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Home My WebLink About0115 LOOMIS LANE - Health 115 LOOMIS LN CENTERVILLE A= 231 033 i I S////,_�/ " ° llll � bpc 12534 No.2,� 1„53 OR �bs►. ims-ripies, YN TOWN OF BARNSTABLE op 01 LOCATION l SEWAGE # 1-TILLAGE C..,�*1dLc j,U=C ASSESSOR'S MAP &LOT 3 INS.TALLER'S NAME&PHONE NO.��• }�. M or.;�. SEPTIC TANK CAPACITY _ _ 1S0c) Grk6-.� LEACHING FACILITY: (type) a��Si-�r.c `�►T (size) GX� NO.OF BEDROOMS 3 BUILDER OR OWNER PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility IVIA- Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) . /A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) I Z8 Feet Furnished by k Au-, k L% I Y C C 1,71,12 E e/GS•J� f /I / l� �i' 23p� 4� No. — Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(pplication for Xigpogal �bpgtem Congtruction Permit Application for a Permit to Construct( )Repair(✓jpgrade( )Abandon( ) ❑Complete System ❑Individual Components .., Location Address or Lot No. Owner's Name,Address and Tel.No. 78t—.1$4-38 2.2— 1 5 L.op,,ti�S tn4 ti L C-EAtWtt+,.lj�C. M 01 1.atr-�S w 1t•s f Assessor's Map/Parcel �•n•�o� �l C-19161 Installer's Name,Adds,and Tel. N Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms -3 Lot Size \g )35 sq.ft. Garbage Grinder( ) Other Type of Building of Persons Z. 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) �� oc, c. `� r��, 'V auk' �l 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 f itle 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d=ar h. Signed Date Application Approved by Date �oS"--7 - ry Application Disapproved for the Rowing owing easons Permit No. FY- 6 Date Issued g„1,,.y,..,er^�0• '- ` ...rrY.,ae..--`.•.. 'i!rP�y,;;.+r...,-rD Fee V" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication4or Migpogar 6pztem Construction permit Application for a_Permit to Construct Repair( "<Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 781—a 5 y—3 B ZZ 115 t-00"11 �^C e,�tl1� MA 1.�tr t ga.%TCf ,. Assessor's Map/Parcel O a k C)C pP u 1 L.o r Ct �1 �, i w,✓.- C::)Q 36 Installer's Name,Address,afid Tel Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other x Type of Building Ze,. of Persons Z Showers( ) Cafeteria( ) Other Fixtures r 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) T h �c�r C�\` �_ , c "c� A 1�L� nr 3 by C.�G c�w�M�vt • Date last inspected: Me,"" 9 8 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions°.f itle 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issd d by thi Boar fo h. Signed Date Application Approved by Date ' Application Disapproved for the fo owing reasons Permit No. Date Issuedw �.. THE COMMONWEALTH OF MASSACHUSETTS f BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, t`at t�hee On-site Sewage Disposal System Constructed(, )Repaired (k)Upgraded( ) Abandoned( )by /V 4 -. at 1 f has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - a, '2 dated Installer Designer r The issuance of this t shal not b onstrued as a guarantee that the syste �Ifunction as detd.jQa i Date Inspector f ---cy--'••1—/------------------1W -------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ligpogal 6pztem Construction permit Permission is hereby granted to ConstrucQ )Repair(.-,f')U rade( �) bandon( ) System located at �� '7 " and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: J - 0 9 Approved by ® . Q TOWN OF BARNSTABLE LOCATION 1 SEWAGE # �✓ _E1 VII.LAGE c z,�t.�� ll s ASSESSOR'S MAP & LOT 3 INSTALLER'S NAME&PHONE NO.__ ,T• �. M or.'.^ SEPTIC TANK CAPACITY ISOC) Cxl�c,n_ LEACHING FACILITY: (type) e�C,S�, ^��-r (size) C'X�� NO.OF BEDROOMS BUILDER OR OWNER _ I-t.rrti C RY�r er PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility IV/A- Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) t l A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) I Z8 Feet Furnished by /-A J e tz II V I f� Q A I Daylor Consulting Group Inc. March 17, 1998 Dale Saad, PhD Barnstable Board of Health Town Hall 367 Main St. Hyannis, MA 02601 Subject: Confirmation of adequacy of existing septic system 115 Loomis Lane,Centerville, MA(Wequaquet Lake) Assessor's Map 231, Parcel 33) Dear Ms. Saad: I submit this letter to you in confirmation of our discussion relative to the above referenced project. Daylor Consulting Group Inc. represents the buyer of the land,Lawrence Salters(current owners Francis G.& Natalie Haggerty). Mr Salters intends to raze the existing three bedroom dwelling and construct a three bedroom dwelling as depicted on the attached site plan. I understand that the existing subsurface sewage disposal system has passed Title V evaluation and is functioning properly. The system was repaired within the last.four years. The above facts are merely to refresh}'our memory as our visit was some time ago. incidently, I appreciate your expert analysis. My memory of your opinion was that considering that municipal sewer will be available at the front door of the locus Within five years,coupled with the condition of the existing system, it's reasonable to recycle the existing system with the understanding that when sewer is available, it will be mandatory for us to tie-in at our expense. In preparation for the eventual tie-in to the municipal sewer line, Daylor Consulting Group proposes to install a new 1,500 gallon septic tank. This tank will be situated for convenient conversion to the proposed sewer line. A grinder pump could easily be added if circumstances warrant. The D-box and leaching pit vill be recycled. Provisions to protect the system will be implemented as to prevent any possible damage during demolition and the construction sequence. Upon completion; we will certify to the new location and proper function of the system in an as-built submission plan before occupation. This should ensure that the Board of Health interests as well as the new Title V pro\isions are adhered to. I sincerely thank you for your input and review of this matter. If you have any additional input,comments or requirements please don't hesitate to contact me. Very truly yours, Daylor Consulting Gro rp Inc. John B. Thunberg Project Manager/Survey Mali r II ICI I<\1.i%Al A%k P I I I '.Ifl Plr ;;4.1-1AH � �� o�� _� J _ _ h .� _ � -_.__. � Y 01/20/98 TUE 19:27 FAX 781 5823822 Ocean Hill, Inc. 0 001 iki/20/1998 12:02 17013415099 PAGE 62 01/01/2994 00;36 560-798-1576 J.F.MACM4ER a SON PAGE 91 ti JOSEPH P. MACQMBER &SON, INC- ".M"K CcAnAWILl[.IM CZU24M s 77bM= 7764012 FAX COVVA SHEE1 DATE: 1� B TO:_JA3fte,,,6jM1sL�tt*rmy FAY PFIONE r_2$1_.U:L5Qj6 ----------------------- P1IOM:_J-P-"CCmber 6 son Inc. FAX PHONEt;"790-1578 _ -- Skip Kacomboz TQTAL F OF PAGES INCLUDING COVER:--.&—- IF YOU Op NOT RECEIVE ALL PAGES, PLEAS9 CA1.1. 5G8-77,3-3338 ME:--1-5 z•.00mis Lame Centerville�!!ass -- - - --------- SPECIAL IMSTAUCTIONS OR MESSAGE: This is a tf tl� jtive Septic S stem. 715 Code -------- Y � ) ?his Assign covers a three bedrCeem house without a garbage d3.9posal. IVA-X S 7-6 Z,/k f E. 01i20/98 TUE 19:27 FAX 781 5823822 Ocean Hill, Inc. 0 002 81/20/1990 12:02 17013425098 PACE 03 82/91/1993 88:36 M-790-1578 J.P.MA R 6 WN PAGE 02 i � A'f i 1 1 TMt aowwaKwtwS.Tw oy "'pSiACM++lrrr: 8OARD .OF HEALTH JVv.�. -- TOWN OF BA FtN57-A Qi.V 3s 69veby �rance0.....?:p "a!gjoeihor Cp o� Jr. f � � fte ar x �Lc�otn� as Ind, _........._..... ... ... 'V_z i-e�� is sh&AM an the'Mia4en 5or dam Watksy�; ...... �.._., •__------ _ - •yea. �.....____.�_..__-�-_ ...._ �" • 8�.��;-_.__.. ...�----....�. saas..+rn's..S.sa+.e SOAROOp F11EatT�y TOWN OF QARNSTAB E errs rs ro c��nFy g4"i`f eW. f&MFjianct b!'-?';,F.�Malcoath�r Ji,l'ft°i the lndividud$,�.s,, p Di !2 5 _....,„...�W........_..--._...-. ..., spoaal SrUV"(Qnsmuc#W{ n. of . Lo2of s Lane ;;,�;;� .. .. ......,, ...—. , i yr Repaired t XX7D hbarn ieuratkd &-wr4A a•+nb 112e �__ .. - . ..._.... • BAN �ecEs�t►ri3t pers�A k 31' Smoe Lnvitoet�et+ta)Code as c cr�?sM in sTsr�, caR SNP.( NOT u C� aam,d _ DAY._ � SORT. �♦ �iIARANTt��ti+ult.T+� 01/20/98 TUE 19:27 FAX 781 5823822 Ocean Hill, Inc. 1@003 01/20/1998 12:02 1781941509E PAGE 84 a V PATE: 10/31/97 PROPERTY A00R6SS_ Fran-k Haggerty 115 Loomis Lane •Centerville,Mass. 02632 On the above date, J Inspected the septic system at the -above address. TnIs system consists of the following: I . 1-1000 ,9allon septic tank. 2. •1-Distribution box. 3. 1-1000 gallon precast leaching pit. 9esad bn my Insnoctlon- J cenIfY the following conditions: 4. This is a title five septic syst-ace_ ( 78 Code D ' 5. The .septic system is in proper working order - at the present time. 6. System was installed 10/12/94 - StGHATUR7-- Name:_,_P_Macomber Company:J. P_Macomber b-son. -Inc .- Address:_ _b6--�-�-a------ __CenCervflle�Me99e_02632 ' THIS CERTIFICATION DOES HOT CONSTITUTE A GUARANTY OR WARRANTY )OSEPH P. MACOMBER. & SON, INC. Tanks-Coupoof rlsacnHeld& PvrnP+d L Jn&UJ1•4 Tory $ewer Connections P-0. Box 66' Ctnterville. MA 02612-0066 775.3338 775.6.412 01/20/98 TUE 19:27 FAX 781 5823822 Ocean Hill, Inc. R 004 01/20/1990 12:02 178141599E PAGE 05 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL FROTECTIO. zi r OSE WINTER STREET. BOSTO>`. MA 0_109 e17.29:.�ioo utizv- WILLIAM F wELD T;,`: Go,cmor ^RGEO PAUL CELLt1C0 D.Ak 9 Lt.Govchurr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION Foltm [�R PART A CERTIFICATION Frank Haggerty Properey addtess_ 1 15 LOOmis Lane Centerville Address of owner: Road Brandt IsIdnCl Date of Imptction: 10/31/97 of dif(eeenp Marne of Inspector: it mbar Jr. MattapoisettIMA I am a 0EP approved system inspector pwsuant to Seetion 1S-140 el Title 5 010 CmA 15.000) 02739 Company Name: J.P.Macomber & gon Ing- w+a'hng Address_ a3rsy4le 02632 Telephone Nvmb*r; CERTIFICATION STATEMENT I cenrty that I hit-is perbonalfy an)pecletl the sewage disposal systesTt at this address anti that Ise Informal100% reponp below is.trLe.ac. and comelete as or the lime of inspection. The in)pdAipn was performer based on My training and e=per,ence in toe proffer fvncuon rtla-tenanct of on-site se age disposal systems- The system Pa)ses Cond,t,onally Passes needs Further Evaluation By the local Approving kuthor,ry fads Inspectors Signatuee; its y_ The Syu.n,lnspe<tor dull svbt%it a Copy of sits in)pecti" re"01 to the Approving 4utnor,ty within thirty 4)0t trays W cvmpler,ns,n-, -,+speet-On It she system rS 3 shared sy3t*m or has a d4Wgn (lo— Of 10.000 gpd Or greater, the ,nspeCoor artd the Sysreln oar shalt s� the report to the appropriate regional oflice of the Oepanmem of Environmental Protection. The orig.nal srtovld ue sent to the tvslern arts copies sent to the buyer-if applicable, and the apiweving authority, INSPECTION SUMMARY_ Check A, 6. C. of D: A) SYSTEM PASSES: s have not lo,rnd anT infernwhon which indicates that the syettrn violates any of the fa-lwe cater,il in doilnod ,n 310 CmR 15 Any fadure criteria not evalvated art irsd-Wled below, COMMENTS: BI SYSTEM CONorTIONALLY PASSES: -,(,- One of more system Comp(intnts as described in the *Conditional Pass'3CClion need to be replaceo or repaired, The tts;e- COMO elton of the rePIKerrsr rtt or repair, as appfoved by the fSoard of Health.will pass. Ind.Cire tts_no. or not determined M N.or NO), 0"elibe basis of determination in all instances. If-not determ;ned explain .nv n, The xptle tank is metal. ueien the owner or operator has provided the system+rnspeow with a copy of a Ce",catr Compliance lanached) Indicating that'he tank rr& Instaliiad within twenfy 1201 years prior to the date of Me enspen.o the seplsc tank,whether or net melal,is craeked, sinxturafly unsound_shows substantial inffhfal,on or eddlrauon, 0, failure is imm,ntnt, The,system will pass inspection if the existing septet lank is replacee w,ih a Confone,n$ wed.c as &pprored try she Board of Health. ,r.v31.a o.raarr>' vsp. a er 10 OEv 04 tM s1lpnp V,yOe wee rMlpNrwrr�Onet ettlQ nv rYo.p a Prntled on d.aaso oaw, 01/20/98 TUE 19:28 FAX 781 5823822 Ocean Hill, Inc. 0 005 E➢1/=E)/199EI 12:0'_ 17513415098 PAGE 06 SUBSURFACE SEWAGE DISPOSAL•SYSTEM INSPECTION FORM PART A CERTIFICATION tcominueds Progeny ^ddtess: Fr'arik Haggerty O—ner: 115 LOOMLS Lane CEnterville,Mass. Dale of Insoect;vn- 10/31/97 01 SYSTEM CONOtTIONALLY PASSES icoorrnuedi Se—age twwo or twv)kout or high static watet level observed to the distrsbvt.on boa is d.,e rO OrOLQn Of o.pe[sr Or due to It broken. settled or uneven distnbuuon ban The system%will pass InspeCilDn rt IWrtn ainlre•a: a :me, Board oI Heafthl. Describe obsewations: broken plpew are replaced owifuction iy removed drslr.but,on box .s levelled or replaced The system reached pvmPrng Tote Than (ovr times a rear due to broke- or obstructed P,pe(st Tne %vslem —.It Gass ,nspeo.on .r I%v,th approval of the Board of Health) broken ptpels)we replaced �+ obstrvct-on t>removed C) FURTHER EVALUAtION 15 REQUIREO 9Y THE BOARD OF ►tEALTH: Condn.ons et.sl —hick require Ivether e-aluatron or the Board of health to order to determine it the system y fa-ling 10 proteG Inc publ-c hea4n_ sarety and the env,►onment II SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT WhICTIONttiC 1K A wt-.KFR WHICH WILL. PROTECT THE PUBLIC HEALTH Aw0 SAFETY AND THE ENVIRONMENT; Cesspool or privy is arrm.n 50 feet of a surface .water Cesvoot or or—" is +rth.o $O feet of a bordering �cgeiaied vwedand or a $aft marsh It SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES Tnat THE SYSTEm IS FUNCTIONINC IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND Ts+E ENVIRONMENT: 41. The system hail a septic tank and soil absorption systom tSASI and fhe SAS is w0h�n 100 reel to B s_•rr3Ce -water sv:a+t It rt-Ify 14*1Yrf#SS —ate•a.wy. The sysle-Nas a septic tank and soil absorption System and the SAS 4 within a Zone I of a Public-ater scoot; —ell the system has a woItc tank and so.l absorption system and the SAS is within 50 feet of a Dr a=e vats• suool, - -- The system has a seplr[tank and soil absorption system Ind the SAS is less than 100 fert but 50 leer or mote Irom 3 vr'vale water supply well, unless a .-ell water analysis(of Cog-form bacteria and volal;le organic compounds .nao;'(t% one: the•-etl a(fw from pollution It"Ihal facilih and the pf%wnce at anmmCAia nitrogen and notate nitrogen It ecla: :o :' lest man 5 pprn. Method wed to determine d.vante A,'A - -- faOProalmat.on not valid) 31 OTHER At rr- s.•a os-;73islr Lpa 1 vl 30 01/20i98 TUE 19:28 FAX 781 5823822 Ocean Hill, Inc. Z 006 0,1/20/19,30 12:02 1781341SO98 PAGE 07 SU$SURitaCE SEWAGE 011POSxt SYSTEM INSPECTION FORrt PART A • CERTIFICATION tconi-nuedt Proper(♦ Address: 115 Loomis Lane -Centerville,Mass, 0-Aer= Frank Haggerty Gate of erapentortA 0131/97 0) SYSTEM iatllS: You +hall tndieaie ear et 'Yes at-No as to each of the fallowing I ha-e detTiAlihed that the system violates one or more of the following failure crneria as defined !n jIt) Cns^n 13 )03 -r•e for this oeterm.nalion is identified below. The 8owd of Health should be contacted to dttefmtne what w4l be necessar� rz: . _ the fativre Yes No LJ flaCkvy of xwaae into facility or system coe►ponem Ave to an overloaded or clogged 5^5 or[essDonl o.seharge or pesna.ng of effluent to the surface of the ground or surface •eaters due to an overloacoa or civigSirc SA cesspool StltiC hQuid ie=_eMsn. I e -lints.iton boa *eve outlet lr%-*A Oue to en o.erlaad*d os clogged SAS o•ceiszco' er Clov.a 400th tin "ispeol is less titan 6"below mrM or available volume n less than 1!. Oay flo_ Reovtred pv—o,ng -ore !h��art O t-mrs in the fast year�dve to clogged of obstruneo �.perst +; mb uer of t tutef .mq% Pumped AAt poAion of the Sod Absarpbots Syslem, cesspool or privy is beloi.the high gtound—aler elevalto-% Arir port-on of a Cesspool of privy is within 100 feet of a surdaee -ail/ smooly or tributary to a svviace .aver s_=:. any 00!teon of a cesspool a!pfedlr is witl+to a Zone t of a public :vsfl tan n i ._.. j� r oo+ti o Of a cesspoo or privy is wllAln $O lets of a private rrelpr supplT..ell. AAT poAion of a Cesspool at privy!s less than 100 toot but greater than SO feel from a private Wiley wopti -til _r, acceptable —ater aval.ty analysis If the well has been analyzed to tie aCcepmble_ artach copy ai —ere wale: ana.v%,% cohforrn bacter.a, Vetaltre orpri-C coo"Pts"4s. arnmeints nitrogen and nurate nitrogen. f)L^ACE SYSTEM FAILS: low Qlvsv indicate either-yes or-No-as to each of the feft—ing TAe lelto•..ftg cftle.•a applt to large systerns in addition to the aliefta 40o•e The system serves a fiction _111%i design flow of 10,000 god or greater(large Systems and the srsten, .t a sig,+.;.ran: .n.ts; tc puotic health and Safety and the VwItOntasenl because one or more of the fotlo-nng conditions eaisl tri np Me system is...Thus d00 feet of a surface drinking .oatet supply AO the System is within 200 too► of a tributary to a ssidbee drinking .rater supply the system is located in a nitfogen sensitive area(interim W/llhggd Protection Area• lwPAJ or a M%aapee Zone 1, or t public water supply.cell) Tne owner of operator of any such system shall bring the system and facility into full Compliance with the grpsrndwater treatrhenl �tcB : reptrtfefrtenrs of 31a CMR 3 00 and 6.00, Pltise Consul(the local regional office of he oeparimeni for funher inlormaitor tr•�I.•a o•natrs, P.q. s •{ 10 01/20/98 TUE 19:29 FAX 781 5823822 Ocean Hill, Inc. Q 007 01/20/1998 12:02 17E1!;415098 PAGE 00 SUBSURFACE SEWACE DUPOSAk SYSTEM INSPECTioN Fokm PART I) CHECKLIST Property Ader.II: 115 Loomis Lane Centerville,Mass_ o•ne,: Frank Haggerty Date of Inspection: 10131/97 ChKk d the following have been done: You mvat IndiCate either 'Yes"or"No"a$to each of the follcs-ing Yes Ho PumOing Information was provided by the owner. Occupant. or Board of Health. ►.tone of twc syster..components have been pur►Iped for at least two weeks and the System has been re<e,Y,ng normal flow rates dvrinE that period. LwSw volVrnes of water have rM been inlroduce4 taro the System recenthr pe as part of this ;n6pectipn, As bu%lt plans have been Obtained and eharnined. Nate it they are not atiailable with N/A _ Tne iae:liry oe dwelling .as .nipecled for signs of sewage baci•up. Tree system does not receive non-witary or industrial waste flow. The stye was Inspected for signs of breakout, _ All system e:omoonents .9cludtng the Soil Absorption System, have been IOgttto on the sae _ The septic rank rnanholel were-nco•eied, ooened,and the interior of the septic tank wai Inwecfiiid for coe.o-reon ai baffles Or tees, rnalertal of construction, dimensions, depts of fiQvid, depth of sludge, depth of siurn The size and location of the Soil Absorption System on the site has been determined based on- The ta:duy owner rang tXcvpartts, ,f tliflerent from ot••rerl..ere ptov;tled with ;ntormauon on the v+over nty.nlerinCe C: Sub•3urface O;Ioosai System L — Exisims information. E_. Plan at B.O.H. L' _ Oetc!"n'A"in the furld fit any of the failure tr;leria related to Part C Is at issue, approadmalton Or dtslance Is unacceotablel [15.)02f3)tbil .a.a..a oN7s/h1 4 or 29 - t 01i20i98 TUE 19:29 FAX 781 5823822 Ocean Hill, Inc. 0 008 01/20/1998 12:02 17813415098 PAGE 99 SUBSURFACE $fWACE DISPOSAIL SYSTEM INSPECTION FORM PART C SYSTEM tNFORmATION PropeerrAddow. 115 I,00mis Larne CentervilleeMass. 02632 Owner: Frank Haggerty Date of Inspection: 1 0/31/97 cLOw CONDITIONS RE510ENT1! L: Des•gn flow.:- Wgp dJbedroom for S.A.S Nvmbee of bWroomj; 13, Number of Current res-dents Garbage grinder(yes at no): Laundry Connedled to system(Yes Of no): Seasonal vx tees or no): L Lvarcr rnerer read-9t- w of av fable rigor two 121 yea* age tgPdr: suwtp Pumb Ives or not: l0 --- - — r Wit date of occtrpinCv��T l CQMMERCIAVINDUSTRIA-U Type of eltabi-al+rnent, / 00111% Adf—jalloftvvav Grease slap OrCsenl. lyeg,or no)AQ Indvbtr-al Waate Hoto-ng Tank present: tyes er nolAo eon-san-tary —rite d-scharged to the Titre S sysrenr: ryes or nol > 61ev nnffr r934,ngs. ,f a-arlable A& ojAv- Last date of o<cupancy: OTHE4-t0eser-bet Last date of eccaoancV: if/if ` CENERAL WORMATION PUMPING RECORDS and sour a ol i formation: Systern pumped U pan of-Olveclam'Ives at nolA* if yes. •olurne pvreped: alttrns Re4son fps pwrr*p ng r _ TYPE Oi>YSTfws S�pfif, tan4Jdrstr�bvtton lso,ho:l absorption SYster*+ Single eesspoof Ovem*-. ceaspool Ptwy Shared s"lem lye* of no) lrf yes, 4114ch Vf9vtovs insoeoion records, if any) VA Technology ere. Copy of vp To date confrat:ef Other --CPROp T ACE of Of e0mfleals, date insnRird (if kno•-n)and source of inlv►myion:&�S CtaT' $9wz'6e odors deuctw .Then arn.rng at the site:(yes or no) / Ie..2,6.4 OuiO/hr l.y• ! of ao 01/20/98 TUE 19:29 FAX 781 5823822 Ocean Hill, Inc. Z 009 01/20/1998 12:02 17813415098 PAGE 10 SV85t11qF^CE S(%%CE OISPOS?t SYSTEM Ir,15PECTfON FORS DART C 5YSTfm V+FOftp^^TfON feontinved) P,00e,ty Addrew 115 Loomis Lane Centerville,Ma58. 0-ner: Frank Haggerty 04tr of Inspecron: 10131197 dultOINC SEWER: ,;*cafe on sne plant Oepfh beio.- grade ig ,nalertal of conwuctton• I iroA�a0 PVC_other Se:plaint O,stanGe from wjp ale aa+cr supply—ell or suctioel line g( ✓',arn�ier 7 \ Comments-tcond,t,on et lo,nis. "ni-g_ evidence of leakage. eft.) >wC !!/ ag i SEPTIC TANIL-,LL�Rq-fZ lA4 •101afe o'+ Sole plant Ocon Defo.. grade !� +v,er,at of ConSrrvll•oA: Znceele _,metal_P.berg19Ss _0ofYe1h11lene _olheneapfam) it tank t! fttai,list age Is age eoAlamed by Cend.cate of Comisltance tYcyfdel 01menswAs S�G'Aga OV�V� fr' Slvoge Qepfh 0-ston&e from ,00 al sfvdge to bottom of Witt Sac or baffle ii�ll�m Scum th,t?kneSl owartce itom top of scum to too of owlet tee of baffle rJQ(,ri Otstance from Donooh at scum to bonom*1*wlff tee.Of baffle Mo— d-meAt,ons —are deteemtned Comrnrmts I,et0,nj7Mr1daf.0n for ovmp,A& Condfr, of,nle1 ant?ovoef fees or baffle►, etcpt4 of Irpv.Q )"ef .n rgial,*n to ovrlet ,A�em. sUvinwa- ,ntcgrtn, e.tdence I leakage. a .) a CRE�.SE TRwP��'� •ItsUle on I,le plans OCbtn W10--grade wlerfaf of coAsvvctfon�i0eoneret mataf,(�f.bergla»�i�PolYefhYlene��btAeHeapia.n/ rJ,merss,ons: Scurh thickness. 0-Stance from top or aeon+to top of ovdet tee at baffle__A&Q Otuinee from bottom ofscm to ooftom of outiel tee or baH A9114 late of fast Dven0mg.� Coe*unents urcommenOmon for N-Ving_ co+sdiuon of'Wel and owlet tees or baffles, deplh of Ugtj4 level In relaf.on to ovtlef en.en. •nie$ar}_ evidence of leakage_ etc; .r.-f..o O��Sae fir a�g• � o! 10 01i20i98 TUE 19.30 FAX 781 5823822 Ocean Hill, Inc. 0 010 .01/20/1998 12:82 17813415098 PAGE 11 SUBSURFACE SEWACI O►SP®SAL SYSTEM INSPECTION FORw+ PART C 5Y5TEH1 INFOR "TION (cont:nwed) Property Address_ 115 LOOMIS Lane Centervi Ile,Mass. Frank Haggerty Oase ar mtvtctio�_10/31/97 TICMT OR AOLDINC TA►iK (hnr nurft be pumped pr,ryr lo.or it (ur,e, of+nspeatt>ni rloease on site plane Depot too. grade' rwaler.al of conirriijeston+llJlRconcrelernetaFftbergfals4�aolleu+YtenlAede=pla�nl 01me">�on1: Cazacirry: sailons Cestan ifo.., galfons/dat +alarm 1t-es: Alarm to�Qrk.ng ojdeu%4 Ye54,A No. Oare of pre'-ws oump;ns camnVny KonO�tiOn 0i-nit'tee, condition of Ilarm it'd float 3.witchas. ett'1 �A AI► L ti � .a DISTRIBUTION 60r: Uocarg on S.te pran) D9P(h C: LCY�d level above owip.1 tnveol'—Ap— cWho►tenls: (no i1 I=ref and do'serr ion is eatal. evidence r to of lekag-� Me. a onto or ow at boa. etc, gig rump CKAM6Ffl: uOCatc on Nle.plans >'umOi.nortM` Order, tires ar rJejbQ, AtarMS 1n ..orftrri8 order IV*% or No)� l Comment,: 'note cond;t'on or pump Chamber, corsdtlton of Ournpi end appvAanances, etc.I rr.��..c o•/13/nt I01/20i98 TUE 19:30 FAX 781 5823822 Ocean Hill, Inc. 16 011 91/20/1998 12:02 17E13415098 PAGE 12- 5ueSURFACE SEWALCE 415POSo L SYSTW INSP(CTION FORM PART C SYSTEM INFORMATION ('continued) Propenv Aedresf= 115 Loomis Lane Centerville,MaVs. O-ncr' r'Zank Haggerty Date of Inspection: 10/31/97 SOIL ABSORPTION SYSTEM iSAS) gocate on stte olan. it possible e.cavatton not required- but map be aopto:.mated by non-mirosive methodsl If not delctmined to be present, explain- Type _ leaching pas, number- leaCning chambers- nurttber: 10 .. leaching galledes, number. leaching trenches- aumber-)ertg)h: —16 lcachmg riel&- number, d.m I.ors�:_V Ovemlorr eess000l- n.rrnbec AI(erna ive s►Sienm; name of TecMology- Comments. tnac Condit( of spit. s.gns of hydra tic fai re, fe..el of ponding condn•on of vegetation etc.) 1� CESSPOOLS:�J� (locate on sit& Mani Number and configuration: Depth-top or liquid to-Met -even: add Depth of solids faver- Deptn of scum carer C11menslard of cesspool_ Materials of constNCt;on: - Ind'Otion of groand••ater: " - inflow(Cesspool Must be pumped as pan of inspec).on) lnCte Condition of sot'. signs of hydraulic (a:lure. level of ponding. Pond:elon of wgetit:en_ CIU 1100le on site plan) "'We6als of con ./ Qimens/Ong: /�I� Depth of sorid,struct Corninenuc (nom condition of soil_Signs Of hydraulic failure, level of ponding, condition of vegetation, etc.) tr..•ai•a 01/20/98 TUE 19:55 FAX 781 5823822 Ocean Hill, Inc. 0 001 01l�E3/199E 12:82 1781341509E PAGE 13 C31 SUSSUPCACf S(wACE CISPOSaI STSTEµ INSPECTION FORm .PART C_ S YSltAa oWFoamatION itonf."MEA) ►fac<n. Aao.ew 715 Loomis Lane Centervill_e,mass. 02632 sn►o.aio Frank Haggerty OAro a) .. 10/31 /97 51(ETCn Of SEWAGE DISPOSAL SrSTEa —ham),es)a N loath w.0 pt,~cvrn Wwontes lam/E& o,bonMmaAs 10-t i))—till—,thin IW 4ocne+,here owthc=are•s000)r comp suo hornel t 1 1 !J ,r to Construct u Shown on il -� DATE...... L_77�_ /l6, D 01/20/98 TUE 19:30 FAX 781 5823822 Ocean Hill, Inc. q 012 a01/20/199E 12:02 17813'41509E PAGE 14 SVIiJURFACt SJIVACE CIS/• SaS111.1 INSPfCTIOW FOAM ST51(on INfol ION Icnnlinued) I j� '�°Dt^•�34•e.s, 1s Loomis Lane Centerville,Mass. o.rte r: 0410 el lA$"cl;enFrank Haggerty 10131/97 OWN to Crovnd-ater/:Feet Plow tne•Cate all the me:nodj-vxd to down-ne n79A C/Orndwa.-W kILI-xlon. _Z0.4o cd Iron Oe»gn PtanS on record /bra.at�of S•e lAbunwg propeft, obSetrattew bob.ba►er.crr+ame VC-) G°earm�ae is Imm tool eendk-oh-, Check—etn iow Bore of health Check FE...••.rwo, Check pomp.eg r°eordt Check local o.ca+alo.r_^n Laflei: Use ViG5 Data Dru•De ,n".0 o—n-0,4%how vor.utabl,sned the I,-gh cc CMMv1eted? J.P_Macomber & son Inc. Installed this septic system in October Of 1994 . No wtaer encountered at 141 _ tom.-L.° 0•/79/!�) e•;• a( IO 1 44 7 � S by l ONWEALTH OF MASSACffUSE'TTS OF ENVIRONI MNTA L PROTECTION BE IT KNOWN THAT Joseph A Macomber, Jr. e Department's qualificatigns as required and is hereby authorized to use the title TUIUD TITLE 5 SYSTEM INSPECTOR 310 CMR 15.340 and Section 13 of Chapter 21 A of the Issued by 'lie Department of Environmental Protection. A(61%8 L>imcioq of Ibc If W'blcl Poilution Control 01/20/98 TUE 19:31 FAX 781 5823822 Ocean Hill, Inc. 1@ 014 01/20/1998 12:02 1701342509E PAS 16 TOWN OF Sarnstahle UDARu OF HEALTH SU1)3U11FACF. SEWACF. UISIVU1, SYSTEM INSPFCt'I OPt FORM - PART D.- CEttTI F1 CATT()H -TtPt CA PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 115 Loomis bane Centerville Mass. ASSESSORS MAP, BLOCK AND PARCEL f OWNER's NAME Frank Hagaerty Pn111* y - CERTIFICATION NAME OF 214SPECTOR Joseph P_ Macomber J>1•� COMPANY NAME h P. Maco &'boa Inc. COMPANY ADDRESS Box 66 Centerville, Ma. 02632-0066 Str+oi Town or city scat, LIP COMPANY TELEPHOKC 1508 ) 775 -3338 FAX (508 ) 790 _1578 CLRrIFICnTZON STATEMENT I certify that I have personally LASPeeted the sewage dispose'1 system at this nddress and that the information reported is true, accurate, and complete as of the time of .iespection_ The inspection was performed and any recommendations regarding upgrade, maintenance, and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems. so Check one: S79teO PASSED Tile inspection which I have conducted has not found any infcrmetivn . . which indicates that the system fails to adequately protect public Ileaith or the environment as defined In 310 C14R 15, 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of Lhis Corm. �_ System FAZLEUs , ` The Inspection vi)ictl I have con ticted has found that -the system fails to Protect, the public henith ^Ad the environment in accordance with Title S . 310 CHR 16 . 303, and as specifle811Y noted on PART C - FAILURE CRITERIA oC this inspection form. Inspector Signature • Date 10/31 97 One copy of this certi (icwtion must be provided to the OWNER, S -hore oyplic&bl9) and t,h• BOARD OV 1t8ALTJ1. the BUYER • If the inapoetlen FAILED. th*v owner or-46reLor v che n one year of eli@ date of ah411 the inrlpectio►s, unless allowoddorChe o °Y°tein otherwise ay provided in 310 cmR 15 .305 . t'aqusreci Partd.doc r5 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 1 DEPARTMENT OF ENVIRO.NMEhTAL P-R0,?EJ 11�� J ONE HINTER STREET, BOSTON. 10A 02108 617-291 kSOG / 1� �l3& !� t uILLLAStF GELD t'� �y ci, O ' " Go.cmor ARGEO PALL CELLUCCI Lt Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO; FORM' PART A ti CERTIFICATION Frank H e. Property Address: 1 1 5 Loomis Lane Centerville Address of Owner: 1 26"--Br° ndt Island Date of Inspection: 1 0/3 1 /9 7 (If difierent) Road Name of Inspector: - r,Gaflh P Macomber Jr. Mattapoisett,MA I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) 02739 Company Name: J.P.Macomber & Son Inc. Mailing Address: BOX 66 C'Pnt-Pryj 11e. Mass 02632 Telephone Number: 5 f1�-77 5 RR CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reponee telor is a.,e acc, and complete as of the time of inspection. The inspection was performed based on my training and experience in Ine Droner n ;,c jr maintenance of on-site sewage disposal systems. The system /Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority fails Inspector's Signature: Date: _L7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of com::ret,n3 ,r•„ inspection If the system is a shared system or has a design flow of 10.000 gpd or greater, the inspector and the system o,-�r sr.a!i s_:;^ the repon to the appropriate regional office of the Department of Environmental Protection. The original should t e sen; !o T,e and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as dei,ne n 3t0 C,.t; } Any failure criteria not evaluated are indicated below. COMMENTS: 61 SYSTEM CONDITIONALLY PASSES: f _ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired Tne s.s e— 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', e.p a,, ..n, ,( The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Cer•.•' Compliance (artached) indicating that the tank was installed within twenty (20) years prior to the cate of tre the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial !nfil!ration or failure is imminent. The. system will pass inspection if the existing septic tank is replaceo with a corform,ng _J as approved by the Board of Health. (r.vi..d 01/25/97) D.g. 1 of 10 DEP on the World wide Weo. nnp.rnw..magnet state ma uvoeo Printed on RecycieO Paper I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Frank Haggerty O. ner: 115 Loomis Lane CEnterville,Mass . Date of Inspection: 1 0/31 /9 7 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in (he distribution box is due tc Dro.el o pipets) or due to a broken, senled or uneven distribution box The system will pass inspection w a ^rc Board of Health). Describe observations: . broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than (our times a year due to broken or obstru�ed p pets) Tne s ste .ass inspection if (with approval of the Board of Health) broken pipe(s) are replaced obstruction is removed 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 s la ! ne o pub!.c health. safety and the environment 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONIN'C IN A WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy .s within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DFER,,,I S +' THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND TrE ENVIRONMENT. The system has a septic tank and soil absorption system (SAS) and (he SAS is within 100 feet to a s_na:e ate �c 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 �a:er The system has a septic tank and soil absorption system and the SAS is within 50 feet of a pr,,ate -at r.,Dc!, -,e The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 eet or Tore 'rc-^ private water supply well, unless a well water analysis for coliform bacteria and volatile organic compot,ncs C Cctei "d' the well Is free from pollution from that facility and (he presence of ammonia nitrogen and nitrate nwoge., s e-._.,3 less than 5 ppm. Method used to determine distance 111t_ (approximation not valid) 3) ,OTHER it r ➢.q. 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.m PART A CERTIFICATION (continued) Property Address: 115 Loomis Lane Centerville,Mass . owner: Frank Haggerty Date of lnspection:l0/31 /97 DI SYSTEM FAILS: You must indicate e,. et -Yes" or "No" as to each of the following I have determined that the system violates one or more of the following failure criteria as def-ec in 310 C- for this oeterminatton is identified below. The Board of Health should be contacted to determine wnal —ii ✓e the failure Yes No Backup of sewage into faciGry or system component due to an overloaded or clogged SAS or cess000 Discharge or pondrng of effluent to the surface of the ground or surface waters due to an oyerioaoec or r 03gE cesspool. Static liquid level in Ire distribution box above outlet invert due to an overloaded or cloggec SAS e, r(r l.qu.d depth n pp;ypppl is less than 6" below invert or available volume -s less than ':!? Ca, ic., Requ,red pumping more than 4 t-mes in the last year NOT due to clogged or obstructee Number of l-mes pumped&- Any pon,on of the Soil Absorption System, cesspool or privy is below the high grouncwater e e,a _- Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributar,, .o a s.na_e 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 portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private wafers acceptable water qualify analysis If the well has been analyzed to be acceptable, anacn cow of gel coliform bacteria, volatile organic compounds. ammonia nitrogen and nitrate nitrogen EI L.,RCE SYSTEM FAILS: You must rndicale either "Yes or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above. The system serves a facility with a design flow of 1Q000 gpd or greater (Large System) and the syste.T s a s:z- public health and safery and the environment because one or more of the following conditions exist Yes No the system is within 400 feel 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 Protecnion Area • IWPAI or a - public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundNater IreatTe c"=;_ requirements of 31a CmR 5.00 and 6.00. Please consult the local regional office of the Department for iurther in:orrr.8:.o- lr•v�.•C 0./JS/9]1 ➢•0• 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 115 Loomis Lane Centerville,Mass . Owner: Frank Haggerty Date of Inspection: 1 O/31 /97 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. 1' None of the system components have been pumped for at least two weeks and the system has been rece,: ng no,r,-o' now rates during that period. Large volumes of water have not been introduced into the sysiem rece^:i, as pan of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A The facility or dwelling was inspected for signs of sewage back-up. j1 The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components,Icluding 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 inspeRed for condition baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum — The size and location of the Soil Absorption System on the site has been determined based on The facility owner (and occupants, if cjfferent from owner) were provided with information on me proper Sub•Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance s unacceptable) (15.302(3)(b)) (r.vl..d 04/29/97) P.9. 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Address: 1 1 5 Loomis Lane Centerville,Mass . 02632 Owner: Frank Haggerty Date of Inspection: 1 0/31 /97 FLOW CONDITIONS RESIDENTIAL: Design low._, __g p d./bedroom for S.A.5. Number of bedrooms: Number of current residents: Garbage gander (yes or no). Laundry connected to system (yes or (1o):—W, Seasonal use (yes or no):�f� Water meter readings, if ava�Table (last two (2) year usage (gpd): Sump Pump (yes or no):/,�U Last date of occupancy 4LI—$�L / COMMERCIAUINDUSTRIAL: Type of establishment. .( Design flow: NCI,p Rallons/day Grease trap present. (yes or no)A44 industrial Waste Holding Tank present: (yes or no)ZLI� .Non-sanitary waste discharged to the Title 5 system: (yes or no) C& wafer meter readings, if available .LG4' Last date of occupancy: OTHER: (Describe) Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS and sour e ofJ,i� formation, System pumped as pan of inspection: (yes or no)d,1:2 If yes, volume pumped gallons Reason for pumping TYPE OF YSTEM Septic tank/distribution boVsoil absorption system Zjb Single cesspool Overflow cesspool Privy Shared system (yes or no) (r(yes, anach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other 41e —A2,PROXIMAT AGE of all components, date installed (if known) and source of information: �u �-c �~ '7� Sewage odors detected when arriving at the site: (yes or no) (r.vi*.d P.y. 5 of 10 SUBSURFACE SE%VACE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properl* Address: 115 Loomis Lane Centerville,Mass. owner: Frank Haggerty Date of Inspection: 1 0/31 /9 7 BUILDINC SEWER: .ocale on site plan) Depth belo, grade Material of construnron cast iron ✓40 PVC _ other (explain) Distance irom private wallet supply well or suction line 4/4 D,ameler yr, Comments tcondu-on of joints, venting. evidence of leakage. etc.) -Je 2T� y, B / /e.a AC, Y G dUS+2 �lrr ti SEPTIC TANK:,&6deye4kc6 locale on sale plan) r Depth below grade ,,aier al of constructionncrele _metal _Fiberglass _Polyethylene _other(explarn) 11 tank is metal. list age &J Is age confirmed by Cenifrcate of Compliance(Yes/No) D�menS�Ons Slvage aep(r) Distance from top of sludge to bonom of outlet tee or baffle ;110�11ke— SCum thickness Distance trom top of scum to top of outlet tee or baffle: `.a�G�i Distance from bonom of scum to bonom of outlet teeC or baffle .^iow dimens,ons were determined. Comments uecommendanon for pumping, condo;T of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, sircc,- a nlegrjn, evidence of leakage, etc ) f e , CREASE TRAP: :locate on site plan) Depth below grade cater al of conslrun on 10 concrete metal4/�Fiberglass4/APolyethylene 4other(explain) AJ� Dimen Si On s: Scum thickness.�L Distance from top of scum to top of outlet tee or baffle:�A4 Distance from bonom of scum to bonom of outlet tee or baffle:X4 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, ntegw,y. evidence of leakage. etc I ,r ir•vi••o 0�/l5/9)1 V•p• 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 115 Loomis Lane Centerville,Mass. Owner: Frank Haggerty Dale of Inspection:1 O/31 /97 TIGHT OR HOLDING TANK (Tank must be pumped pnor to, or at time, of inspection) (locate on site plan) Depth below graded!/%' matenal of construclionQ/concrete/�jmetal4A/ Fiberglass4/4PolyethyleneC,4other(explain) Ip Dimensions /q Capacity: gallons Design ilow, t gallons/day Alarm level•_ Alarm in working order YeSA( Nu Date of previous pumping: Comments (condition of inlet tee, condition of alarm and float switches, etc ) DISTRIBUTION BOX:z Ilocate on site plan) Depth o: hcu,d level above outlet lnven Comments (no if level and Is tion is equal, evidence of solids carryover, evidence of leakage into or out of[Jbox, etc ) �J PUMP CHAMBER:,(A/[- (locate on site plan) Pumps in working order: (Yes or No) alarms n working order (Yes or No)—AIW Comments: (note condition Of pump chamber, condition of pumps and appurtenances, etc.) lr.�s.b 01/25/97) P q. 7 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address: 115 Loomis Lane Centerville,Ma'ss . Owner: Frank Haggerty Date of Inspection: 10/31 /97 SOIL ABSORPTION SYSTEM (SAS):_ ,locate on site plan. J possible, excavation not required. but mad be approximated by non intrusive methods) if not determined to be present, explain: TYDe leaching pits, number. leaching chambers, number: leaching galleries, number:= leaching,irenches, number,length:-6 leaching fields, number, dim nsions: L/ overflow cesspool, number: Alternative system: Name of Technology: / e Comments (note condnr n of s ill signs of hydraulic fai ure, level of ponding condition of vegetation, etc.) Y -) G /Ul _ - n4)�I I>s .v _ CE5 SPOOL 5: Lf/E' I locate on site plan) Number and configuration: If/IV Depth-top of liquid to inlet invert -4,9 Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: / indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:�_ /C- (locate on site plan) Materials of constructro : Dimensions: Depth of solids: 16/1141 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) /5 (r.vi..d 01/75/97) D.g. a of 10 SUBSURFACE SE"'ACE DISPOSAL SYSTEM INSPECTION FORM PART C SY51EM INFORMATION (continued) Properly Address: 115 Loomis Lane Centerville,Mass. 02632 O.nef Frank Haggerty Date of Inspection: 1 0/31 /97 SKETCH Of SEWAGE DISPOSAL SYSTEM: ,nciude ties to at least two permanent references landmarks or benchmarks locate all wells within 100- (Locate where public water supply comes into house) No- I'err-.r=Sir)gy. to Constr":Ct 1. : > sT•{ � 1, as s;-:owr: on thy• D.-\TE._ . 1 OR. 36-30e -098S C tnvf..a Gs/J9/f7) ➢.q. 9 of 10 SUBSURFACE SEWACE DISP• , SYSTEM INSPECTION FORM C SYSTEM INFOI 10,\N (continued) Properly Address: 1 1 5 Loomis Lane Centerville,Mass . : Date of inspection: Frank Haggerty Date o 10/31 /97 Depth to Crvundwater/9— Feet Please tncicate all the methods used to determine High CfoundwaiV E(L, a'.ion: —Zoo:amed from Des,gn Plans on record Observation of Site (Abuning property, observation hole, basemcrshsimp etc.) Determine it from local conditions Check with local Board of health Check FEMA ~saps —tfllCheck pumping records Check local excavators. installers use USCS Data Describe �n Your own words how You established the High CrouncJ1.+J Cr J levation. (Must be completed) J.P.Macomber & Son Inc. Installed this septic system in October Of 1994 . No wtaer encountered at 141 . Inrt••G Ox/IS/9'11 e•5' or IO e .ter+—n,rrTr-.r+r.-mrn m.rrrt.r..re-r.rr-r:•.r+•nv.rrwr*'+rm errn•v r.o•�nv mn ma.rrr:e.ra�rrrrT-+•,—�-- _. ._ T ' TOWN OF Barnstable BOARD OF HEALTH SUIISURFACF SFHAGF DISPOSAL SYSTEM INSI'FCTION FORM - PART D CF,RT1FICAT10"q �„ �•.•r.. � .--e,.. -rn.r.r•vn•rt:mrt.r crrraaTn-.'—•n�rrt+.�■em.er-rn+rr.ew�nrsn++ae�.,r•nr� n,m n•�+rrrrt*.+rv-'rr+.,+r —.,-r.- .- _. _. �. -TYPE OR PAINT CI.EAAL1•- PI?OPERTY INSPECTED STREET ADDRESS 115 Loomis Lane Centerville,Mass. ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Frank Hagtierty PARV D - CERTIFICATION 1 NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAME Joseph P. Macomber & 'ion , Inc . COMPANY ADDRESS Box 66 Centerville , Ma. 02632-0066 Street Town or City St.t. LIP COMPANY TELEPHONE (508 775 -3338 FAX ( 508 ) 790 -1 578 CERT'IfICATION STATEMENT I certify that I have personally inspected the sewage disposal system nt this address and that the inrorination reported is true , accurate , and complete as of the time of .-inspection . The inspection was performed and any recommendations regarding upgrade ; maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Check one ; System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 - 303 . Any fail(ire criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con acted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date 10/31 /97 1777 One copy of this certification must be provided to the OWNER , the BUYER ( where appl icable ) and the BOARD OF ILEAL1'II , • IC ,the inspection FAILED , thl owner orsoperator shall upgrade the eyatem within one year of the dnte of the inspection , unless allowed or required otherwise as provided in 310 CHR 15 . 305 . Partd . doc w v� _ 7 � s TEE ZM CONONWEALTH OF MA.SSACI]FUSETTS DEPARTNMY,,NT OF ENVIZONIVMNTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Deparnnencs qualifications as required and is hereby authorized to use the title CER + { D TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21 A of the General Laws . Issued by Tlie Department of Environmental Protection. lurx 8, 199 Acting I)Ircctor of the O� ctIojl W1Iu Pothitioo ('o(Ilfol f ' TOWN OF BARNSTABLE LOCATION //,� L. o 0,M /S L.4 SEWAGE # VILLAGE C e N 1'e R yi L P ASSESSOR'S MAP rm INSTALLER'S NAME G PHONE NO. .4 c o w! /3e SEPTIC TANK CAPACITY pOD LEACHING FACILITY:(type) p/T (sue) :-NO. OF BEDROOMS PRIVATE WELL OR-PUBLIC WATER MroM OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: /`� VARIANCE GRANTED: Yes No .I n SL I �A ` r TOWN OF BARNSTABLE LOCATION //,r L. 00A1 JS 1- ,4 SEWAGE #��'J� VILLAGE G eAlf-J 'X III Z/-e ASSESSOR'S MAP & LOT25/1 INSTALLER'S NAME & PHONE NO. n,4 c o A4 eeR t s SEPTIC TANK CAPACITY pOD LEACHING FACILITY:(type) (size) /0 o O NO. OF BEDROOMS Z PRIVATE WELL OR PUBLIC-WATER ERUZMOROWNER ?- DATE PERMIT ISSUED: f ZZ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ' f•' �� 7 ."o FRim THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iratiutt fur Di-npoiial Works Tunitrnrtiun rami# Application is hereby made for a Permit to Construct ( ) or Repair KX) an Individual Sewage Disposal System at: „-, ---7,00mis,„Lane,--Centerville ------•---------------•-•---------•--•---•--•-----•--------....--•-------•---•--•----••------..... Location-Address or Lot No. Haa�erty Owner Address a __J..P:Macomber Jr. Installer Address d Type of Building Size Lot............................Sq. feet Dwellin No. of Bedrooms----------------2 --------------------------Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ............................ No. of persons........-------------------- Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------- ------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv............gallons Length---------------- Width---------------. Diameter._._.......--.-. Depth................ x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter...----------------. Depth below inlet..........--........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................minutes per inch Depth of Test Pit..------............ Depth to ground water........................ rZ. Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water.............--....----. V+ ------------------------------------------------------------------------------•-•-----------•--•-_.................................. -•--..... ...... .......... 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ W Sand & Gravel U ---------------•--------------------------.......----------------------------------------•----------------------------------------------------------................................................... W Z -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable-----------Omit e e s sp o o l . I n s t a 11 17.10.0.0... a.1.lan...t.anX... .di-s�xi.�.ta.tio� ��'� X•-100Q gallon...leacft_.lit-------------...........---- 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 been ' sue board f h lth. / / Signed - - ---- -----------r.. ..............................;� .. ......-- ---------------------------------------- Date ApplicationApproved By ................. 1—.s............................................................................. Application Disapproved for the following reasons: ..... ....... ....... ---- .................................... .... --............ . ..... ...... ...... ............................................................................... ......... ................................. .......--- . . . ........................................ Date Permit No. ...... f Issued ............ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gez#tftctt#e of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XXX) by J.P.Macomber Jr. -------------------- - - - hti�:�ue 115 Loomis Lane Centerville at --------------------------------------------------------------------------------------------------- ----------------------------------- ----------------------------------------.................................. has been installed in accordance with the provisions of TITLE 5,of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------7.7. -—._--,- ---- dated ----------------------------------------__-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... �j p -. ,. r�'? Ins ector-� - _-. �� .... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 3000 No. :U •.?... FEE....................•••. Dispop l Workii Tnni#r Lion "amit J P.Macomber Jr. Permission is hereby granted---------------------------------------------------•----•--••------------•--••-•-------•-----........--•--••--•---•--•......••--•....--.•---- to Consul f't (LdoomriRep,aiirn(�X)Cen1 Inedii idu�al SSewage Disposal System atNo............................ ------•--•••-------•---••-•-•---- -•••-•-•-•-------•-•••-•••--------- -------------------•-•--------•----•-------•--......------------------................. Street �� C as shown on the application for Disposal Works Construction Permit No---- _-------- Dated...... F>.-------_.._.... l l -/? -� �- ........................................... Board of Health DATE........ - ---:------•---- - . FORM 36508 HOBBS&WARREN.INC..PUBLISHERS gc, 30 00 No...._y:._ .<-f Fps....��....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uinpoottl Wor1w Tonitrnrtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (KX) an Individual Sewage Disposal System at: 11.5 Loomis Lane Centerville ......--•.............•----•-••--------•-----•----..........------...._•---•---------.......__...• ------------•••--•---•---•.....----•-.....------------------------------------------------........ Location-i\ddress or Lot No. Haggerty Owner Address W J.P.Macomber Jr. Installer Address Type of Building Size Lot...........................Sq. feet Dwelling X No. of Bedrooms------------------ ---------------------.----Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons------- Showers ( ) — Cafeteria ( ) 04 d 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. I................mtnutes per inch Depth of Test Pit-..__________---__-- Depth to ground water........................ rs. Test Pit No. 2................minutes per inch Depth of Test Pit__._-_-_------__-__ Depth to ground water........................ 9 ......••-----••-•..............•-.......-----------•-----•--.......-••••----------••-----.....------._.._...-------•----...------•-•-••........--------...... ODescription of Soil----------•--• . . .............••-•----------............----••--------.---.... -••---•---•---------•-••--•-----•----------••••-..........------..----- x Sand & Gravel U •--•----...----•-----------••---------•--------••---•----------------------•-----•-------.....----------------------------------------------------------•-----------------.....------...........-------• W x ---•--------------------•--------.......----•-•----.............--------•--.._...----•--------•••-••-- ------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.-___-_-._.Omit cesspool . Install -------------------- ---------- 1•-....QO.--aa_hlon•_.to IX.__1-d. str bution_-hox___1_-1000---gallon._ leach 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 'ssued'by 'board f h Ith. Signed ... . 1. ...6....94..... Date Application Approved By • .......... .. ......t - --....... - - .................................. . ................ ......&--�..-../.. .-.�.[;/ Date Application Disapproved for the following reasons- --------------------------------------------------------------------------- ..................... ... .... . ......... .............................................. . .. ........................... ... ............ Permit No. I L1......... ....��----------------------- Issued ....................... ............. ....--.-.......D..ate......... Date .y . ... .� ..ter lam' V LZ. •r„ r..'I �. 13 1.. H K � 4-7 i r P t i •. , . .I �°• .• , i •I � � .�•jE �iEr •� � � 4-1 w Q _ _ • • ,� . •; � , � � � � fit• c9 4-1 . ►ram //3 f! 2O 1=7. �...• w• , v� '" Revisions 9/16/98 ADDED DWELLING LOCATION CERTIFICATION WEQUAQUET LAKE FLOOD ELEVA RON 34.7 GENERAL NOTES: Project Title 1. LOCUS OWNER: LARRY & CECILE SALTERS 1 4.i cavroUR 16" RED w"� .__fZOOD _ PLA/N 2. DEED REFERENCE: BOOK 11440, PAGE 246 A6 8" REDMAPL MAPLE 12" RED MAPLE 10" RED _ c PITCH �91.47 MAPLE MAPLE �P/NE.� 3. NOTICE OF INTENT FILE ##SE3-3347 '- —""—"' "' -----• '"� 4 - PROPOSED •• .... ......._..._A ........ RECORDED BOOK 11521, PAGE 122. AlsX2EDGE DEMOLITION 4. BARNSTABLE COUNTY REGISTRY OF DEEDS. OF BANK 36X3 P o AND 5. LOCUS IS SHOWN AS LOT 33 MAP 231 OF THE TOWN 0 om OF BARNSTABLE ASSESSORS MAPS. —38 - STEPS BUILDING PERMIT 6. ELEVATIONS REFER TO N.G.V.D. DATUM (1929). RECONSTRUCTION 7. THE EXISTING SEPTIC SYSTEM IS TO BE RECYCLED. THE _ _ �roPOF BANK 42X___. 6 IN WHEN DWELLING WILL 71E INTO MUNICIPAL SEWER N AVAILABLE. r � BARNSTABLE, MA 8. LOCUS IS LOCATED WITHIN THE 100 YEAR FLOOD PLAIN `_ LAND • ROPOSED r&ACA, HAYBALES ELEVATION 34.7 TOWN OF BARNSTABLE MASSACHUSETTS • 1 1 e NEW� PATIO ————— BARNSTABLE COUNTY FIRM PANEL 5 OF 25 COMMUNITY • PANEL # 250001 0005C MAP REVISED AUGUST 19, 1985. ExISNE' NEW PATIO EX►snNc � fZAGSTANE PA770 AREA BENCHMARK THE REMAINDER OF THE SITE IS IN ZONE "C". I DaMVNG i 3 21 , o (TO BE REBUILT TOP FLAGSTONE PATIO Prepared For 1 EL.-45.7 FROM PLAN 9. WETLAND LINE AS SHOWN FLAGGED ON 3/23/98 BY I I ao o BY OTHERS KURT OLSON PHD (DAYLOR CONSULTING GROUP) AND 1 J OCEAN HILL INC. FIELD LOCATED BY DAYLOR CONSULTING GROUP, INC. o ��J/'T/TITJT� N 8 OCEAN HILL DRIVE V, //1 13. W KINGSTON, MA 13.4 ypPROP X/S77NG HOUSE N OSED�ro BE RAZED � HOUSE 100' 1WRAND_ SE78 D-B i-- ®OX --- _. ,_, Ga EXI o , I 47X9 I CERTIFY THAT THE PROPOSED DWELLING IS rAsK sEPnc �j Da* 1as LOCATED WITHIN ZONE RD-1 AND MEETS L T AREAL /�-� ' THE REQUIRED FRONT YARD AND SIDE YARD I Q SETBACKS. 45x I GrOW � tH OF yQ fs9„ I \�EXISr SEP77C Wft UTILITY 4X0 1 t j LEACHING PIT � 4r UP /� yG POLE ��_T 0IFRHEAD RE 0 RIILPH wwLow ( Ten Forbes Road N+ 0244 f 44X7 O POLETY Braintree, MA 02184 44X4 46x6 PROPOSED 781.849.7070 S - I 44X8 I ROOF DRAIN FAX 781.849.W% L a J DRY WELL (M) PROFESSIONAL LA D SURVEYOR DATE /LD�NG SETBACK (SEE ATTACHED 44x4 � 46xo AV DRAINAGE CALC'S) Drawing Title O (FND) 46X1 L _ = 5 9 �M9 —25 .79 R_g3.2 44X94 PLOT PLAN O 4 48X2 AY / S I CERTIFY THAT THE EXISTING DWELLING TO BE RAZED AND A N THE PROPOSED DWELLING TO BE CONSTRCUTED ARE THE SAME 47xs AS SHOWN ON THE NOTICE OF INTENT PLAN (APPROVED NOTICE OF INTENT FILE ##SE3-3347) DATED JULY 1, 1998 AND ARE IN THE SAME LOCATION. Scale: 20' OF4 0 10 20 30 40 50 FEET PMA ow v! Date SEPT. 10, 1998 Drawing No. Design J.B.T. JBTPL�OT.DWG Check J.B.T. Drawn J.L.P. Job. No. 1.1149.0 Last Rev. 9/16/98 of 1 w e