HomeMy WebLinkAbout0072 INDIAN TRAIL - Health 72 INDIAN TRAIL, CENTERVILLE
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DATE: 3/30/98
PROPERTY ADDRESS:72 Indian—Trail--------
/�L/U
-- Centerville,Mass __-___- 0/3
02632
------------------------
On the above date, I inspected the septic system at the above address.
This system consists of the following:
1 . 1 -1000 gallon septic tank.
2 . 1 -Distribution box.
3 . 1 -1000 gallon precast leaching pit.
Based on my inspection, I certify the following conditions:
4 . This is a title five septic system. ( 78 Code )
5 . The leaching pit is dry.
6 . Tank heavy solids and scum layer. Pumped tank.
7 . The septic system is in proper working order
at the present time.
�SIGNATUR
Name:- J. P__Macomber_Jr.
____ N ��
Company:Josg� P,_ Macomber & Son, Inc. ,y j �0 y%
Address:__Box_�_Fz------------
__Cen ery-t l--e,_Ba--Q2632-0066 P
0
Phone: 508-775_3338
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tan ks-Cesspools-Leachfields
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775-3338 775-6412
LOCA ION . SEWAGE PERMIT NO.
�L
INSTALLER'S NAINF & ADDRESS
8 UILDE OR W
DATE PERIAIT ISSUED
DATE COMPLIANCE ISSUED
Lh,ov/
COMMONWEALTH OF MASS,ACHUS,ETTS
EXECUTIVE OFFICE OF ENVIRONMEN'TAL AFFAIRS
g DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON, MA 02108 611-292->500
WILLI.4N1 F.WELD TRUD1'CO
Governor Sccrct
ARGEO PAUL CELLUCCI DAV D 3 STRU
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM l.orr.missio
PART A
CERTIFICATION
Property Address: 72 Indian Trail Centerville MAAddress of Owner: 12 White Oak Road
Date of Inspection:3/3 0/9 8 (If different) West Roxbury,Mass .
Name of Inspector: ,TO-Pph P_Ma camber Jr. 02132
1 am a DEP ap roved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: J.�.Macomber & Son Inc.
Mailing Address: BOX 66 Centerville,Mass . 02632
Telephone Number: S08-77S-3338
CERTIFICATION STATEMENT
I cenify that I have personally inspected the sewage disposal system at this address and that the information reported below is (rue accuratE
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper iunc,Ion and
maintenance of on-site sewage disposal systems. The system:
asses
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Si nature: o Date: !�9 .'
P g r _��'
• The System Inspecto all submit a copy of this inspection report to the Approving Authority- within thirty (30) days of completing inis
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owr)er s�.ali submit
the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to t+,e system own,
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
AI SYSTEM PASSES:
��l have not found any information which indicates that the system violates any of the failure criteria as defined in 310 C,AR 15.303
Any failure criteria not evaluated are indicated below.
COMMENTS:
BI SYSTEM CONDITIONALLY PASSES:
,00 One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upc
completion of the replacement or repair, as approved by the Board of Health, will pass.
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 Ceriiicate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the ins h'Clion; t
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltrauur, or tan
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming se~pt,c tank
as approved by the Board of Health.
(revised 04/25/97) Page 1 of 10
DEP on the Wortd Wide Web: hapWwww magnet state.ma us/oep
a�'j Printed on Recycied Paper
r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued) Y
Properly Address:72 Indian Trail Centerville,Mass .
Owner: Robert McLaughlin
Date of Inspection: 3/3 0/9 8
B) SYSTEM CONDITIONALLY PASSES (continued)
&6p Sewage backup or breakout or high static water level observed in the distribution box is due to oroken or
pipe(s) or due to a broken, sealed or uneven distribution box. The system will pass inspection if (with apprc-a: c ,ce
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipets) The system . ,n ,,ss
inspection if(with approval of the Board of Health):
broken pipets) are replaced
obstruction is removed
N REQUIRED BY THE BOARD OF HEALTH:
FURTHER EVALUATION IS E
C) U Q
_Z Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing :')e
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING In A M.AN.ER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
UD Cesspool or p�ry is within SO 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) DETE?,mI,,ES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
10 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a suriace water s.cc , or
tributary to a surface water supply.
/ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a pu'oIhc water suppl, -el:
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a pry ate Bier
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or Tore is:)r-, a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds n a:es mat
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen rs e ._ to of
less than 5 ppm. Method used to determine distance iU/11 (approximation not valid)
3) O�TdHER
AW
'YJ
Ir.vs..a 0♦/)5/fl) Y.y. 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued) y
Property Address:
p 72 Indian Trail Centerville,Mass .
Owner: Robert McLaughlin
Date of Inspection:3/30/98
D) SYSTEM FAILS:
You must indicate el-.- er '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 3'0 CmR 15.30 e oas s
for this determination is identified below. The Board of Health should be contacted to determine wha: will be necessz� c coRee
the failure
Yes ^1�
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspoo!
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or cloggec SA-S or cess,--C
Liquid depth in cesspool is less than 6" below inven or available volume is less than 1/2 da, iiow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pi;�05)
Number of times pumped .0.
Any ponion of the Soil Absorption System, cesspool or privy is below the high groundwater eieva:lon
(/ Any ponion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface —er s.,.o s
Any ponion of a cesspool or privy is within a Zone I of a public well.
Any ponion of a cesspool or privy is within 50 feet of a private water supply well.
Any ponion of a cesspool or privy is less than 100 feet but greater than 50 feet from a prl�ate wafer suoo 1 �,e ne
acceptable water quality analysis. If the well has been analyzed to be acceptable, anach copy of well -;;er a ;,s ;o(
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 above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significan
public health and wfery and the environment because one or more of the following conditions exist
Yes No
601 the system is within 400 feet of a surface drinking water supply
I& the system is within 200 feet of a tributary to a surface drinking water supply
C/A- the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area • IWPA) or a mappcc Zo-)e 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 trea:rren: c�rar�
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information
(r•v1o•d 04/15/97) Fag. 3 of 10
1 \
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST y'
Property Address: 72 Indian Trail Centerville,Mass .
Owner: Robert McLaughlin
Date of Inspection:3/3 0/9 8
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection.
_ As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
_ All system components,,/c luding the Soil Absorption System, have been located on the site.
4 _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condit,on of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum
— 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 System.
Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) 115.301(3)(b)J
(revised 04/25/97) Pegs 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM IINSPECTION FORM
PART C ,
SYSTEM INFORMATION
Property Address:72 Indian Trail Centerville,Mass .
Owner: Robert McLaughlin
Date of Inspection: 3/3 0/98
FLOW CONDITIONS
RESIDENTIAL:
Design flow: R.pd./bedroom for S.A.S.
Number of bedrooms:
Number of current residents
Garbage grinder (yes or no):
Laundry connected to system (yes or no):
Seasonal use (yes or no):/� /
Water meter readings, if available (last two (2) year usage (gpd):
Sump Pump (yes or no):.-VO 110,71 G.
r
Last date of occupancy: 11A/1
COMMERCIAUINDUSTRIAL:
Type of establishment:_ 'Ut#
Design flow: W,4— allons/day
Grease trap present: (yes or no).f*
Industrial Waste Holding Tank present: (yes or no)V
Non-sanitary waste discharged to the Title 5 system: (yes or no),CZA
Water meter readings, if available: X4 4
Last date of occupancy: 9
OTHER: (Describe) /9
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)
If yes, volume pumped: eWQ gallons /
Reason for pumping: ag�== 4� Lli.�f
TYPE O j Septic
Septic tank distribution box/soil absorption system
_ Single cesspool
�Z Overflow cesspool
Privy
W-
Shared system (yes or no) (if yes, attach previous inspection records, if any)
t)i I/A Technologgetc. Copy of up to date contract?
Other
.-&?P MATE APE of all components, date i talled (if known) and source of information: �_`ZK
Sewage odors detected when arriving at the site: (yes or no)
(revised 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM ).NSPECTION FORM 1
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Indian Trail Centerville,Mass.
Owner: Robert McLaughlin
Date of Inspection:3/30/98
BUILDING SEWER:
(locate on site plan)
tl
Depth below grade
Material of construction: Zast iron _L140 PVC _ other (explain)
Distance from private water supply well or suction line N
D,ameter
Comments (condition of joints,-yen ing, evidence of leakage, etc.)
SEPTIC TANK:.&mji¢4L^y
(locate on site plan)
Depth below grade M _ — — _Polyethylene _other(expla n)
If tank is metal, list age Is age confirmed by Cenificate of Compliance.V (Yes/No)
6„1� ,ram
Dimensions: � /s//.fJG�i Y !lJ jll� 67 "? �
Sludge depth:
Distance from top of ludge to bonom of outlet tee or battle:
Scum thickness: L
Distance from top of scum to top of outlet tee or baffle: x
Distance from bottom of scum to bosom of outlet tee r baffle: C�
How dimensions were determined: T
Comments
(recommendation for pumping, condit n of inlet and outlet tees or baffles, depth of liquid level in relation to ovule: nveri, struc_r,I
Integrity, vidence of leakage, etc.) — �9 S,
GREASE TRAP:%•C,
(locate on site plan)
Depth below grade:A29
Material of construct iony�concrete J2Ametal.W9FiberglassVAPolyethylene./Aother(explain)
Dimensions:
Scum thickness: N
Distance from top of scum to top of outlet tee or baHle:A1L4,
Distance from bottom of scum to bonom of outlet tee or baHle:,&2L
Date of last pumping: 1
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, sv,.1c1'r--1
integrity, evidence of leakage, etc.)
use A9 424� - --
tr.vl..d P49. 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Indian Trail Centerville,Mass .
ON net: Robert McLaughlin
Date of Inspection: 3/30/98
TICHT OR HOLDING TANK:!(Tank must be pumped prw; to, or at t,me• of inspection)
(locate on s-le plan)
Depth oelow grade
Malenal of con strua ton,VAconcrete,"metal.d4Fibergl ass 4.)4Pol yet hylenezAother(explain)
„4 —
D.mens,ons Alm
Capac'ry gallons
Design i; el ,2,p la(m in ay
Alarm level Alarm to working orderer 1'es;414 Nu
Date of prey,ous pumping.
Comments
Iconda,c.n of nle( tee, condition of alarm and float swathes, etc )
—=TE .uT ---
DISTRIBUTION BOX:
tloca:e c-+ s,:e plan)
Deoln c I c.-d level above outlet tnven:•�ioo
Commer:s
to to i level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc _.
r A re /11� 0/c Sv�1 s (�, ,1,,h y n2,lel'_
'4ew iV7� or dci?' e V aec: - ---
PUMP CHA.%ABER: ��
(joc.3le c-) we plan)
Pumps �r -citkrng order: (Yes or No).A�e
Alarms n •,orking order (Yes or No)•11/z
Commen:s
(note condition of pump chamber, condition of pumps and appunenances, etc.)
I ' +
l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 Indian Trail Centerville,Mass .
Owner: Robert McLaughlin
Date of Inspection: 3/3 0/9 8
SOIL ABSORPTION SYSTEM (SAS):-�Olh 0a"t.
;locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type: 1 leaching pits, number:
leaching chambers, number:
leaching galleries, number: ,q
leaching trenches, number,length: V
leaching fields, number, dime ion
overflow cesspool, numb�v_
Alternative system:
Name of Technology: WA!;�,
Comments:
(note conditi of soil, si ns of hydr ulic failur , level of ponding, c ndition of vegetation, etc 1
CESSPOOLS: d2i4 /C
(locate on site plan)
Number and configuration: / 19 r
Depth-top of liquid to inlet invert: 4-14
Depth of solids layer:_ A14
Depth of scum layer:
Dimensions of cesspool:
Materials of construction: 424
Indication of groundwater: a
inflow (cesspool must be pumped as pan of inspection)
7
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
01,
PRIVY:
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:z��—
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(z.vl..d 04/25/97) Y49. B of 10
J,
' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Properly Address: 72 Indian Trail Centerville,Mass.
Owner: Robert McLaughlin
Date of Insaection: 3/30/98
SKETCH Of SEWAGE DISPOSAL SYSTEM:
r.c.L,ae ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
4
I '
3Q
I
t
tr wif•d C4/25/97) Pag• 9 of 10
SUBSURFACE SEWAGE DISK S t`STEM.INSPECVON FOR.,
i
+ SYSTEM INFOI: :i0•N (continued) 1
Properly Address: 72 Indian Trail Centerville,Mass .
owner: Robert McLaughlin
Date of Inspection:3/30/98
Depth to Groundwater 991 Feet
Please ind,cate all the methods used to determine High Groundwa:¢d, Eli a on:
Ootatned from Design Plans on record
rZ bservaocin of Site (Abuning property, bservation hole, basemeN-s imp etc.)
a
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
I
Check pumping records
--4zCneck local excavators, installers
Use uSGS Data
Descr,be n your own words how you established the High Groun, ,xer;Ievat�on. Must be completed)
Used Water Contours Map.
Gahrety & MIller Model
12/16/94
I
Ir•vl.•C 01/35/971 P•c• �Uuf 10
♦: rrn r. —n.rr—.r-ir.rrrr.•nmr,rnr.re'rrerr:-.n.•+++v+rr�rr-.rnm m-rnv'rs,nTer.n-s• �.. r.-ra-:rcrerrr-a.rn-�-a�-T-,—. _ �..
t F:
TOWN OF Barnstable BOARD OF HEALTH
1 SUBSURFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIF1C�TION
`� F^•T•^. T ...—�.II.. .�TT.,T.�1-R.TT TI T.4T}TI"'1"."1'r—•.'t rt111'T\i11T1Pr1"n1:'fRs'ir lliZ T'ITiT.niTf lST1fl1'TTTT"n'IZiP'T."rn•r''T.:�..-.'•'- r1 .�.
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 72 Indian Trail Centerville,Mass .
ASSESSORS MAP, BLOCK AND PARCEL # -:1-149 0 13
OWNER' s NAME Robert McLaughlin
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber. & Soil"'inc.
COMPANY ADDRESS Box 66 Centerville,Mass . 02632
Street Town or City Stat. LIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578
q
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate , and
complete as of the time of .inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one ;
_Z__S'*ys tea; PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection wllicll I have con lcted has found that the system fails to
Protect the jiublic health and the environment in accordance with Title
5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature Date Z�J
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF HEAL'1'il.
• It the inspection FAILED, the owner or " perator shall upgrade the eyotern
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 3.10 CMR 16 . 305 .
partd . doc
0
J � a
-r
1
ti
_ S
THE COMMONWEALTH OF NIA.SSACIMSETTS
DEPA ATM ENT OF ENVIRONNIENTAL PROTECTION
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTHi1E D TITLE 5 SYSTEM 11\6PECTOR
w
as r vide p o din 310 CMR 15 .340 and Section 13 of Chapter 21A of the
General Laws . Issued by Tile Department of Environmental Protection.
/fie Ling Dlicctor of the f)S c mfi of %V31cr Polki11on Control i
%3
s� ¢Q
No.-Xl8_-3Z/..... Fu$... ....2 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Town.....................OF..............Barnstable
-
Appliratiun for Disposal Works Toustrurtitun 11trutit
Application is hereby made for a Permit to Construct ( ) or Repair (X)o an Individual Sewage Disposal
System at:
--•-----72 _Indian Trail Generua.11e....
L ation- d re.ss or Lot No.
J. Robert Mcfau"4V1 in
......................-- ....- -• --•-• ---...-•-----.................................... ..........-•......................................................................................
Owner Address
W J.P.Macomber
............... ......__.
Installer Address
Type of Building Size Lot............................Sq. feet
Dwellings No. of Bedrooms..............3............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
0 g ............................................
Other fixtures --- ----------- ---- ---------• •------- ------------------- ---------------------------------------------------- -----`-
W Design Flow______________________ gallons per person per day. Total dailyflow............................................
gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1.............___minutes per inch Depth of Test Pit.................... Depth to ground water___-_____-____.________-
�, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__-_____ ____________-
-----------------------•-------... ---------------
-_---------------------
•-------••---------------------------------
---------------------------
0 Description of Soil--•-------------------•-----------------------------................----------------------------------------------------•------------------------------•--.._..---------
x Sand & Gravel
U --------------- •-------------•--•-•---•-•----------...----------.._..--------
W
U Nature of Repairs or Alterations—Answer when atp tp linable .. ._... __
1-1000 gallon tan7� 1-1000 gallon plt_ __________________________________________________
--------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
nlc-�
the provisions of�"ITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance hdbeiss d e board of h th.
Signe ' ` __9_.................. .....7/141-H.......
Date
Application Approved BY +1 ----•-•---.-
Date
Application Disapproved for the following reasons:................................................................................................................
--------------------•_--•----------------...-------------._...----------......-----.......-------•-------------------------------------------•--•-•---I------------------------------------•------_-••--
Date
Permit No---------625.-. 7/........................ Issued-.......................................................
Date
a!o ��3 TOWN OF BARNSTABLE�==�
CATION� -=z '� '. - � %�9✓L SEWAGE #
kGE sJ2rv►;�� � �!d7�3 ASSESSOR'S MAP & LOT_J
!ISTALLER'S NAME& PHONE NO. '
SEPTIC TANK CAPACITY /�� d�
Y.EACHING FACILITY: (type) _J�d�aCy"WIr (size) `�®d
NO. OF BEDROOMS
BUILDER OR OWNER BtY `yi�r1>�,�cioV.E'�
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 f leaching oaci '' ) Feet
Furnished by feet i
L_
t '
i
(r
TOWN OF BARNSTABLE
LOCATION r� 7` # 7f
VILLAGE r Y U l`II-le- ASSESSOR'S MAP ry LOT
S 3
INSTALLER'S NAME & PHONE NO.j • P. Mar- �ifv�
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)� (s►ze)
NO. OF BEDROOMS PRIVATE WELL OYPUBLIC WATER [,_
BUILDER OR OWNER � -
DATE PERMIT ISSUED: - 6 4-1 S ir
DATE COMPLIANCE ISSUED,:
VARIANCE GRANTED: Yes No-1 _
..`� �.� �, ice/ -
37
No............. Fps...... .. o i3�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
p _
ApplirFation for UiipunFal Works Tontitrurtion Famit
Application is hereby made for a Permit to Construct ( ) or Repair ( Xk an Individual Sewage Disposal
System at:
7 2...l aal.a n----T ai-I... .
}Locaation-Address or Lot No.--..........•. ..... :..c`.... ......il.�r:+:LEA.,11 .......................... .....--
Owner Address
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling NKRNo. of Bedrooms...............2._.........._.............Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............._.............. Showers ( ) — Cafeteria ( )
04 Other fixtures ..----•-•--•-----•-•---•..................•---•--......---•--.............------------._...---..........-----•-------••-----•---...........-•---.••-•--
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter...__-_-____---- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.---____---_--___-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
•-' Percolation Test Results Performed by.......................................................................... Date........................................
W
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_--__._-------...____--.
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---____-.---••--_____-_.
Ix -•-------•-•-----------------••-••.....•--•---•..........------.....---------•--._.....-----.......
...
-----------
•----------------------
--------------------
0 Description of Soil..............................................................................................
-------------------------•--------------------------------•-------..••---
U .......................................................Sajn.d...&... -raMP-Z.--------•--•-•-•--------------•--•-•----------.....--------•-------•----------...-•--------...---•--------.
W
---------------- ........ --------••...... ------•---•-------------...---••-•-•••..._...------••••--•-•-•----------•------••...---••-•----•-•••------•--•-••-........................................
V Nature of Repairs or Alterations—Answer when applicable...............................................................................................
............................................1-aQnfl---ri.allon--tank..... ....gA > ? °
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
t't T I`1 e�
the provisions of'TT LE, 5 of the State Sanitary Code f The undersigned further a rees not to place the system in
operation until a Certificate of Compliance has been issued by the board of lielth.
p
ApplicationApproved By......................-•------•-••.....-------•..........-•----•---•--------•....................
afee"�`
Date
Application Disapproved for the following reasons:--------•---•-----------------••-------------.........................----•-------------------------•---------
......................................... �-. �J 7 ..............................................................•-•-••---------------••-•----•-------••-•---------••-----•••--•--••--•----
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
: vt2................OF...........BarnsLable
. . ..............................................
TrrtifirFatr of Toutplitanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by..... --------------------------•--•--......----........ .----......_...-•------...--•------------............-------•---•----•----•-------•------•--•------------
72 Indian trail Centerville Installer
at...................................-•-----------------••----•-----•---•------•-•..... --• _
has been installed in accordance with the provisions of i- �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 CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....................................................•--......----•-•-----....... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
C'rp 37/ BOARD OF HEALTH
b 0 ...............Tot..:.?................ .....---OF Barnet;ab...e.---...----------•---..........._............No....... ............... FEES...2�%.QQ.---
Rapm al Vorhi5 Tonitrnrtion antit
Permission is hereby granted-------------J,_t�.Mac.ctv_,:.:tCr
to Cou truGt or Repair T(X) an Individual Sewage Disposal System
at No: li1_..a n Trail Centerville
••-----•----•-•---------------•---........_..............--•---------......--••------ .321.........................................................
Street
as shown on the application for Disposal Works Construction Permit !............... Dated..........................................
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
I II I II O
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REMOVE I _ 0
EXISTING WINDO.0
GAS METER I I BLOCK UP
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............................................_........._....._....................._._._....
t � I4 I I REMOVE
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DATE: 01/12/2005 McClearn Residence FIRST FLOOR PLAIN INFO.:
SCALE: I/4"= I'-0" SKETCH# �-
BAA#: 72 Indian Trail Centerville, MA
O O
2 ` I _ 011
5i = 0CNI
11
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dow i Block up Opening _
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Shutters I IIII
10 LOFT
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OR IUINDOW
TO REM�IN ��� LIVING;
II
�i NEW
OSMOKE `— ROOF _ �I
DETECTOR NEW
ROOF
SECOMD FLOOFR FLAN
DATE: 01/17/2006 McClearn Residence SECOND FLOOR PLAIN INFO.:
SCALE: I/4"= I'-0"
SKETCH#:
BAA##: 72 Indian Trail Centerville,MA L —1®2
I
21 _ 0II
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DATE: 01/12/2005 L�t INFO.:
1VIcClearn Residence FOUNDATION PLA
SCALE: I/4" = I'-0"
SKETCH#:
BAA#: 72 Indian Trail Centerville, MA A—5®1
d .
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REMOVE
EXISTING
❑ WINDOW O 0� _d WALL
jIII � �I
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55 EEA<F>45T <I It CHEN I
Electrical
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EXISTING '0
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FI �ST PLOO � FFRA� INGP FLAN
DATE: 01/12/2005 FIRST FLOOR INFO.:
1!/IcClearn residence
SCALE: 1/4"= I'-0" FRAi'VIII G PLAN SKETCH#
BAA#: 72 Indian Trail Centerville, MA A—5®2
4
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2"xO" LEDGER
i I
Existing
ROOF to
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Odd 3-2"xl0% 2- 2"x8115
Existing �-
Roof to be OPEN TO
Removed BELOW
ATTIC
Existing Uf=f=E R LIVING
Floor to -
Rema in
NEW
ROOF
NEW
ROOF
5ECONED FLOC � FLAN
DATE: 01/17/2006 SECOND FLOOR INFO.:
MCClearn Residence
SCALE: 1/4"= 1'-0" FR�VIL TG PLAN SKETCH#:
BAA#: 72 Indian Trail Centerville, MA A-5®3