HomeMy WebLinkAbout0037 COLLINS AVENUE - Health 37 COLLINS AVENUE, CENTERVILLE
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UPC 12534
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THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
0[ppYication for Migool *pgtem Con6truction Permit
Application is hereby made for a Permit to Construct( )or Repair�X )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
37 Collins Ave Kenneth Duarte
Centerville,Mass . 02632 37 Collins Ave Centerville,Mass.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
J.P.Macomber Jr. Richard J. 0,Hearn
Box 66 Centerville,Mass. 02632 191 Main Street West Dennis,Mass.
Type of Building:
Dwelling XXXio.of Bedrooms 3 Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow �;/,r,; 3 3 0 gallons.
Plan Date 3/3 0/77 Number of sheets Revision Date
Title
I
Description of Soil Sand & Gravel
N ture of Repairs or Alterations(Answer when appplicable) Adding an additional 1000 gallon
leaching pit to an existing 1000 gallon tank and 1000 gallon leaching
pit.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code d not to place the system in operation until a Certifi-
cate of Compliance has been iss d by this o of H alth.
Signed Date 6/26/96
Application Approved by
Application Disapproved for the following reasons
r
Permit No. Date Issued
awl* r f D O 7
40.00
No. + Fee
- - THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
0(ppricatiou for Mi5pont *pgtem Construction Permit
Application is hereby made for a Permit to Construct( )or RepairTX )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
37 C111ins Ave Kenneth Duarte
Centerville,Mass . 02632 37 Collins Ave Centerville,Mass.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
J.P.Macomber Jr. Richard J. 0,Hearn
Box 66 �enterville,Mass. 02632 191 Main Street West Dennis,Mass.
Type of Building: b
Dwelling XXj'&o.of Bedrooms 3 Garbage Grinder( )
Other -1 Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow h I55=130 gallons.
Plan Date 3/3 0/77 Number of sheets Revision Date
Title
Description of Soil Sand & Gravel
i
Nal8re8 of Repairs
or Alterations(Answer when ap licable) Adding an additional 1000 gallon
g pit to an existing T000 gallon tank and 1000 gallon leaching
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code d not to place the system in operation until a Certifi-
cate of Compliance has been is d by this o )of H alth.
Signed Dateaz 6/26/96
h v
Application Approved by /
Application Disapproved for the following reasons
..
Permit No. k2 Date Issued_62
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
-Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced]tXj on
by J,P Ms aomb-r Jr. for yo�g D�t�rt o
as Co P habqen constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ' dated
Use of this system is conditioned on compliance with the provision orth below.
-- — ----------- ------- ---- ---------�..�.._'
No. .. Fee $ 40.00
THE COMMONWEALTH OF MASSACHUSETTS
t
PUBLIC HEALTH DIVISION - BARNSTABL-E, MASSACHUSETTS
t -
wi5ponl *pgtrm Construction Permit
k d
Permission is hereby granted to J.P.Macomber Jr.
to construct( )repair(XX)an On-site Sewage System located at ! ~
37' Collins Ave Centerville,Mass. r
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes is/her duty to
comply with Title 5 and the following local provisions or special.conditions.
All construction ust a com ted ithin two years of the date below. 1 / b 0
Date: Approved by ' 71 m /"
Existing leach pit
New 1000 gallon Existing box
leaching pit.
O Existing Tank
37 Collins Ave Centerville,Mass .
I
a
OIL SKETCH AND APPLICATION FOR A DISPuS;,t,
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
. 1
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I, J.P.Macomber Jr. hereby certify that the application for disposal works
construction perirut signed by me dated 6/26/96 , concerning the
property located at 37 Collins Ave Cpri jerv; l l e;Mass meets all of the
3
following criteria:
• There are no wetlands within 300 feet of the proposed septic system
• 1'herc ui��:o tn;vate was within 15o feet of the proposed septic system
11
The observed groundwater table is _4 feet or greater below the bottom of the leaching facility
• There is no increase in flow and/or change in use proposed 1
There are no variances requested or needed.
SIGNED : i DATE: 6/26/96
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNS.TABLE NUMBER o�r�
(Attach a sketch plan of the proposed system. Also if the licensed installe"r poscsses a certified plot plan,
this plan should be submitted). A
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FCETIFIED PLOT PLAN IN
n/ MASS.
i y TH�4T THE r�r„�r'�T/ON RICNARD �J• O'NEARN, 8
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C '- W ' MIS �L-1,4* //� �.�cC�/T�iD DENNIS ) MASS •
ON THE GROUND AS 1ND/CATED AND WEST
CONFORMS TO THE 20/V//VG LA WS
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OA-'� i-PEG. LAND SURVEYOR
UT TOWN OF BARNSTABLE
LOCATION ,�7 �.l�d✓�►s SEWAGE # 0"&�47
VILLAGE &01 ASSESSOR'S MAP & LOT/!?,OP'd*qZ
INSTALLER'S NAME&PHONE NO. Sd/rr LvtL
SEPTIC TANK CAPACITY 1 oo-0
LEACHING FACILITY: (type) 0 -7?t��- 'S (size) 100 O
NO.OF BEDROOMS
OR OWNER /- r7t/14
PERMIT DATE: '" �" �7 COMPLIANCE DATE �"'
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) j I Feet
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DATE: _ 6/1'3/`i6 .
PROPER) Y w% '�, )RE_-SS: 37 Collins Ave
Centerville ,Mass .
02
02632 `�lt �
JJJ
On the above date, I Inspected the septic system at the above Add-r=ess. N 1 9
This system consists of the following: 1996
1 . 1-1000 gallon tank.
2. 1 -Distribution box
3 . 1 -1000 gallon Leaching pit. 61x7 '
Based bn my lnsDection, I certify the foligwing conditions:
T. This is a title five septic system. (. 78 Code )
2. The systom is in failure .
• 3 . System must be upgraded by adding an additional leaching pit.
4. Sanitary tee is missing on the outlet end of th.e : septic tank. Install
new tee nrd. line to the distribution box. Line is light w-ieght.
5 . System is r5-fled to capacity and. should be pumped. sewage is over the
in143t I f i V C, of the leaching pit .
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SICNATUR�: bl,/�
Name J P '�9.i� Jr
Company- ,J . Ptii'"Cn1i"her_ &_ Soil-_Inc ,
Address:
- '..? t = ✓i Mass .' 02632
Phone: 1
THIS CERi;i=1C, �<1 � DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tsnkt Css�psaols-Leachfllds
Pumped & InsUII&d
Town 'twer Connocttons
P.O. Box 66 ' Centerville, MA 02632-0066
775-3338 775-6412
' i
C. ; ,onweatth of mossachusetfs
r-{eculive Office of Environmental Affairs
,. „ z artment of
Environmental Protection
W111larn F.Weld Trudy Coxe
Governor K+rY
A rgoo Paul Uluccl David B.Struhs
LL Gowma Cortvnfs&"(
e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
37 Collins Ave Centerville ,Mass .
'ropertyAddresa Margaret Duarte Address of Owner. 320 Village Ridge Road
Sato of Inapootiou: 6/13/96 (If different) Powell Ohio
q&mo of Inspector.Joseph P. Macomber Jr. 43065
:ompany Name,Address and Telephone Number.
J.P.Macomber & Son Inc . Box 66 Centerville ,Mass . 02632 508-775-3338
;ERTIFICATION STATEMENT
certify that I have personally inspected the sewage disposal rystem at this address and that the information reportod below is true,accurate
uld 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-site sewage disposal systems. The system-
_ Passes
_ Conditionally Passes
Further Evaluation By the Local Approving Authority
_ Fails
aspoctot's Slgnat /4
'he System Inspector shall submit a copy of this inspoction report to the Approving Authority within thirty(30)days of completing this
aspoction. If the system U a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
port to the appropriate regional oMcs of the Department of Environmental Protection.
he original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
NSPECTION SUMhL1RY:
Check A, B, C, or D:
.J SYSTEM PASSES:
_ I have not found any information which indicates that the gygtem violates any of the failure criteria as definod in 310 CUR 15.303.
Any failure criteria not evaluatod are indicated below.
tl SYSTEM CONDITIONALLY PASSES:
One or more rystem components hood to be replaced or mpairod. The system, upon completion of the replacement or repair, passes
inspoctioa.
to yes no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If'not determined',expli►in why sot)
The septic tusk is metal, cracked, structurally unsound, shows substantial Lnfiltration or exfiltration,-or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic taak as approved
by the Board of Health.
-eylsed 11/03/95) 1
One Winter Street 0 Boston, Massachusetts 02106 0 FAX(617) 556-1049 9 Telephone(617)292.5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (oontinued)
Property Address; 37 Collins Ave Centerville ,Mass .
Owner. Edward Duarte
Date of Inspection: 6/13/9 6
B)SYSTEM CONDITIONALLY PASSES (continued)
Ae Sewage backup or breakout or huh static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken piper(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipes)are replaced
obstruction is removed
Cl 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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 119 NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
AW The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
AJO The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis 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.
3) OTHER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oontinued)
PnopertyAddress: 37 C.611ins Ave Centerville,Mass.
Owner. Edward Duarte
Date of Inspection: 6/13/9 6
D) SYSTEM FAILS:
•
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
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.
AID Static liquid level in the�distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
r�.Z Liquid depth in oesspee}-is less than 6"below invert or available volume is less than 1/2 day flow.
A2 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
/0' Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 60 feet of a private water supply well.
40 Any 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
,1:ly the system is within 400 feat of a surface drinking water supply
the system ii 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(IWPA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall.bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for hirther information..
(revised 11/03/95) 3
.�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 37 Collins Ave Centerville,Mass.
Owner. Edward Duarte .
Date of Inspection: 6/1 3/9 6 s
Check if the following have been done:
�u,unping information was requested of the owner,occupant,and 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 part of this inspection.
2A, -t 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.
/Ime system does not receive uou-sanitary or industrial waste flow
The site was inspected for signs of breakout.
,/All system components,.Lding 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 baMes or
tam,
material of construction, dimensions,depth of liquid,depth of sludge,depth of scum.
ZTha sixe and location of the Soil Absorption System on the site has been determined based on existing information or
ap roaimated by non-intrusive methods.
.L The facility owner(and occupants, if different from owner)were provided with information on the proper
Surface Dia S P P Per maintenance of Sub.
System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 37 Collins Ave Centerville,Mass .
Owner. Edward Duarte
Date of Inspection: 6/13/9
FLOW CONDITIONS
RESIDENTIAL• ,,/
Design flow.� 330 P as per`CM)l •
Number of bedrooms. X
Number of current residents•1r"—
Garbage grinder(yes or no): v4LQ
Laundry connected to syste lyres or no):
Seasonal use(yea or no): O n
Water meter readings,if available:
=/' S=
Last date of oxupaacy:n
COMMERCIAL/INDUSTRIAL:-
Type of establishment:
Design flow: ons/day
Grease trap present: (yes or ao)•4�j4
Industrial Waste Holding Tank present: (yes or no)" .
Non-sanitary waste discharged to the Title 5 system: (yes or no)"
Water meter readings, if available: A)
Last date of occupancy:
OTHER(Describe) g
Last date of occupancy:
GENERAL INFORMATION
PUMPING WORDS and so�ee o ormation:
System pumped as part of inspection. (yes or no)_
If yes,volume pumped: �_gallons
Reason for pumping:
TYPE O"YSTEM
Septic tank/distribution box/soil absorption system
�1LSingle cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yea,attach previous inspection records, if any)
VOT Other(explain)
APP MATE AGE of all components,date installed(if known)and source of information:
C),n v�c
Sewage odors detected when arriving at the site: (yes or no)&�
(revised 11/03/95) 6
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C-
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SEPTIC TANK:,Lr�d,
(locate on site plan)
Depth below grade:_
Material of construction: concrete _metal _FRP_other(explain)
� K
Dimensions:_X., '
Sludge depth: rt
Distance from t2p9f sludge to bottom of outlet tee or baffle:.-,__
Scum thickness:? AC 1
Distance from top of scum to top of outlet tee or baffle: i}�
Distance from bottom of scum to bottom of outlet tee or baffle.—
Comments: 'Linvert
ommendation for pumping, condition of inlet and outlet tees or baffle. depth of liquid level in relation to outle , structur Iintegrity, evidence-of leakage, etc.) Pump ariiival lya arba e dis o_sal. resent•Ouonc3�ets' tee
• M t b r la ed. Liquid T vel at ut t Inver �1n • Se is
ii i s ru ra No qi.gnlq of a acit en
eltniil ri l,o mimr�orl
GREASE TRAP, /vCNf
(locate on site pian)
Depth below grade:•-4)_#
Material of construction- zoncrete —metal _FRP_other(explain)
Dimensions;
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: �(
Distance from bottom nt srum to bottom of outlet tee or bafle:/(
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
iri rity, idence of leakage, elL•i-
A UQA4Wpurrs
•s
(revised 8/15/95) 6
SUBSURFkCE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddreaw 37 Collins Ave Centerv,ille,Mass .
Owner. Edward Duarte
Date of Inspection: 6/1 3/96 {
TIGHT OR HOLDING TANK,&61,t,,
(locate on site plan) •
Depth below grade: .414
Material of construction/ oncrete_metal_FRP_other(explain)
_A)4
— 6)A
Dimensions:_ ALA
Capacity:_A._aallons
Design flow: ons/day
Alarm level:
Comments:
(conditio inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan) tL
Depth of liquid level above outlet invert: Q
Comments:
o).e ' vg le an Vribu 'o .'n equal, evidence o so carryover, evidence of leakage into or out of box etc.)
iAri�u�ion ox has equal ow; Has evidence of solids carry over:
ge in or out of the box No repairs nee e
At the nrenAn . t.i me—
PUMP CHAMBER&/2,ve,
(locate on site plan)
Pumps in working order:(yes or no)A.11�-
Comments: .
(note condi ' n of pump chamber, condition of pumps and appurtenances, etc.)
_— ,���rs
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (oontinued)
Property Addrona: 37 Collins Ave Centerville,Mass .
Owner: Edward Duarte
Date or Inslt:.:: 6/13/96
SOIL ABSORPTION SYSTEM (SAS): /04'f1,�l,/" 'X-7
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
Y
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:
leaching galleries, number: 7P
leaching trenches, number,length:
leaching fields, number, d' ions:_
overflow cesspool, number
Comments: (note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
CESSPOOLS:ZIZ4 _
(locate on site plan)
Number and configuration: K)of
Depth-top of liquid to inlet invert: m6
Depth of solids layer: Avg
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater: _
inflow(06apool must be pumped as par: of inspection)
Co en (note condition o soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Co �
PRIVY:102'jAA! ._
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments- (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,'etc.)__
11/d �rir���c.r�VTS
(revi sed.11/03/95) 8
-------------
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
PropertyAddresm 37 Collins Ave Centerville,Mass.
Owner. Edward Duarte
Date of Impeotion: 6/13/9 6
SKETCH OF SEWAGE DISPOSAL SYSTEM: e
inch"' ties to at least two permaaeat references landmarks or benchmarks
locate all wells within 100,
Centerville Osterville Marstons Mills
Water Company
428-6691
Q
DEPTH To GROUNDWATER
Depth to groundwater. 1 : + feet
method Of determination or approximation: q a s g A 4 ()A-*9 C
(revised 11/03/95) 8
Yam'
CLEAN SAND
4,PVC PIPE
fO M/N. P/TCH— CONCRETE
p PER FT. COVER
CONCRETE �8
COVERS
LAYER „
3 '. OF /8= 3/d
LIQUID Wgs)4ED STONE
LEVEL
4'CAST IRON Box WASHED ST N
PIPE-MIN. EPTIC
S PRECAST SEEPAGE
PITCH X 7PER FT. TANK o° �9 W W • o p/T OR EQU/Y.
o
o k o 0
0 o W --7 2 FT
I �oFT ,O/A•
.e. GROUND
wATER TABLE '
.5EC T ION .-. OF
SEWAGE' -LISPGS64 SYSTEM
NO T TO SCAL E
INVF'RT EL E 1/AG IONS--- FT p 1 L LOG
G
1NVERT AT BUILDIN FT S
INLET SEPTIC TANK FT DATE OF SOIL TEST �
OUTLET SEPTIC TANK _ FT. W17-NE55ED BY _ MIN/
U INCH
INLET DISTRIBUTION BOOR --- FT pERCOLAT
OUTLET DISTRIB IoIV RATE
i TION B FT. ELEVATION
/NL ET SEEPAGE PIT
_ TOpsplG
DESIGN CRITERIA _ I
NUMBER OF gEDROOMs D �uk3so�c.
DISPOSAL UNIT �—
c�Ns vF
GARBAGE _ GAcIDAY : coARSE GRAvE� �SS-
', TOTAL ESTIMATED FLOW j ,P,.is_�F M
//UMBER OF SEEPAGE PITS
--�--_ —5' N R.L.S.,R.5
' /g=_SQ.F.T. -:CQi9R SE SF�ND
SIDE LEACHING AREA 7e z—SQ. FT. gR"gvEG LAB/�f=s RICHARA9 MAIN S
T.
O LEACHING AREA SQ. FT _/o, MAs s .
,gOTT MZ 1,yE5T DENNIS
` TOTAL LEACHING AREA ZG 7 SQ.FT -1NNITE / S�NO 0e W. O 3* CLIENT�iizcc� lP�.sc
FZE SERVE LEACH/NG AREA —/Z • /
NO A/4TF2 tavrE= g�3//» sNEEr Z OF Z
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c JAMES
/ O'HEARN
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CERTIFD PLOT PLAN IN
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/D7 *7 - F TE21/lCG
CERTIFY THAT T,4E ��"'^1ne9 /on/ RIC14ARD cl O'NEi9RN, R.L.S., R. S.
I /9/ MAIN ST. (RTE. 28)
S',I WAI ON THIS PLAN IS LOCATED
ON THE GROUND AS INDICATED AND
WEST DENNIS ) MASS .
CONFORMS TO THE HoAIING LAYV5 DATE: - ,-7,/3a/77 SCALE: /"= 30
OFI3A2^/srA13cF. MASS. JOB NO._4 �� CLIENT.• C/�ccF lPF��
8Y: SHEET_L OF /
'L
DA� iPEG. LAND SbRVEYOM
SEWAGE PERMIT
LO.CAT
ION
VILLAGE .
—r;:• ,ire. /" }� �— --
INSTALLER'S NAME & ADDRESS
B U1.1DER OR OWNER
DATE PERMIT ISSUED
DAT E
COMPLIANCE ISSUED - -2Z--��
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THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTLFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
` June 8, 1995
Aging Director of the �- ion of Water Pollution Coatrol
r.. Barnstable
TOWN OF [lUAItU OF 11EAL1'll �
+I SUBSU11FACF SEWAGE DISPOSAL SYSTEM INSPECTION FOIZM - PART D •- CE11TIFICATION
'--'.—":^:.----......... --r+rcrrr.�r•-r:.--r..r.�•srr..�-r�rxrss:�nr.'rrrTrsrr..rr+-r.•.—rrr•r•�..—
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 37 Collins Ave Centerville,Mass ,
ASSESSORS MAP , BLOCK AND PARCEL #
OWNER' s NAME Edward Duarte
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P. Macomber Jr.
COMPANY NAME J•P.Macomber & Son Inc.
COMPANY ADDRESS Box 66 Centerville ,Mass ,
Street Town or City State LIP
COMPANY TELEPHONE ( 508 } 775 3338 FAX ( 508 1 790 - 1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage dis•poszl system at
this address and that the information reported is true , accurate , and
complete as of the time of .inspection . 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 :
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health 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 .
'XXXXXXXXX System FAILED*
The inspection which I have conducted has found that the system fails to
Protect the public health and the environment in accordance with Title
5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
� 1
Inspector Signatur - Date 6/15/96
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the I30ARD OF HEAL'I'ii.
* If the inspection FAILED, the owner or.",operator shall upgrade ' the system
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 310 CMR 16 , 305 ,
partd .doc
J �J j TOWN OF BARNSTAkE
LOCATION 57 L-DZZ' il.l g<—1*��
VILLAGE [ e,7-2k� A SES OR'S MAP& LOT
RS NAME44MMNO,
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) /�� � v `a`' (size)
NO:OF BEDROOMS
- OWNER A /���
ATE: 4 L DATE:
'Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 Leaching Facility(If any wetlands exist
within 300 feet of leachin faci ' ) Feet
Furnished by
• I
�IVN
37 COZ4 /*J' 4rle
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Dom` ......OF............. ---..... .........--------
Appliratiun -for Digpu.sttl Vorkfi Tomitrnrtinn Vamit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at*
04"4 / T � 7
p Location. ress 1 or...L....
ot No.
... -�►-✓I. -------- ------ ----------------- --------- ----------------------•1.3 z
Owner Address
--—----- .
Installer Address
Q Type of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms--------v99----------------------------------Expansion Attic ( ) Garbage Grinder (A)
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ---------------- -------------- --
W Design Flow----........1�._.0--------------------------gallons per person per day. Total daily flow-------10 10_--__-.._-----_.-.-.--_.-_.gallons.
WSeptic Tank 1 Liquid capacity_4?g0__gallons Length----------------_Width._--.._.__----_ Diameter_.--._..- -_ Depth.-._------.-----
x Disposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area-..-------__-_-_-_:_sq. ft.
Seepage Pit No-----/-------------- Diameter---LIPP o_-- Depth below inlet__ ._^__.,_�____.. Total leaching.area.....___-._--_-sq. ft.
z Other Distribution box ( ) Dosing tank ( ) — o/�• ;P — 2-/f` 71
aPercolation Test Results Performed by.......................................................................... Date------•------------------------•-------
,� Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water---------------.-_.-___-
(i Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------.--._------.
a' _ =
Description of Soil----- �° -•--- � " i
x L�� l�l ._..
-------------------- =- --•- ---
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 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 issued by the boa of health.
S. ' /
- ------------ - ----- -------------- --------•--•----------------------
-------------------------------
Date
Application Approved By----- --- a,-44-al------------------- W_- /'-7.7--------------
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
-----------•----------•••-------•--------------------------------•--•--•••----•--•-•---•---------------•....••-•--•-•---.....•--•--•--•-------------------••-••--•----•-----•----•-----------------------
Date
PermitNo......................................................... Issued....................... ................................
Date
w
No...............
�rl• F>c .... ...
"'.THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF !HE A TH
4
Appliration -fur Rii oiittf Works C onstrurtiou �
Application.is hereby made for�~a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System s G� °�1, / . 7- ,�t 7 ,
-•--- ....................................------------------ -------•.....----- h'
Location ress or Lot NIvy
.................................
Owner Address
a •••--- ----••..-•------•-•••--- •••--•-----•-•-•-•••...--••••------ .................................................................. ----
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—IVo. of Bedrooms_______ _________________________________Expansion Attic ( ) Garbage Grinder (A)
aOther—Type
of Building ____________________________ No. of persons-_____.._________.__________ Showers ( ) — Cafeteria ( )
d Otheio
xtUres --------------- --------------------------------- --------------------------------------------------------------------------------------------------
Desi n Flow__________ ________________________gallons per person per day. Total daily flow_______:_!Q¢______•._._..____-_-__-.-_-gallons.
W g g P P P Y Y
WSeptic T:.nk-higitid capacity_41000__gallons Length________________ Width................ Diameter................ Depth___-_____-_-.__.
x Disposal Trench-No_ ..........._......... Width.......... _ _ _Total Length------------------ Total leaching area....................sq. ft.
Seepage Pit No,____`__.:__: -Diameter...l_ ?p_®__:_ Depth below}' let,__/,-_____ _ Total le cliin area__:_- __________sq. ft.
Z Other Distribution'box ( ) Dosing tank ( ) a o' / '' 'I ` 77
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date___---------------•----•------------
a 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---------------._____-_-
-- /
D Description of Soil__ __--02!!- ____. ............ _ :_ .- f' "� s
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 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 issued by the bo of health.
Signe
Date
Application Approved BY .. .. f�.
r- ---------
Application Disapproved for the following reasons:......:::..................................-___.: -----------------------------------•--...Date-----•--••--•-
--•-•--•-•-•-----•----------•---•------------------------------•-._.__..----------------------•------•------•---•--•----•-•-------...•-•--••--•--•----- ---••-------•----------••-----•-----•.........
Date
PermitNo........................................................ Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD :F,!H EALTH
..........OF...: �. .....................
Trrttf tratr of ("U'lamliftttnrr
THI IS,TO IF , . at the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by..."... -------•--•- ------ -----••-- --------••-•-
o Installer
at.......__._ ,., =
--
has been i stalled in accordance with the provisions of Ar ' XI f The State Sanitary Code as ........descri�d in the
application for Disposal Works Construction Permit No._-_:______),_:
•-----•-•----_.. dated.--`---=`�----'r----r--------------••-------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
1 j
DATE. .... --;?---- ,�-,--•---•---- Inspector• • ----
THE COMMONWEALTH OF MASSACHUSE S
7� BOARD OR HEALTH
.:..-... /
No.••--•----•/!�`_._ FEE__lur.................
ZoAlom
Permission i reby granted.__""`__°.__r!------ l_ ---------------------------------------------------
-
to Construe ( or e it '( a Indiv' al ae'Disp ,al stem
at No.. � '. :� rya
------------------------------------ •••--
Y, Street
as shown on t e application for Disposal Works,Construction P
Xr, it No. ::_ _i_._._. __ Dated___ :- ..
.........................
oard of Health
DATE---------------------------------------------------------------••••-••-•---_...
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS * ,�,.
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CERTIFIED PLOT !PLAN /N
//I3.9Rni s•T"q/3/ � , MASS.
L97 7 CDOLf.I/.IS wE - ` /y7'621//LGI=
I CERTIFY THAT THE Foy/,/P q7-/on/ RICHARD J. OWEARN, R.L.S., R. S.
S4V WN ON TglS PLAN /S LOCATED 191 MAIN ST. (RTE. 2 8)
ON THE GROUND A S INDICATED AND WEST DEN/V/S ) MASS .
CONFORMS TO 714E ZONING LAWS
OFf3A-Pn/sTi9J3�F MASS. DATE: 31301?7 SCALE: /"'= 30
JOB NO. 0 .3 4 CL IEN T.- C/2ccE/2,F.,:;,c
3 30 7?
DA T �?EG. L.A/V9 SURVEYOR DR. f9 Y: ,P 41 SHEE T-L OF I
1
20 MInI.
/O /+41�� 4•Pvc PIPE CL EAN SAND
MIN. PITCH-
f � " CONCRETE
CONCRETE
COVERS 8 PER FT. COVER
h 3
{� LIQUID 2" LAYER
r LEVEL OF �8~ 3/8 .
4+CAST IRON o WA5HED STONE
PIPE- M/N. D�ST j
PirCN SEPTIC ° 31,f=//2"
Y PER FT. TANK BOX ° °
WASHED STONE
C PRECAST SEEPAGE
o Q o ° PIT OR EQUIV
y ° 14 o
° o
` 6FT O/A•
2 FT
/o.ter o�,�• f�,N
GROUND WATER TABLE
SECTION OF
SEWAGE DISPOSAL SYSTEM
NO T TO SCAL E
INVERT ELEVATIONS
INVERT AT BUILDING FT.
INLET SEPTIC TANK FT. SOIL LOG
OUTLET SEPTIC TANK. FT.
INLET DISTRIBUTION BOX FT DATE OF SOIL TEST
OUTLET DISTRIBUTION ,BOX FT WITNESSED BY
INLET SEEPAGE PIT FT. PERCOLATIOIV RATE MIN./INCH
ELEVATION
DESIGN CRITEPIA — °
NUMBER OF BEDROOMS 3 - TaPSOI�
A &ARBAGE DISPOSAL UNIT
TOTAL ESTIMATED FLOW .300 GA[.IDAY — Z
/NUMBER OF SEEPAGE PITS I _.COAR"SE .GR.'aVEG LOT�� GaaGGINs /9��_
SIDE LEACHING AREA I85- s SQ..F.T. —3-' 13A,e,,/s7,1913c F ,MASS.
BOTTOM LEACHING AREA 28•� SQ. FT. -COF/RSE .S.gn10 �
TOTAL LEACHING AREA 267 SQ. FT. RICHARD J. O'NEARN,R.L.S., R.S.
RESERVE LEACHING AREA ZG 7 SQ.FT. /9/ MAIN ST.
WH/7E-/W,50 5~0 WEST DENNI S P MASS .
—/Z Job No. CLIENTrIloCGF e_,9G7`
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LOtCATION SEWAGE PERM T NO.
VILLAGE
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INSTALLEJR'S NAME & ADDRESS
BU.ItDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED . "-2
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