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HomeMy WebLinkAbout0048 HADRADA LANE - Health 48 Hadrada Lane Centerville, MA A= 148 - 102 AN UPC 635 0� � a i _No. THE COMMONWEALTH OF MASS412-HU E,hTTS FEE `BOARD OF HEALTH u+iK — OF �Lriy TG�ti V t t-L � APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade A) Abandon ( ) - ❑Complete System Individual Components 4 ti4 aA Cat 6X6_N r PC_4AX4CL ,Fq J 0 Lo�cationrj-- i t//� /,)I�'owner�jame Map/Parcel# �— Address +;L e � S-d Lot# Tel hone# �o w jsoo stall ame Designer's Name qddress Address Telephone# ;22Telephone# Type of Building: CYM C.r[ 7 7,4 C Lot Size Sq.feet Dwelling—No.of Bedrooms 3L°r1f.f.S% U� '� � arbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) So gpd Calculated design flow gpd Design flow provided..- gpd Plan: Date � L 4p!�_ Number of sheets i Revision Date Title Description of Soil(s) �ti1�4l�•� � Soil Evaluator Form No. Name of Soil Evaluator ®� ,J® lf"'Y3 Date of Evaluation 6 DESCRIPTION OF REPAIRS OR ALTERATIONS �en���� O'<<-clp 1w �'� f h- ✓CLLf ,2S L A act o C -4 The undersigned agrees to install the above described Individual Se a Disposal System in accordance with the provisions of TITLE 5 and fu r a ees not to place the s m in operation until a Certi to of Compliance has been issued by the Board of Health. QQ Signe Date ' 64ispec FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 J ^✓NOfC .�? THE COMMONWEALTH OF'111iIASSACI -SE '£TS FEE s 60ARD OF .H:EALTH Tb4-0/c o F Gnu 7-�•..v,`� 'C,.,-.--✓ 4: APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct,( ) Repair ( ) Upgrade A) Abandon ( ) - ❑Complete System [Individual Components T prf cs f LL Location t Owner's Name 7 ap1Palrcel11 —�/ Address 4a3 ~ S-dX Lot# Tele hone# nstaller's ame Designer's Name 01'MA11t g v c d Address Address ` Telephone# c _ _ �.�.- Telephone# f Type of Building: Q140 ef4 r« of Size Sq.feet Dwelling—No.of Bedrooms 3 ex rS i 40 w lT/�-fL sfLffO,�arbage Grinder ( ) )i1.• 'Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) V Other fixtures so Design Flow(min. required) .3 gpd Calculated design flow gpd Design flow provided3 S.,kgpd Plan: Date (�4s Number of sheets / Revision Date bS' Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Z `Jo ffP-P'`� Date of Evaluation 6 DESCRIPTION OF REPAIRS OR ALTERATIONS XCCN.d�� tom+` �-�'' 1.'If1' �•-� i4 f e IL rich The undersigned agrees to install the above described Individual Se a Disposal System in accordance with the provisions of TITLE 5 and further:it es not to place the s stem in operation until a Certi ate of Compliance has been issued by the Board of Health. Signed Date '�C► '�5` Inspections ! I v t FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. j THE COMMONWEALTH OF MASSACHUSETTS FEE f/J� >L)S_.Y' f .(.,,)c,4ab\ga BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑(Individual Component(s) ❑Complete System The undersigned hereby certify4fh,at.-the Sewage Disposal System;Constructed( ),Repaired(w,Upgraded( ),Abandoned( ) by: ram,/ r/-�-S at � ���/l. -/i� W. r has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built 1i plans relating to application No. dated / Approved Design Flow 7 d P g PP � PP g -��(gP ) 1 0 -3S� /_Z Installer., 0. Al, _ Desi ner:�--fin!/P / g ./.� ✓� JU��.S ►� Inspector l Date r7 The issuance of this certificate shall not be construed as a guarantee that the system will function.as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE /0()- 2 Uos 3S� BOARD OF HEALTH DISPOSAL SYSTEM.CONS�T" RUCTION PERMIT Permission is hereby granted to Construct ( ) Repair (W ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at If(. z 11)/1 /IAJ10 I —as described .in,the application for Disposal System Construction Permit No. 2 rr,,N 5 -3.52 dated 7/?61 GS Provided: Construction shall be completed within three years of the date of this permit.A l local conditions must be met. Date .r-,h Board of Health ! � FORM 2- DSCP /r DEP APPROVED FORM 5/96 ' FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON ` 1 ` •'f t 'tti J1 yj - i♦ 11 52510 r NOTICE:This Form Is To Be Used For the Repair Of Failed Septic Systems Only., PERCOLATION TEST AND SOIL EVALUATION EXEMPTION b FORM I, -Di4/y(C`"L Jo ff1vs`31v hereby certify that the engineered plan signed by me . 1 ' f dated 7 / concerning the property located at meets all of the 5 a following criteria: — ' i • This failed system is connected to a residential dwelling only. There are no e commercial or business uses associated with the dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. ' • The bottom of the proposed leaching facility will not be located less than Fourteen (14) feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Rimptor method when applicable)' Please complete the following- A) Top of Ground Surface Jilevation (using GIS information) `r6 B) G.W. Elevation 31. adjustment for high G.W. DIFFERENCE BETWEENA and B f `I li 4 SIGNED : DATE: ! -9�os NOTICE Based upon the above i formation, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. Io— q:health folder.p=r-xmp Town of Barnstable ° Regulatory Services r� 9rVmAgg Thomas F. Geiler,Director Public Health Division Thomas McKean,Director f 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Designer Certification Form Date: 7 A Designer: pwytet- j04,A.S'yO", /LoS. Address: la, 04 �5 0.f' V t a On was issued a permit to install a (date) (installer) septic system at MI-vic-L6 based on a design I drew, 4 (address) dated T% 03- Ac" 7/12�_/Os_ s 1 I certify that the septic system referenced above was installed substantially according to the design. I certify that the septic system referenced above was installed with changes but in accordance with State & Local Regulations. Revision or ertified as-built by designer to follow. p p 4gq����ts 3 1 ETA esigne s Signature) (Affix Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form F FS' >t • Commonwealth of Massachusetts Executive Office of Enviromnental Affairs Dept. of Environmental Protection • One winter Street Boston Ma. 02108 Jolui Grad ' D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION j Property Address: 48 Hadrada Lane Centerville Address of Owner: %moulth Date of Inspection: 11/25/07 (If different) Q,(�Name of Inspector: John t3racl Estate of Lang C10 Mrs.La art :16 Wo6d0 Rd. I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) i Z Company Name,Address and Telephone Number: 1. 1111 l0`�')'oF 19 oFl�e� CERTIFICATION STATEMENT I certify That I have personally inspected the sewage disposal system at this address and that the informs 'an it accurate and complete as of the time of inspection. The inspection was performed based on my training and experience- a h_p ope f nction and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection is based on criteria donned In Title V Conditionally Passes code 310 CMR 16.303.My findings are of how the system Is performing at the time of the inspection.My inspection does — Needs urth Evaluation By the Local Approving Authority not Impyany warranty or guarantee of the longevity ofthe Fef is septic system and any of Its components useful life. Inspector's Signature: I Date: 11127197 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound,shows substantial infiltration or exfiitration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04=97) One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)2925500 A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 48 Hadrada Lane Centerville Owner: Estate of Lang C/O Mrs.Laverty:16 Wood Long Rd.N.Dartmouth Date of Inspection:11125197 _ Sewage backuta or.breakout.or. hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 pipe(s)are replaced obstruction is removed 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 the public health, safety and the environment. f) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS 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 of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. 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 the SAS 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. 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. Yes No _ — Backup of sewage in 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 cesspool. SAS is in hydraulic failure. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property AddreSS: 48 Hadrada Lane Centerville Owner: Estate of Lang C/O Mrs.Laverty:10 Wood Long Rd.H.Dartmouth Date of Inspection:W25197 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. 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 1 of a public well. Any portion 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. 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. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: 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: Yes No the system is within 400 feet of a surface drinking water supply the 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 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 further information. (nvlaed 04R7187) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 48 Hadrada Lane Centerville Owner: Estate of Lang CIO Mrs.Laverty:IS Wood Long Rd.N.Dartmouth Date of Inspection:IV25197 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _X_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)) (revised 04127)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 48 Hadrada Lane Centerville Owner: Estate of Lang C/O Mrs.Laverty:16 Wood Long Rd.N.Dartmouth Date of Inspection:11125197 FLOW CONDITIONS RESIDENTIAL: Design flow: 22D g•p•d./bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yee Water meter readings,if available:(last two(2)year usage(gpd): rile Sump Pump(yes or no): No Last date of occupancy: summeruse COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:a gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nla Last date of occupancy: nla OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped to the last year. System pumped as part of inspection:(yes or no)Yes If yes,volume pumped: loon gallons Reason for pumping: Maintenance TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source Information: 1976 Sewage odors detected when arriving at the site: (yes or no) No (revised OQ7)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 48 Hadrada Lane Centerville Owner: Estate of Lang C/O Mrs.Laverty:IS Wood Long Rd.N.Dartmouth Date of Inspection:11125197 SEPTIC TANK: x (locate on site plan) Depth below grade: t' Material of construction:x concreate_metal_FRP_Polyethylene—other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le•e^he•r-w4'1V Sludge depth:e" Distance from top of sludge to bottom of outlet tee or baffle: 29" Scum thickness: Distance from top of scum to top of outlet tee or baffle:t' Distance form bottom of scum to bottom of outlet tee or baffle:o How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septle tank and all components ere structurally sound.Recommend pumping system every one to two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: We Date of last pumping. Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: t-tr- Material of construction:_cast Iron_40 PVC_other(explain) Distance from private water supply well or suction line c— Diameter: 4" gimments:(conditions of joints,venting,evidence of leakage,etc.) I d M7f97(rev to ) b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 48 Hadrada Lane Centerville Owner: Estate of Lang C/O Mrs.Laverty;IS Wood Long Rd.N.Dartmouth Date of Inspection:11125197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rya Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nra Capacity: rVa gallons Design flow: We allons/day Alarm level: n1a Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) ro. DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: rda Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) rra PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Yaa Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) Iva (revleed 0427187) _ t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Hadrada Lane Centerville Owner: Estate of Lang C/O Mrs.Laverty:16 Wood Long Rd.N.Dartmouth Date of Inspection:11125197 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Ma Type: leaching pits,number: 1Aoo gallon leach pft leaching chambers,number:nia leaching galleries,number: nVa leaching trenches, number,length: rda leaching fields, number, dimensions:rda overflow cesspool,number:nia Alternate system: wa Name of Technology:_as Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The leach pits are structurally sound.PR shows signs or having 5'In It,at time or Inspectlon Itwas empty. CESSPOOLS: (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: r9a Depth of solids layer: rda Depth of scum layer: We Dimensions of cesspool: n� Materials of construction: We Indication of groundwater: nra inflow(cesspool must be pumped as part of inspection) rJa Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) We PRIVY: (locate on site plan) Materials of construction: rds Dimensions: rda Depth of solids: rda Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rds (revised 0412747) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 48 Hadrada Lane Centerville Estate of Lang C/O Mrs.Laverty:lo Wood Long Rd.N.Dartmouth 11125197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 1 pit( DerK I flo P� �t 4j Page 9 o! to (revised OAf27197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 48 Had rada Lane Centerville Estate of Lang C/O Mrs.Laverty:16 Wood Long Rd.N.Dartmouth 11/25197 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revised04R7197) 19ge 10 4rI 111 o. Fs$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE L H Appliration -fur Uhipuiittl Workii Towitrurtion Prrutit Application is hereby made for a Permit to Construct (•�or Repair ( ) an Individual Sewage Disposal System at: " ...Z=Z--- ----------- Location-Ts aa �,, or Lot No. ......................... "�R�_............ -•-•--•---------•--•--------------•-........................... W Owne n Address ............... ...A= �--- l --S Installer Address Type of Building Size Lot..... ...._/.. �__Sq. feet Dwelling—No. of Bedrooms--------- ------------------------------ Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ---------------------------- No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures ...................................................... W Design Flow...........SM------------------------gallons per person per day. Total daily flow........... ___ -- ......... WSeptic Tank—Liquid capac >___gallons Length................ Width------.......... Diameter-----....__-___ Depth---._--_--.--. x Disposal Trench—No. .................... wilkth__---.______ __ ___. Total n�g, _O_" Total leaching area_._= 8_.c —_sq. ft. See a e Pit No.-_---.__._� - � � �5 sc ft. p g me er ------ ept belo Total-le ping area------- -------• 1 z Other Distribution box ( .) Dosing tank ( ) ��-_3 aPercolation Test Results Performed by----------------------------------------------------------- --- Date---------------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Vest Pit.................... Depth to ground water....___..-______-__.-.-- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-.-.-.--___-__----.. - ---. 4 -- ..--''{�`--------- Descriptio of So 1 - - � - G.. -- - ------ - ------ ------- •- ----- --------- x _ _ _ L ,� ,7 U Nature of Repairs or Alteratio s—Answer when applicable..---------------------------------------------------------------------------------------------- -------------- ----------------------------------------• ....................._......................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board o�alth. Signe . -- . -----_GCl....C-... ........................---_..__........... -- ------r ' Date Application Approved By---- -•------ -- --------------- ................ -L....... . ----- � Date Application Disapproved for the following reasons:----••------------•---...--•-••--•-•-•-•..........................••----------•-----. -------------------------- ---•-------------------------------------••----------------------------...----•-------------------------.--------------.-•-------.._...--_..._...-•-•---•-----------------------_....__....------..••--- Date PermitNo......................................................... Issued•...�- ........................ ................... Date T..• 1 ' - o. F>z$............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD F I-!E,�L��� .........OF....._i...................... ................. Applirtttiurt -fur Biipuuttl Works Towitrurtiutt Vrrmiit Application is hereby made for a Permit to Construct (t-<or Repair ( ) an Individual Sewage Disposal System at: -Z•---•-. ..• . -----------••-•-----------------•----- Location- ddress D l J or It No. ................—•-........ ........ _ w ..t.......... Ownx Address +.+. Installer Address s UType of Building Size Lot----- .......... feet aDwelling—No. of Bedrooms---------3..............................Expansion.Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a, Other fixtures ------------------------------- -- Desi n Flow_-__----. 5-m w g �J __._...--•-------------gallons per person per day. Total daily flow---------- WSeptic '1'ctnk—Liquid capac�' ` �-•-gallons Len th________________ Wi dill_..___........_ Diameter__..__:._.___ Deptll,-- x Disposal Trench—No. ---------.......... h.__________. T tal n tl ._-___ -_-----__-- Total leaching area.... Seepage Pit No........1 i en .-Z_. ept �bel'o > Tote le thing area. ___________sq. ft. Other Distribution box D � / -.3 z ( ) Dosing tank ( ) � / S aPercolation Test Results Performed by---------------- ......................................................... Date------------------•-•------------------ Test Pit No. L_______________minutes per inch Depth of "lest Pit.................... Depth to ground water..-.-_-----.--..------.- G14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water -- .---.__.-__-_-------- � -- D l - ! -..criptiiooS �� . ` _. -- .r�` - - ---- ---- - x c ----- ....... ------------ fi -# - V Nature of Repairs or Alterat�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 be issued by the board ofth Signe . •• • •---•L� '" -'� - ------ ------- App Date Application roved BY J� � .------•- •-•--------------------- •• 1 A. Date - - Application Disapproved for the following reasons:.-.-----+-----•---------•-•----•--•-----`:----•-------=--••-•-------------------------------------------------- .............•--------••••-•-•--•----•-----------•------------•....---------•--....._:_...---•-----••--••.....-••-••••-------------••---••••-=-----•-------_.._..----------------....--------.......---- Date` PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,CIF HEALT / ............OF.......41) ................................. ...................... ......... Tatifirtttle of f.T.untpliatta THIS IS TO CER FY, at the I ividual Sewage Dis osal S tem constructed ( or Repaired ( ) by Z / .. .................................................... JJ Install�- at........................... --------- ------ -------- T:/ has been installed in accordance with the provisions of _ i e XI of The State Sanitary C de as describ d in the application for Disposal Works Construction Permit N .._. . .___ ____________________ dated..._ -..5____-_� ____._.._.____. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COId RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACT RY. � DA-TE----------- .^ Inspector •----- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE�LT ........../�%K.....'` ............OF.........../�' 4-ti ........ . No......... ......... ............. FEE........................ �,rk�, �utt�trurtiutt rrtat't Permission is h eby granted ----------------- .............................. '1= ------------ --- ............................... to Construct )pep r ( )1 -T-6t- id, 2ge • posal System at No.......... ---- --------- 7 / Street // as shown on the application for Disposal Works Construction4PNo.--_ ,.... . _ Dated-_-..1_--.__�_._'_7 cam__........ DATE-------------------------------------------------------------------------------- Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - } F I9 , � � � �s•.�.� �a':�.-�5<_,0 �Y �..G.OY' /t�',J.F'E �s y , • I � �4 �T®.4 �01_ /®?' A=.Lm XPAJ T-�--Itf r>4516S ' -434CLaA.E 7/Z.:r Pi 7-' !I//7T/�" BE/.t�G L O 7- 2 ' Bc�_J.� { � 7-NF7T T.4Jer a l/LD/A_1cF i e TE Z), O.V TINE ' OF `, .. CO.t/FOL�V1 TO T/✓� ZO,cI/.IJGy U. C�, AD 4lQWS O o- TyE 70kVA.1 of �?A.F'.c�5, 7 8G c o ARNE G! y1/i/E.V CONS TBC/C 7'E D. (i� H• r I _ `s OJAI A Ln 4 #;G634c3 GIs k�, 4 QA/a sel��s�roes iZ%7 �S Y � e• � i a x,. ®CJTE �o� S��E�MOC�Tf/e /LJ�JSS. DF� E, ,eEG: LA�tJ rt f . . j1 T t, 5 LOC&T O �0 SEW O►C;E P�kRMIT ®o . VILLAGE {IVSTQLLER S IJLd�k � &DDRESS .00 BUILDER 5 &MF- ADDR SS E DATE PERMIT 155UED ID �,TE eot�nPLl n.t�10E ISSUED :,� �'� _ 1 ,f� TOWN OF BARNSTABLE LOCATION q6 fy��e-A SEWAGE # VILLAGE CeNfiel-64114P ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO .4 ca.&2.J TOR -WO-7/ '9 SEPTIC TANK CAPACITY Ci4 LEACHING FACILITY: (type) Z SCX�agl A (size) A2)C:1,C' NO. OF BEDROOMS S BUILDER OR OWNER I? 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 and Leaching Facility (If any wetlands exist within 300 feet of leaching faci 'ty) Feet Furnished by :ems J-0 nC-3 1 zs aa �•cn 1,29 i p. 3 0 T 5EW a C.4E�PERMIT _ O' NJILLAGF— IP1STl�LLER 5 1.1� AD/DRES N d — BUILDER 5 ME �/ iNDDRIVISS mew Dfh►TE PERMIT 1.55UF—D — — — — D ATE COMPLI W ACE ISSUED : � a © Y J'a AoT Loc&.TION ' 5EWaC4E PERMIT UO. r ILLAGE — — — — — — — 1M5-T&LLER'5 IJ&ME 6 DDRESS BUILDER 'S Q &MF- 419,: &.DORE 55 DINE PERNAVT ISSUED & 2 _ - DATE COMPLI bJ ACE -ISSUED: J s �� �-� - � ,�11 », �,• ��' �_ .- �� Pearsall Residence 48 Hadrada Lane Centerville, MA oo New Existing 0 Front Elevation I i 18, FWD fO s C Pearsall residence Bath Bath 48 Hadrada Lane Existing Centerville,MA Bedroom#2 combine space with living room 28310/2 CTN28-2 New Master Bedroom/Bathroom � I ..... ... .. ... ..... ..... .. ... .. ... Kitchen N Garage structural ridge - - - - - - — - - - - - - - - - - -jI — — — — — — — - - - - -- - - - - - - - — — — — - - - - - - r' Existing house 7 I I Remove walls Hang calling josts @ midpoint to roof @ ridge i 712" i 10' Existing living room Bedroom#1 � 28310 � 28310 o a 4' _ 8'3" � �Y 18' }�a Y »k 0� � DISTRIBUTION BOX P! A N OF- 5 C P T I � s ,1���� /,H za REMOVABLE COVER / 4"SCH 40OU T LE7 LATERALS A 4 1 = O REQUIPEMENTS OF 310 CMR MIN UM OF THE LEVEL RS FOR SL TEST PIT DATA DISTRIBUTION BOX TO 14EET SET 15.23211a'ATERTIGHTNESS + FEET AND CONNECTED TO Performed By: Daniel B. Johnson, R. S . , C`. S . E . CONSTRUCTION ETC). .- L; �) f EACH DISTRIBUTION LINE WITH SOLID SCH 40 PVC PIPE GCH 40 Date: June 17, 2005 NO OF OUTLETS 2 4 '��24 i 6 EL. . � EL =36 07 ° ti'(MINI o — MECHANICALLY CRUSHED �S vv Th-1 M. 7e 99.2) ° � � _ � ° � = STONE(<a 3/4"DIA I STABLE LEVEL BASE 0" - 9" A 1 gYR4/3 Loamy sand 9 - 31" Bw, 7 . 5YR5/8 Loamy sand 31" -132" C1 , 2 . 5Y7/3 Menaum sand 1 - E4..HiNGDRYwELLS 500GA1LON5 No Observed 1ESHWT riN E� ,Sv i No Observed Groundwater� - - END"CROSS SECTIOP! Lf o2 AGY W&LL S ���� sus 10ODEL SHOREY PRECA;T ,UNCRETE C EST) FiNA�GRADE TO BE STARILI�^ED . S-,L y. /a,yv X z "y P r:RcoLAT'TON TEST DATA EL -992 S , A 3a r� F�NISHEG GRADE(.L>3F'E � Oti 5,1k Date: June 17, 2005 ~` _ Q 4 ENT 12"IMINI I ' `" EL 96.50 Soil Class : Class 1 (0. 74 G/S F) t oe V— __ __--H -10 TPF'A1cOUTI, 6E,yr,y/nARK LEACHING DRY WELLS 2 1 ^ ' , -�,'4" 11�'GGUBLc 0, ao B'S'LX4'10"twX2'1' + �� { fId4� -_ Ix i -.__-- _-_ OVERALL LEACHING AREA �325' 1 xz� WASH PE N£ 3CEEDULE -jF' ELEVATIONS �--�-- � .� 3/4"- 11/2"DOUBLE GoNG/LeT� 25'Lx12'Wx2'H ( =� _ z-� c: ��•' V�ASHEQSTOPlE -- P/►T,a _ [EFFECTIVE.AREAL �o I , _._. - _nv. Cut Foundat_on (ex-sr_ing £L =y4X Inv. In -'eptic Tank iex13t.ina) - No OFF GRADING iS LEACHING DRY WELLS P REQUIRED OR SAE: T WITH T►-+F -�+sr�NG _nv. Out Septic c Tank 'exis+ lrlG e r D t,�MPL.Y N. �9 oNc , nv. In Distribution Box OUT FOR rWSSFP.I � __. � .�� _.�� <..�......_....t _�. $' '�MENTSOF /O00 bAL�on! 9y, a Inv. Dut S8'TrL TANK O D3stribUtiCP, BC.: (� 100 rio 0 Inv. In Dry We 11 s Bottom of Stone I �� , yTrH(r rfo�SE I a Bctt.orr �f "'r_ , .. \1b� _-.. ..- SP�I E gFE 93, I 'LEGEND - I 00, 6- I I 1 I Existing Contour - - 96 MOs'88 ! Proposed Contour 96 ` 1 . All construction methods shall conform to the Title V ,, 31, CMRRegulations .' , 15� and the Barnstable Board of Health Regulations . Test Pit no to p public wells within 150 �711'I°' > Finished Floor Elevation FFE � feet/40GThere e�eetknoes private or / I I m pectiveiy, of the proposed leachin : rv� she proposed leaching area is not within 100 feet of a / A Basement Floor Elevation BE'F. wetland, nor is it within 200 of a river front . } Water Lit Exis6.ting septic tank to be partiaiiy pumped and new SCH 40 PVC outlet tee and filter to be installed. Tel, Eioc.- . Fs C'Ab.1.a - � --- i, „ _ -. vPR 4 . No changes are to be male ln the field without the approval- of the Board of Health anp the design engineer. N,4A>xffiD.4 LAND ------- - _ . Proposed leacfiinc field is not designed for use with garbage disposal . b _ ours prior• ";ont-act or mac' nCitify ._�y ,}a�,µ ,; r, rr ' construction. A00; 344-7233 . Property ilne _.9formdL1 n -rOm Degur reference nce 3,o^.T > A 4 ) = e 943, page 41 and "subd_v_sicn Plan of sand in Barnstaple, >p a ! r .entervi._ie MP. prepared �'• a a p Cod Survey Con.su:Ltants, .-� S D�rP � I' � r ► •✓ � �. L, dated September 973, reference Plan Book 281, Page 72 ;Lot _ OLD Sr y � Z a ' r�� yF/Lr �F � rl� �y 5rE '`� rs "`P V ° 4 t 22) . The sept.• -c P- be used as a property line _//��......_ t�j() � ~rf'�At ° ar � o r e c c� r '-`.. � Gn is not tv p p 'Y survey. ' �11�� o's'v. i t Remove and replace existing .Leaching area aand or ; impacted soil, if encountered and replace with any TitleaVe s°`da o `t �4 F° o ;,"* =i 11 (sand, ref. 310 CMR 15 E . The total amount of fill �� t Oar o;`J o r' • a z a 4 (sand) is will vary 'estimate cubic yards . q`Sck VENT R 9. Contractor shall verify ali plumbing umbing from rom existing structure cz �. is connected tc the existing septic system prior to 6± ` p0 ro. construction. If any existing plumbing exiting the structure is found to be different the that shown on the Cf,iTin(7 fS0.4016 'C^"+N•1 � . ... . ' , ; ! . approved septic system plan, the contractor shall notify the A1- nterna1 vvF� iu,'noi1 / 415EQ g ( ± ♦ ";w 'r 4!`� { designer. p g 3hd ! Vic? Chi".n$C:@ta t —en W r rN�N 6 • 1 Op 7U i ,r R. ws� t `5''y':�`.. t, :r.less other'hr sty Spec " ( OF 6-x4D� Ck"�°) �*h ]� 1 .........-..-•�. it3G . e 14 .r w D 9b 97 0� s r y 6 7' _ /aedrouTM ? Bedro- s E_ at ,r. Pare 2 MP , Class , j) -gJX t I I PROPOSED LEACHING AREA: 91 �F� 93,�t po gflr- ar, vF yr;vE) -ry ;Ale.IS : ?5' l� }: l�` W X 2' wt . ..:._. / a - DR•y r.� ELLS - t Side Area : 148 SF X 0. '74 G/SF _« �sL � /xw X % � � Tc��4���mI-Area �t'�'.ac. .SP X 0 . 74 G 3z- •� � S r IAd& �SZE r�E rA,I-) { 9.Z /Ov o UALL04 ►i' 5,FP7-(C T,4N1K T-A LL N F-44 9�= 11) P V 11 Ir/J S 4 f '=.t.zt 41 L P_ A C.!•f ,N it r`�i L°''L •� T"'4 Q iR.Y c.r�l l l f '-'_ _; -.•,. . r! (r i g$ " t+a r tt : nJ o :�15 S. {To/ I N° 0�5• ESNwT �,. SUBSURFACE SEWAGE DISPOSAL SYSTEM Pam,\ 48 Hadrada Lane, Centerville O�f _ - ------..._.._._ •. .r APPROVED BYSCALE: DRAWN BY -- - ---- — - - - . p+oo p+,Q 0+}0 0+3 0 0+4u o*S'0 Ot60 Or ot13v Ot9a /t00 DATE: 7/19/05 Daniel B So o REVISED Prepared Brent Pearsall (508) 429-5927 a 8or: 48 Hadrade Lane, Centerville, MA 02632 (/,� prepared DCt4LSTZC sEP".'ZC DESsQI, Z2iC. (508) 477-9909 DRAW{NaNUMBER ��I7 By Box 8z! Cstervslle- NA 02655 J-2013