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Home My WebLink About0316 CAP'N LIJAH'S ROAD - Health 316 Cap'n 1-.'jah's. Road Centerville P _ —A 193 10910, ) �i 41 omrford, NO. 152 1/3 ORA 174 10% t. DATE :11 /25/02 PROPERTY ADDRESS: 316 Captain Lijahs Road __-__ Centerville,Mass. 02632 UL6 1 0 2002 ------------- TOWN OF BARNSTABLE HEALTH DEPT. On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank. 9 2. 1 -Distribution box. 3. 1 -1000 gallon precast leaching pit. ( 6 ' X9 ' ) Based on my inspection, I certify the following conditions: MAP 4. This is a title five septic system. ( 78 Code ) PARCEL ' 5. The septic system is in proper working order at LOT z3 the present time.. 6. waste water is 60" below the invert pipe of the leaching pit. SIGNATUR / Name : J . P . Macomber Jr . Company :jo5peh 8 Son, Inc . Address :-_Bg;_6f�_____-_-_-- -_c-esu2rYtL.tp-,_Na--2.?-632-0066 Phone :_-508- 775_ 3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632.0066 775.3338 775.6412 ,per �\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM z PART A CERTIFICATION Property Address: 316 Captain Lijahs Road en ervi e, ass. Owner's Name: Helen Whitaker Owner's Address: 1.1/25/02 Date of Inspection: Same Name of Inspector: (please print) Joseph P.Macomber Jr. Company Name: _J.P.Macomber & Son Inc. Mailing Address: Rnx 66 . 02632 Telephone Number: c;ng_77g,_-j-j-jR CERTIFICATION STATEMENT I certih that I have personally inspected the sewage disposal system at this address and that the information reported below is rrue. accurate and complete as of the time of the inspection. The inspection was performed based on my rratnine and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section15.340 of Title 5 (310 CMR 15.000). The system: J Y Passes Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �� / Date: '� The system inspector sha bmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authorir)•. Notes and Comments •••'This report only describes conditions at the time of Inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Ff Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 316 Captain Lijahs Road Centerville Mass. Owner: Helen Whita er Date of Inspection: 1 1 2 5 0 2 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. S tem Passes: �D I have;not foun�iinforma hick indicates that any of the failure criteria described in 310 CIWt 15.30 or mCMRailure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the prPSP_nt t i ma B. System Conditionally Passes: ,Ul) 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,ND)in the for the following statements. If"not determined"please explain. 4AI The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existiAg tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: tb Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: AThe system required pumping more than 4 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 obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropeM- Address:31 6 Captain Liiahs Road CPntPrvillP�MngR _. Owoer:Helen Whitaker Date of lospectioo: 1 1 /25/02 C. Further 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 system ' is failing to protect public health,,safety or the cnv rortment. I. System will pass unless Board of Health determines In accordance with 310 CMR I5.303(1)(b) that the system is not functioning in a manner wbich will protect public bealtb,safety and the environment: AP Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 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 any)determines that the system is functioning in a manner that protects the public health, safety and environment: WO The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or rributary 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 supple. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. /1' The system has a septic tank and SAS and the SAS is less than 100 feet b 50 feet or more from a private water supple well" Method used to determine distance 1_ '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 must be anached to this form. 3. Other: c 3 Page 4 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 316 Captain Li ' ahs Road Centerville,Mass. Owner:Helen Whitaker Date of Inspection: 1 1 /2 5/0 2 D. System Failure Criteria applicable to all systems: You must indicate'yes"or"no"to each of tife following for all inspections: Yes No Xackup of sewage into facility or system component due to 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 —i/clogged SAS or cesspool ►/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or _cesspool y L0A-q&jv C4,0 'Z Liquid depth in4e%p"l is less than 6"below invert or available volume is less than 'S day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number 2,A f times pumped Q. y portion of the SAS,cesspool or privy is below high ground water elevation. An y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water su ply. 1 . � portion of a cesspool or privy is within a Zone I of a public well. portion of a cesspool or privy is within 50 feet of a private water supply well, 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. (This system passes if the well water analysis, F perfarmed 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 must be attached to this form.l o _(Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply — 2the system is within 200 feet of a tributary to a surface drinking water supply _ Zthe system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 316 Captain Lii ahs Road Centerville,Mass. : Owner: HP1 -n Whi ak _r Date of Inspection: 1 1 /2c;f 0 . Check if the following have been done. Yod-must indicate"yes"or"no"as to each of the following: Yes No umping information was provided by the owner,occupant, or Board of Health — Y Were any of the system componenys pumped out in the previous two weeks? — __jZ/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 this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up y _ Was the site inspected for signs of break out? V---/ Were all system components,&luding the SAS, located on site? `. Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of tKee baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yyno / Existing information.For example,a plan at the Board of Health. d — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)] 5 Page 6 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _ 316 Captain Li J ahs Road _Centerville,Mass. Owner: Helen Whitaker Date of Inspection: 11 /25/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): "01 Number of bedrooms(actual):DESIGN flow based on 310 CMR 15.203,(for example: 110 gpd x # of bedrooms): we—VvelA Number of current residents:t &Xk6 Does residence have a garbage grinder(yes or no):1/D Is laundry on a separate sewage system (yes or no)Aj_ (if yes separate inspection required) Laundry system inspected(yes Seasonal use: (yes or no):yes Water meter readings, if available(last 2 years usage(gpd)): 2000-31 000 gallons=84. 94 GPD Sump pump(yes or no): V6 . ; 2001 —37, O gallons=1 01 . 37 GPD Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: / Design now(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Al 4 Grease trap present(yes or no):,VA Industrial waste holding tank present (yes or no):,& Non-sanitary waste discharged to the Title 5 system (yes or no):,121 Water meter readings, if available: AM Last date of occupancy/use: OTHER(describe): A)14 GENERAL INFORMATION Pumping Records Source of information: Was system pumped as pan of the inspection (yes or no): If yes, volume pumped: d_gallons •• How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box,soil absorption system Single cesspool Overflow cesspool iU Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained f7om system owner) Tight tank X ,Attach a copy of the DEP approval '�d Other(describe): i1JJ� Ap -roximaltage of all components,date installed (if known) and source of information: - — Built 1982 per owner. Were sewage odors detected when arriving at the site(yes or no): 6 Fage 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:31 6 Captain Lij ahs Road Centerville,Mass. Owner: Helen Whitaker Date of Inspection: 1 1 /2 5/0 2 BUILDING SEWER(locate on site plan) Depth below grade: .,7 Materials of construction: cast iron _✓40 PVC mother(explain); iLG9 Distance from private water supply well or suction line: /e y Comments(on condition of joints,venting,evidence of leakage, etc.): Joints appear tight-No evidence of 1 akagg The system is vented through the house vents, ' SEPTIC TANK: (locate on site plan) Depth below grade: 9 Material of construction: concrete metal,�,Lfiberglass�t!polyethyIene 4yother(explain) ZF If tank is metal list age: a is age confirmed by a Certificate of Compliance(yes or no):d)d (attach a copy of certificate) Dimensions: Sludge depth: Distance from to o dge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scrap to bottom of outlet toy,or baffle: How were dimensions determined: ��1j'�,f Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc.): PumA the septic tank every 2-3 years Inlet & outlet tees Fare in place. The tank is structurally sound and shows no evidence of leakage.The liquid level at the outlet invert is fift on inches. GREASE TLPAL*tt(locate on site plan) Depth below grade: r Material of construction.44iV concretep metaLW fiberglass, olyethylena�9 other (explain): AM Dimensions: /L Scum thickness: Distance from top of scum to top of outlet tee or baffle: l�f� Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: it Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Grease trap is not present. 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 316 Captain Lij ahs Road Centerville,Mass. Owner:Helen Whitaker Date of Inspection: 1 1 /2 t3 j 0 2 TIGHT or HOLDING TANI (/�e,(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: VA Material of construction: AM concrete metal A fiberglass d, Polyethylene&o other(explain): Dimensions: A)A Capacity: A)A gallons Design Flow: A),+ gallons/daye Alarm present(yes or no): I/Y`? Alarm level: AJ4 Alarm in working order(yes or no): Date of last pumping:_ & Comments(condition of alarm and float switches,etc.): Tight or holding tanks are not present_ DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: tj�) Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc): D,Strihtiti on hnx has nne 1 afPral ,Un_evidpnce of solids Carr nvpr _ Nn evidence of leakage ini-n n-r cit—nf the hQX■ PUMP CHAMBERt(gjg.�t(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Pump Chamber is not preapnt, 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:316 Captain Lijahs Road Centerville,Mass. Owner: Helen Whitaker Date of Inspection:1 1 /2 5/0 2 SOIL ABSORPTION SYSTEM (SAS):Z(locate on site plan,excavation not required) 1 -1000 gallon precast leaching Pit. ( 6 'X9 ' ) If SAS not located explain why: T,nr-a Pr3- .-PP page in T✓ leaching pits,number: j 4 leaching chambers,number: 0 / _Q leaching galleries,number: p leaching trenches,number, length: p 4.)6 leaching fields,number,dimensions: D 'AT—overflow cesspool,number: � innovative/alternative system Type/name of technology: iT Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand to. medium fine sand No signs of hydraulic failure or ponding. Soils are dry.Vegetation is normal Waste water is 60" below the invert pipe. CESSPOOLS12tg,(cesspool must be pumped as part of inspection)(locate on site plan) Numtrer and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: 104 Dimensions of cesspool: ev Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Cesspools are not present PRIVY &41ocate on site plan) Materials of construction: Dimensions: Depth of solids: IVIV Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Privy is not Aresent 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 316 Captain Lii ahs Road ('Pnf Pryi 11PiMaGG, Owner: Helen Whitaker Date of Inspection:11 2 5 0 2 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 0 O 10 Page I 1 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 316 Captain Li-i ahs Road Centerville,Mass. Owner:, Helen Whi taker Date of Inspection:1 1 SITE EXAM Slope , Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate check all methods used to determine the hi ground water elevation: (check) high YES Obtained from system design plans on record-If checked,date of design plan reviewed:1 1 2 5 0 2 YES Observed site(abutting property/observation hole within 150 feet of SAS) YPS Checked with local Board of Health-explain: Obtained as built card. yps_Checked with local excavators,installers-(attach documentation) YPS AccessedUSGSdatabase-explain:ht-tp- [/tnwn harnstable.ma.us. / You must describe how you established the high ground water elevation: Used: Gahrety & Miller Mod 1- 1 ./16/94 Ground watpr elevations ahnve spa level. Used: US_GH: Ohs rva inn well data Tune 1997 Used: USGS- Tar•hnir•a1 h„11et-in A2_.0Q0 1 P1ateg9AnnuaI ranges Of—grnUndd Water eleva pJsu?;anuary 1992 Leaching Pit 9 . ;eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom Of the leaching pit and the adjusted groundwater table is feet. 11 `a•n►.nrn+—n r�+••:-rr' rnrarn•nsPrlre•n r7rRr�*�rr.7+•rt�f►tTlrenlrn ne►n�Y T•�'�n�l reT .�' 16 TOWN OF Barnstable BOARD OF IIEALTII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION `I .^•Tn^T•: ::1—T,.1R^.�Tr1.1'IT.TI•If.'1rI T.RIRf7A'71Tt:r—l•Ir'1VTR17rRpTT7'1R�t7�Ttt'.�\ enrt •.�.rrr^•rr•„—...1 -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS316 Captain Lijahs Road Centerville,Mass. ------------- ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Helen Whitaker PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son; inc.-4 ' COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City state ZIP COMPANY TELEPHONE (508 ) 775 -3338 FAX ( 508 ) 790 - 15.78 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa4l system at this address and that the information reported is true , accurate, and omplete as of the time of4inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one: '-z/ Sys tern PASSED ; The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection whictl I have con Ected has found that the system fails to Protect the j-)ublic health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 3[nd copy of this certification must be provided to the OWNER, the where applicable ) and the+ BOARD OF HEAL711. BUYER * If the inspection FAILED, the owner or.".operator shall upgrade ' sYste within one year of the date of the inspection, unless allowedorthe requiredm otherwise as provided in 3.10 CMR 15 . 306 . partd.doc TOWN OF BARNSTABLE L,X-7%',P-,QN 316 Captain Lijahs Road SEWAGE # 1 1 /25/02 h VILLAGE: Centerville,=Mass, ASSESSOR'S MAP & LOT%5J f 0 �ns ector J.P.Macomber Jr. XMINAME & PHONE NO. SEPTIC TANK CAPACITY 1000 gallons + box LEACHING FACILITY: (rypc)1 —LP-1 0 0 0 ( 6 'X9 ' ) (size),1 5 0 0 gallons NO. OF BEDROOMS 3 BUILDER OR OWNER„ He ej rahi a'<C�r Ixisj;)ection 1 .pk*qDATE: 11 /25/02 GXXN2MEZUAM, Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Lea ping Facility (If any wetlands exist within 300 feet of/le i aciliry) Feet Furnished by f ,� � �r e t rV THE COMMONWEALTH OF MASSAgHUSETTS BOAR® OF HEALTH ..................OF.......................................................................................... pplirafion for Ui"vii al Mirkg Tomitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• 3 , a ,� ,�% �,`- > ---------------• -.--•••-•----•-•-----'•--'-•'• -.._.... :/ ....._______--------.--------•--------_----•- a .....-- "�f r •-bocation:-Address, �� -- _ ••----•-...•or Lot No. Owner ..................................."-••--•.Address ................ Installer Address Type of Building Size Lot_ 5 --------Sq. feet Dwelling—No. of Bedrooms.______.._______________________________Expansion Attic ( ) Garbage GrindoP-•r-T-- Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ____________________________ _ > .. ................... --------•'--•-------- W Design Flow......S�______________.p________gallons per person per day. Total daily flow_.____ss.1___p......._________________gallons. WSeptic Tank—Liquid capacity..........__gallons Length................ Width................ Diameter,_................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No/��!P-0--------- Diameter____________________ Depth below inlet........._.......... Total leaching area�7Q__.......sq. ft. Z Other Distribution box (1! � Dosing tan ) ~' Percolation Test Results Performed by-----------J!_._._. ___. __-_ _______________ Date...6I.V1h't,_________-. aTest Pit No. I.._ L-___minutes per inch Depth of,,Test fit____________________ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth-of Test Pit.................:_. Depth to ground water.......................... x -f; ----- - ----•---•----------------------------------•-------•----------------------------- p Description of Soil---------� 1-----L --------•- z ! Z....................... -- W ----------------------------------------------------------------------------------------------------------------------------------------------........................................................ 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 iITLs: 5 of the State Sanitary Code—Th undersigned further agrees not to place the system in operation until a Certificate of Compliance has been -ssu the board of health. Signed et/✓ 1 1 / / Date Application Approved By--•-------- -% - --- ........................ �,� L............. Date Application Disapproved for the following reasons----------- ---------------------------------------------------------------•--------------......•----''----••--- ---------------------------------•-----...._..__.._..._._.__..------.._........_..----------•--'-'-----'-I--•--_---- Date I " Permit No......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...•................ --------......OF...................................... Appliration for Disposal Works Tnntrnrtinn Vvrrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Ir ................:�.....---...---------•--... ..........-�---------•-------•---•--•---------•---•-------•----------•-------......----------- ,r tocation-Address or Lot No. t . _l •----•----..�t._.:.:1' : :�--=e.a..........--•--.....•...--•--- -----�=r- -- ----------------••-----•-•----..................-- . --= Owner � •^^ � Address a .--... iC...... .1..................................................... ............•--.......___-----...............................-----....................._......___. Installer Address Type of Building Size LotJ_�. ' ---------Sq. feet Dwelling—No. of Bedrooms—.....*..................................Expansion Attic ( ) Garbage Grindei-(—)-•-- `4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria Otherfixtures .---•---•-••--- •-•---------------•------••---••--------------•-•-----------.............--------•-- d X)--:---�--------------------------------- W Design Flow.._...z._-3''°�.............................gallons per person per day. Total daily flow------ 4�f_____.......-•.........._....gallons. WSeptic Tank—Liquid capacity`'........._gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.6n- ---_.__.. Diameter.................... Depth below inlet.................... Total leaching area.. "10_..._.._sq. ft. Z Other Distribution box (11� Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•----•-------------------------•----------------•-------------•••-------•••------•-------------------- -•---------------- ---------------------------------- 0 Description of Soil........................................................................................................................................................................ x U W ---------------------------------------------- ------------------------•--------------••-----••------------......--------------...--------------------•-----------------------••------••......--------- 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 TIT1E 5 of the State Sanitary Code— Th undersigned further agrees not to place the system in operation until a Certificate of Compliance has beeJ/n�. s!f he board of health. Signed..; l // ; t ' Date Application Approved By... .... .. • /:.- .... �'' Date Application Disapproved for the following reasons:............................................................................. -•--------•--- -------------- Date PermitNo......................................................... Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtif iratr of Tomplianrr j THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ' .:.. .................•-------•----------•----------•--•------•---..-•----......--------------•---•-----......... d�r As fauer ;4 at --1 --------•-------- ........ - ................... has been installed in accordance with the provisions oi"TITL 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 CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector... = --•-•-------------------•. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF........------............................--•--...................................... No..�l'. .' ?' FEE.:...................... Disposal Works T.Onstr ion rrmit Permission is hereby granted............l.•"-__...... r + �`�...... ------------------------------------------------------------------- to Construct ( )-or Repair ( ) an Individ al Sewage,`Dis osal S tern ........................................... Street as shown on the application for Disposal Works Construction Permit No. ated.......................................... ..� d of Health _ DATE...................... ' ------------ ........ Boar FORM 1255 HOBBS & WARREN, INC., PUBLISHERS f I 1 - I Z-o T 23 I T4�•s I O i `Y ° / N OF ht-;4, a THOMAS �j THO ME. R5 G � E. G� LL w a . KEIIEY �43� L` M.24260 � ��GISTS QQisvT ; 171z /SCOT!Ct ED PLOT . PLAN THOMAS E. KELLEY CO. LOCATION t ENGINEERS—SURVEYORS SCALE 346 LONG FOND DR VA SOUTH YARMOUrH,MAS. PLAN REFERENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CERTIFY THAT THE ....... . . ...... SHOWN ON THIS PLAN IS TED ON THE GROUND ' r ✓i�rUG �'' AS SHOWN HEREON DATE . PETITIONER REGISTERED LAND SURVEYOR TOP OF FOUNDATION A y CONCRETE COVER `,• CONCRETE COVERS • 7rnrmX7T 4"CAST IRON 12"MAX. 12" MAX. PIPE (OR - 4"ORANGEBURG(OR EQUIV) EQUIV.)— MIN. PIPE- MIN. > LEACH ' PITCH 1/4"PER. PITCH 1/4"PER.FT. > PIT PRECAST e•o e a :..:: LEACHING N INVERT e•; PIT OR ` '' INVERT •°: w EQUIV. �.o EL.. .QO• SEPTIC TANK EL.4�:�r.� BIOS)TC, EL¢r >= Q INVERT p I— �I a' EL :7�.rll.. ,D. QO. . GAL. INVE� INVERT v w Q .�• 3/4'�TO I l/ EL`,-1,4 ' : Lo Q WASHED :.� EL¢�iO.. w STONE tp 0. /O A./�-- -�—6'DI --• I NO •' �--�� D I A.—+� PROFILE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SO L LOG ��--WITN ES,S�E) BY : �C.TI t�/ / ,� •. BOARD OF HEALTH DATA&,. �-:jt�' TIME.��r . . 0 ,1 TEST HOLE I TEST HOLE 2 �, ( �K--�C.L• 7 ENGINEER ELEV.¢Ji 5• • . . . ELEV. .. . . . . . . . . DESIGN DATA '. o _ tZ NUMBER OF BEDROOMS . . . . . .� . . . . E el 503SOt L TOTAL ESTIMATED FLOW ? GALLONS/DAY 0a BOTTOM LEACHING AREA 0p�'S� . SO.FT. /PIT SIDE LEACHING AREA . . .I BE. .' . . . SO.FT./ PIT '' MD Firt/Lr GARBAGE DISPOSAL . • (50 % AREA INCREASE) S -Utz TOTAL LEACHING AREA SQ.FT PERCOLATION RATE�.�r /1J MIN/INCH LEACHING AREA PER PERCOLATION RATTESSO SQ.FT. OV.v. .WATER ENCOUNTERED NUMBER OF LEACHING PITS APPROVED . . : . ': . BOARD OF HEALTH DATE . . . AGENT OR INSPECTOR C-fivt/d; It,.-)7- 03 THO/�AA yG O KELb THOMAS E. KELLEY CO. 4UO o y ENGINEERS—SURVEYORS 346 LONG POND DRIVE /STEM sOUTY YARl OLrM,MASS. s�ANAL�a6 PETITIONER / 6/lL�. /r/`� •'� �� i i !� L ION .# SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS d UILDE R OR OWNER DATE PERMIT ISSUED 7Zl6 �5�,. DATE COMPLIANCE ISSUED J r --IO. --�-� a�,�$........ ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TGWN. . .......... OF.............BA.R.N.S.TA.BLE............................................ fir �u for Di-a uiitt1 Works Tutuitrurtton Vrrmit Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal System at: Lot___-#231 Capt. Li jah ! s Road, Centerville ��3 � 4 ® Location gdre s or Lot No. David A. Tellegen,kcAael C. Ferrone 22 Corporation _Road,__ ..............nnis______________ - -------- ---------------- ........................ Address a ---Robert-----.•--Our---------------- .......C.r-e-a t--A1-e-S-t_er-n---UA4...Rd.,...AN ....Ra.r.wi c h Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...............3..---__-_-------..........Expansion Attic ( x) Garbage Grinder ( ) Other—Type of Building ._.._...._.--_----.9--_- No. of persons g Dw a l l i n p _5------------------ Showers ( ) — Cafeteria ( ) 0.' Other fixtures ---------- ------------------ W Design Flow............. D..........................gallons per person per day. Total daily flow.._.._.---_ -3QU--------.--------.._.gallons. 9 Septic Tank—Liquid capacirila_U_Qgallons Length................ Width................ Diameter_..._....----- Deptl;____..__------ xDisposal Trench—No- -------------------- Width-------------------- Total Length__..._..-..-.-----_ Total leaching area----------.---------sq. ft. Seepage Pit No-------1----------- Diameter---6_-_K---B--- Depth below inlet....... .......... Total leaching area_-----_.__.._.sq. it. z Other Distribution box ( ) Dosing tank ( ) (� �� ' �� -' Percolation Test Results Performed by-------- ------ --------•-- -----------------------•---------------------- 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......._..-----.-._-.._. --••---------------- y� - --------------�-------- .. - -----------•----------- O (< Description of Soil... .......... �?..-., ..:�._. d. - d6 ------------------ ----- ------------- --------- -- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss the board of health Si 'e ..... . ---l. rr... ------------ --, � i� Date �j— Application Approved By-.-.-._�. '' �� .yjyly . " Date Application Disapproved for the following reasons:................ '-•--•.•------•-------•------...--•.............................. ............- 'i •-•-•-•-•----•-------•-----•----•---•-------------------------•-•---•-------•--------•---•-•--••-•--••-------------------------•--....-•---•-------------------•----------•-------------•--------------- Permit No-------------_---------•---........................... Issued.... -•--- i • 's � h i s. /� No......................... ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T.0..'�N.............. .....OF...............B.kR,. ST.A i3.LE.......................................... Appliration -fur 43itipmat Workii Tonatrjtrtion Prruiit Application is hereby'made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: ...................................................3 .1...-=-s----Road.......:..n..e r.. ,l-1 ------------------------------------------•------------------------•-----•-•------ Location- ddFess or Lot No. David A. Tellegent;Mi-chael C. Perrone 22 Corporation Road, Dennis______:--_- Owner Address W Robert t O Our -------••-.•-•-• _-_--!r ea t---i(Le•s.t43.Pf.1---49-9-�----R -- -N------14&F ttti c h Installer Address QType of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms.................3____.__.______..___.___.Expansion Attic ( Garbage Grinder ( ) Other—Type of Building No. of persons........._0................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------------- - W Design Flow--------------50-------------------------gallons per person per day. Total daily flow................. .Q.0................._gallons. WSeptic Tank—Liquid capacity. e-Q-Q-9allons Length________________ Width...._.._....._.. Diameter---------------- Depth....-_--__-.---- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No---------1.......... Diameter-----5____x---- . Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '— Percolation Test Results Performed b G-* Y - :.............••----.. .'.�.!`Date........... ,_l Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water......_._._....._...__.. G4 Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water._..-._--___-__-_.___..- P4 ------------------------------------- ............................................................................................................ O Description of Soil A----- Z/ m x ,hand -- v W ----------------------------- ---- ........... --------------------------------------------------------------- ------------------------- VNature of Repairs or Alte at n� (VKv e applic�bl ---------------------------------------------------------------------------------------- ------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu e board of health. Sig .--- ---_--------- ------- -- LI 1l 1 /� 7`-�ljl.1'o rr a /Datq. `T.� Application Approved By J.. ---- Date --- ---- ----�(/ 6� Application Disapproved for th.e following reasons:---------------------------------------•--------------•------•---•--- ......................................... --------------•-•-------•---•---•-----•---------• --------------••---•-•---•---------------------------•-------•--------------•------------_----•------------------------------------•----•--- Dat Permit No......................................................... issued....../4a-te -�� -� �-- `. J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7- rJ ....................................................... Trrtif irate of 0.11,11utpliatme S I, TO E TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) -tY-• .....--Cf.-------- � ---------- -------------------------- ---- ---------------------------------------••-------..---------_--..-.------- �a f - --------Installer---------------------- -----.-_-.--------_-------------- 1 as been installed in2c�t`�dance wi pirovisions Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No :..\___________________________ dated-_.._-______:_____-_.____..__.__-.-..-------.._- VV THE ISSUANCE OF THIS CERTIFICATE SHALL NOT'BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FACTION SATISFACTORY. DATE................................................................................ Inspector•-- • ----•--- ••---•'0_9_�-------------------------------------------- -•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH //� .. •�--�r� -------•---- ..........I......0 «_ _",� FEE...---•---•............. Dip patitt ark antitrurtion Prrmit Perm ssi is hereby gii(tl�i ------ -- --------- -•----------•------ - •---•-•-----------------------------------------------••--•-----------------•---------- to n ct ( ) epaan i I a osal`System ---------'•••-•-•-••.J as shown on the applica on for Disp� Constructio�erm o. .... Dated---------------------------------- �._ f f oar H Ith DATE........./9 •--- 7- ��--,-` ----._------•--------- �a FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LUT' 2/. LOT 22 t L 07 23 N loe O�y a � S/LL. EtE✓ Pez7- A80✓4 PO.4D L0CA7-rON: c�^�T ; v/�.� _. SCALD— ��=IQ?Z;,AT& 1(2-3-5— _. 23 A s SIV0O jA.-)aAv �L Anr �3od -PA 6E 5 :✓�3s ` NL—Z45Y C'EQ7"i FY'T14 A T THE EX�.ST- W I� t_FkE:? r O /NIG F4G/NDA T/ON L 4 T/ON /S CbZ 'E TAYLUR x ,� rNE sur�z��v� � E3.4ce,�E.Qc�/,eE�fvr n bF T.w6 TOH/ni OF _Z3 A;?NS -- r 2 --- �, 4C. 4 7,4 y . B /GGOGt/ST Gil�T� T MA. LOCQTLON_ _ _ 5EW.0,64E PERMIT UO. , `Lot 23— Cap t Leah s Rd VILLAGE = = — — _ -Un Centerville Mass INST-I&LLER'S U&_ME. -6 .AD.DRESS Robert B Our-, Co Harwich Mass BUILDER 5 tJ l"F— ADDRESS David Tellegen Dennis Mass Do,TE .PERMIT. ISSUED 9/8/7510/9/75 DATE- COMPLI &MCE ISSUED; — �9 �6Z oN1'' � 3t � �7 � 1