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Home My WebLink About0019 HITCHING POST LANE - Health 19 HITCHING POST LN., CENTERVILLE A=173-031 ECYCIp 1111 UPC 12534 N0. 2153,LOR �ADS1•CON`'J� HASTINGS, MN f - - Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cM 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in way. Important:When filling out A. General Information forms on the ra computer,use 1. Inspector: C) only the tab key to move your Robert Paolini cursor-do not Name of Inspector "= use the return key. Ca ewide Enter rises,LLC `` cn ` Company Name -b :;Z) r� P.O.Box 763 Company Address N Centerville Ma. 0 632 —. �rmn City/Town State Zi Code (508)428-4028 1 Telephone Number License Number B. Certification I 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: Passes. ❑ Conditionally Passes ❑ Fails ❑ Needs Further E luation bby the Local Approving Authority 6/26/2007 Inspec is Signature Date The system inspector shall submit 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. ****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. 19 hitching post In.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection B.. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: l ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ 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: ❑ 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 19 hitching post In.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts, W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the 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: ❑ 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: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is.within 100 feet of a surface water supply or tributary 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 supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 19 hitching post In.-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.), C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: / **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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 '/z day flow ❑ ® 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 19 hitching post In.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is Centerville Ma. 02632 6/26/2007 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El ® 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails: I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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 If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 19 hitching post In.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c 19 Hitching Post Lane Property Address Darlene Brennan - Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection C.,Checklist Check if the following have been done. You must indicate "yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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? El' ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding 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: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 19 hitching post In.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2006:17,000 9 ( Y 9 (gpd)): 2007:37,000 Sump pump? ❑ Yes ® No Last date of occupancy: 6/26/2007Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 11 hitching post In.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ , Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system"owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: New leaching chambers installed in 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No 19 hitching post In.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage,etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8'6"x4'1 0"x57' Sludge depth: 0 1 6„ Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 9., Distance from top of scum to top of outlet tee or,baffle Distance from bottom of scum to bottom of outlet tee or baffle 30° How were dimensions determined? Measured 19 hitching post In.•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection I D. System Information (cont.) 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 tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. / Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): / Dimensions: 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 Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑.concrete ❑ metal ❑ fiberglass ❑ polyethylene' ❑ other(explain): 19 hitching post In.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 19 Hitching Post Lane Property Address Darlene Brennan ` Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 � � every page. City/Town State Zip Code Date of Inspection D. System Information(cont.) Tight or Holding Tank (cont.) J Dimensions: Capacity:,. gallons t Design Flow: gallons per day Alarm present: ❑ Yes ❑ No. i Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.):, l *Attach copy of current pumping contract(required). Is copy attached? ❑'Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has two laterals out.Flow is going to new chambers with speed leveler going to leach pit.No evidence of solids carryove.No signs of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 19 hitching post In.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cwM 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): I Soil Absorption System,(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-1000 gallon ® leaching chambers number: 2-500 gallon ❑ leaching galleries number: ❑ leaching trenches number, length: \ ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): - Sandy soil.No signs of hydraulic failure'Leaching pit was dry at time of inspection.Leaching chambers had 3" of water at time of inspection: 19 hitching post In.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer n Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(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.): . . I 19 hitching post In.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Hitching Post Lane Property Address Darlene Brennan Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i i i I �X i NCO• 19 hitching post In.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 19 Hitching.Post Lane Property Address Darlene Brennan J Owner Owner's Name information is required for Centerville Ma. 02632 6/26/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: Bottom of leaching pit 45' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain I l You must describe how you established the high ground water elevation: . Used:Gaherty& Miller Model 12/16/94 Ground Water Elevations.Used:USGS Observation Well Data June 1992.Used:Technical Bulletin 92-000-01 Plate#2 Annual ranges of ground water elevations. 19 hitching post In.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE LOCATION) SEWAGE # � YII..LAGE C'P-&) y'i<<€. ASSESSOR'S MAP& LOT ®�I INSTALLER'S NAME&PHONE NO. A[' is Jh A I(L ILL L 96 -:5 5Z-e SEPTIC TANK CAPACITY /00n LEACHING FACILITY: (type) '5 (size) NO.OF BEDROOMS BUILDER OR OWNER . PERMTTDATE:' 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 facility) Feet Furnished by �5. \\\ �� `` 1� �� a` � �9 O � � gii � �a C� � � °� 5 No. ' Fee $ 50. 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatton for Digpogal *p5tem Con.5tructton Permit Application for a Permit to Construct( ' )RepairX X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.19 H i t c h i n g p o s t Lane Owner's Name,Address and Tel.No. 4 2 8—1 5 4 3 Centerville ,Mass . 02632 Gerald J. Brennan Assessor'sMap/Parcel 17S D 3 ` 19 Hitching Post Lane Centerville Installer's Name,Address,and Tel.No. 5 0 8—7 7 5-3 3 3 8 Designer's Name,Address and Tel.No. Mass . 02-632 J. P.Macomber & Son Inc . J.P.Macomber & Son Inc . Box 66 Centerville ,Mass . 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling XXNo.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder IQ0 ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 0 gallons per day. Calculated daily flow 3 x 110 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Existing 1000 Type of S.A.S.e x is t i na 1000 LP Description of Soil 1-o a m y sand t o b a n P y m a d i „m c a n rj Nature of Repairs or Alterations(Answer when applicable)Add in g two 500 gallon chambers packed in 4 ' of. stone . 25 'xl2 ' 10" x 2 ' 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 and of to place the system in operation until a Certifi- cate of Compliance has been issu by this B ar f Hea h. Signed Date 1/11/9 9 Application Approved by _ Date j 2 Application Disapproved for the following reasons Permit No. Date Issued l Z No. / —3S Fee $ 50. 00�./ THE COMMONWEALOF MASSACHUSETTS Entered in computer: Yes TM' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZippYicatiou for Migoar *pttem Cougtruction Permit Application for a Permit to Cons Repair X pp tract( , ) epat � )Upgrade( )Abandon( ) El Complete System ❑individual Components _ Location Address or Lot No.19 H i t c h i n g p o s t Lane Owner's Name,Address and Tel.No. 8— 5 3 a Cebterville ,Mass. 02632 Gerald J. Br,ennan i Assessor'sMap/Parcel /7 ;1 O ✓/ 19 Hitching Post Lane Centerville r' Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. Pass• b J.P.Macomber & Son . Inc. J.P.Macomber, & Son Inc . Box 66 �enterville ,Mass. 02632 Box 66 Cente.rville ,Mass . 02632 t.,: Type of Building: Dwelling XXNo ofBedrooms 3 Lot Size sq.ft. Garbage Grinder;�0 ) Other Type of Building No.of.Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 x 1 10 gallons. _ "Plan Date Number of sheets Revision Date Title Size of Septic Tank Existing 1000 Type of S.A.S.existing 1000 LP Description of Soil Loamy sand to boney medium sand . i ` Nature of Repairs or Alterations(Answer when applicable)A d d i n g t w o p 5 0 0 gallon chambers packed $n-4"' of stone . 25 'x12 ' 10" x 2 ' Date last inspected: Agreement: t The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and t to place the system in operation until a Certifi- cate of Compliance has been issued by this B ar/f keah. 02 Signed Date 1/11/9 9 Application Approved by Date Z V9 Application Disapproved for the following reasons Permit No. Date Issued _ Z _ M THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(XX)Upgraded( ) Abandoned( )by .J.P.Macomber & Son Inc. at 19 Hitching Post Lane Centerville,Mass. has been constructed in ace r�nce with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 dated / ` Z 7 Installer J.P.Macomber & Son INc. Designer J.P. acomber & So(n Ilk , The issuance of this pej shall otfbe c n ed as a guarantee that the syste i i%tio. as desig ed/ c Date Inspector // Vf`(,l G7 J / ` ——--——————————————————————————————————— No. 9,9—, ` 6F Fee$ 50. 00 t� iHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Xiopood *potem Cou5tructiou Permit Permission is hereby granted to Construct( )Repair X X)Upgrade( )Abandon( ) System located at 19 Hitching POst Lane Centerville ,Mass. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this it. Date: J 7 r / / Approved by (r�s6�✓1'ay 0 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, Josplih P Mac:am pr- Jr- , hereby certify that the application for disposal works construction permit signed by me dated 1/11/99 , concerning the property located at 19 Hitching Post Lane Centery 1 i e meets all of the Mass . following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will poi be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: r A)Top of Ground Elevation (according to the Engineering Division G.I.S. map) !a B)Observed Groundwater Table Elevation (according to Health Division well map) / SIGNED : / DATE: 1 /11 /99 AW LICE SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). q:health folder:Bert ��_ c� �'� �'g�`�R ®®® �. d - �� G��a � � �a�l �. � � 1 TOWN OF BARNSTABLE LOCATIONIi te- , •e �,6, Q.in SEWAGE # '' 2 VILLAGE_f 2.Aa�E \r i ASSESSOR'S MAP& LOT. INSTALLER'S NAME&PHONE NO.-to C e%M s 2. T) 'i— 56 �s 33-e SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Q_ ��y c� � 5 _ (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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 facility) Feet Furnished by a� I / of / . .. ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ll,;:P,..Z^ .--OF....--..., 1.a�z Appliratiou -fur 43iiputittl Works uustrurtiou Pprutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal system a . %: .__ ds Location Address or r,,oyr o. ON �S 6�C'. CG�tIJell Owner Address � - Installer / Address !! Q Type of Building _ Size Lot�`.S/.I. ----Sq. feet U Dwelling o. of Bedrooms..v....../.............................EYpansion Attic (_ ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers V- — Cafeteria ( ) P' Other fiat res .. !._.•.. Q -•-••-----------------------•------------._--..---•-•-----•---••------.-----•-•------ W Design Flow...........5.............................gallons per person per day." Total daily flow........----__-______-__.----_._..gallons. WSeptic Tank—Liquid capacityl0'.01)---gallons Length--------------_ Width................ Diameter................ Depth.-..------.----- x Disposal Trench—No.... .. Width.................... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No..../'d.�.�0S1 Diameter.................... Depth below inlet_____-____---....... Total leaching area.....__....._....sq. it. z Other Distribution box ( ) Dosing tank ( ) dA. -- PC�i -7 aPercolation Test Results Performed bY....----------............................................................ Date--------------------------------------.. a Test Pit No. 1----------------minutes per inch Depth of •Test Pit.................... Depth to ground water..-.-___.___--.._._-_.-- 4, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._.----.-_---_.----- 9 --------------- --- ------------y,----- .... 6.escrpton of Soil--.- --> ---- -------------- U ----------------3--`-- '� - .ct!,...� �� ..........,5 ?�iC...b!-�Jre rr�__ -'-�f-40..1 ------•---- W ---------------- ---------------- -------•----------------------...------------------------------. ---------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable..---------............_--__----------_-..._-.-.-.-:..-.-.___--____....__....__.___--------. --------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- --•---•--• --------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 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 the bo f he th. ned---- ---• • -- . .----- --•- ............................... Date Application Approved BY ----------1/1 �� ... --------- Date Application Disapproved for the following reasons:......................................... ----•----.....-•----•-•-•-•--••-•-------._.........------.......------ ------••--------------•••-----------------------------------•-•----•-------------•----------•-----------------------------••------•------------------------------------•-•-•----------------•--•----•-•- Date PermitNo........................................................ Issued........................................................ Date ................................................................................................................................. . THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH ..................OF........... .. ... ..`:.......................------.............. C�� r' %-En if irate of f�ontphaurr TH j)S TO rRTIFY, That the Individual Sewage Disposal System constructed ( �or Repaired ( ) by ,('�7 = ----- ----------------- -------- -- nstaller r — ............................................•---............--•--_.........--- at. .?.-.has been installed in accordance wiXh the provisions of . I of The State Sanitary Code as describ d in the application for Disposal Works Construction Permit No..............+, __ __-- .-_--__. dated.....1�--..�^'-��.----.----- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE- ,+1---...:'.1.. �..7�--------------•------•---. Inspector----• ........................................ h� .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ,� .....�.(} ^� ........OF.........., 'U�'� '...................... Appliratioo -for 11-4poottl Workii Tomitrurtion VProitt Application is hereby made four a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at V G�y /l�/G. .----------r ------------------------------------------- ----------- �3-------------------- --- N-----, - LocationJ�Address G / � or I,ot/ o. ........ Owner Address W � Installer Address /�-'� �G UType of Build Size Size Lot............C-J.---_-.....Sq. feet Dwelling No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building --_--_-•____________________ No. of persons..-_____---________-._--_._- Showers (/ ) — Cafeteria fiat res ----------------------•----------------------------- W Design Flow____________ _ _________•_-_---_----_gallons per person per day. Total daily flow.........4r?-----_-----___------._...gallons. WSeptic Tank—Liquid capacitylCM_--gallons Length------------- Width................ Diameter------.--------- Deptli._..--_-___----- xDisposal Trench—NoT if... Width-------------------- Total Length.................... Total leaching area--------------.-_.-.sq. ft. Seepage Pit No._-_--1-e-Y�__"1 Diameter.................... Depth below inlet.................... Total leaching area-.---__.._._...-_sq. it. z Other Distribution box ( ) Dosing tank ( ) - D J)- d-7 c 12;, - 16 - 41_ 7 6 Percolation Test Results Performed bY.......................................................................... Date--------------------------------------- ,� Test Pit No. 1________________minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.__.---_-_-_-_._--. - P4 -------------- - -- - -----------------�-- O Description of.Soil---- r � �'�lc `l-rl�L �� .. 0 `` ✓�✓ stJ - ------ --- --------------------- U W x ---------------------------------------------------------------------------------------------------------•--------- --------------------------------------------- --------------------- --------------- U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --•------ ------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bl thhe/bo r f Zelth. G�! Signed------4` ...--•--- Date Application Approved BY l mil-.........C J J ! �.-._/ .�..---------- Date Application Disapproved for the following reasons---------------------------------------------------------•-----------------------------------•-------------- ---------•---------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------ Date PermitNo......................................................... Issued...................... ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ............OF..........! .1/vYL...�........................................... o %Vrrtifira#.e of f�om�ltttrirr TH S IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �r Repaired ( ) ` ( by - -- -- ' ._.:_ __-- =%,�-�-----r- •..... ------ -•-----"------------ `�/`/! at......j....1 t_l.. .......�. --- -'�- -------- ..... G- --------- has been installed in accordance wi the provisions of 4k",'1I of The State Sanitary Code as describ d in the application for Disposal Works Construction Permit No /� /�''" .._-� ..�_:__.___.___ dated__.__lf_'_./..'". ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector-------------------------------------------------------............................ THE COMMONWEALTH OF MASSACHUSETTS lBOARD O HEALTH .ti No.------ -•---�----- FEE,ZZ- .•-----....... �i��o,�tt ork��i�or��trortioit �rrutit Permission is hereby ranted_ -- .__ez'-_______? `_.fit - '�'- g to Constr•ct or Rep 411� 'r ( ) a Individual Se D.i osal Syste at No.6r -� _2..__..:!z;. •- � :z. r �a-1_.Y 1:•� G '-• -----••--- Str t as shown on the application for Disposal Works Construction /Pe No.---_ _. ----- zted �1-----------------------••••.... -------� - ------'- --- DATE.---.._..--•----•--------------------------------•-•------------•--••----------• Board of ealth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1117CH NG 0 5, r Yl 1 O'M,n tooaya/ Mfj /oco qa { CERTIFIED PLOT PLAN NEW CONSTRUCTION ONLY : TOP OF FOUNDATION IS 'y FEET IN ABOVE LOW POINT OF ADJACENT 'aAsl h �9 fA.0Ir , A ASS. ROAD. SCALE: �� ► DATE :tle f/91/4;16 ELOREDGE ENGINEERING CO. INS �( I CERTIFY THAT THE CLIENTh UGK�� SHOWN ON THIS PLAN IS LOCATED EGISTERED REGISTERED CIVIL I LAND JOB NO. ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR DR. BY p �� CONFORMS TO THE ZONING LAWS ---� --- -- - OF BARNST BLE , MASS 33 NO MAIN r 71? MAIN I- CH. BY - __.---- f , 4,1\4 ,gA I '0 YARM+ il 111 MA:.,: Ii �ANNI' , MA: aHEET � . UF �• _, UA1E HEO. LAND SIIRVlYOR 20 FT. MIN. S FT. MIN. 'glad CONCRETE 401 PVC PIPE CLEAN SAND MIN PITCH I/8 PER FT- COVERS CONCRETE . • A 10 COVER LIQUID LEVEL 10" AST ii i -aL 2�� LAYER *; PfPE /®do g a -OF 1/8"- 3/811 ImwIN BITCH- 1 • • e s s • ° 1 ° ° I/411 R FT SEPTIC. TANK DIST. ` ' • • • • . • ° ° WASHED STONE BOX ° • o EFFECTIVE °, 3/4 I I/2 DEPTH • ' ' ° WASHED STONE t" ° ° ° 1 • o o • • 0• o PRECAST SEEPAGE •' 1 • • • • • too ` ; ° PIT OR EQUIV. INVERT ELEVATIONS 6 FT. DIA. o 10 FT. DIA. , G (SEE TABULATION) INVERT AT BUILDING 9� FT. INLET SEPTIC TANK `fS^s FT. GROUND WATER TABLE OUTLET SEPTIC TANK 9S�.3 FT SECTION OF INI.IT DISTRIBUTION BOX 93"0 FT SEWAGE DISPOSAL SYSTEM T DISTRIBUTION BOX 9to, FT. SCALE: 114 / _Oit Y, T SEEPAGE PIT FT. TABULATION #DESIGN CRITERIA DIMENSION A FT DIMENSION B -FT. NUMBER OF BEDROOMS DIMENSION C V FT 'h GARBAGE DISPOSAL UNIT TOTAL ESTIMATED FLOW GAL./DAY SOIL LOG SOIL TEST NUMM OF SEEPAGE PITS ✓ ELEVATION DATE OF SOIL TEST SIDE LEACHING PER PIT J 99 SQ. FT �L��, RESULTS WITNESSED BY BOTTOM LEACHING PER PIT 79 SQ. FT PERCOLATION RATE MIN/INCH TOTAL LEACHING AREA 26C SO. FT co 0'11X to RESERVE LEACHING AREA ESQ. FT ��... I3 ,& OF Mq: ♦ L / / /+��i� — �Pgcy a" Y fr+�Pa✓ c ��`� LG� 33 /�l �C/llP;5; �CS� le�h ' EwxtvGc ELDI ° .. I DGE ENGINEERING CO. INC. � ,o a op, Fc,sT *Z41 33 NO. AMAIN ST. 712 MAIN ST. �n v�y � SO. YARMOUTH Hlf7�►NNISc MAS .; sUR b JOB NO.7CGC7A SHEET.1 OF .2... I -� �' :.;,�; a..- �_ � � ��,\ �� d � i i i �� , { I � � LOC TION ' o �`� 5EW&C,E PERMIT Uo. — IWST LLER'S W&ME ADDRESS BULLDER 5 Q E & DDRE SS DATE PERMIT ISSUED DATE COMPLI &MCE ISSUED : r . t �� ,� ti; � ^� `f Q I Lim