HomeMy WebLinkAbout0017 LAWRENCE LANE - Health 17 LAWRENCE LANE
CENTERVILLE
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TROY WILLIAMS 410
SEPTIC INSPECTIONS
g ,
Certified by MA Department of Environmental Protection �o� 9' (508) 385-1300
19 Hummel Drive � 1%
South Dennis, MA 02660 .i CA
9
COPY
COMMONWEALTH OF MASSACHUSETTS
- EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE.WINTER STREET, BOSTON MA 02108 (617) 292-5500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B. STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: j 7 L�..,.+✓eHc a— �-""`a Name of Owner
_ /7^^ NNwN/ -L• JOirnSOh FS�f�
C '. u- )<< Address of owner- (ko
Date of Inspection: i I /I /cj q
Name of Inspector:(Please Print) Troy wlliame_ Po- �G� y tit w, 01(, 7,S
1 am a DEP approved system inspector a r rr..o✓ rro
appr yst pest pursuant to Section 15.340 of Title 5 310 CMR 15.t )
Company Name: Trod wltiams Septic Inspections
Mailing Address: 19 Hummel Drive, So. Dennis MA 02660
Telephone Number: (508) 385-1300
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspectors Signature:`�itot, Date: it/18 /5-4
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to ttte
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
Although system meets the minimum requirements set forth by the Massachusetts Department of
Environmental Protection,certification is not to be construed as a guarantee of future working condition
of system,piping or components. This inspection represents the conditions of the system on the Date of
Inspection noted above.
revised 9 /? /qA _
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner: 17 Lawrence Lane,Centerville,MA
Date of kupec : Hannah L. Johnson Estate
INSPECTION SUMMAF2Y Ve11C�k8A, , C, or O:
A. SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES: ^I#/g
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.
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 provi
ded the sy
stem inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to'the date of the inspection;or
the septic tank, whether or not metal,is cracked, structurally
unsound, shows substantial infiltration or exfiltration, or
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank task
approved by the Board of Health.
e
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
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 pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
revised 9/2/98 Page 2or11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 17 Lawrence Lane, Centerville,MA
Owner: Hannah L. Johnson Estate
Date of I"spe<-t,°":November 18, 1999
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N1,9
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment:
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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3orII
SUBSURFACE SEWAGE DISPOSAL SYSTEA4 INSPECTION FORM
PART A
CERTIFICATION(cofttimied)
17 Lawrence Lane, Centerville,MA
Property Address: Hannah L. Johnson Estate
Owner: November 18, 1999
Date of Inspection:
D. SYSTEM FAILS: V 1,4
You must indicate either "Yes" or "No" to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due-to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water-supply well.
Any potion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" 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 significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page.of II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 17 Lawrence Lane, Centerville,MA
Owner: Hannah L. Johnson Estate
Data of Inspection: November 18, 1999
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. /
_ /
.1C None of the system components have been Pumped-for-art least two weeks and-the system has be.en,receiving-normal flow j(
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
/ inspection.
Y N�� As built plans have been obtained and examined. Note if they are not available with N/A.
]C/ _ 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.
V// _ All system components, excluding the Soil Absorption System, have been located on the site.
The septic tank manholes.were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum.
/ The size and location of the Soil Absorption System on the site has been determined based on:
✓/ _ Existing information. For example, Plan at B.O.H.
lC _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
/ 115.302(3)(b)]
- _ The facility owner(and occupants,if differen
t from owner) were provided with information on the.proper maintenance-0f
Subsurface Disposal Systems.
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner: 17 Lawrence Lane, Centerville,MA
Date of lrupec-: Hannah L. Johnson Estate
November 18, 1999
RESIDENTIAL:
SOW CONDITIONS
Design flow: //O g;p,d./bedro M.
Number of bedrooms(design): Number of bedrooms(actual):
Total DESIGN flow 3.�0
Number of current residents:.Q
Garbage grinder(yes or no):�/o
Laundry(separate system) (yes or no): ,'D; If yes, separate inspection required
Laundry system inspected (yes or no)
Seasonal use(yes or no): /Vb
Water meter readings,if available(last two year's usage(gpd): 9 7' 7 JOU
Sum Pump a/(. > 8 ' UUO S/lea S f'7= y1y0v05ri/�o�.t
P p(yes or no): /l/o
Lest date of occupancy:_ yu.�S w; .n, o c.u c-s i 1
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow:_ gpd (Based on 15.203)
Basis of design flow
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present:(yes or no)—
Non-sanitary waste discharged to the Title 5 system: (yes or not
Water meter readings,if available:
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of Information: /�
e-J a' 1 1 'f- IIb-�^h S �.� 1 /^i t a-e}'/s. h�- p`-��iti h 4-.
System pumped as part of inspection:(yes or no)�tJ
If.yes,volume pumped: gallons
Reason for pumping:
TYPE,OF SYSTEM
�_ Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
1/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all
e components,date installed fif known)and source pi information:
hs4u,I/t A /o I a,,a �0 cv ws�3�, r G•�dl�of
go S o SS u,,i ,� N S -b i. f e�� r o + !f 6 H.
wage odors detected when arriving at the site:(yes or no) No
revised 9/2/98 Page 6of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 17 Lawrence Lane, Centerville,MA
Date of ktsP—i : Hannah L. Johnson Estate
BUILDING SEWER: November 18, 1999
(Locate on site plan)
Depth below grade:
Material of construction:—10K iron�40 PVC-k/other(explain)
V .
Distance from priv a water supply well or suction line �q
Diameter V
Comments:(condition of joints, venting, evi nce of leakage,etc.)
Fl_s/.�.r _ ', t4_
via C--Yt;o�.
r
SEPTIC TANK:
(locate on site plan)
i
Depth below grade:
Material of construction:Zoncrete_metal_Fiberglass _Polyethylene—other(explain)
If tank is metal,list age_ ls.age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: S y 0 d
Sludge depth:_
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: A)
How dimensions were determined:
Comments:
(recommendation for pumpin ,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structur"tegrity,
evidence of leakage,etc IIIM
wwe�
Q�t1-.c,/. �o �✓f�c .. u 1C S t.-,� c���vr.�t c�C c� ti.. ..�,..t { ...r o✓/t G. s
GREASE TRAP:
(locate on site plan)
Depth below grade:_ .
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:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet Invert, structural integrity,
evidence of leakage,etc.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 17 Lawrence Lane,Centerville,MA
Date of Inspection: Hannah L. Johnson Estate
November 18, 1999
TIGHT OR HOLDING TANK:_ (/�j9(Tank must be pumped prior to, or at time of, inspection)
(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(ezplain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: "4J 1 .
Comments:
(note If level a d distribution is equal,evidence.of solids carryover,evidence of leaka a into or out of box,etc.)
`� r r�✓
6✓ 6 G✓
h
PUMP CHAMBER-
-A�j9
(locate on site plan)
Pumps in working order:(Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98 Page 8ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 17 Lawrence Lane, Centerville,MA
Date of Irupection:Hannah L. Johnson Estate
SOIL ABSORPTION SYSTEM SAS1:17
(locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods)
If not located, explain:
Type:
� (
leaching pits, number:p�' x` � �-4-'� �. �s '�j w 1 1z
leaching chambers,number:_
leaching galleries,number:_
leaching trenches,number, length:
leaching fields, number, dimensions:
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.)
�t 11
CA-b. al
u
_ c. a y
O L JH42 b t
CESSPOOLS:_
(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(cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level=conditionn, etc.)
PRIVY-_
(locate on site plan)
Materials of construction:
Depth of solids: Dimensions:
Comments:
(note condition of soil, signs of hydraulic failure, level of pondi condition of vegetation, etc.)
revised 9/2/98 Page 9orit
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 17 Lawrence Lane,Centerville,MA
Date of Inspection: Hannah L. Johnson Estate
November 18, 1999
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
10007.1/0-
01
y
36
hew �'x'c ' 1 �� �, �, f vry'�t
s)b► A-
revised 9/2/98 Page 10ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(con6nued)
Property Address:
Owner: 17 Lawrence Lane,Centerville,MA
Date of Inspection: Hannah L.Johnson Estate
November 18, 1999
NRCS Report name
Soil Type_ A114
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate
Deep_ ✓
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwatera�fFeet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
/Observed Site iAbutting property, observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records.
Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be,completed)
r 4* / . h 4 l
I 7 G 5 'L A o)< rc c—d o+n /o/4—h
w cN. V r
f Lf� J Ya dt. f�✓a ...k W u c✓ N�ado /"r lac r h S �t S h e j S
9,r., o)v 04 wi•fit✓ G—T 4 s 4-b 30 r S t t�e, r c�Y tw Al.
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T T.✓. ,alb �j {N�nfA, O
W S q / T /o C 0. 4- 44
revised 9/2/98 Page 11 of 11
ee a c� a•
No..../...8.: .{�..1 Fssi...3��.... ��..._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Uispnsal Works Tongtrnrtinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair M an Individual Sewage Disposal
System at:
17 .Lawrence Lane Centerville
--........ -__. --......................•------................----------••--•---------. --•--•--••--._.....-•----•----•---------•-•------._...._.....-----...........•-----............---
Location-Address or Lot No.
•--....-Lafor e -.. -- Owner ..............
_ Address ..........................................
W J.P.Macomber Jr.
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling M No. of Bedrooms.............3............................Expansion Attic ( ) Garbage Grinder ( )
PL44 Other—Type of Building No. of persons............................ Showers — Cafeteria
Q' 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 ( )
Ht Percolation Test Results Performed by.......................................................................... Date........................................
1.4
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
GZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+ -•---•-----•-----------------•---------------•-•--------------•....•-----------.....-••-•----------•........................................................
0 Description of Soil........................................................................................................................................................................
x Sand & Gravel
v --------------------•------•-•--------------•--•------•-•-•-••----•---------••--------•••...--•------------•-•--•-------•••-•---•---•----•----------•-•-.._...._......----.......-••---------•--•-_--••-
w
V Nature of Repairs or Alterations—Answer when applicable____________________T:.__________._________.._,______._._._____.._.__._.._........
l-1000 SR..11 ch--_........h---p 1 t ---------------------•-•----------•-------
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 ce has b e ssue� by the bo rd o ealth.
Signed T aG � 11/21/9C
.. --------------------------- -•----------..........................
I Date
Application Approved By .y. ... G,c Dat e
Application Disapproved for the following reasons• ------------------------------------------------- ---- -------------- --------------------------------------- ------------
---------------------------------------------------------------- --------------------------.................................................................... ------------------------------- ----------....-------- .--..._.....---
n Date
Permit No. ------ ........-------- Issued
Date
f
,
.\ yr 1i
tic "
No.... d.�....:._.�.� Fes$A....3...0.....0.......0
....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tonstrnr#iun Permit
Application is hereby made for a Permit to Construct ( ) or Repair ` X}' an Individual Sewage Disposal
System at:
17 Lawrence Lane Centerville
• - ... ---...---••-----•-••--•--------•--•........................•-•........... ..-•--•-••--...•--•••-•••----................•---••-•-.............-••-•--•---................•---
Location-Address or Lot No.
..� a.g,. ...................... ..•-•................................•........• -••-•-.........................._.._........•- •--..........................................
Owner Address
W �_9. '.tMa:ccambex Jr...
Installer Address
Q f Type of Building Size Lot............................S q. eet
U Dwellin --No. of Bedrooms..............3 .....Ex a�ision Attic Dwelling-! ---------------------- p ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
QOther fixtures -----------•------------------------------------------......------------------------------------------•-----------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
xDisposal 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........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
P� Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 ----
--------------------------------------------
----------------
•----------------
•------------------
--------------
----------
-...
•......
•........
.-••---------
0 Description of Soil........................................................................................................................................................................
x Sand & Gravel
v
w
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••.......
U Nature of Repairs or Alterations—Answer when a plicable...._______________________________________________----------------------------------
__________
................................0 �a 1 loh leach Pi.......------------------------------------------
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 b-en�iassue by the board o health.
Signed... - /- '.,! A ----------------------------------------
I11/21/90�1 -----------------------
�j--- Date
Application Approved BY .............a /iJQ ..... ....
Date
Application Disapproved for the following reasons- -----------------------------------------------------------------------...............................................................
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------
PermitNo. ........- --.----S'a�- ...................... Issued ..... ------......................-----..............Dare-..........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF' HEALTH
TOWN OF BARNSTABLE
(9erti irate of (110 ntylinu e
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX)
by..J-..P.,Mac qmbe.r..... .r....------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------
Installer
at -..17 Lawrence Lane Centerville
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------
has been installed in accordance with the provisions of TITLE 5 of he State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..........���5......5...A./..... dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE'......................f .... ._-...f- ... Inspector .... ~ ....... ....--. ..--.---------........
+ ` THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No......
�1�..:. FEE... .-..�-�...
Disposal Works Tuns#r unlit "permit
Permission is hereby granted__:T�.P 9M ? s3nt?_ r...rT .6...............................................................................•----•--•------
to Construct ( ) or Repair (� ) an, Individual Sewage Disposal System
at No...17...Lawrence Lane CLnterville.�............................ ...•---•••.....
Street Q
as shown on the application for Disposal Works Construction Permit No..,/. _-_i Dated..........................................
1_. �l----------------------------------------------•---------
DATE... -,l 4
� C� Board of Health
..........................................
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS
TOWN OF BARNSTABLE
LOCATION Lf:' -y ram,C"- _ Ly 4(4 , SEWAGE
VILLAGE CLITrrvi l lP ASSESSOR'S MAP LOT
INSTALLER'S NAME PHONE NO.j1p
SEPTIC TANK CAPACITY
LEACHING FACILITYAtype) J400
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER �a
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes Y No (/
)tr
Q�
\r
�o I Lk 4 1`Z
LOCATION / SEWAGE PERMIT NO.
,�tl Y-C rj
VILLAGE _f r
INSTALL R'S NAME i ADDRESS
7^
3 U I L D E R OR OWNER
DA T E PERMIT ISSUED
DATE COMPLIANCE ISSUED ,/l/c�/��
\ /
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THE COMMONWEALTH.OF MASSACHUSETTS
BOAR® OF HEALTH
.................. �.t�//!/....OF..... 7-,*.AS.4-e5....................................
Applira#ion' for Dhipaottl orko- Tomilrnrtion Famit
Application is hereby made for a Permit to Construct (►✓ ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Ad o t No.
Owner ddress
a i�rGy �I�.S�... ............ ��t!� �'i11.� .._....-•-----•-•----•---.......•-•--- = .... S
Installer Address
Type of Building Size Lot-------�_.}_�� �Sq. feet
Dwelling—No. of Bedrooms_____________-3._...............--.....Expansion Attic ( ) Garbage Grinder (U1
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ----•--•--
ID %3 i� �vrJ... --------------- .............................................................
WDesign Flow................./ ._.._.__...._._._......gallons per p -per day. Total daily flow............_...> _ ...............gallons.
Ri Septic Tank—Liquid capacity/ gallons Length4 --!4._.. Width49.......... Diameter---------------- Depth._g:.:—_�
W Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
x
Seepage Pit No......... Diameter...../!�?..! Depth below inlet.....6-.= Total leaching area—z-6--7...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.... .........x.........f.`...............................•.. Date....a/ .........
W
,.a Test Pit No. 1....i4. .minutes per inch Depth of Test Pit.................... Depth to ground
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................•.: Depth to ground water.............................
•_ - -• .
a --•--• ----••••----••-••- •....-•••-•••••••-••-••••---•--•-•-•...............•--•--•••-•--......---•--•--•-•---••-----......-•-••-•------•--....---•-----
0 Description of Soil---•••• „ _ r` L b� ` N=..1 f-�... /`� o• s 4'`��'
-----,..........-•-•--••-•••-••••-. •-
V ------------------•----••------------------ 1 `' ?4........ .--.....-•-•-•--•---....-----------------------------•-----....--------------
W
U Nature of Repairs or Alterations—Answer when applicable..............................:................................................................
...-•-••----•-••••-----•••-••----•••••---•••-•--•••..............••--•--••••-••-•-•••--••-.........••-----•-•-•-••--•----•---•--------••----•••-----••-••-•------••--•••----•••••••--•-•.....•------••--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLi� 5 of the State Sanitary A, b
undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be ��gn ...... ........................................................
Date
Application Approved By...... ....• ............................ ...... •
Date
Application Disapproved for the following reasons---------------••-----------••--------------•----------•------------------------.............•--•••......•--••-.
..................•.......-•------•---------------•-----...........-------------••---------••-------•-•---••••••-•---••••-•--•--••••-••-•••••---•-•••----•-----••---•.....------•---•••-•-••--....•-----
PermitNo......................................................... Issued..........................................
Date
_Cfm)
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-?`osvv...O F....r�............................................ ivt T,
Appliration for Disposal IV"
rk C1.1ntrnrtinn Upantit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
u...� �........ 1"L ,l K� .� r- .........
Location-Address or t No.
.... . �- .... -- .,� &- 1 ---------------
owner ddress,
Installer ..
ddress
U Type of Building /�^�U ..
Size Lot_.__ __ ,, � Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (oj&
Other—Type of Building
,- p., yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures .----•---•----•-•-•------------
-, �3' 0 2ddi�'l -----------------------------------------------------Q--•--------------•------..
WDesign Flow................ 1_ ............... per. sew per day. Total dais flow--_--------_---�_7-.---.............gallons.
. /ODD ! _ �
• W Septic Tank—Liqu>d ca.pacrty......._.._.gallons Length B___G.:_ Width.'t�_.la_. Diameter................ Deptli:�"__-�/.
x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No........../-------- Diameter.....Z.52_!f5TDepth below inlet.....6 r'T Total leaching area.,Z.�._7...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by__..�0x_2-� `_ Y__ ._.....�........ Date... ........
Test Pit No. 1..!5� minutes per inch Depth of Test Pit.................... Depth to ground water........................
G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ...........................................................................................................................................................
Description of Soil............... �. 4� ---.1 Dom -- .Ds.�o/Ley r�NO.............•-•.....-••-•.--..--•---. . ..........-•_..
V -----------
'------
•....... ...............................................------------------------....--•--._._.----
x ------••----------------•--•--------•-•••-----------•--•••••-•-••--•----------.....-••-•-•••--.....-----•-------•-------•----...-------••-•---------•-•-•-•••-----•-••--------•--•••••......-•--•-------
U Nature of Repairs or Alterations—Answer when applicable...__...........................................................................................
--------------------------------•--------------...-•----------------=------------------.....-•----------------------------------------------------------------------------------••--------•--•........_.
` Agreement:
} The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL% 5 of the State Sanitary Code The undersigned further agrees not to place the system in
operation until a Certificate of Co ance as been by th and of health.
nd...l! ........................................... b K Q
ate
ApplicationApproved By••••--•-•••-•--•-•-----••-••-------•-•................•-...__-------•-•-•-•-•.......---..-•-•-- ........................................
Date
Application Disapproved for the following reasons--------------------------------•----•--------------------------------------•--------------••--•----------•-----
-•••-•.....................................•-•-•••....---••--...-••----•-----••--•---••••-•---
Date
PermitNo......................................................... Issued.......................................................
Date
.q
THE COMMONWEALTH OF MASSACHUSETTS
• BOARD F HEALTH
/
A ,l .. ..............oF..... . .. . , .. --................
(Intif iraft of Toutplianrr
TF�IyS/I�S TO CE�gRTAIFY, That the Individual Sewage Disposal System constructed (�r Repaired ( )
by �f°�.•F Ca>. _..._ �:1_ .A5- . �w �---•-••---stall
at 4..........!*wr... ...k.r.111
has been installed in accordance with the provisions o LF bf he State Sanitary*?assc
rffied 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.. -•- /f!` �� Inspector,�i -- ......................................
THE COMMONWEALTH OF MASSACHUSETTS
) [�J BOARD F HEALTV /�
......� -................................OF.--•- -.� -.J�. .� `�4_ .... ...............
No.........................
Permission is hereby granted-•--
to ConstruftVor Repair ( ) an Ind-vidual Sewage Disposal S tern
at No. L•. ---- ..-- trees f �{�=V=-4cd...................
as shown on the application for Disposal Works Construction Permit ��
-- ....................................................... ---------------- .---_----_--------
Board of Health
DATE/ ...............................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ,
.37
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CE.?_.T/49r T�tA?'.
.avv T,�//s ,w`1 .4 1,/ ��,..�,r,..,v..�,�s ;r<_a ,•-'"f.';.` ��ii�`./�i/�.
�.r"TCr//_ �„<," C>' F T',�,.�• `:_i.?li>'r4/' GI.}'''" ,�f�i;-�y� T. 'ti1,�� r'7rl_S�.
RICHARD y'
1AMES \.
O'HEARN � i"' JAMESD
O`HEARN i
F>� � No.691
LEGEND �Z,�G�src�':: f;. �FGis tEh`
EXISTING SPOT ELEVATIONS O,A ►rP..;•aw'�` sa,vllr�a�`' °`
EXISTING CONTOUR— — 0 - _
FINISHED SPOT ELEVATIONS
FINISHED CONTOUR o PROPOSED PLOT PLAN
APPROVED: BOARD of HEALTH '
1A , MASS.
l
DATE" AGENT
CERTIFY THAT THE PROPOSED R. . J. 0 HEARN, INC., RLS, RS
HUILDI.NG SHOWN ON THIS PLAN 1348 ROUTE 134
CONFORMS TO THE ZONING LAWS EAST DENNIS , MASS.
'OF , . 'iVS?'.�8 �, MASS. DATE _ ',� 9 <9 SCALE g
y .
s JOB' NO. CLIENT: r✓� -��—r
DATE REGISTERED LAND SURVEYOR DR. BY SHE E T L OF21
_.. r , 77 _
SOIL TEST INVER ELEVATIONS NOTEs�
DATE OF SOIL TEST � �
�.rs INVERT' AT BUILDING FT. . ALL yIORKMANSHfP APJD NIATERIAS }
WITNESSED BY X� ���/I/�c �!.� �'
iNEET:':.SEPTLC TANK FT. SHALL CONFORM TO D.E.Q.E. TITLE.. 5 .
PERCOL:ATION . RATE �z MIN./INCH OUT SEPTIC TANK 96 �: FT. " .
AND..T.NE TOWN
- N HOLE N HOLE 2 INLET :'D!STR.IBbTION BOX 9�, � FT. AND :.REGULATIOSANLTARY SUBSURFACE SEYV GE �
OBSERVATION I OBSERVATION - DISPOSAL . of I
3 OUTLET :DISTRIBUTION BOX c35,�3 FT
ELEVATION= ELEVATION'
INLET .LEACHING' PIT .57
"
BOTTOM_.�., BOTTOM ,LEACHING :PIT d2-Q FT.
DESIGN CALCULATION'S
-- ' t
NUMBER OF BEDROOM..S ,
. GARBAGE DISPOSAL U.NIT.::
TOTAL EST-IMATED FL04'1 (r/O GAL./BR./DAY x 3 BR.)... -�34� GAL./D:kY
s f REQUIRED SEP T:LC TANK _ CAPACITY. . :: ... : . ... ... . . . 9 ' .GAL. �
ACTUAL SIZE OF SEPTIC TANK TO BE INSTALLED... . 1°04 GAL. .
I. LEACHING AREA REQUIREMENTS
SIDE :WALL AREA2-0 GAL./S.F
BOTTOM AREA l GAL./S.F.
I1�� �r':d A`:;w •- f E=� r _ 7 GAL.
i
LEACHING' CAPACITY ( :BOTTOM SIDEWALL ).. . ... . . . .
RESERVE LEACHING CAPACITY. . . . . . . .
GAL,
TOP OF
L
FOUND
E, E.V. iu. " r;. CONCRETE 4" SCH. 4.0 -` CLEAN SAND
COVERS PVC PIP
MIN, -
PITCH , CONCRETE 1
1178 PER. FT COVER i
2%o WN. PITCH
7 r_,.;.• I � 12 MAX.
--�-- . AYE R F i72 tj rRICHARD ' NICoH. 6A4R!DFLOW LINE WASHED STONE JArES
O HEARNO'N RN
t4 27871
4" CAST IRON -to 3/4"- i I/2t
b'P , w j WASHED STONE `� fiQ1sTE�`` pc2;t c�sz4
PIPE -'MIN. ITCH
tr n ' n i PRECAST LEACHING ��
1!4 PER FT. FIST. sURV��
. ' o
BOX oD v w n BASIN OR EO.UIV. :
W li n • I
W
GAL
MASS.-
4 SEPTIC
TANK` R: J. '0 HEARNI oNC., RLS, R S ,
�� 191 MAIN St.. 4RTE 28
I WEST DENNIS , MASS •
PROFILE OF GROUND WATER TABLE
a SEWAGE DISPOSAL SYSTEM J08 No. ICLIEr11.—
' NOT TO SCALE DATE c'/'9/ v SHEETZ OF -2 ,