water separator. As observed before,
there is about 4 inches of sludge at the bottom of this separator. This is probably organic sludge, but
is not likely to contain significant petroleum products, since these are lighter than water and would
appear on top.
2. The scum layer floating on the top of this tank is thin, and there is mostly open water
on the top of the tank. This water is not covered with an oily sheen,and I believe there has been no
significant addition of oils that would be trapped by the separator. Nor is it likely that the oils have
exited the tank.
3. The remainder of the septic system has been located at or very near their actual
locations. Based on the above observations,I believe that oils have net accumulated in the overall
septic system.
4. The final location of the septic tank is beneath the blacktop. I recommend that
another riser type manhole be installed over the septic tank to facilitate access for maintenance.
Yours truly,
Thomas S. Leue
cc: Northampton Board of Health
2 Bay Garage
vents Oil Separator
25, ,
`� 26. Distribution Box
O
0t p.
7
ti 1
Septic tank, not confirmed
vent -- -
e ,UL LL
Leach tanks, estimated layout
MECo pole 01
Note: No known drinking water sources within 100 radius.
Date: Owner: HOMESTEAD INC.
As-Built Drawing 11/27/02 Thomas S. Leue R.S.
Existing Septic System Francis Rauch
245 North King Street 1664 Cape St.
Scale: 1 : 20' Revision Date: Northampton, MA 01060 Williamsburg,MA 01096
[413[628-4533
Except as Noted 3/12/03
COMMONWEALTH OF MASSACHUSETTS (-N-@-- � d [ (t jt
EXECUTIVE OFFICE OF ENVIRONMENTAL • ," Rf a _ ?I(
9
DEPARTMENT OF ENVIRONMENTAL PRO E ON I
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
ty Address. 245 North King Street GARAGE. Northampton, MA
's Name: Francis Rauch
s Address: 960 Westhampton Rd. , Northampton, MA 01060
Inspection: 11/29/02
Board of Health, Northampton; Pat Goggins. Goggins Realty
s: Owner• Buyer Number: SSDS-756
d Inspector: Thomas S. Leue
ny Name: Homestead Inc.
Address: 1664 Cape St. , Williamsburg. MA 01096
one Number. (413) 628-4533
TIFICATION STATEMENT
fy that I have personally inspected the sewage disposal system at this address and that the information
;d below is true, accurate and complete as of the time of the inspection. The inspection was performed
on my training and experience in the proper function and maintenance of on-site sewage disposal
is. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).
ptic system condition must be evaluated and classified into one of the following four conditions:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
'stem condition: Passes
:tor's Signature:
Date: December 6. 2002
ystem Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health
P)within thirty (30)days of completing this inspection. If the system is a shared system or has a design
f 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
al office of the DEP. The original should be sent to the system owner and copies to the buyer,if
able and the approving authority.
and Comments
his report only describes conditions at the time of inspection and under the conditions of use at
me.This inspection does not address how the system will perform in the future under the same or
ent conditions of use.
Inspection Fomn 6/15/2000
page l of 9 Homestead Inc.
)FFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
rty Address: 245 North King Street GARAGE. Northampton MA
r: Francis Rauch
if Inspection: 11/29/02
Sion Summary: Check A,B, C,D or E/ALWAYS complete all of Section D:
System Passes:
I have not found any information which indicates that any of the failure criteria as described in 310
CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
[tents:
System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of
Health, will pass. Answer yes, no,or not determined (Y, N, or 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
urally unsound, exhibits substantial infiltration or exfiltration, or tank failure is imminent. The system
ass inspection if the existing septic tank is replaced with a complying septic tank as approved by the
1 of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a
icate of Compliance indicating that the tank is less than 20 years old is available.
xplain:
Observation of sewage backup or break out or high static water level in the distribution box due
,ken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass
ction if(with approval by the Board of Health). broken pip(s rare epl replaced
distribution box is levelled or replaced
—
xplain:
N The system required pumping more than four times a year due to broken or obstructed pipe(s).
ystem will pass inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
:xplain:
N Other: explain: _
urther 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
im is failing to protect the public health, safety or the environment:
iystem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that
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.
5 Inspection Form 6/1512000
page 2 of 9
Homestead Inc.
JFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION (continued)
rty Address: 245 North Kina Street GARAGE, Northampton MA
Francis Rauch
fInspection: 11/29/02
System will fail unless Board of Health(and Public Water Supplier, if any) determines that the
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
e water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I 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
e water supply well** Method used to determine distance
is system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria
jlatile organic compounds indicates that the well is free from pollution from that facility and the presence
monia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
ggered.A copy of the analysis must be attached to this form.
they:
System Failure Criteria applicable to all systems:
nest indicate either"Yes" or"No" as to each of the following for all inspections:
(Y) or NO(N)
Backup of sewage into facility or system component due 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 outlet invert due to an overloaded or clogged SAS or
cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume less than 1/2 day flow.
f Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
i 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
water supply.
I Any portion of cesspool privy is within a Zone I of a public well.
Any portion of 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 with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis mast be attached to this form.]
fhe system fails. I have determined that one or more of the above failure criteria exist as defined in 310
15.303, therefore the system fails. The system owner should contact the Board of Health should be
acted to determine what will be necessary to correct the failure.
5 Inspection Form 6/15/2000
page 3 of 9
Homestead Inc.
)FFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION (continued)
rty Address: 245 North King Street GARAGE, Northampton, MA
t; Francis Rauch
fInspection: 11/29/02
rge Systems:
considered a large system the system must serve a facility with a design flow of 10,000 to 15,000 glad.
lust indicate either"Yes" or"No" as to each of the following:
Blowing criteria apply to large systems in addition to the criteria above:
Y)or NO(N)
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- 1 WPA)or
ped Zone II of a public water supply well)
answered "yes" to any question in Section E the system is considered a significant threat,or answered
in Section D above the large system has failed.The owner or operator of any large system considered a
icant threat under Section E or failed under Section ID shall upgrade the system in accordance with 310
15.304. The system owner should contact the appropriate regional office of the Department.
PART B: CHECKLIST
c if the following have been done. You must indicate"yes"or"no" as to each of the following:
(Y)or NO(N)
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 the inspection?
L Were as built plans of the system obtained and examined? (If they are not available note as N/A)
Was the facility or dwelling was inspected for signs of sewage back up?
Was the site was inspected for signs of break out?
Were all system components,excluding the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the septic tank inspected for the
tion of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
size and location of the Soil Absorption System(SAS) on the site has been determined based on:
a) Existing information. For example, a plan at the Board of Health.
b) Determined in the field(if any of the failure criteria related to Part C is at issue
aximation of distance is unacceptable) [15.302(3)(b)].
The facility owner(and occupants, if different from owner) were provided with information on
er maintenance of Subsurface Sewage Disposal Systems(SSDS).
IOURCES•
Department of Environmental Protection,Western Regional Office,436 Dwight St., Springfield,MA
01103, (413)784-1100;Title 5 Hotline-(800)266-1122
5 Inspection Fonn 6/15/2000
page 4 of 9 Homestead Inc.
)FFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C: SYSTEM INFORMATION
rty Address: 245 North Kino Street GARAGE. Northampton MA
Francis Rauch
f Inspection: 11/29/02
)ENTIAL
FLOW CONDITIONS
DESIGN flow based on 310 CMR 15.203 (gallons/day)
Number of bedrooms (design)
Number of bedrooms (actual)
Number of current residents
Is there a garbage grinder ?(Y or N) _
Is there a Laundry Hookup? (Y or N)
Is the Laundry a separate system?(Y or N) (If yes, separate inspection required)_
Seasonal use (Y or N)
Water meter readings,if available(last two years usage)(gallons per day)
Sump Pump(Y or N)_
Date of last occupancy_
MERCIAL/INDUSTRIAL
of establishment: 2 bay garage without Gasoline sales
n flow (based on 310 CMR 15.203): 450 gpd
of design flow (seats/persons/sqft, etc.): minimum for £acility_
e trap present(yes or no): No
trail waste holding tank present(yes or no): No
•meter readings, if available: N/A
late of occupancy/use: continuous
3R(describe):
GENERAL INFORMATION
?ing Records
:e of information: probably not previously pumped.
N Was system pumped as part of the inspection(Y or N)
yes, volume pumped: gallons --How was quantity pumped determined?_
eason for pumping:
omment: Not particularly overdue for pumpina
E OF SYSTEM:
Septic tank, distribution box, soil adsorption system.
Single cesspool
Overflow cesspool
Privy
Shared system(Y or N) Of yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach 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):
Were sewage odors detected when arriving at the site(Y or N)
5 Inspection Form 6/15/2000
page 5 of 9 Homestead Inc.
)FFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C:
SYSTEM INFORMATION(continued)
rty Address: 245 North Kinq Street GARAGE. Northampton, MA
Francis Rauch
f Inspection: 11/29/02
PROXIMATE AGE All components, date installed, and source of informatio
tic plan: 11/18/86 Design date
Source of Information BoH
:LDING SEWER (located on site plan)
18 Depth below grade (inches) Estimated Average
12 Distance in feet from private water supply well or suction line
ast iron Materials of Construction
Comments:
'TIC TANK (located on site plan)
:oncrete Materials of Construction
24 Depth below grade (inches)
24 Riser depth (inches)
59 Septic tank width (inches)
124 Septic tank length (inches)
58 Septic tank height (inches)
1,842 Calculated gross volume (gallons c lcul_ted
10 Air space in tank (inches)
1,500 Net Volume (gallons calculated
22 Baffle depth (inches)
4 Sludge thickness (inches) Average
1 Scum thickness (inches) Average
32 Top of sludge layer to _ (inches) calculated
11 Bottom of scum to outlet. (inches) calculated
8 Top of scum to top outlet (inches) calculated
runents:
ik structurally OK. Baffles intact. Level appropriate
ier blacktop, ends not accesible Some dimensions based on typical.
•ommendations:
MP CHAMBER
N Pump part of septic system: (Y or N)
Pumps in working order: (Y or N)
Alarms in working order: (Y or N)
mments:
5 Inspection Fonn 6/15/2000
page 6 of 9
Homestead Inc.
)FFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C:
SYSTEM INFORMATION(continued)
245 North Kino Street GARAGE. Northampton MA
Francis Rauch
11/29/02
qty Address:
f Inspection:
TRIBUTION BOX (located on site plan) ("D-box")
Y D-box part of septic system: (Y or N)
Depth of liquid level above outlet invert
ments: Under blacktop. Not accessible for inspection.
L ADSORPTION SYSTEM (SAS): Technology Used (located on site plan by estimate):
y leaching pits& number. 2 pits, 500 gallons each plus sto
leaching chambers and number:
leaching galleries and number:
leaching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool, number:
innovative/alternative system,Type:
unents: (note soil conditions, signs of hydraulic failure, level of ponding,condition of vegetation, etc.)
problems seen on surface. No evidence of breakout.
er blacktop. Vented. Not accessible.
kS not located explain why:
HIT OR HOLDING TANK (tank must be pumped at time of inspection)
N Tight tank part of system: (Y or N)
Depth below (inches) Measured
grade
Tank width (inches) From Plan
Tank length (inches) From plan
Tank height (inches) From Plan
Calculated volume (gallons calculated
gross
Materials of construction
Design flow: gallons/day
Pumps in working order: (Y or N)
Alarms in working order: (Y or N)
Date of last pumping
amens: (conditions of inlet tees, condition of alarm and float switches, etc.)
IVY (locate on site plan,if any)
N Privy part of system: (Y or N
Materials of construction:
Dimensions:
Depth of solids:
nments: (soil conditions, signs of hydraulic failure, level of ponding,condition of vegetation, etc
Inspection Form 6/15/2000
page 7 of 9
Homestead Inc.
)FFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C:
SYSTEM INFORMATION(continued)
245 North King Street GARAGE, Northampton, MA
Francis Rauch
11/29/02
-ty Address:
f Inspection:
SPOOLS
N
vents:
(cesspool must be pumped as part of inspection)
Cesspool part of system: (Y or N)
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 part of inspection)
(note soil conditions, signs of hydraulic failure, level of ponding, condition of vegetation
USE TRAP (Usually present in certain commercial systems)
N Grease Trap part of system: (Y or N)
Materials of construction:
Depth below grade (inches) Measured
Dimensions:
Depth of solids layer
Depth of scum layer
Top of scum to top outlet
Date of last pumping
Bottom of scum to outlet. Calculated inches
Scum thickness (inches) Average
ments: (recommendation and conditions)
colenlatna_lackan
E EXAM (Source of Information)
Slope
Surface water
Check Cellar
Shallow wells
>132 Estimated depth to ground water (inches)
se indicate(check) all the methods used to determine high groundwater elevation:
Obtained from system design plan on record
11/18/86 Date of design plan reviewed
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Design perc test
at this or greater depth to groundwater
ormation:
I Inspection Form 6/15/2000
page 8 of 9
Homestead Inc.
North
2 Bay Garage
25' 3-51A
'
vents K of
Distribution box
I
y Leach tanks, estimated layout
MECo pole 01
Note: No known drinking water sources within 100 radius.
Date:
Owner: r°F HOMESTEAD INC.
As-Built Drawing 1 1 /29/02 °"� Thomas S. Leue R.S.
Existing Septic System Francis Rauch �� e O�u
245 North King Street �� u
Scale: 1 : 20' Revision Date: Northampton, MA 01060 /
t - 1664 Cape St.
A, ,'y Williamsburg,MA 01096
f�9tt'PED b/.��'d> 141316284533
Except as Noted _. --.. - _
Prepared For:
/V0 (t Street Mccthary fft-bn
Number of Bedrooms: ( Garbage Disposal:
PROPOSED DOMESTIC SUBSURFACE DISPOSAL SYSTEM DESIGN
((on( IC,
Location:
$S Gal/on /.tae# per /000SF F/oerA2eu- • 9 % Gallons /La,
K t•S • /44
LEACH AREA DESIGN
Bedrooms x 2 persons/bedroom - persons
Persons x 55 gallons of vastewater/person/day a total gallons of
wastewater/day.
Percolation Rate: /0 min/inch
Gallon of wastewater/square feet of leach area for a Percolation Rate of:
/0 min/inch - to Gal/SF Sidewall Area
n,r,S Gal/SF Bottom Area
* If a leach bed is to be installed, no sidewall is allowed.
* If percolation rate exceeds 20 x. /inch, no bottom area is allowed.
- SEPTIC TANK -
* WITHOUT GARBAGE DISPOSAL:
-1 REQUIRED effective liquid
Gallons of wastewater/day x 150% - /� T
capacity of septic tank.
RECOMMENDED: /50r) Septic Tank
* In no case will the septic tank be less than 1,000 gallons (effective liquid capacity).
** WITH GARBAGE DISPOSAL:
Gallons of wastewater/day x 200% ° REQUIRED effective liquid
capacity of septic tank.
RECOMMENDED: Septic Tank
In no case will the septic tank be less than 1,500 gallons (effective liquid capacity)
**
ALMER HUNTLEY,JR., & ASSOCIATES, INC.
LAND SIR\'ES ORS - PROFESSIONAL ENGINEERS LANDSCAPE ARCHITECTS
LEACHING PIT DESIGN
re' „t•{ w et-n
Precast PitsUsed: $.5 ' Long x Q.O.} ' Wide x
' Effective Depth
Using 2 • of stone all around and io I' of stone under pit.
SIDEWALL AREA:
71 5 • Long z '=:. • Effective Depth x 2 Sides • /J ''
SF
9.(c r • Wide z 2�=� ' Effective Depth x 2 Sides
46 SF
Total of /46 SF (Sidewall Area) x /,L■
Gal/SF - /41-0 Gal/Pit (Sidewall)
BOTTOM AREA:
2.1,5 • Long x ?,(;}' Wide • /$cr' SF
_ilk__ SF (Bottom Area) z 0 ,« Gal/SF a. /07 Gal/Pit (Bottom)
(40 Gal/Pit (Sidewall)
/0 : Gal/Pit (Bottom)
214
TOTAL Gal/Pit (Designed)
* Without Garbage Disposal: / `/& Total Gal/Day (REQUIRED)
Gal/Day (Daily Flow) is Gal/Pit
* With Garbage Disposal: 1.5 z (REQUIRED)
Using /rr% Gal/Dap (Daily Flow)
14z— Gal/Pit — _�_Pit(s)
ALY+LR HL\ILI , ]R., & ASSOC KISS, INC.
LAND SURVEYORS - PROFESSIONAL ENGINEERS - LANDSCAPE ARCHITECTS
$IRO GOWEN ' j 4--O"
4.50440/tt 8• COIkXETE AU ARGUNO
!
or
4'ir1TEktic
`f.
• Atg YENT DETAIL
NO7 7D SCALE
11
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF Northampton
1ppliratinn fur iffiupnuttl lflnrks Cnunsirnrtinn 1rrmit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
rstemat
;;..1.-Pc North King Street Fran's Used Cars
Location-Address or Lot No.
Francis Rauch 930 Westhampton Road Northampton
q/( r ° J Address
Address
Installs
Size Lot Sq. feet
we of Building Garbage Grinder ( )
Dwelling—No. of Bedrooms Expansion Attic ( ) Garba g
Other—Type of Building Garage No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
resign Flow gallons per person per day. Total
Icptic Tank—Liquid capacity 1500 gallons Length Width
Width Total Length
De th below inlet
)isposal Trench—No.
ieepage Pit No 1
Miler Distribution box (
'ercolation Test Results
Test Pit No. 1
Test Pit No. 2
Diameter
Dosing tank
Performed by RP
minutes per inch
minutes per inch
daily flow 147
Diameter Depth
Total leaching aacmerty=2742 s t
Total leaching area sq
gallons.
Huntley Assoc. Date 11-6-86
Depth of Test Pit Depth to ground water
Depth of Test Pit Depth to ground water
Description of Soil 7'0° clay fill 4'0" red clay sand no groundwater at 11 '0"
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System
the provisions of TITLE 5 of the State Sanit y Code—The undersigned further agrees not to
operation until a Certificate of Comphanc as been issued b •e ho ar. cf health.
. L M
Application Approved By
Application Disapproved for the following reasons
in accordance with
place the system in
till nab
7, ,._Cax
Permit No
issued-
Date
THIS IS iN
THE COMMONWEALTH OF MASSACHUSETTS
BOARD'OFI HEALTH OF
'
atm.-titivate (ltnmplittnre
TIF That the Individual Sewage Disposal System constructed (LI<Repaired (
re me ∎
&
a K � Ys4V GIse/
Is been installed in accord with the provisions of TITLE,E 5qi-J he State Sanitary Code bed in the
splicarion for Disposal Works Construction Permit No
// JrSP dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRLLED AS A GUARANTEE IMAT THE
YSTEM WILL UION ATISF Y• /�y�
■ATE '{ Q•�i ■ Inspector
•
vo 7/ `-z-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O/F` HEALTH
4 OF. . W. ".
/ traction rrmit
�ispnstts 3nrkn ft
Permission is hereby granted 0-1..,L.e--h
Indi i al Sewage Di posal Syst
o Construct ( rr.Repr ( ) /
a No t' k ....�� Street -..r G�∎.n._d.._G'�.S..et/ E.1:5
It 14
5 / 7 lgs'l
FEE
is shown on the application for Disposal Works C
DATE
uction Permit
'ORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
aria
Health