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HomeMy WebLinkAbout0039 GORHAM LANE - Health 39 Gorham Lane Centerville P A 1.93 ` 140 No. 421 1 f3 ORA po andavus'Ke 10% U& 9YIbYYY05EMl`;YfIW1u�- .....:. .—:.. '—.r,-_rsaw' .. .. � ,. • '. '. � ..... 2: DATE : 6/11/02 PROPERTY ADDRESS: 39 Gorham Lane ----------------------- --Centerville ,Mass .———— ——— 02632 ------------------------ On the above date, I Inspected the septic system at the above a dress, This system consists of the following: 1 . 1-1000 gallon septic tank . 2 . 000 gallon precast leaching pits packed in stone . 6X C� r Based on my inspection, I certify the following condltlons: y�0 �bl O 3 . This is a title five septic system. ( 78 Code 4 . The septic system is in proper working order �yO�Asj o� at the present time . T�6� 9 . #1 pit is dry . #2 pit 68" below the invert pipe . SIGNATURE :, Name _z _P Macomber Company :-Joseph-P. Macomber—& Son , Inc , :; c,� ress : Box 66 __Cente-rv11 ) e , Ma__ 02632-0066 Pnone : 508- 775- 3338 ---- ----------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks•Cesspools•Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632.0066 775.3338 775.6412 COMMONWEALTH OF MASSACHUSETTS nj EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION iqj TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 39 Gorham Lane Centerville .Mass . Owner's Name: Charles Saladino Owner's Address: Same Date of Inspection: 6 11 0 2 Name of Inspector: (please print)Joseph P .Macomber Jr . Company Name: J. P. Macomber & Son Inc . Mailing Address: Box fife CPnrPrvi 11 e Telephone Number: — —3338 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ZPasses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails g Inspector's Signature: 1, Date: The system inspector shall ubmit 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 authority. 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. Title 5 Inspection Form 6/15/2000 page l Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 39 Gorham Lane entervi e , ass . Owner: Charles Saladino, Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. S stem Passes: ' �� �in ot found any in�exis �nyfailure hich indicates that any of the failure criteria described in 310 CMR 15.303 criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time . B. System Conditionally Passes: ,06 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. 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 existing 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: 4V& 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: &� The 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 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address39 Gorham Lane Centervi e , ass . Owner: Charles Saladino Date of Inspection: 6 11 02 C. Further Evaluation is Required by the Board of Health: /04 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 environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15,303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: Ab 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 any) determines that the system is functioning in a manner that protects the public health, safety and environment: N6 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 1 of a public water supple. f�! 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 I 0 feet bu�t 0 feet or more from a private Water supple well-. Method used to determine distance f����4i "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 attached to this form. 3. Other: 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: 39 Gorham Lane entervi e , ass . Owner: Charles Saladino Date of lospection:6/1 1 /02 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no" to each of the following for all inspections: Yes No _ — ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge or ponding of effluent to the surface of the ground or surface waters due to m overloaded or /clogged SAS or cesspool _Z Static liquid level in the dismbution box above outlet inven due to an overloaded or clogged SAS or cesspool ZS Riquid depth irts less than 6"below invert or available volume is less than 'h day flow ya�,fpeel. equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped y ponion of the SAS, cesspool or privy is below high ground water elevation. /Any portion or cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ater supply. y ponion of a cesspool or privy is within a Zone I of a public well. y ponion of a 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 well with no acceptable water quality analysis. (Tbis system passes It the well water analysis, performed at a DEP cenified 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 forma �� (Ycs'No) The system fails. I have determined that one or more of the above failure criteria exist as described in )10 CMR 15 )0). therefore the system fails. The system owner should contact the Boa-c 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 now 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) �cs no/ !/ the system is within 400 feet of a surface drinking water supply Lh 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 — IWPA) or a mapped Zone 11 of a public water supply well !f you have answered "yes" to any question in Section E the system is considered a significant threat, or answered es" in Section D above the large system has failed. The owner or operator of any large system considered a s:eniFicanl threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR ;04 The system gwner should contact the appropriate regional office of the Deparnnent. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 39 Gorham Lane Centerville ,Mass . Owner: Charles Sal adino Date of Inspection: 6/1 1 In 2 Check if the following have been done. You must indicate`yes"or"no"as to each of the following: Yes No _ZPumping information was provided by the owner, occupant, or Board of Health Y- 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 pan 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 backup? Was the site inspected for signs of break out ? z_ Were all system components,�cluding the SAS, located on site? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the 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: Yes no / G/Existing information. For example, a plan at the Board of Health. 7 Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CIAR I5.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 39 Gorham Lane Centerville ,Mass . Owner:Charles Saladino Date of Inspection: 6/1 1/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): * DESIGN flow based on 310 CM 15.203 (for example: 1 10 gpd x M of bedrooms): -101 Number of current resider Does residence have a garbage grinder(yes or no):*S' Is laundry on a separate sewage system,(yes or no):4& (if yes separate inspection required) Laundry system inspected( es or no): Seasonal use: (yes or no):A✓ Water meter readings, if available (last 2 years usage (gpd)): 2000-31 , 000 gallons-84 . 94 GPD Sump pump(yes or no): " 2001-34 , 000n gallons-93. 15 GPD Last date of occupancy,14M&141101L COMMERCIAL/LNDUSTRIAL Type of establishment: AM Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): jig Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):4& Water meter readings, if available: W,4 Last date of occupancy/use: la 4 OTHER(describe): WX GENERAL INFORMATION Pumping Records Source of information: 41yk Was system pumped as part of the inspection (yes or no): If yes, volume pumped: 4 gallons-- How was quantity pumped determined? Reason for pumping: TYKE OF SYSTEM Y Septic tank, distribution box, soil absorption system ,J&Single cesspool tb Overflow cesspool ,4k Privy Shared system (yes or no)(if yes, attach previous inspection records, if any) 4 ,0 Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) iUDTight tank NO Attach a copy of the DEP approval kb Other(describe): Approximate ate of all components, date jgstalled (if kn w)anq source of 1 Were sewage odors detected when arriving at the site(yes or no):11_0 6 i Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 39 Gorham Lane Centerville ,Mass . Owner: Charles Saladino Date of Inspection:6/1 1/0 2 BUILDING SEWER(locate on site plan) Depth below grade:� Materials of construction: dv cast iron l/40 PVC mother(explain): _ ,t�4 Distance from private water supply well or suction line:,df" Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight .No evidence of leakage The system is vented through the house vents . SEPTIC TANK: (locate on site plan) /"fN44vZ'F Depth below grade: Ape IV Material of construction: concrete /lnetal440 fiberglass polyethylene .deJother(explain) ,IJ If tank is metal list age: -VO Is age confirmed by a Certificate of Compliance(yes or no): A4 (attach a copy of certificate) / Dimensions: 09Xz,'Wle Sludge depth 2,..c.� �r Distance from top 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 scum to bottom of outlet tee or baffle: 1i How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of-leakage, etc.): Pump the septic tank every 2-3 years 'Inlet & outlet teps a in place . The tank is structurally sound and shows, no evirdenrp of leakage . Liquid level at the outlet invert is fifty one inches . GREASE TRAI (locate on site plan) Depth below grade:4 Material of construction;,tkconcrete44 metal thf fiberglass��olyethylene/W other (explain): A)X Dimensions: AM Scum thickness: to Distance from top of scum to top of outlet tee or baffle: /J�A Distance from bottom of scum to bottom of outlet tee or baffle: t W Date of last pumping: /Lys 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 pre Sant 7 Page 8 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add red 9 Gorham Lane en ervi e , s . Owner:Charles Saladino Date of Inspection: 6 11 0 TIGHT or HOLDING TANG &,i (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: 41A concrete Alf metal Aj_fiberglass4y polyethylene4e# other(explain): AM Dimensions: tiIA Capacity: Ulf gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: At,4 Alarm in working order(yes or no): WV Date of last pumping: Comments(condition of alarm and float switches, etc.): Tight or holding tanks are nor preSeIlL . DISTRIBUTION BOX: Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Ali 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.): Distribution box has two laterals . No evidence of solids carry over . No evidence ot leakage into or out of rhe bux . PUMP CHAMBEPA/O C (locate on site plan) Pumps in working order(yes or no): �G4 Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present . I 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: 39 Gorham Lane entervi e , ass . Owner: Charles Sala ino Date of Inspection: 6 11 0 2 SOIL ABSORPTION SYSTEM (SAS): Zoocate on site plan,excavation not required) 2-1000 gallon precast leaching pits . If SAS not located explain why: Located : See page 10 Type leaching pits, number: A)a leaching chambers, number: <1 leaching galleries,number: _k)leaching trenches,number, length: Q AJO leaching fields,number,dimensionso -4z overflow cesspool, number: _0 ,��-- , 4,)0 innovative/altemative system Type/name of technology:�iJ'�il;/"1f�t° r�& P 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 . #1 pit . DRY #2 pit . 68 below the invert pipe Vegetation is normal . CESSPOOL(cesspool must be pumped as part of inspect ion)(]ocate on site plan) Number and configuration: n Depth-top of liquid to inlet invert: 42A Depth of solids layer: AL Depth of scum laver: Dimensions of cesspool: &dA Materials of construction: VA 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 . PRIVY4WV-(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.): Privy is not present . 9 page 10 0(1) OFFICLA_L INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (conlinvcd) ➢roperry AOGres1;39 Gorham Lane en ervi , Owocr:Charles Saladino Dcic of Inlpccti0o: 6/11/02 SKETCH OF SEWACE DISPOSAL SYSTEM Piovioe I Ikcich 0f the Icws;c 4ilpoltl Iyltem inelvding tics to 11 Ieaal rw o permanent reference IbnGmarks o <ncNnukl Locstc III wcllt withi n 100 feel. Locctc where pvblie w&Ier supply enters the bviloing. .39 �xa�/iar>h . In Cah�crv�l�2 � / Zo' 1qr to Page 11 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 39 Gorham Lane entervi e ,Mass . Owner:Charles Saladino Date of Inspection: 6 1 1/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 100 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system esi lans on record- if checked,date of design plan reviewed: t�t1 served site abutting property/ servation hole within 150 feet of SAS) A)Checked with local oar o Health-explain: zo Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: h t t p : town . b a r n s t a b l e .ma , u s . You must describe how you established the high ground water elevation: Used ; Gahrety & Miller Model . 12/16/94 Water table elevations above sea level . Used ; USGS ; Observation well data. June 1992 Used ; USGS : Technical bulletin 92-000-1 Plate #2 Jannary 1992 Anual rngPG of water table elevations _ r un Leaching Pit ;eet Groundwater Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft P Per Frim ter Method Therefore, the vertical separation distance between the bottom C of the leaching pit and the adjusted groundwater table is feet. 11 t? r-rnr+^nrr—T+rrn-mrnn-rr+�er.rnr.m.+r^nr+*v.�r*nr*emm�ns-tit.+a-�+e.w••.+ .����-..,-•.r-. .F TOWN OF Barnstable WARD OF HEALTH 1 SU11SURFACR SFWAGF DI NSAL SYYSTF,M INNSPECTION FORM - PART D .- CERTIFICATION -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 39 Gorham Lane Centerville ,Mass . ASSESSORS MAP , BLOCK AND PARCEL # 193-140 OWNER' s NAME Charles Saladino PART D - CERTIFICATION Y NAME OF INSPECTOR Joseph P .Macomber Jr . COMPANY NAME J. P.Macomber & Son Ine-e COMPANY ADDRESS Box 66 Centerville ,Mass. 02632 Street Torn or City State LIP COMPANY TELEPHONE (508 775 - 3338 FAX ( 508 790 _ 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at >rlecoinmenda his address and that the information reported is true , accurate , and omplete as of the time of .inspection . The inspection was performed and any tions 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 healLh or Llte environment as defined in 310 CMR 16 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection wtticll I have co acted has found that the system fails to Protect the j)ublic 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 . Inspector Signature Date � 41w2 ne copy of this ification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF 11EAL'I'1I. * If the inspection FAILED, the owner or"'oporator shall u pgrado ' the eystem within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CMR 16 . 305 , partd . doc TOWN,OF BARNSTABLE '-OCATION ��6�✓YJ.�w+1 Z.l0?, SEWAGE # 'll✓dam VILLAGE �•� ' '��. �/� ��.41 ' ASSESSOR'S MAP & LOTJ 9ilyd INSTALLER'S NAME&PHONE NO. Ci .✓ SEPTIC TANK CAPACITY. LEACHING FACILITY: (type)���»C�J (size) Z NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 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 d Le ng Facility (If w tlands exist within 300 fe f 1 n ty) Feet Furnishe y r �9 �arh��► : I�1 �h�crv'o!Ce ' 1q 201 TOWN OF BARNSTABLE ` t LOCATION ` SEWAGE VILLAGE Cerr/w pr'l/e ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. j 7, SEPTIC TANK CAPACITY JUG 0 LEACHING FACILITY:(type) �� (size) LOCH L NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER S !✓ 0 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 3q sd1 \ r 0 Q • I 5 Fes$..... ...3 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Miposal Works Tonstrur#ion lbratit Application is hereby made for a Permit to Construct ( ) or Repair (KX) an Individual Sewage Disposal System at: . �-•-Gorham Lane Centerville Location-Address or Lot No. Charles Saladino --------------•--------- - •----------•---•----•-•-..........•-•••---•-•- ................................................................................................. Owner Address aJ.P.._Ma c omb e r Jr....................................................... .....•----------------....----•--•----•--------•------••-•--•-----•--••--•-•--•-•---••--•---•••--- Installer Address Type of Building Size Lot----------------------------Sq. feet U DwellingX-No. of Bedrooms............3 .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter--.............. Depth................ 0W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. .1 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation 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----.................... a •---•--•-------•--••-----------------•-------------------..........-------------•---•-•••--------............................................................ 0 Description of Soil...............................................................................--------------------•-----------------------••--------------------------..........------ x Sand &---Grave 1 W __ UNature of Repairs or Alterations—Answer when applicable........................................................................................... ----------------------------•---------------------------1-1000.--gallon...leaching---pit. .............................................................................. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beenA's�uyeJd by theZbbrd of ealth. Signed . J�:...%/! ---- ---------------------- ---�I-W91-------- Date Application Approved BY -+� ------- �`.-s"`". ---------------------------------------------------------------- e Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------ ------------ ------------------------------------- Permit No. .............71.-------1..?1------------------- Issued Date No...n-1...y/.;I./..._ Fizil; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applitatiun for Disposal Works Tonoirurttun Vprrutit Application is hereby made for a Permit to Construct ( ) or Repair (Xx) an Individual Sewage Disposal System at: . .9..Goarham-_z: :!fie Qal t e.3 J: P...................... ........-- - - - - - • ............. Location-Address or Lot No. _Charles Saladino -- .... Owner......... .•-----__---- ----------------------------- --------------------------------------------•-A d--••dress •----•-------- ------------•--•------•--•------- WJ.P�Mac omb e r Jr, ---•---•-•-------•-------------------•--- ••---••-••-----------------...--••••-••---••----••.....-•-•------••••••••--•-•••----•---•---••---- Installer Address Type of Building Size Lot............................Sq. feet Dwelling?{No. of Bedrooms............. ......_---------------------Expansion Attic ( ) Garbage Grinder ( ) p4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ------------•------------------------------------ - - W Design Flow............................................ per person per day. Total daily flow............................................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--------------------- Diameter............._...... Depth below inlet.................... Total leaching area..................sq. ft. 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_._._...__._.__.-_.____. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________- •---•-----------------------------------------------------------•------------.._....•---••------•••.......................................................... 0 Description of Soil........................................................................................................................................................................ -Sa.z----_8c--Gxave 1-----•----------•-----------------------------•------------------•-------•--------___-___-_----------------•--•--•----__-----•---------------- W -----------•----------------------------------•--•----•-------------•------••--------•----------------------------------•---•------•------•------•--......--•---------------------------._...----•------ VNature of Repairs or Alterations—Answer when applicable............................................................................................... 1-1 � a Azl... achin -?................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health Signed - l � ,I"'- -�!�.c+►A.�' Y. 1�/_l,1 A) I Application Approved By --------- ------------' .. ....-.... - --------- Application Disapproved for the following rearons- -------------------------------------------------------------------------------------------------------------- ------ --- ------- .............................--- ------------ ------------------------------- --------------------------- ....--------------------------------------- PermitNo. . -----yC :7 --------------------------- Issued ----------------------------------------------------....Da.e Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�er#ifirate of YL-Om slinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (KXX ) by----j-,-F,a ©,b_e_x--J .............................................................. ------------------------------------------------------------------------------------------------------ ------------___ Installer at ...... -Q-...Gorh-a.m....TAnP....Genterv.i 11Q-------------------- ............................-------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..-- 1- � - --..-^.. dated ................................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT � CONSTR(UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ' y� DATE—.5-4 ..�- ----------------------------------- ---------------- Inspector /L..'-:--.....- ......,........`-f ---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE ..... FEE...,-.,...?9-o^^=.. Disposal Works Tonstrurtion Uprrntit Permission is hereby granted..ri_._PAM!.;...c-.omk.P .... to Construct ( ) or Repair 4X) an Individual Sewage Disposal System atNo.39... orham•_Lane---Centeryi lle................................................................................................................... Street as shown on the application for Disposal Works Construction Permit ,,1!,2,1.__. Dated.......................................... ............ ......................................................... 7/ •--••---•-••-----------•--•---------•------ oard of Health DATE----••--•-?'-'---�--^-�y� FORM 36508 HOBBS&WARREN,INC..PUBLISHERS