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Home My WebLink About0023 LAURA ROAD - Health 23 Laura Road - Centerville P A = 251 112 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 23 Laura Road Centerville Owner's Name: Bob Adams DEC 1 5 2004 Owner's Address: �- `• TOWN OF t3j;�T.�ST�,LA E Date of Inspection: t �— ! I HEAr-(N JFPT. Name of Inspector:(please print) Wi 11 i am _ •Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 _Centerville, MA Telephone Number: (509) 775-8776 CERTIFICATION STATEMENT 1 certify that 1 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.lam a DEP approved system inspector pursuant:0/5pe:ses ion 15.340 of Title 5(310 CMR 15.000). The system: Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: b ,, ,, - Date:Z Z_ ►3—6-V The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health of 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'scnt to the buyer,if applicable,and the approxing authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 Laura Road Centerville Owner. Bob Adams Date of inspection; /,2-- '13-- "J Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy�st i�Passes: I have not found an information which indicates that an of the failure criteria described Y y b to 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. S' tem Conditionally Passes: ne or mores stem components as described in the"Conditional "Y p o al 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 Ieptic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance ind icating!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 pipes)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND ex\pte n: system required pumping more than 4 times a year due to brokm or obsut.eted pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rcmovcd ND cxp raiw Page 3 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 Laura Road Centerville Owner*, Bob Adams Date of Inspection: . t i 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 o protect public health,safety or the environment. L System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the sys em is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within _ p p vy h n 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. S stem 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: LThe 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 I of a public water supply. LThe 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 front a pVivate water supply well•• Method used to determine distance .•IThis system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and - th�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: 1 _ 3 Page 4 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 Laura Road Centerville owner: Bob Adams Date of Inspection: b D. System Failure Criteria applicable to all systems: You m st indicate"Yes"or"no"to each of the following for all inspections: Yes +N+ o I 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'/,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. Any portion of a cesspool or privy is within a Zone 1 of a public well. r _ 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.IThis system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from that facility and lire 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 or the analysis must be attached to this form.] (Yes/No)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 now of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: Me following criteria apply to large systems in addition to the criteria above) 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 strrface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"inISection D above the large system has failed.The awrrcr cr operator of"large system considered a significa t threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. hVT em owner should contact the appropriate regional off-ice of the Department. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.B CHECKLIST Property Address: 23 Laura. Road Centerville Owner: Bob Adams Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes N 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? ,/ }lave large volumes of water been introduced to the system recently or as part of this inspection?, j/ 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 7 ✓ — 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: Yes-no 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)13 10 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 23 Laura Road . Centerville Owner Date of inspection: L FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):) Number of current residents: Does residence have a garbage grinder(yes or no):z,�-a" Is laundry on a separate sewage system(yes or no)*.' [LVyes separate inspection required] Laundry system inspected(yes or no): !� Seasonal use:(yes or no): IL, D ,/l� ¢� Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 3 — 91 , 0 0 0 I�_l I_, Gam. Sump pump(yes or no): /1--'Q 2002 — 1.1 4,0 0 0 Last date of occupancy: COMMERCIA � NDUSTRIAL Type of establiseent: Design flow(based on 310 CMR 15.203): gpd Basis of desi0ow(seats/persons/sgft,etc.): Grease trap p�csent(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sani70coccupancy/usc: rwaste discharged to the Title 5 system(yes or no):_ Water mreadings,if available: Last date OTHER(describe): GENERAL INFORMATION Pumping Records 1 p � Source of information: Was system pumped as part of the inspection(yes or no):4,L-3 y If yes,volume pumped: I goo allons--How was quantity pumped determined? Reason for pumping: A, s TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _mgle 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: Were sewage odors detected when arriving at the site(yes or no):)& 6 ]'age 7 of I I OFFICIAL INSPECTION FORIYI—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 Laura Road Centerville Owner: Bob Adams Dale of lnspccllon: d�.— /3— OZ BUILDING SENV R(locate on site plan) gr Depth below a 7 Materials of con truclion:—cast iron _40 PVC_other(explaur): Distance from rivate water supply well or suction lute: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:`(I'cate on site plan) Depth below grade: Material of eonstrucI otl-_ —metal metal fiberglass polyethylene _othci(cxplain) . If tank is metal list age:_ Is age confinned•by a Certificate of Compliance Oyes or no): certificate) —(attach a copy of Dimensions: Sludge depth: / Distance from 110p of sludge to bottom of outlet tee or battle: Scum thickness: Distance front top orscun,10 top of outlet ice or baffle: Distance from botiont of stunt io bonom of outlet tee or banic: 1lo%v were dimensions determined: - Comrnenis(on pumping recommendations,inlet and outlet ice or baflle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): CREASE TRAP: (locate on site plan) - Depth below grad :_ (explaain):: Material constr —uction:_concrete metal— fiberglass—polyethylene._ollier _ Dimensions: Scull)Ihicknerss: Distance fir "IIop of scum to lop of outlet lee or baffle: Distance fioin bottom of scum baffle: to bottom of outlet tee or Dale of laz�I pumping: Conutten� (on pumping reconunendations,inlet and outlet ice or battle condition,structural integrity, liquid levels as relate Io outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORII'IATION(continued) Properly Address: 23 Laura Road Centerville Dwner° Rnh Adams Date or Inspection:_s 13•-6 4-1 TIGHT or IIOL G TANK: (lank must be pumped at time of inspection)(locate on site plan) Depth below gra e: Material of coils ruction: concrete_metal fiberglass__polyethylene other(explau)): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm prescn (yes or no): Alarm level: Alarm in working order(yes or no):— Date of las pumping: Continents(condition of alarm and float switches,etc.): DISTRIBUTION BOX:/ (if present must be opencd)(locate on site plan) Depth of liquid level ab�ve outlet invert: Continents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of/ox,ctc.): 7- PUMP CHAMBER: (locate on site plan) Pumps in working order�(e,cs or no): Alarms in working order(ycs or no): Continents(note condition of pump chamber,cundition of pumps and appurtenances,etc.): , • Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:2 3 Laura Road Centerville Owner: Bob Adams Date of Inspection: 13—(.-, Lj SOIL ABSORPTION SYSTEM(SAS): i (locate on site plan,excavatiodnot required) If SAS not located explain why: Type i leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): L CESSPOOLS: I (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: L-/ ,3 — w 10 w Depth—top of liquid to inlet invert: Depth of solids layer: I-a f 'I Depth of scum layer:j- �Z— Dimensions of cesspool: L w Materials of construction: !3 !a) r, '1 d _fz� L Indication of groundwater inflow(yes or no):�v Comments(note cojtdition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 0*1 - a PRIVY: (I Cate on site plan) Materials of c nstruction: Dimensions: Depth of so�tids: Commen (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 Laura Road en ervi e owner: Bob Adams Date of Inspection: ) 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. L� �S 1 G II 10 Page 11 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address.. 23 Laura Road Centerville Owner. Bob Adams Date.of Inspection: SITE EXAM Slope r Surface water Check cellar. Shallow wells Estimated depth to ground water 1 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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 groundwater elevation: 11 TOWN OF BARNSTABLE LUdiATIONQ''i AURA AU'P- SEWAGE # VILLAGE &?g6rt �U1 LC�' ASSESSOR'S MAP Q LOT / INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 3X LEACHING FAC.LITY:(tape) (size) NO. OF BEDROOMS__ _—PRIVATE WELL OR PUBLIC WATER OWNER , je s DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: `:es No F-01C IV 13'HO Z ' ( • f4�Y /ON �y ® u �5 106 C No..... � Fms.....'...3o.:.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for llhiposal Works Tnnstrnrtiun Frrutit eV Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 7d Laura lie Craigville ___ __. - • -- ....................... -••--•------•--------•-•--•........-••-•-•-•.....................•................................ Location-Address or Lot No. Swanson. ...................-.......................................................................... ..........--...............................................................................-..... Owner Address W J.P.Macomber Jr. a ----.....•..............•--........-•-•--••----------------......------------------•-•------•-••-- ---••---•-----------•---•-•------••-..........•---••••-•--••-••---•--••-••---•--••---------------- Installer Address dType of Building Size Lot............................Sq. feet Dwelling X No, of Bedrooms................3.........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons-_--------.----.-..------- Showers ( ) — Cafeteria ( ) P4 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........................................ Faj 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...................----. aI -----------•----------------- -----•------------•-••--......-------•.....-•----••---••-••••------•--......................................................... 0 Description of Soil...............................................................................----------------------------------•-------------------------------------......-••------- v ---.....----••-------------------------•--•----......---------•------------------Sand-------•----------------------•------•-------------------------------------•----------••----•-•----........ ---------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------..................--- U Nature of Repairs or Alteration —Answer hen applicable..:.................................................--.......................................... 1—s1000 gallon septic tank. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e has b nsued y the boa of alth. �N ------ 11/2/ 0 Signed �. -- . ---- 9................. Da ApplicationApproved By ..... .,rL -..-------- ----------------------------------------------------------------------- ---��{/. ............. / IY�ce Application Disapproved for the following reasons- .............................. .............................................................../// ............................ --------------------- --------------- ....----------- -------------------.. ........ ----------------------------------- ------------------------------------------------- --------------------------------------- PermitNo. - {�.�------------------ .----- Issued ---............................................._....... ate Daze No...... ._:.. .._ _.. Fss.. ...30..00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH` — TOWN OF BARNSTABLE Appfiration for Dispviial -10orks Towitrurtion , .>mit �- Application is.hereby made for a Permit to Construct ( ) or Repair ( X) an Individual 'Sewage Disposal ` System at: ... La_u_.r..a......k-v--•e--....C.raigville ----------•----••--•------- ----------••-•----------•----.............-•-- Location-Address ot Swanson No. - --- •-- Owner Address w J.P.Macomber Jr. ........ Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling-K No. of Bedrooms------------------3-.._....._..._..._____..Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of personsl.......................... Showers ( ) — Cafeteria ( ) Other fixtures ................................................................- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Wx Septic Tank—Li uid'ca acit ............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No.................... Width................ Total Length.................... Total leachin..area....................s . ft.Seepage Pit No..................... Diameter.................... Depth below inlet.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ a --------•--•---------•-------------•----••-------•---------•---••--••---•-•---•--•----••••......----......................................................... 0 Description of Soil---....................................:..1........................................................................................................................... V - "" 8t7 d ---------------------------- ------------- .......------------------------- -------- ------------------------------------------- -------------- `------}1 —;--------------- ---------------•---•-••-------------------•------------•-----...... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ......•--•- ......-•-------•....................••1-1000--•....... Agreeme,t: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e has be-n issued by the board of h alth. Signed -..:... � y...�C.._./ 'd ! _ y fir_ .......�._ I1% 9rJ Da e Application Approved BY ALA . Uv7 -. .. r '`. ... /.............�----. ....1-/-f. .................. Date Application Disapproved for the following reasons: It -------------------------------------- -------------- ------------------------------------- -------------------------------------------------------------------- ................................. ---------------------------------------- Dace PermitNo. ---------------------- --------- Issued .....----------------------- Dace THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH TOWN OF BARNSTABLE T_Xr#iftrate of k"Llon tinure THIS IS TO CEM��TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) 'J. .Macomber �r. by-------------------------------------------------------------------------------------- -------------------------------------- ------------------------------------------- ------------------------------------------_-------------------- Installer at ............56...L a re:.....Ame........ r a lgv.1-a 1.e------- --- ------------------------------------------------------------------------------------- --------.-------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Envd" onmental Code as described Iin the application for Disposal Works Construction Permit No. .....I0 41?.,� .... dated 11 ------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 7 DATE L .."..... .............. .......... .......... ......... � � ............................Inspector .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE. ......rJ.: Q... Dispaa l Works Tons#rudirin "prrnti# Permission is hereby granted.....J... .. &c.onthar..t1r.,,..--•--------------•----.................................................................... to Construct ( ) or Repair (XX an Individual Sewage Disposal System at No.......... ... !.l�rq..Ame...G r,9 av :1a.......................... ...---- Street �/��jj as shown on the application for Disposal Works Construction Permit NoO__.173.. Dated..........-.Qa................ -------------------•--------•... n / Board of Healfh DATE ..................................................... •-•..........................•............. G FORM 36508 HOBOS&WARREN,INC..PUBLISHERS r { TOWN OF BARNSTABLE LOCATIONZ t4u.v-n Ay,-- SEWAGE #� qrZ VILLAGE Ce-✓► /e r )i,"/ AS MAP & LOT INSTALLER'S NAME & PHONE NO. P/ a,:fo SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) D l; f NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: �� VARIANCE GRANTED: Yes No ; /r ------- i -- _ /� � �I ,z�.�12�' 3�sJ� 3� ��o r3l o � - o � .v n�Fi r.,-f.,.. .r..,, c THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPROVED TOWN OF BARNSTABLE Barnstable Conservation Department �a -gi. Appliration for 3�iopooa1 orkii Tonli#rur TAR- uti f Date Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 23 Laura Road Centerville ,Mass . - - .................................................... .... ...... - .....---... Robert Adams Location .... -Address or Lot No. ......................................-....................................0...................... ......................................................... W .P.Ma e o mb e r Jr,Owner Address J --......... .......... ,4 .................................. M Installer Address UType of Building Size Lot............................Sq. feet DwellingX1 No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ M ----------------------------------------------------------- ------------------------------------ ••-••...... ................. •-•---..---••--•--••.... .......... 0 Description of Soil...............Sand__8c__Grave 1 x •. U ....................•-•-----------••------...---------••--•-------•------------.....------......•--•---------•---•----•-----••-----------•-••-•-----------------••••--•-•-•---------.....------•---••--•- w x --------•---•-----------•---------•---•--••-•-•-._...------•-------•••---------•--•----•••--•--•---•------•---•------•-------------------------------------•--•---••••-----•-------......--------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ................................................ --1000---dallon leaching. .-pit ----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e issued by t boar of health. Signed . .. . .... ; ........................... .9/2.5/9..2....---------- Dace Application Approved By ..... -- ------------------------------------------------------------------------------- �-... Date Application Disapproved for the following reasons- ---------- -- ----------------- ---------------- -------------- - --- ------------------------------- ----------------- Date Permit No. ..........2a...`.....Y-s(--------------- ---- Issued ........................... Date No----G�---2:: S:!? $ i0 Fps.......__........._....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tons rnrttnn Firmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 23 Laura Road Centerville ,Mass . --...------ ----_..... ........... . --- - - - -- -----------------------------------------------------------------------------e......- Location-Address or Lot No. Robert Adams ........... .. .___ ._..__...- --------------------------------------------- .... -...---------------------..-- W J.P.Macomber Jr. °wn� ;duress `f , ,-a --•--------•••---••----...•---------•-•-------------•-......._....------------.....-•--•-•-----. ................................................•---- Installer Address UType of Building Size Lot__,'_r----------------------Sq. feet Dwellings No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) p" 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 ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LL, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--------------•---.____. -----------------------•-----------•----•-------....-----•-•---•-•--------...----•-----...-----•---•......................................................... 0 Description of Soil---------------S .nd-- ............................................................... ..............•-•------•--••--•-•-•---••--••-•-•-•--...--------•---•---••-••--•---•-••------------•-•-•-----•-•-------•-----••----------•------••-••---•_... W U Nature of Repairs or Alterations—Answer when applicable- ....--•••••••••••••.....-•--••--•---•-•-•••••-• ....................................................................................................................................................... _leaching.pit---------------••---------------------------------------------------•--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ,,has been issued by the board�of health. Signed ' ' t� '' ------------------------ 9/2 5/92------------- Dare Application Approved BY E - �•� ""^=9� ---------------------------------------------- ------ Y ........ ---------- -------------------------------- Application Disapproved for the following reasons- ----------------------------------------- ----------------------------------------------------------_------------------- ---------------------------------------- Date PermitNo. ........... 1(-�-------------------- Issued ----------------------------- -- Date THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE Cfez#tf ra e of C�omyliance THISMIS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired (XX ) by J P. acomcer� Jil. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=-- Installer at .....--?3--- ur . L 4 .-d....C.ente r�_.ille -has been installed in accordance with the provisions of TITLE 5 ro�f The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....Y;?nL/..glo----..------ dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ��. - - T, ------------------------ Inspector ------------. _ �� ------•---------------------------_---- ----------- d THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH pp TOWN OF BARNSTABLE Biqa sal ifork.5 Tun#ru#irin frrufit Permission is hereby granted...J_._ _.Macomber Jr........................................................................................ to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at No.._23--I,a_iira....Roa.c.._Centerville---------•------- Street �^ � � as shown on the application for Disposal Works Construction Permit No.______.`_ Dated.......................................... d•------------------------------------•----•------..--...-----...- q _ .............................. Board of Health DATE-----•-•------..!...`---��-- - ---�`-' FORM 36508 HOBBS&WARREN.INC..PUBLISHERS FEs.....$.....30.........._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPROVED TOWN OF BA R N ST A B L E Barnstable Conservation Department Apphration for Eiop000l Works T000tr 9 Date Application is hereby made for a Permit to Construct ( ) or Repair �[X) an Individual Sewage Disposal System at: Willow Run Centerville . ................-................................................................................ .......---•-•---•-•------.....----•-•.....---------•-•------------...........-----................ Location.Address or Lot No. ................. ................. ------------------------------- ...... ---------- -.-------- ---------- -..... •.............. ......... .------ *........ ...._ W J.P.Macomber Jr. Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling-X No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P- 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........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-____________._---. 44 Test Pit No. 2................minutes per inch Depth of,Test Pit.................... Depth to ground water........................ a -•-•---••---•-------•-••......----•....--•••-;............................................................................................................... 0 Description of Soil...............................................................................------•--------------------------------------------.................................... W Sand & Gravel V W x ••-•---••-------- -•-....•-------•---••••------------------•---------•---......----••••..........--- ---••------•.._..---.........-----•------••-••-•--•--------------------•-•-••••...--------•-....... U Nature of Repairs or Alterations—Answer when applicable._l_--Sedti.c---tank. 8....infiltrators,- Pump•._8c---Pump_chamber light & Alarm: Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli nce ha ,ee iss ed by the oar of health. Signe l� 9�28�92 ----- -- -- ---- - -- ----------- ------------------------------- -................................. . Date p Application Approved By ,�'�,,,�-„`' --------------------- ---. .....--- �.... ---------'--------'----------------- Dace Application Disapproved for the following reasons- .............................---------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- --.....--------.......... -- -- ......-----........---...--------------................-- -- .................15;................. Da PermitNo. .-----.79...........Y..25.7--------------------------- Issued ------.....--.............------------------------------te-------- Date THE COMMONWEALTH OF MASSACHUSETTS VFEZ......$...3.0.......... BOARD OF HEALTH TOWN OF BARNSTABLE ZTA 7. Z ApplirFafiou for Disposal Works C��n��rttr#ann��Crrutt� Application is hereby made for a Permit to Construct ( ) or Repair (KX) an Individual Sewage Disposal System at: Willow Run Centerville . --.......---•----•-•------------------------•-----------........--•---•--•--•--••-.......--•-••-•- ........••-------...---•••--•---••••-•---••••--•-••••......---••---•-......-••-•-......--••----•-- Location-Address or Lot No. Dr. Gradv ............................•--•• .........._.................................. ............................................... W J.P.Ma e omb e r Jr. Owner Address W .........•••-----•--•-•••--••••----•---.......-•••------•......................................... ..........................•---------..---•• -•................................•--.....-••--...... Installer Address Type of Building Size Lot............................Sq. feet Dwelling---XNo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 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. M Other Distribution box ( ) Dosing tank ( ) a Percolation 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 P •-----------------------------------------------------------------------------------------------••--......................................................... Description of Soil................................................................................-........................................................................................ W Sand & Gravel v W U Nature of Repairs or Alterations—Answer when applicable._1_-s e,�t i C---tank ,8_ infiltrators_, Pumn & Pump _chamber light & Alarm. -------------------------------------------------------------------------------------------------------------••.•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee, iss ed by the •"oar of health. Signed rJ 9/'28/92 Due Application Approved BY ---------------------------------------------------------------- -------- '0'---9 2 f Dare Application Disapproved for the following reasons- .......................................................--------------------------------- ---------------------------------------- -----------------------------------_- ---------------- ------.....--------- ---- ---- ------------...--------- -------...------ .......................................................... ----------I........................... Dare Permit No. --------,r��.--'---- ----9-7-----_----------------- Issued ......... ............................... .------. ---------------- .. ------------------------ Date THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH TOWN OF BARNSTABLE &r#tftrate of Q-Tomplinure THIS IS TO CERTIFJY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X ) by J . P.Macomber r. .........................................................................................................................----------------- ---------- ------------------------------------------------ Installer at ..--.Willow -Run Centerville ----- - --- -------------------------........................................ ------ ------------------------------------ ------- ---- ---------------------------- has been installed in accordance with the provisions of TITLE 5 o.4 The State Environmental 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. JEDAT -- .........................� . Ins ector ................................� THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH TOWN OF BARNSTABLE F 30 0 E> ...................... Disposal Works Tnn#rnrtion Dvrrutit Permission is hereby granted........... •. J--P.Mac omb e.r Jr-------- -------------------------- -------------------------- ........ .--------- ..................... to Construct ( ) or Repair (KX) an Individual Sewage Disposal System at No.....Wil_l-o...... un__Centerville_________________________ Street �a_ y8 7 as shown on the application for Disposal Works Construction Permit o..................... Dated.......................................... q � c. ------------------------•-----------------............---. Board of Health DATE1.....: :. �.�-------------------•--•---- FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS