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Home My WebLink About0075 HORNBEAM LANE - Health '-:'75 Hornbeam Lane Centerville A=206-065 S M EAe Na�1s�trOR UP01204 smsad = • Mob la UBA . roAl jo Commonwealth of Massachusetts ��~"��8�� 0� ��`��°��N N��"�� N~�� Title �� N�m@ Inspection �~ ~ �� .��mm ��mmmw S Subsurface Sewage Disposal System Form 'Not for Voluntary Assessments 75 Hornbeam LO -- Pmpeny/�6��----------_------------------ ---'------ --------------- - -- Gena|dE. Anderson o*no, -------------------------- ------------------ -- cxwneroName � --- - -------------------------------- infonmationis ' required for every C ____� �a___ _0�632 _ 8/20/2013 p�e� �^p/»w» 0a� ��Code Omteuf|nupectiom Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist mt the end of the form. |mpndantvvxnn �� filling "��^ "��ral Information on the computer, use only the tab key�o move your 1� Inspector: ' cursor do --- ' SS�nKA J�neo uoo�e�mm --'----_-----...... - key. Name of Inspector, Capewide Enterprises Company Name ��------------- ---- ~--~ 153 Commercial St. ' 02649 Mash Ma ' cnn/own State Zip Code � 508-477-8877 S145�2 Te�000noNumuu, ��-- ------ -- --'------. ------------------------ ^ Lk�naeNumbv B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is boe, accurate and complete as of the time of the inspection. The inspection was performed based onmytraining and experience in the proper function and maintenance ofo`site sewage disposal systems. \ am a OEP approved system inspector pursuant to Section 16.340 of Title 5 (310 C8NR 16.000). The system: Passes Ej Conditionally Passes [l Fails L] Needs Further Evaluation bv the Local Approving Authority design8/20/2013 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Ap�prbving AutTR)rity (#oard of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a - ' of -'--- g,- or greater, the inspector^ and ~the system "= shall sw"vot report to the appropriate regional offic�of the DER The original should be s " Af ent to the A�stemwner and,copies sent to the buyer, ^ applicable,^ and-the approving authority****This report only describes conditions at the time of inspection and under the conditions of use m*that time. This inspection does not address how the system will perform im the future under - . the sammaord�ymrmntuond�homsmfuse. - ' em"'3/13 Till.somum Form:Subsurface ' ^ -�.Page `~ 1m`, Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is Centerville Ma 02632 8/20/2013 required for every page. Cityrrown 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: ® 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 dwelling located at 75 Hornbeam Ln Centerville is served by a Title V septic system consisting of a 2000 gallon septic tank, distribution box and 4 flowdiffusors. The detached cottage has a grinder pump that flows to the main septic tank. The system was found to be in proper working condition at the time of inspection. 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)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 exfiitration 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is Centerville Ma 02632 8/20/2013 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 or 17 1 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owners Name information is required for every Centerville Ma 02632 8/20/2013 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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. ❑ 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 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 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 day flow than 1/2t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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. ❑ ® 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. [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 it 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ..r 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 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? ❑ ® 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 1.5.302(5)] 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 gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts MOW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,..'" 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: 201.1 —257,000G & 2012—265,000G Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date 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: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): 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: routine maintenance, outlet filter clogged 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is Centerville Ma 02632 8/20/2013 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 6/22/1989 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok, no leaks, vented through the roof Septic Tank (locate on site plan): Depth below grade: 2 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: 2000 gallons Sludge depth: --- t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge 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 How were dimensions determined? tank pumped for inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was pumped at time of inspection because of high water level due to clogged outlet filter. Tank should be cleaned every 2 years for proper maintenance and filter should be cleaned every 6 months to prevent clogging which could result in sewerage backups. Covers are on risers. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. City/Town State Zip Code Date of Inspection 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.): F 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): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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 was found to be rotted with excessive root infiltration. Box was replaced for inspection. Permit#2013-317 Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Cottage on property has a grinder pump which flows to main septic tank. Pump chamber was filled with water to confirm that the pump and alarm were in proper working condition. Alarm sounded and pump came on at the correct elevations. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 flow diffusers ❑ 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.): s.a.s. was dry with no sign of past hydraulic overloading. 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 Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 17 Commonwealth of Massachusetts OfficialTitle 5 Subsurface Sewage Disposal System Forty - Not for Voluntary Assessments 75 Hornbeam Ln __. --- Property Address — Gerald E. Anderson Owner ..-....._ ...... ............. ...... .. Owner's Name Centerville Ma 02632 8120/20�3 information is required for every _...____.___.._ ..___:... .._....__ ......_._ page; City/Town State Zip Code Date ofInspection . . D. System Information (cons.) Sketch Of Sewage Disposal System: Provide a'view of the sewage disposal system, incluing ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one,of:the boxes below: J hand-sketch in the area below El drawing attached separately - ,.I I LI ps � 1 _ I3-1;7 2 1 . t5ins•3113 Title 5 Of!cial.:irspeclion Form;Sugsuiface Sewagii Disposal S siem•Pege:15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. Cityrrown State Zip Code Date of Inspection D. System information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 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: 2/15/1989 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: design plan dated 2/15/1989 indicates that no groundwater was encountered at 126" , bottom of s.a.s. is 5' below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 75 Hornbeam Ln Property Address Gerald E. Anderson Owner Owner's Name information is required for every Centerville Ma 02632 8/20/2013 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. o t3, 3 (—� Fee !t o , __� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Veiposal 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) []Complete System N001'ndividual Components Location Address or Lot No. �� 6`! �'� Owner's Name, k, Tel. ClA 1k Assessor's Map/Parcel lis o4AIIS 6 A , W-1 3 Installer's Name,Address d Tel. o. q- -n-9$'7"7 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 3'aS A str f[ Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) kC-c-P, b— 13 6x 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 not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date �'';t 013 Application Approved by W�12LV /►., — l Date ivZ(7 —� 0 �3 Application Disapproved by Date for the following reasons Permit No. _—] Date Issued a C) No. (� {� Fee ,THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH.DIVISION -TOWN OF BARNSTABLE,w MASSACHUSETTS Yes 200Iication for IBisposar �§Pst �o stru�tio Prtttit Application for a Permit to.Construct( ); Repair(\4 Upgrade( ) Abandon( ) _ ❑Complete System EN Individual Components Location Address or Lot No. GEC \/A, sr vw Lt)v%A_ Ownerls Name,Addressg an Tel.No. ` Assessor's Map/Parcel'b 45/15j LJQ- tt, 10"N 0. 1-3 Installer's Name,Address aid Tel.Not ':;V-6- c��-9 6 7-7 Designer's Name;Address,and Tel.No. Opt Ev`1 u C SAS♦l� I Type of Building: Dwelling No.of Bedrooms Lot Size A sq-ft. Garbage Grinder( ) i �. Other Type of Building No:of Persons Showers'( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title s Size of Septic Tank Type of S.A.S. - Description of Soil Nature of Repairs or Alterations(Answer when applicable) r1V - Date last inspected: f 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 not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed—T / _ Date �9 1 . Application Approved by 1 vl C- 2 Date r ApplicationDisapproyed�by Date'_ .;for the following reasons fj. { P,ermitNo. �,1 ►Z �, "7 Date Issued �yj a — 0 1 Z. ------------- --------'------- _.-.-.-,.-.:-.-.:-.-.,-.-.--.::.-.-. -:-.-.:.-,,-_--- _.- .--.:_f __ . -------- _ . ------------------------- (1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance l THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by Q ..��n. at �/S W c�`C V\ . es�.eN� CQ- YY�\kyhas been conducted in accordailee with the provisions of Title 5 and the for Disposal System Construction Permit No b daedl Installer C NzW- W Aq � 6%ktre r�S - LA C Designer #bedrooms 1 " Approved design flow ( gpd, The issuance of this p rmitn shall ,�no be construed as a guarantee that the system Will function )asf�designed. Date /l " 1 17' Inspector v Y/t/, J/r 1X /( ' No. � 7� 2 1:5 � I THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *Pot Construction permit Permission is hereby granted to Construct( ) Repair( Upgraded( ) Abandon System located at 75 l i n�C 1(��.. .��- �b�. Q y\\�•V°� W( and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to p omply withV Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. / Date Approved by on a TOWN OF BARNSTABLE LOCATION / ,5 rtactz �sayy\ 4, SEWAGE #001' VILLAGE CetACIr \!°k`f- ASSESSOR'S MAP & LQT ,, O0 D6y INSTALLER'S NAME & PHONE SEPTIC TANK CAPACITY •o LEACHING FACILITYAtype)llovi i USSArS (size)q-- '"1Xo O. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ------------ BUILDER OR OWNER DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: VARIANCE GRAINED: Yes No o Q is Tree . lee a�� Y� NO._ Fmc...,;w ._......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..................OF......�F.2.V41M.3•4. 4x___.......................................... Applirttfiu for Biupu,iFai Works Tomilrurtion nutit Application is hereby made for a Permit to Construct ( ) or Repair (A) an Individual Sewage Disposal System at: .................. -•---................................................... ------•-•-•-•------•--........----•----•-•-...-----------•--------•----...-------•••------•------- Location-Address or Lot No. ............ trWj4� -... 7. __t!t2�� . 4X caner Address .....u�- G-a...urdi/�t Installer Address Type of Building s Size Lot......3o g-S-Ac-•_s, .- U Dwelling—No. of Bedrooms___.,17. _ca_e __________________________Expansion Attic (Alc) Garbage Grinder Other—Type of Building ___-\_______________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures __________________________________ WDesign Flow___________________________________4:5__gallons per person per day. Total daily flow............. ............ lrO_.___gallons. WSeptic Tank—I,pquid capacity_r�C?cpgallons Length./_��-///" Widths__`_; ..... Diameter__ ----- Depth S_.'=_� x Disposal 449—" . o...... Width.......l.?....... Total Length____.__...... Total leaching area...!S.91A____sq. ft. Seepage Pit No---_---------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq..-ft. Z Other Distribution box (x) Dosing tank (x: Po, n p eka.-ti,6--- `-' Percolation Test Results Performed by- -tar' ss-s_.kai_lscm j__ I�]� _AJ!1.! ........... Date...;San...U.j_L`lk5--------- Test Pit No. I......7-_._____minutes per inch Depth of Test Pit.../Z6�`_______ Depth to ground water________ ___®�' f Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..... __- _..-_:..-•----------• --------------••---••-••-•---••-•--••--._..._..-----------••-•------------•-----•--....•---=-------------•-•-••• S°PEf'F#EN . Description of Soil---_-S2_`1&---:-Te,V.&ai l--. ------------------------------------------------------------------------------- U ------------- 1�-._.12.1e. ►YYIr�!�m= �s ...��` _n4 ..--------------------------•-------------------------------------- .....WtLSON No 30216 UNature of Repairs or Alterations—Answer when applicable_._.!? :ip.l 'G S/ _1.LG77�----Sc�f?.�zG.__f4lzEt--- ----=4...��f�.�aL�.l�a�L;'S.......................................................................-...........--•----- - --•Agreement: �40 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with -�• the provisions of�:'IT r1 LE 5 of the State Sanita Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h n isss� d b t o board f heaX Signed --.....•---.....-'------- ................................ Application Approved By......... e Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------•-••-------_..._ ---------•-------- Date PermitNo....... '_ _ .................. Issued....................................................... t _ qQ i r ............"� THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALTH { ..................OF......: _9 _4x.......-.................................... AVp iration for Ditym al lVorkg Toutitrnriiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: •---•...................................•--•----•--..........----------•-----••--....•............ --•----•-•--........-•--••----•-----------------.....----•----........-----------•-•-•-----••-.... Location-Address or Lot 'No. ............ .................................... .•--___.7 --.Fly-�r.�-E.+.rc..0 ..�•,+G• ----------------------------------------- Owner Address Installer Address Q Type of Building Size Lot...... U Dwelling—No. of Bedrooms....,=®.0 .........................Expansion Attic (/L/� Garbage Grinder ( Uy a`4 Other—T e of Building No. of persons............................ Showers YP g ---------------••----------- P � : ) — Cafeteria ( ) QOther fixtures ..----------•----•-•---------------------•-•--•-•---..........•---------............--•-----------•----------------•----------........•-•............. WDesign Flow.....................................�_.gallons per person per day. Total daily flow............................A/+- j.....gallons. fs: Septic Tank—L', uid capacity..aZUgallons Length./!'- !__' Width6_.:= ,"__ Diameter_______—.____ Depth_S__'-_ _''.. Disposal �." '"=-No. ___.. _,,,, _s_ Width.......L?_'____.. Total Length_..._Az# ....... Total leaching area.__Z_S-.,!k-_--sq. ft. Seepage Pit''No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (x) Dosing tank (X) pv,h cI�4,�6. Percolation Test Results Performed ........... Date..Z�,,R...Zy...1.1j4_y_........ a Test Pit :No. 1......2.-------minutes per inch Depth of Test Pit---/Z,(."....... Depth to ground water...._____, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------ fy `. Descnption of Soil_.._..D._1 ---------------------•---••------•----------•-•- $��- O ----ic't'�.o,.l-._E__S.t�sca�-- ----•----------•-------------•--- ---SIEPH.EN 'fG C`X ------•------•---...------ t�l. 12(a�� tYYlE�Iaw�Y►_<._G�c.r�e �N��------------------------------------------------------------------ ALLYN W WILSON -------------•---------------------------- .... •. ..... 4- -0 N 30216,Q U Nature of Repairs or Alterations—L Answer when applicable-----kc oa_/......sas,w41rt _ �_�.�._ ��1 1f . ar.ki :acvzh-c.__�atalC ---•)Jru �G�- S6�1'W.--••----------•---------------------•-----------------..........------......------....... Agreement: N The undersigned agrees'to install the aforedescribed Individual Sewage Disposal System in accor nce wit�G �pf' the provisions of TIT .; 'of the State SanitarCoe—The undersigned further p 5. C e g ed urt er agrees not to place the system in operation until a Certificate of Compliance Sam b n iss kd by the board ,f heal Signed ^` ! =............................. ............................... Date Application Approved By......... .............. 41._�. _�_. Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ......................•--...•••••....•-••-•-••••••••-•----••••-•-•••••••--•••--••-•-••.......-••••••••-•-•••••••••-•••••••-•••-••-••--•-•-•-•----•-•-•••••••---••-•----• ............................... Date Permit No.......9' - -' ,..*7V------------------ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O/F� HEALTH ........OF............. 1 ............................................ (9rdif irate of TlantViiFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................•--•----...•••---•-•••••.......-••._....•--•-------•...._._.....•-•--•••••-----•-------.....-••---------•-•-••-•-•••...................•--•-•------.......--•••----•--•-••--•--•••- / Installer at-------------7-5------- r� ''�' ' "..•----4,-o-- -- -------------------•------•--•-----------------•-------------------------- has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... -------- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------- e::' ................................ Inspector........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH�If 'f '......,OF.............. .: ,1J�.. FEE. . .......... Disjumal Warkii Tomitratinn rrntit Permissionis hereby granted.........-----------•--•--------....------•--...---------------------------•-----•---•...................................................... to Construct ( or Repair ><) an Ind*vidu 1 Sevtrage Disposal ystem ------ -- -- - Street p as shown on the application for Disposal Works Construction Permit No.L! `"AWf Dated.......................................... ................................... o Health DATE................................................................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS OF T H E TO 4 BSE15T�fiI b 9. �o°' `C�'C�ZQ� 1.�CGGLG�2 :Cj�Zj�ZC.11Lf�2 �'o day k 367 MAIN STREZ-1 HYANNIS, MASSACHUS=S 02601 COM24ONWEALTH OF MASSACHUSETTS WETLANDS PROTECTION ACT AND REGULATIONS, G.L. 131, Sec. 40, 310 C14R 10.00 AND TC'rq-N Or BARNSTABLE ARTICLE XXVII EMERGENCY CERTIFICATION FROM Robert W. Gatewood, Conservation Administrator TO• Mr. Gerald 'E'. Anderson Same (Name of applicant) (name of property owner) 75 Hornbeam Lane Centerville, MA 02632 Same (address) (address) DATE• ° June 8, 1989 LOC.7TTON• 72 Hornbeam Lane, Centerville F I;VD! 1GS: 1.) The a and of Health & Cnnaervatinn r'nmmi S,zi nn hereby certifies pursua-'lt. 0 310 C:^R 10.06 than. the work described below is necessary for t e protection of �he neaph and safe`- of the Ci tizens of the Cor�::onwealth and will be per=orr,',ea bV or has been crdered to be cer=ormed by an agency of the Cclmonwealth or a subdivision thereof. 2. ) A site inscection was per=Ornied on June 6, 1989 3. ) The a encv crdering or %�x�;� •9 the e L er_ency work{ is Board of Health (name of agency) . (ilot the Ccmmission unless -Mork is on land owned or controlled by the-nni.) 4. ) DesC=_ze .reiCw, the work, which is allowed to proceed under this Cer-J Lc. L_cn. 'o wc '.. 'tevc::C that :ecessary to abate t.-e emer;ency may e So C6r _r12�.. r * Seot-i c system unQr'de in ccnformance with plan re-J Ginn of 'J, , 1 n , lag() (St -ashen T,7i l cnn, PE) . * A limit Shall sides of the nrnrnge,l cvstem and -vrCA I'laln Stake,; ''lay bales shall be used or, d r= cC,-mot;pr?,-V bad� S to •2T"o'' nt cerinan- tation imoacts. A Notice of Intent for the project must -be -filed b ' July 1555, 1989 . - _--_ _ v= _Sc_ihe�: •,�-cr kti Jul' 6, 1989 d G�� Va =:.cr�� C: Ce_`_- C=C -------_cn ^_e'SS Zne Cc:��.r:�S�_cne- c= �.E = So a__- .7es ) = -c ED �_ �� e t ratP•,;end CnnGorvation Administrator -r` DEOE, S _ -- r O a� z m BATH I _•`\_\\4_�T_I_-Ir 1 01 aq IIII III--LJ—I_�Sm1—I �I11 �V8 UHA��ybraCj �eQpp�Q�!'WOsQ1G611 r st Vu�}p_jI6C5 IL 0-b6q PROP. EXISTING 2-16" EXISTING PROPOSED0- 0- BUILT IN ORE ER MOVED FROM EXISTING STEP"" ST E f_ 41 Ifl PANTRY L------ lit PROP. 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Laiop"Joh)% OF kjlh" 4'll� U14Z Un U T1W5 hRE, APPRAXIMl1TWO i PRIoit -m -rwa STgR'T or CAfPTRucinoW (�IU�1movn 7L'LNcs.� CALL Q _ -- - -ZI GS ASK (_l-OW-3U-4644)- 6alII TUG MULL E- dErO �LLA WATM 9MPr. (. 42*- WAI _ 2. DAT00 : lWw.etf GCC44ftc U49'"-a 1 Z"C KO-11 D ,�� —•�`' k 3. FGDGF .3'?d!A` .�}/Q nl.G.14,G. A� X -----•-=---- - F �..,E�Ayre.�?�. /.. Q�AtB� ..�cewsad. .�G1,1p-,b�,a': . _ �� 'ti,._ � ` �� I < j � t 'e'xLf.5t„-.y PUMP CHI�l�'IIIER_ -DETAIL Cd lifi•�c f --?-I , h i_`�� . `Fr►v�mnmeet� �� ---Amodnl_fo_L a-Sc.rit4 b ._Alarm.. } Pn>arer. Co„ncatitn � �+rcuri Lircn►ccrs _ SEPTIC 5YSTEM REPAIR 75 HORN13EAM LANE �•,,,, e o C' ENTERVI LLG . MASS . ., - ,o,c.,o��cc0 fo.• _ Q► E-RA4L AN�DERSO AlozF% Fe/cc /I� I� 3hw// A-- /aic� so Abaf it { � 8 -- - �e"� �t �" i•` i p � �s .• _ dt *� .: � SGRLE': / -/O Tom': Fcbruzr /S /989 c 1 q 56?R-2,G 9�1JC. two rce tY11u i;t G«.� be aPr err i•�e aC/ c.,� tQy scar etc winlEi` e�,t1 t7J d �o nd�f G' Y;A' "'"• '�4 S�\'�v .4�v/S�'o i �6. 8.9 /989 S.A.4/. wok/r STEPHEN c ALLYf1 w1L�:,, TER NYE Zvc. A. BA�c � c` � '� '\ �`� r�• �` `' R�ST+�+Qen i�ula GuRvGl+OR.S * CIVIL 'I;N61A16�R.S -•� '" si , _ QS?�' �.t..� /�J'�455AGI1/(/•� 77r'S i M v•�e• � . T• •� tier/G. 8883