HomeMy WebLinkAbout1995 Mar 22 - Sewage Disposal System Evaluation by Bortolotti Construction ,
I. �r �� �� . ] �y-���.y�/�T -�7�q,
; ,=~-�y� �7� �..lJlrv��w�.ill4\�. 11`Il.. .
iy
� 765 Wakeby Road
; - MARSTONS MILI,S, MA 02648
(508) 771-9399
(508) 428-8926
� DISPC�AL SYSI�i F.VAI�JATICN
� InsPacted BY- nate:_ 3-�- 5��—
I �'���� & Lot# �
/� l-�66�. Go�P_
; r�.i�i� ��ess:1�'7,L:/� �r�� >�.�� /��-/r�c��.�.�,,/`i l.¢ oa�l c�
�
� N�l.�: A satisfactory evaluation does not guarantee that the system will continue to
function. A sketch of the property and sewage disposal components must
accompany this fonn.
K��1'IA"1, . G�F� .�t'�'..-�:iAL USE
. Lot Size: Lot Size-
� No. of Bedroa�c�s; � .
�pe of Business:
� Garbage C�-ir�r: Water Softner- .Sq. Ft. of B1dg.:
OthP�r Water Use: (Appliances) No. of II�loyees:
� � , Water Use A�ctivity:
� Y� x�a: Y� s ,s��: --
�� Water Sov.roe:�GGJn Water Sotarce: -
, � � Septic �yst� Installed(Date): Title V Yes ( t�' No ( )
� - NO. SIZE LIIVG'I'Fi TypE FT. Tp FT. Tp CONDITION
� WE[.�L WETLAND
`. Bu�lcling Se�r
� Se.ptic �ank /GY.b . �
� oo�
Effluent Pipe s�/� �
Dist. Box
� Dist. Pipe
Leach Fit
Flaw Di.fu.ssors
Isac� ZYr.,rrh
St':or�
�s.spool / �bG/�. cS3�n� `yCo�m� G '
P�m�/Chacob�i ,
;n s . �.� �,� �p � !
Evidence of GYound Sta.in Yes ( ) No (f) Unknown � '
Evidence of Breakout/Overload Yes t } N o ( ,�) U n k n o w n ( )��
Evidenr�e of Overflow to Surface Yes ' ( ) No { �) Unknown ( )b��
Etridence of Lush Growth around Pit/Cesspool Yes ( ) No ( � Unknown ( )
Standing Liquid in Pit 1/2 or More �Z11 Yes ( ) No { � U�� � �
Et�iden of Excessive Pumping Required Yes , ( ) No �:i) U�� � �
E't�[u�erlts: ,
� ' I
% , f
f
r • y
�_ . ._ �G�r�7or,�1�7�bY`v'�-
' LOT NO. : ADDRE S S: 'J �CY�'����PQ�c�'Dd
�tc�QS
NAAfE:_��s/��iC� �/`'e..
� ` SEWAGE PERMIT NO.: NEW: REFAIR:
DATE I�SUEll: DATE IPISTALLED:
Ir�STALLERS NAME:
I N STALLAT I Or1 OF: •
j - �,
WATER TABLE: FINEIL INSPECTION BY:
DIt�AWING OF� IIvSTALLATION ON REVERSE S IDE:
; .
�
i'
!
,-�
�,
i
t�--.
v
.� �
� ��� �
�'
-� v--
. ��� �
L� L
4 (� � i
' �
0
,
' , •. :���.��
� _._ _ .._.. . . _ . _ _�__::.__.� _
,�;
; , < _ .__ -.,
� ���t � �
�- _ __ __ ., � t�._..:,.,,,.:..,,,,._,,,,:,w,.,,� �.��
,
__ ..�a�ro�rr� co�vsr�v�o�r; �r�e: ..t �OG�C�G�3DL�G°�. . �. ._n. ..;��
�� 765 Wakeby Road
MARS"�����..4264,8 ��� ����
� �5�8) �28=$�'�5 ,�• � onre oF o�a
� CUSTOMER'S OROER NO. PHONE . . , !�!��
; /� MECHANiC HEIPER STARTINfi DATE � .
. � . BILL TO ������/ �
� . . � . � / TAKEN 9Y. . . .
`1`'��j� �
noDRESs
❑ �KS'WORK
�� jiG�C�NTRACr
', ❑ EXTRA
��.. JOB NAME M�ID LOCATION �
�'�}-' S �. ,-Y,
JOB PHONE ' .
DESCRIPTION OF WORK � �
�,��-{C. ..�.c� - �`� ,nc _ � � ��-�
�
� �7�t�' �1/S . - ? �c.�.�'�i'ry� i
Cx�r-� �r-?��r�
�
I
� ,
, I
.,.. .._i�ii�+...h.r}CSSTI'a f s.-�.�t,t�'i,�,:.. .
� ' - ��i;Y:t:�:t:..n:2::-ti::�.
G i �( �,.
� r r G h�- _,� �
TOTALMATERWLS �
TOTAL LABOR
TAX
DATE COMPLETED WOqK ORDERED BV .
TOTAL AMOUNT $
❑No one home ❑ Total amount due ❑ Total billing to
Signature for above work:or be mailed after
completion
I hereby acknowledge the satisfactory comple6o� of work
of the above described work.
�.,.