244 Septic Inspection 2004 RGEO PAUL P011 flea
manor
ANE SWIFT
tom tenantGaternor
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF EmnitONMENTAL PROTECTION
ONE WINTER STREET. BOSTON,NA 02108 617-292-5500
SUBSORFACE SEWAGE DISPOSAL SYSTEM WSPECDONROW
PART A
CERl1FICAT1011
Property Ad*Ea�_'a6" rass ?, fie J -f torE .ccc I'�'�/�,
/� Name of Owner _e
Owner:y+ecroc' j-OQ' r-
Date of Inspeattun:8 2-h i K n�r �
Name atbweller please IWO KAy CLELWrYJA44>UC.
Iva -- tGSeottr.15.540 otTAIe 5(510 CMR 15.000)
Company Names
MawtgAOtrw //L`lf f______ _acr11610 Alf.
Telephone Weber Vi3 Shy- /Pic
ti/C aysa-aN�'zs✓ iatPtze4
CENUFICATION SEATHfErTT
I certify that Have psaonaly SpKkd the sewage Ifispossd system at Ibis address a it eat the SJOmibon reported
tsdo.M Ins,accurate as complW sod Our the of ispec NL Ile iga[SNSas;Wowed used m ay owing
and experience in the properfus0on and m.Wemew ofanefe a awya*WW1 WIMas. The system
Passes
_ PwsdtlovOyPass
Further E.aiotion Bylate Last Approving Authority
BOB DURAND
Seaesry
LAUREN A LISS
Commissioner
gePtlme7sds
Inspector's 59ohro-IktZf 'crw-y rEL,
DaM:B -ol
The System ispeelo arson Wawa copy dtlitMpemtiert vemeettetba Appvig AWwray(Board t Watts or
DEP)manin Tbty(30)days of ew¢Mtinp Ibis-W salota tithe ayabw 4•tlr W system arias•dselyn low t l0,OOD
god or gear.BN isMDtorsod Um system owner all submit Marapatto theinnpr eta regionalpRns rift
0websent et Eminenwo,Aal Wotsuwa The original Would be motto tae gabs wow sod copies motto IS Omyee,
Rm iEeable amdOs opossum awes*.
NDTEsnancoMMETTS f) Lejc_i per, } 74' 'Gtte,O tv.dh 65 •5-ft.Leirur
Loa-1-er, V
Z� da �Fi s )Late r.elo14 ec/ .4) The_ d<s4 eu,4
PVC.. 4\AsFrc s94-41e5
This iNonamion is a.ailail a atrium form Irearwig ow ADA C*Nbarn OM,R 401.OEP on the YWN W*Wet
Oftpffitroresnagnel slae!,alaSep
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t
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a} awaaeam a
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an si"uW ¢�p a4 %poamaW+Y+ 7ta9
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(Wa-Ma04 NCUVOUNI)33
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TOLO3NiSee2aaxBHSSAS1l'aadr.—a SKaS It3W'\SBRS
SURSURFACE SEWAGE DISPOSAL SYSTEM MISPECDON FORM
PANT A
//"`` CERTIFICATION(c//o'nytMaed)
Property Address:Q14V afe-. f, rnt$ I. -T'r0re 'cc- mat).
oamer o• D:4s-4-6 as
Dote d"APesson:6 1 -o y
C. FUR114ER EVALUATION IS MEOWED BY THEBOARD HEALTH:
_
Camitions Cam—ti twist-4th aae the 8o+dci Heath i order to& na Res system Is
tam m protect flit pubic Raab.afetyand emAroraawA
1) SYSTEM WILL PASS UNLESS BOARD OF TIDE'TERMIES RACCORNICEWHN etOCMR15.EW
(t NW THATTE SYSTEM IS NOT IN A MANNER SYNCH WILL PROTECT THE EVENS MALTY!
AND SAFETY AND THE ENVIRONMENT:I
Cesspool or pt9 is within W)wwof swims water �.eaadaa wanwrsh.
CmrtCItS sew bwMik tests&abosMasig ed
2) STS)[M WILL FAX UNLESS THE BOARD OF HEALTH RAMC WATER
TEPIAl1CIEl1IFA)DETERMINES
THAT T R AD
IE SYSTEM IS Fu:CT10RC IN A MANNER TS• . ..
AND ThE ENVIRONMENT:
The system iris septic tank and sod :.-. . •. .a1 (Si$and the SAS is within 100hst of
wgtaee w.YFwippy>tributary to a walvsuppIy. Me 9ABb+WinaZene lefa public_ The system has a septic tank and sea . , eAMw
The system stemye a smiths SAS N within W featda poste
water supply at
_ Tarnsystem haaseWmtank and soil .�. . . . rising
Theessystsm Ras a a SIC teak and so, splint widths SASH StVra.100 bet but SD feet
CT manilas a pnLatawater*apply .:. antes*swell war aMyMata cowoiju. -.aid
same unmet coMpOUNISSIMSEMSS VIII SIM hie haw peikdawtea fiat fa lai ardthe
presence ofasnrwda NbOgew a ad libUgelniellard to Or1MBVam 5 ppm- Method used to
3} OTFER
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SUBSURFACE SENAGE DIBP3501.SYSTS1 MORMON FORM
S-Btaf INFORMATION(aont tired)
oparW Minn: t2W asJ�Arms ?. /%reuc . MA
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Dinemelente
COP -
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Yana present
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Dab et prealme pumping
Cannmenbc
(condltlan ofNatbe.canal/en et
DISTRIBUTION BM_
locate casks plan)
Depth o{liquid level above
Comments
(nob Ibal and
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ending switellea.
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