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HomeMy WebLinkAbout0092 LIETRIM CIRCLE - Health 92 Lietrim Circle Centerville A = 169 044 a 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owners Name information is required for every Centerville Ma 02632 7/11/2012 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. C y e Enterprises �y Company Name 153 Commercial St. Company Address Mashpee Ma 02649 City/Town State Zip Code 508-477-8877 SI 4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and•maintenance of on;_site sewage disposal systems. 1 am a DEP approved system inspector pursuant to'Section 9T5.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails _ w' ❑ Needs Further Evaluation by the Local Approving Authority 7/11/2012 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 12-, t5ins-11/10 Title 5 d I Inspection form:Su rface Sewag Disposal System-Page 1 of 17 5 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 92 Lietrim Circle Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 2 500 gallon precast leaching chambers. The system was found to be in good working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is.removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered:A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determirfe what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 349 gpd provided t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system repaired 3/12/2003 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 6 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related,to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Inlet baffle and outlet tee intact and in good condition, water level was at bottom of outlet invert, tank was not leaking and was structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was functioning as intended. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2x500 gallons ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of inspection the leaching facility had 1" of standing water with a stain line only 2" higher indicating that the system has never been hydraulically overloaded. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 92 Lietrim Circle Property Address - LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is Centerville Ma 02632 7/11/2012 required for wery page. cityrrown state Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 160 feet. Locate where public water supply enters the building. Check one of the boxes below. ® hand-sketch in the area below [] drawing attached separately a�w f7 r' • p,�� � 7 r C ,4-Z , A3 3S a_3 33 n - A-Y �2 f3'N . � A'S H7 cs�• 1110 Two 6 official Orep000n F--sub-11tw s*-go o44oae1 SY9—•PaP 15 or 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 11 + feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7/29/2002 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Design plan dated 7/29/2002 indicates that no groundwater was encountered at 132"and system is designed to have a seperation of 5'+ between bottom of s.a.s and adjusted high groundwater elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 92 Lietrim Circle Property Address LAWLER, MARGARET M &WILLIAM P Owner Owner's Name information is required for every Centerville Ma 02632 7/11/2012 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION L2 G Z�'rX IZM C 1 SEWAGE #2 0 a _ D 9� VILLAGE C e,41reA f//L1 e ASSESSOR'S MAP & LOT 16q-c)gN INSTALLER'S NAME&PHONE NO.. ,01 A e CI,Al J5'L S o sl SEPTIC TANK CAPACITY G o D 0 V LEACHING FACILITY: (type) 1— /,1'X ex12 r 1 (size) .�S' /3 -- NO.OF BEDROOMS 5 BUILDER OR O73[/0 PERMIT DATE: T6 -3COMPL�IANCE DAT E: 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist. on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by T . • r No. Z 7003-69 . Fee50 . 00 % THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zpprication for ni5poml bpgtem. QCongtruction Permit Application for a Permit to Construct)(X )Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 9 2 L i e t r i m C i r c le Owner's Name,Address and Tel.NoW 111 i am Lawler Cente v7 1]te,Mass.02632 10 Black Hill Road Assessors ap/I'azce q _®yy Paxton,Mass. 01 61 2 Installer's Name,Address,and Tel.Nos 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—9 7 0 0 J.P.Macomber & Son inc. Ronald Cadillac Box 66 Centerville,Mass. 02632 P.O.Box 258 W.Y Mass. 02673 Type of Building: Dwelling XXNNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 -distribution box- 2-H 1 0 500 gallon leaching chambers packed in 4 ' of 1 ;" stone. 25 'X12 ' 10"X2 ' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by this Bo d of Health Signed Date 3 1 0 0 3 Application Approved by Date 3 Application Disapproved for the following reasons Permit No. Z003 `-O '� Date Issued ja 3 Apo 7 Fee 5 0 00 ....,n. . `No. V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zfpplication for Mi.5pooar bpgtem Construction Permit " Application for a Permit to Construct)(X )Repair( )Upgrade( )Abandon( ) ❑Complete System.. .n Individual Components Location Address or Lot No. 9.2 Lietrim C i t C l e Owner's Name,Address and Tel.No.W i 11 i am Lawler CenteMvMass;02632 10 Black Hill Road Assessor s. aPAP, # Paxton,Mass.01 61 2 tt�9 _�o.yy , Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No-5 0 8—7 7 5—9 7 0 0 J.P.Macomber & Son inc. Ronald Cadillac Box 66 Centervil1e,Mass. 00632 P.O.Box 258 W.Y Mass.0,2673 Type of Building: Dwelling XXyNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number;4fglie6tV it k A Revision Date Title .1ra W Size of Septic Tank 1 Type of S.A.S. ' Description of Soil Nature,of Repairs or Alterations(Answer when applicable) 1 -distribution box. 2-H 10 500 gallon leachint ,chambers packed in 9 ' of 1?�" stone. 25'X12' 10"�K ' Date last inspect d� ' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo"'d o Health Signed sue Date 3/10/0 3 Application Approved by Date 4i 7, Application Disapproved for the following reasons Permit No. 2n©3-C)5!7 Date Issued 3 /0 w 3 THE!COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of A,Compliance _. THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(KX)�Upgraded( ) Abandoned(_ )by J.P.Macoftex & Son znc. at 92 Lietrim Circle Centerville,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2.003 0 7 dated 3-10 --�3 Installer J.P.Macomber & Son Inc. Designer Ronald Cadi l lac,PLS,RS The issuance of/his permit shall not be construed as a guarantee that the system w'I`- nn as esi ed. Date 9) 1 2-�/� Inspector r J No. 200 3—09 rZ s Fee$5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi!5�#opal *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair(KX)Upgrade( )Abandon( ) Systemlocatedat 92 Liettim Circle Centerville,Mass. and as described in the above Application for Disposal fArstern Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio ,must be completed within three years of the date of this zg&�Z r Date I Ul G 3 Approved by s TOWN OF BARNSTABLE LOCATION C l R SEWAGE #2 CIO- - OF VILLAGE_ C P,4/7'eA ylCL e ASSESSOR'S MAP & LOT I -O�f INSTALLER'S NAME&PHONE NO.J e C7'41 SEPTIC TANK CAPACITY G DD L a LEACHING FACILITY: (type),,l- a rev t cl-e zl S (size) Z f-/3 � NO.OF BEDROOMS .3 BUILDER OR OWNE PERMTTDATE: 3 1 flz COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by N6 T . i � i i,44 JOB N0. B02-03 N F `� NOTES Lawler.dwg ' Rd / 1. LOCUS IS A.M. 169, PARCEL 44. (SCALE GRUTCHFIELD 2. ELEVATIONS SHOWN ARE ASSIGNED. s=3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED AUGUST 19, 1985.°' 41 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) -0 N 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER.N 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED.7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14".8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET.x 54.8 BENCH MARK--TOP OF WOOD 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED.STAKE = 53.69 ASSIGNED BUILD UP COVERS TO WITHIN 1' OF GRADE. MORTAR CHIMNEYS IN PLACE. (26'-4• & 36'-8" OFF HOUSE CORNERS) , ONE COVER OF TANK TO BE WITHIN 6" OF GRADE. LOCATION MAP 10. STONE TO BE DOUBLE`WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, 55.0 BENCH MARK--SW CORNER OF CONTACT THE BOARD OF HEALTH,. OQJa J. CADILLAC. CONC. BULK= 54.03 ASSIGNED 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING TEST HOLE 1 IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN DEPTH (inches) ELEV.(feet) N/F LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. p 52.9 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. Fill 54 8 LYONS TEST HOLE DATE: February 13, 2002 5" LOT 27 PERFORMED BY: Ron Cadillac, Soil Evaluator A layer toam 3 2 N/F 54.7 WITNESSED BY: Dave Stanton, Inspector 9" sand lo X 54.4 PERC RATE: <2'-00"/inch (C layer) B layer 10yr 5/6 WOOLF '� ' O O 0 S S. F. S 8 SOIL SURVEY 1993 : Carver loam coarse sand sandy loam 50.1 S � . NO GRADE CHANGES 54.0 GEOLOGIC MAP(1986): Mashpee pitted plain deposits 34" 00 7SO �Op„ ARE PROPOSED Top Foundation rp. 00 �1� Invert 51.45 "10-10- Gas 5 Use Baffle 2 DRY WELLS 54 C layer 2.5y 6/4 Invert 49.72 � � 5 ,53 4.0 Proposed loamy coarse 53,7 t 8 53,6 Top Conc.=50.4 sand 28' rT �53,6 Existing S-1 1/4 /ft Top Peastone=50.1 A 53.69 5349 x 52:7 � 1000 Gal. __ rr 5 �4 2490 132" no water ,44 �53,4 / 41.9 \ - 5 4 + x 52,6 „ Invert 49.60 03,� 3�5• \3,18 \ 51.36 Invert 49.89 5 7 47.6 \ \ ,off \ /` 6 Stone or compact Proposed Proposed I Bottom \ \ �Fo C- ' ^? 6'i 53.13 2.9\ / 2 \5.: 1 Q) C� :.:.:_.•:. E E E E 16 6 53.0 �� �� O• ,` 53,0 52,83 ,� d CD m Bottom TH1=41.9 0 �� �� 0 2.0 '% DESIGN DATA - �� TH 1 lv��. Q,4 � F \ x 51 VV . 52. Nh V.5218 OJ �p� \51,60 BEDROOMS: 3 50.00 LEACH AREA ..::`.•:. ,Z' :::: �, _ _._ .. � GARBAGE' GRINDER: No X 52.0 V. REQUIRED CAPACITY: 330 GPD S 49.59 ` , SEPTIC TANK: 1500 GAL. USE 2 DRY WELLS WITH 4' OF STONE x 5 2 51.9 r V BOTTOM LEACHING AREA: 320.7 SF ALL AROUND FOR A 25 LONG BY S�. C3 o00 48,90 [(25' X 12.83')] 12'-10" WIDE BY 2' DEEP LEACH AREA. 51 2 1S S 'p��•6 51.6 IS, SIDE LEACHING AREA: 151.3 SF ::•�1',48`;•. �0�, dY � / �' [2(12.83+ 25') X 2 DEEP)] 51.1 DESIGN CAPACITY: 349 GPD [(320.7 SF + 151.3 SF) X .74 GPD/SF] 50 -0.0 47.97 x 49.8 N/F FINNIGAN X 48,6 / 7.7 V /45.92 V SITE PLAN FOR THIS PLAN L A VALID COPY ONLY IF IT BEARS WILLIAM P . & MARGARET MARY LAWLERAN ORIGINAL RED STAMP AND SIGNATURE. LEGEND 4f,18 HA FMq LOT 279 92 LIETRIM CIRCLE, CENTERVILLE, MA S RO y� �o RO L gcti� JU LY 29, 2002 SCALE. 1 "=20' o _TH 1 TEST HOLE LOCATION, NUMBER o JAMS ME o JA _S N"'+ CADILL ,,C W WATER LINE MARKINGS j CA 106 E OVERHEAD ELECTRIC WIRES (IF SHOWN) �C # j x 9.5 x` EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) SANirAR�P�' SNC sS �- EXISTING CONTOUR err ° RONALD J. CADILLAC, PLS, RS 8--- PROPOSED CONTOUR Z UZ PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN 0 UTILITY POLE (IF SHOWN) P.O. BOX 258 ® EXISTING DRAINAGE CATCH BASIN WEST YARMOUTH, MA 02673 x - FENCE (IF SHOWN, NOT ALL SHOWN) O TREE (IF SHOWN, NOT ALL SHOWN) HEALTH AGENT APPROVAL DATE (508) 775-9700 PAGE 1 OF 1 C 2002 BY R.J. CADILLAC