HomeMy WebLinkAbout0157 LUMBERT MILL ROAD - Health 115LLumber't Mill Road
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UPC 12543 % o-
No. 53LOR O;OOS.ppHSJ��
HASTINGS, MN
No. ® 1 U � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitation for bisposal *pstrm ConstCUttlon i3ermit
Application for a Permit to Construct( ) Repair( Apgrade( ) Abandon( ) ❑Complete System t[�lndividual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel' L � A C ® r,I`►R �
�. m
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. S � �
500k1 F,-AK� t12 Ord -Vc- �C,GkC"C,�, S'S &to (ty-t/ fd
t—X (i nlX COk QQLJ 1110
s
Type o Building:
Dwelling No.of Bedrooms Lot Size 3 sq.ft. Garbage Grinder(P)1
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided '?,? 6. SL4 gpd
Plan Date ,�Z � .I Number of sheets / Revision Date
Title
Size of Septic Tank f yjZjfi�4 I 6 tO Type of S.A.S. I O p G, L C ".Ab.(r S
Description of Soil X 2-
Nature of Repairs or Alterations(Answer when applicable) p
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 Certificate of
Compliance has been issued by this Board of Health. /
Sim Date (O l i z l r g
Application Approved by I� . Date
Application Disapproved by Date
for the following reasons
Permit No. ®' Date Issued 1 'r
17-
No. "";i Fee ,
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
1 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpYiration for 0sposal *pstem Construction 3permit
Application for a Permit to Construct( ) Repair( j/Upgrade( ) Abandon( ) ❑Complete System [Xndividual Components
Location Address or Lot No. 1 S ) L V M 6-cj-k M;\1 Rd Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel' 1. � C v A tN�"� A C ��\4 taw r t{ �I� Z nc vo r Q r V r-cs1rJ r,�_ L1O1.•G.
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
3GUN rc,wVL i 3 W -ya r'-t)4". 2(� t c o 1 S'S (nu (Zya t/ /t i4 S G btc.
{` n 1001 "001 24ig 000 Y .1 L, — 0ka
Type of Building:
Dwelling No.of Bedrooms Lot Size IS'( .) sq.ft. Garbage Grinder(�)�
Other Type of Building No.of Persons Showers( ) Cafeteria( )
t -
Other Fixtures
Design Flow(min.required) gpd Design flow provided 22 $.&LI -gpd
Plan Date—�C' Sj �/ Number of sheets J Revision Date
Title
Size of Septic Tank -e 0'r0 Type of S.A.S. �-1 I(�s!z p C A (_ C t $
Description of Soil - x ., 5C.e_ QC,-P_IR 2 0 ()
�e S ,
Nature of Repairs or Alterations(Answer when applicable) ����f•�. e K t'�'� �n \-T Q,^tJ
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 Certificate of
Compliance has been issued by this Board of Health. ff
Signed D //ate b /) Z. '
Application Approved by Date
Application Disapproved by 1 Date
for the following reasons
Permit No. Q( Date Issued �6 0"( X
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( /UaliJpgraded( )
Abandoned( )by
- at Lti �N\ rtd C V 1N\hSbeen constructed in accordance _
with the provisions of Title 5 and the for Disposal System Construction Permit No.a 0�g I��6 dated
Installer e- VC Designer\)It
#bedrooms l Approved design flow end
The issuance of this permit hall�not be construed as a guarantee that the system will ct not as d�l d.
Date tp Z7 Inspector `
-------- _----------------•--------- - _---- -_ _ - _--------------------------------------- ----- --- --- ----
No. (go/ Fee /61r.)
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
M sposal *pstem Construction 3permit
Permission is hereby granted to Construct( ) Repair(Vf Upgrade( ) Abandon( )
System located at t S? Lr y r-,-..6-t r.(r A �� (�_rC %9
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be com leted within three years of the date of this permit.
Date (p `(� Approved by
Town of Barnstable
Regulatory Set-vices
Richard \'. Scali, Interim Director
MAS& ON Public flealth Division
1639, 'nionias McKean, Director
200 Main Streit, Hyannis,NIA 02601,
Office: 50862-4644 Fax: .508-790-6304
a - Certit- -m lnst� Iler& Desip-nei ication Fot
Date: LU I SeNvageTerilliN f Assessor's Ma Taircel
Cnstaller: Scj�)S6.?,,4:Ll m!7��tv c I
Address: 6-C-0 Q aL Address: C
CIV 0 11
Oil 9AO kM—WaS iSSLICkl it pCI-Illit to iliStall a
—C
(d a t e) (Installer)
septic system at. L,Outx_71 W based on a design drawn by
(address)
dated VOW Z9, 2V I q
(designer) t
21 certify that (lie septic system referenced above .bvas iiistalled substantially according to
the design, which may i1lClLide minor approved changes such as lateral relocation or the
distribution box arid/or:septic tank. Strip out (if reqUired) was inspected atid the soils
were found satisfactory.t
1. certify that the septic :system referenced above was installed with major changes (i,Ie.
greater than 1-0' lateral relocation of the SAS or any vertical relocation ofianly cornpone rit
of the septic system) brit in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out (if required) was inspected and the soils
were found silt is filctorY.
I certify that the system referenced above was construe fliance with the tertils
A
of the V,A approval letters (11'applicable) .e"001—ill"CF kq
DAVID
D
1
I R
COUGHA'NCW
(Installeris,Signature) No 1093
1P
(Dcsigrierls Sfignaturc) (At-fix DeSI`g'pTET7s_�tan-(p Fl.&C)
I'LEASE, RETURN TO BARNISIABLUI� PUBLIC HE'ALTH DI\ASION. CERXIFICATE
OF COMPLIANCE WILL No,r BE ISSUED UN'ru, i3o*i,ii THIS FORM AND AS-
BUILT CARD ARE.R.'ECEIVED B)'. ,rHE BARNSTABLE' PUBLIC HEALTH DIVISION.
THANK. YOU.
Q:\ScI)i ic\Desi gner Cerii Itcalion Form Re1,8-14-13,doc
TOWN OF BARNSTABLE
;OCATION 137 L(a,/ t �l b J� QJ SEWAGE# O F�- 7(o
VILLAGE Cfj,,�C 1(,P_ ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. Vc-cd�(4 66 G4
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)=SZLGc�L.! `ni k4tize)
NO.OF BEDROOMS
�1 OWNER k 's
PERMIT DATE: 4) 1!a I ( COMPLIANCE DATE:
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) tt Feet
FURNISHED BY [D e �l��
� � 3
Y3
A 3
A 83 � �i, Z
�� y S'y-�
+r
Town of Barnstable P# ! 30
pfrIE
►'� Department of Regulatory Services
Public Health Division Date R 2- Al
. Mesas. 2— ��
200 Main Street,Hyannis MA 02601 N)
tEt,Mxl to
Date Scheduled Time A' ? r m Fee Pd.
_ :.
ht dD
Soil Suitability Assessment for Sewage Disposal ;
Performed-By:- iiV' V� : G®,)g-hu h owrt / Witnessed By: bd
LOCATION&.GENERAL INFORMATION
Location Address Owner's Name
� ' Rd
C�p,_IfJP�t f �� Address f57 L�"ery l ill wl - . c
Assessor's Ma /Parcel: Tl UI g u v 2
P l� � Engineer's Name � a '♦�i if�'�J'T
NEW CONSTRUCTION V REPAIR Telephone# 4 � .
Lund Use_Lar7 I pmllq ,Aq ' Slopes(96)_ !D Surface Stones b n e
Distances from: Open Water Body 1 O V $ Possible Wet Area ft Drinking Water Well i d ft
501 t __J }
• Dral'nage Way i ft Property Llne �ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands in proximity to holes)
wl DS`
\: a --
Parent material(geologic) Q- Depth to Bedrock
Depth to Groundwater.'Standing Water in Hole: a Weeping from Pit NCO h 0 n
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL•HIGH WATER TABLE
Method Used: 4"•f4-1 L0.S
Depth Observed standing in obs.hole: %b In, Depth to soil mottles. 0 0 e �'
Depth to weeping from side of obs.hole: In. Groundwater Adjustment tt.
Index Well-# Reading Date: Index Well level__:_ w„ Adj,•fhetor, ,_. Adj.GroundwaterLevel.,,_
PERCOLATION TEST Date S ,Tnwu.I;41
Observation t ,
Hole# t 'limn at 9"
2
Depth of Pero •��I � _ Time at 6" sO
Start Pre-soak Time @ U—0 0 Time(9"41 'Ll Yn h
End Pre-soak 5-00
Rate Min./Inch
Sitc Sultability Assessment: Sltd Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observdtion Hole-Data To Be Completed on Back`=----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:ISEPTICIPERCFORM.DOC F
DEEP-OBSERVATION HOLE LOG Hole# t
Depth from Soli Horizon Soil Texture Shcl Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders.
,
o isbtency.%'aravel)
o n F�►�brP .
4 ' E Loamy. Sth lD.O-Vi I
2, 3g 8 I_.b �h SDI n 1
GV M h LAa--5-f
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
o si en
FfO Ito
E Loamy 4qnA q �—f
-36 g o h 516 C§0-s
+132
i
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.,
Consistency.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color gall Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders,
Consistency,
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes-.I(—/
Within 500 year boundary No Z Yes
Within 100 year flood boundary No.,� - Yes �.
Depth of Naturally Occurring Pervious Materlal
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? ko
If not,what is the depth of naturally occurring pervious material?
Cedifiication
I certify that on WdY (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that t alysis was performed by me consistent with .
the required training,expertise and experience qcy 15.017.
o DA% Maly Z, ZQ ��
Signature `�-4 atb
r U HANOWR
/CENNSE� 0
Q: HPTICkPEACPORM.DOC EVALU
I
Ha ar u Materials Inventory Sheet Checklist
�o� ate
,< . Physical Street Address-Check database to ensure.it exists.`
-�Working Phone Number
Actual Amounts -( ie. gas being used to fuel machines, thinner to
)clean brushes all count as hazardous materials-no blanks)
V Storage Information -location of storage, how long is storage for?
/ If none, note that.
Disposal.Information :where and who? If none, note that.
TApplicant Signature - understand what is listed and noted
Staff Initial -any questions, know who to ask
J Vehicle Washing/Rinsing? -give a vehicle washing policy and
)explain it
Attach the Business Certificate with your sign off and comments
"The inventory form should explain what the business consists of and the procedures
they are doing. Notes need to be left to explain what you discussed with them.
i a10 alned -f 0 Ise 'SO Sin any 04
— w Wj.A4CrfA15 li 'tea( IseIDw . hit w of l U4oskM
rite I
�0r� leave G� I�-f�
�
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS
NAME in town (which you must do by M.G.L.- it does no g—w—e--y—b-D—permission to operate.) You must first obtain the necessary
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business Ce ificate that is required by law.
Fill in please: Date: y
wz APPLICANT'S NAME: a
KK � YOUR HOME ADDRESS:
,�S 7 L1,74-,er
BUSINESS TELEPHONE # HOME TELELPHONE #:
NAME OF CORPORATION:
NAME OF NEW BUSINESS TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS iS", ,0-1> 2 o,-,2 MAP/PARCEL NUMBER_ff 6 (Assessing)
When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of
Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 20 Main St. (corner of Yarmouth Rd.
& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your useness in town.
1. BUILDING CO SS NER'S OFFICE
This individu I 4seqn in d f an .permit requirements that pertain to this �c�� 3�.dNITH HOME OCCUPATION
uL AND REGULATized Sign ure** UOMPLYMAY RESUL
T
N FINES.
ffl E NT ---�
2. BOARD OF HEALTH
This individual�:�Me��
of rmit requirements that pertain to this type of business. MUST COMPLY WITH ALL
REGULATIONS
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
,. COMMENTS:
Authorized Signature**
a �.
m..^.+..:>wti a v.,�..c.,S; * :�;`r..4 Y A J r.. u� I .��: ''t_ i' a y„•j"ti,^+"+wJ+,'S r.. �• r+ t b ,r -
`1.."' ���Me.v:R•w+►r'i "Yv.wj�ni'`"{. ,
-.
''� � ^'�,�"sir'•'�b.�'_i...l ��^ a'� 604,�!
i
� /Z�/
TOWN OF BARNSTABLE Date: 06
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS:
BUSINESS LOCATION: �S� `"yR 'T ��� i2� :ur`�����E, / ?,9 INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON: ���T �E�✓�'T `
EMERGENCY CONTACT TELEPHONE NUMBER: �ZG3�fGo" Gy2s MSDS ON SITE?
TYPE OF BUSINESS: 6--421
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous.waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils ; Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,iAviation gas Photochemicalsl(Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW I USED
Misc. petroleum products: grease, Photochemicalsl (Developer)
lubricants, gear oil i NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic sl da
Rustproofers Misc. Combusti le
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar', PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetri chloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers
(including bleach)
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers �
Windshield washlool
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE BAR-W f)
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager /tit c,A c.,`_7
Address of Offender . '' ° s '�� ar MV/MB Reg.#
Village/State/Zips' " al 1 �i = sir /
Business Name 1/ / arVpm, on 1211 200` j
Business Address -. ......... MW
Signature of Enforcing Officer
Village/State/Zip '''
Location of Offense '� ?f i; . L.. J, r /;4,1 L r/-/
Enforcing Dept/Division
Offense z f t
e
Facts !,.»�. , s ° t � �� ;, ;:, t lti�.�> • •:f3 =c: - w .
--+ ► v ""`i .�,• *.,s 1 l i' _,i :,. �.t:+] - �"-•1-" R.t.^ M., n-+• ,"t i l ` n G."Y i 1] a j"'.
This will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
t
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Q � �B
MAR
PARCEL , OZ I
TITLE S
OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM FORM
PART A RECEIVED
CERTIFICATION
Property Address: 157 Lumbert Mill Road APR 2 0 2004
Centerville
ABLE
Owner's Name: EAWin Ross TOWN OF BAR T
HEALTH DEPT.
Owner's Address:
Date of Inspection: 4/13/2004
Name of Inspector: (please print) Patrick T. Sullivan
Company Name: Ready Rooter
Mauling Address: P.O.Box 371
Sandwich,MA 02563
Telephone Number: (508)888-6055
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System:
asses
Conditionally Passes
Needs Further Evaluation by the Local Authority
Fails
Inspector's Signature: _ .,!1�...___
Date: s o
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
D.EP)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.
Notes and Comments
""This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 157 Lumbert Mill Road
Centerville
Owner: EOwin Ross
Date of Inspection: 4/13/2004
Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D
Zlhave
stem Passes:
not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need t replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the/
explain. B rd of Health,will pass.
Answer yes,no or not determined (Y,N J
,ND)in the for the following statemetits.if"not determined"please
/!
f;
The septic tank is metal and over 20 years old*or the septic tank(wheflier metal or not)is structurally
unsound,exhibits substantial infiltration or enfiltration or tank failure is imn snent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the��ar'd of Health.
*A metal septic tank will pass inspection if it is structurally sound,not JeWdng and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high c water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven di buation box. System will pass inspection if(with
approval of Board of Health): ,
broken pip )are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
r
The system required pumping mqre than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the,43oard of Health):
r
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of l l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 157 Lumbert Mill Road
Centerville
Owner: EAwin Ross
Date of Inspection: 4/13/2004
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of ealth 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' accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will tect public health,safety and the environment:
Cesspool or privy is within 50 feet of a ace water
—Cesspool or privy is within 50 feet of Bering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if anh determines that the
system is functioning in a manner that protects the public health,safety and;AS
vi nment:
_The system has a septic tank and soil absorption system(SAS)and the 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 ne l of a public water supply.
_The system has a septic tank and SAS and the SAS is wi ' 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is I than 100 feet but 50 feet or more from a
private water supply wells#. Method used to determine ' ce
**This system passes if the well water analysis,perfa ed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that a well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogeg is equal to or less than 5 ppm,provided that no other
failure criteria are triggered, A copy of the analysis piiust be attached to this form,
3. Other:
Page 4 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 157 Lumbert Mill Road
Centerville
Owner: Egvvin Ross
Date of Inspection: 4/13/2004
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_,Z 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 and overloaded or clogged SAS or
cesspool
_ _Z Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow
— __.L 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 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis most be attached to this form.]
0� es/No The stem fail�.(Y ) ry s. I have determined that one or more of the above criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility ` a design flow of 10,000 gpd to 15,Ooo
gpd.
You must indicate either`yes"or"no"to each of the following-
(The following criteria apply to large systems in addition to a criteria above)
yes no r f�
— _the system is within 400 feet of a surface drip'king water supply
the system is within 200 feet of a tribuhyy to a surface drinking water supply
i
the system is located in a nitrogennsitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply v)tell
If you have answered es"to"y any ques�on 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 o famed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner shoal ntact the appropriate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 157 Lumbert Mill Road
Centerville
Owner: Edwin Ross
Date of Inspection: 4/13/2004
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?
G — 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 bales or tees,material of construction,dimensions,depth of li ui depth of sludge and depth of�p rl ��p g ep scum .
_ Was the facility owner(and Owipants if different than owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
Existing information.For example,a plan at the Board of Health.
_Z _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)13 10 CUR 15.302(3)(b))
Page 6 of 11.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 157 Lumbert Mill Road
Centerville
Owner: E11win Ross
Date of Inspection: 4/13/2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): 3
DESIGN flow based on 3 to CUR 15.203 (for example: 11.0 gpd x#of bedrooms):
Number of current residents: �Q
Does residence have a garbage grinder(yes or no):s�8
Is laundry on a separate sewage system(yes or no): oo[if yes separate inspection required]
Laundry system inspected(yes or.no):=
Seasonal use:(yes or no):,t: Z= t t 5-
Water meter readings,if available(last 2 years usage(gpd)): cx�
Sump Pump(yes or no):.c�C,
Last date of occupancy: Gcxsr�
COMMERCIA,IANDUSTRIAL
Type of establishment: _
Design flow(based on/R2,03 15.203): gpd
Basis of design flow(sns/sq ):Grease trap pr�eserut(yIndustrial waste holdise (yes or no):_Non-sanitary waste diso a Title 5 system(yes or no):Water meter readings, e:Last date of occupancy
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: ,,,,,
Was system pumped as part of the inspection(yes or no): �v
If yes,volume pumped: _—_gallons—flow was quantity pumped determiners?
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)
—Tight tank _Attach a copy of the DEP approval
T Other(describe):
Approximate age of all components,date instalpled/(if known)
—p and source of information: / (�
.�7•�/ a 2'�M.� ��tl���ilQ. (,Y / ��(_L__ 2 S �i t •�i Gd� an�.,c�_3� /'
Were sewage odors detected when arriving at the site(yes or no):,tJ6
Page 7 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 157 Lumbert Mill Road
Centerville
Owner: FAwin Ross
Date of Inspection: 4/13/2004
BUELDING SEWER(locate on site plan)
Depth below grade: (O
Materials of construction:_cast iron_ Q PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: (locate on site plan)
Depth blow grade: :2,p Ile
Material of construction:_,e&ncrete_metal fiberglass_polyethylene
_other(explain)
If tank is metal list age: _ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions. IF-w y,!�;- x g. _,
Sludge depth:—__Lf , - 0,-nj.E,
Distance from the top of sludge to bottom of outlet tee or baffle: 9
Scum thickness: Y"
Distance from top of scum to top of outlet tee or baffle: Q`�
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined.
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
�3"'G ' ..., c5l,a.r-c L_' .�°1• � �'t v � mac- c�c.3"Tt i ` �u�.►`T'" ti3'�.." —_.�
GREASE TRAP:_(locate on site plan)
Depth blow grade:
Material of construction:`concrete_metal fibergl _polyethylene!other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee/b�je:,_orDistance from bottom of scum to bottom of oobaffle:
Date of last pumping:
Comments(on pumping recommendations nlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of 1 age,etc.)
I
Page A of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 157 Lumbert Mill Road
Centerville
Owner: Fwin Ross
Date of Inspection: 4/13/2004
TIGHT or HOLDING TANK: (tank must be pumped at time of i on)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass lyethylene_other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working or (yes or no):
Date of last pumping:
Comments(condition of alarm and fl switches,etc.):
DISTRIBUTION BOX: /(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: c> "
Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
�—':?^�,X' '`'�� �����•.�3 ' �.4r� :C�ti r`. sec r �<� c.a�:�' �.-� �' c�
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber ndition of pumps and appurtenances,etc.):
Page 9 of 1.1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 157 Lumbert Mill Road
Centerville
Owner: Edwin Ross
Date of Inspection: 4/13/2004
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS.not located explain why:
Type
/leaching pits,number:
leaching chambers,number:
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.):
CESSPOOLS: (cesspool must be pumped as part of%nspe£�'tion)(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 o ):
Comments(note condition of soil,si s of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions: f
Depth of solids: /
Comments(note condition of soil,signs of hydrauli/ffailure,level of ponding,condition of vegetation,etc.):
f
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 157 Lumbert Mi11 Road
Centerville
Owner: Egwin Ross
Date of Inspection: 4/13/2004
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100€eet.Locate where public water supply enters the building.
h
i
V Q 4 r,T`
/A 3ro, r l
o�31
Page ]] of 1.1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 157 Lumbert Mill Road
Centerville
Owner: EAwin Ross _
Date of Inspection: 4/13/2004
SITE EXAM
Slope
Surface water
Check cellar✓
Shallow wells
Estimated depth to ground water > 1S feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record—If checked,date of design plan reviewed: l/42
Observed site(abutting property/observation hole within 150 feet of SAS)
Clerked with the local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
_,,,ZAccessed USGS database-explain: �,z r--� c-�2,5t_—.s
You most describe how you established the high ground water elevation:
"� F c� w t�! _i�u vC'G+ '� t- n t•v L �� ✓�V�\ Cif'"A u JP`
L TOWN OF BARNSTABLE
(LOCATION%�7 1. LIAAJSG'R r ,4,4 %d. SEWAGE #
VILLAGE 4:, .e Alf e1C- 1 j_1_e ASSESSOR'S MAP & LOT (�
INSTALLER'S NAME & PHONE NO. /0 o A,4 04-0, SQ/�
SEPTIC TANK CAPACITY i, 0 D P
LEACHING FACILITY:(type) /G'{ / (size) /o o 0
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
,.1
b,,ATE PERMIT ISSUED: 9-3
'f=±YDATE COMPLIANCE ISSUED:
- V` 1AIVCE GRANTED: Yes No /'
� � � \
} ®�� � , .
� � �y�° �£ �� � % .
� ^ �® � . ' ��
!
�®�� � ~ ��� �
. i , � �� ��
. � � � + . a
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�.
� 9
. ���
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-- . . . . . . . . . _ . �.\�����i�2\
No.....d s.2^ P yyD____ FEB... .....3 0..0.0..
APP�(ibED
Barnstable ConServCdC1QCVcrtmenfrHE COMMONWEALTH OF MASSACHUSETTS
)' OARD OF HEALTH
Si Datee OWN OF BARNSTABLE
Appliratinn fur Diripinial Works Cnnnitrnrtinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair *x ) an Individual Sewage Disposal
System at:
157 Lumbert Mill Road Centerville
................••--------•--•--....................----•--•--•----------------...............•••. ...••••-••--•-•---•••....-•-•-•----••---••----••••-••..........................•.............••••-
Location-Address or Lot No.
...C.Z1sJ.is e J_1....aamXP_r S--••--•-••••---•-•-•--•-------------•-•-----•--••. ..................................................................................................
Owner Address
-.- _.> acomh8-r...J ---•--•---------•------------------------- ---------••----...-----------------•----------.......-••-••-------------
� Installer Address
UType of Building Size Lot............................Sq. feet
Dwellings{No. of Bedrooms..............3---_-_.-_----.-_---------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building .................. ......... No. of persons.-..-..-.-.-.--.------------ Showers ( ) — Cafeteria ( )
04 Other fixtures ............................... . .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length---------------- Width.----------.---. Diameter---............. Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter..--------- ........ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......-.................................................................. Date......... ----------------------
..
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fi, Test Pit No. 2................minutes per inch Depth of Test Pit............... Depth to ground water........................
a --•••----•-•----••-------------•--------•----------•----•-•-•••--•••-••••-••••.......--•----................--------------•-•-----••••.........-•••..........
Descriptionof Soil-•-•-••------------•-•-•-------•-•---•••--------------•-----.....-•--•--•--•------•-•.......-•----•----•--------•-----••-----•-•--......................................
V .............•••-••••--••-•-•.....---•••-••••••--•-••---•.............•--•-• Sand-•-&.-•Gravel.......................................................................................
W
x ............... --•----------------------•-••--••••••-•.....--------------------•••-••--•---•••-•••----••-•----------------------------•---••--•--......---••••••••••--•••.................-•-...--•-•-
V Nature of Repairs or Alterations—Answer when applicable........Omit ee s_s poo 1 s. Tn s t a l l 1-10 0 0
... .. .... .
gallon septic tank, 1-distribution• box and 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 Yee issu by the 916a50 of health.
Signed .... . ... 11/2�/93
Dace
Application Approved By ............ s-�-- ...................................................*.................. .............1 e...'�.�.- 3
Application Disapproved for the followi reasons: .................................................... . ............ ..............................................................
. .. ................................... ........................................
3
....... ....................................................................................................................... Date
Permit No. .......................-.......�.......�o Issued
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Te>r#ifira e of Clompliance
TI ISPIS ,gCW0TjrFY,j jhat the Individual Sewage Disposal System constructed ( ) or Repaired-(= )
by .......................................................................................................... --------------.---.........----...---.-------..---------------------------------------.-----........................................
at 157 Lumbert Mill Road Centerville
............................................................ ----...---------------_--------------.--------------------.--------------------------------.-----.---------------.----------------------
has been installed in accordance with the provisions of TITLE 5Gof The State Environmental Code as described in
the application for Disposal Works Construction Permit No. -... -- .�>_� .. .._...... dated .........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
... . . . . ..............------
DATE ...................._........LI... ��jj....1 ..`�--, ...................._........ Inspector ..................
..... .....-----
---....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE $ 30.00
N0.73......�2.w FEE........................
Permission is hereby granted- -JP.macomber Jr .---------------------- ----------------------------------------
to Construct ( ) or Repair Z' X) an Individual Sewage Disposal System
at No.........157...Lumbert._.Mill...Road.-.Centery .1le-----------------------------------------------------------------------------------------
Street qq��
as shown on the application for Disposal Works Construction Permit No../S.��� Dated...........................................
................................ -_.....-...-...-..----...-...-------------------.........._
Board of Health
DATE -------------------
FORM 36506 HOBBS Q WARREN.INC..PUBLISHERS _
I
No...... �2.`l0 Fss...$.....30.00..
--• t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 7' �— �� `��-��TOWN OF BARNSTABLE
Appliration for Bi1ipmml Works Tontitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ')�X ) an Individual Sewage Disposal
System at:
157 Lumbert Mill Road Centerville
...................•--•-•--•-•------..........._....----•--••-----------..-----..........._.__.... .••--••-----------------------•-•----•....-•----•--••------....----•--•--•---•--•----••-•----_.._.
Location-Address or Lot No.
f;a1-sl?re_]1...Aankia s__....-----•---•- -•------------------------- --•--------•------•-----------------...........------•---.._....
owner Address
av�• _°-�°�3�tJ:ci2� Jr-,.;.................................................. ...........................••---•-••-----------...----•----••-----._...--•-----•--........-•----._
Installer Address
UType of Building Size Lot............................Sq. feet
Dwellings No. of Bedrooms______________3_____________________.__.__Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
04 Other fixtures .----•-------------•---••----.......-----------...----..._.-----••--------•---._..._----
14
W Design Flow............................................ 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........................................
Test Pit No. I................minutes per inch Depth of Test Pit-------_............ Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
_...•-•----------------------------••••-•••---••--•-•-----------•-•••--•._..._...--•----....._------.........................................................
0 Description of Soil........................................................................................................................................................................
W ....................... ...................................................... and__.&_..Gramel_--------------•----------•----•--------------..._..._.........__..._-•--...-----•_._..
W
-•----------------------------------------------------------------------------------------------------------------------------------------------------------•-----•--•------------------.......--•-_.._.
U Nature of Repairs or Alterations—Answer when applicable.,______-Omit cesspools-. Install 1-1-000
------ -.......
gallon septic tank, l-distribution-ibution box and 1-1000 aallon 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 issued by the "'oar, of health.
11/24/93
Signed J -11. ...�,... ---;I.................................
................................. .........................................
/ Dare
Application Approved B .........._....... ............l...r...�.- ..�:.mI}
PP Pp Y ..........� . --- ..�.----�•--� - -- ......... .......................... 7
Application Disapproved for the followin reasons: .................... .. ................ . . ...........-.........-....... . . ....-.........--- -....................
...................... .............................y^......................../.......................................... . .. - - ......................-.........-..-................... ........................................
/ C% Dare
PermitNo. - -------------------- Issued .-....-....-.._.............. ..........-............-..........-.
Date
ROUTE 28 oko FALMOUTH RD
oNFO AT LEGEND '
0 S E p ��� �M1� pp pp SEPTIC COMPONENTS c WESTMINSTER
• V Qp � N
O T E C W EXISTING
1000 GAL - ROAD Qh �P
� O vh
THIS IS A SEPTIC TANK L Qxh p
COLOR
EXISTING LOCUS (Y 00
lVi l� 1('�j LEACH PIT/
PLAN O CESSPOOL
NOT
USE COLOR PLAN ONLY oqa
FOR INSTALLATION DISTRIBUTION BOXOO �`\ SCE
FULL DETAIL IS BEST TEST PIT CENTERVILLE. 'MA
VIEWED IN �4y1 -
FULL COLORM pq
4, 5�
G�
0
0,0
' Q .
#Oo.Q D
-- . . xfi, v+<
GE OF PA VEMENT ,
e � -
91.05 ft 47 46
k
4 art!A I /./ °Z 45
a y 4EXjSTING
-44
i
46 3 BEDROOMp p p
'PAVED ` ' a DWELLING V j -43 T§L §T§ES
a DRIVEWAY ��p ®� �rIN�JDOI� G WATER LINE — —
,X 4 r o ��,2� `u'� WATER GATE O
GAS LINE -s�GImm--
OVERHEAD WIRE OH
UTILITY POLE
/ 42
j
INSTALLER T
o OF ALL UNDERGROUND 1
o UTILITIES BEFORE
EXIST/Up MINIMAL EXCAVATING FOR
1 C�� coN T�P1 PROPOSED 15 in SYSTEM.
' J"I 45— - r / t PINE
16 in -
�� 4' / OAK 1 -- i42
_�-
12 f 2 — PROPOSED SOIL
\ OAK ABSORPTION
44 i SYSTEM
L ,0'r a -SEE DETAIL
A ON BACK
AREA = 15132 sf+—
Ln
L AND COURT PLAN 31043—A EXISTING LEACH
�- PIT TO BE PUMPED
Assn MAP 168 Pcr, 21
4s� AND FILLED.
Q
Q d 100.36 ft
G�L� A N
SCALE: 1 in = 20 f t
GARB 0 20 40
G R
OT O IO 20
OWED
PRINT ON 11 x 17 in
PAPER FOR PROPER SCALE
OF M4�s P p Mgss
DAVID 9OyG � DAVID 9CyG
COUGHANOWR !11;COUGHANOWR; -
No. 1093 ! No. 461 oTt� SEWAGE DISPOSAL
SYSTEM PLAN
S G► so/ P V�� O�PPNStABIE GIS 04T� _1-O SERVE LY,I S T ING OWL-' ING
ELEVATION .� _ _
JUDITH & ACACIO
T 47.21 BARRIGAS
0� OF P� A r OWNER(F) OF RFr ORO
Fo�No �, .PES 157 LUBERT MILL RD
y
155 Geo Ryder Rd S CENMTERVILLE, MA
t�Ra�-t >,n nrn��P s>
Chatham. MA 02633
DavidcouCDHotmaiLcom OAit-: MAY 28. 2018
508 364-0894 E 1i2 JOt3:, ETE-4291
J(RiIDN
p DATE: MAY 25, 2018
SUL>,- TESTLOG OG'" PERC# 15680' - D��.S•I � � �I
SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE 0461 DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD
WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT.
NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS
TEST PIT PERC AT 58 in - 3 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT. INSTALL
INCHES HORIZON TEXTURE (MUNSELU MOTTLES NEW 1500 GALLON SEPTIC TANK.
42.20 0-4 O LOAM 10 YR 2/2 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW.
4-8 E LOAMY SAND 10 YR 4/1 NONE FRIABLE SOIL ABSORBTION SYSTEM:
8-12 A SANDY LOAM 10.YR 4/4 NONE FRIABLE THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE
39.03 12-38 B LOAMY SAND 10 YR 5/6 NONE LOOSE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES
38-138 C MEDIUM SAND 10 YR 6/4 NONE LOOSE PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT.
30.70 THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY
TEST PIT 2 NO GROUNDWATER ENCOUNTERED 3 MIN/INCH IN C SOILS DEPICTED BELOW CAN LEACH:
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER BOTTOM AREA = (24 x 12.5) = 300 sq. ft.
INCHES HORIZON TEXTURE (MUNSELU MOTTLES
42.00 SIDEWALL AREA = (24+24+12.5+12.5)x2 =146 so. ft.
0-4 O LOAM 10 YR 3/2 NONE FRIABLE TOTAL AREA = 446 sq. ft.
4-6 E LOAMY SAND 10 YR 4/1 NONE FRIABLE FLOW CAPACITY = 0.74 x 446 = 330.04 gal/day
6-10 A SANDY LOAM 10 YR 4/4 NONE FRIABLE
10-36 B LOAMY SAND 10 YR 5/6 NONE LOOSE INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED 1
39.00 BELOW. FLOW CAPACITY = 330.04 gal/dog WHICH EXCEEDS
31.00 36-132 c MEDIUM SAND 10 YR 5/4 NONE LOOSE THE 330 gal/day REQUIRED FOR A THREE BEDROOM DESIGN.
GROUNDWATER AT EL = 12 PER GIS MAP
{1000 ���1 LLON��S�PTIC T,gNK�
TANK TO BE PUMPED DRY AT TIME OF INSTALLATION T(O N
AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL
NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE.
REPLACE WITH A NEW DRYWELL 24.0 ft
I in 1500 GALLON TANK UNIT �—
TAPER IF CRACKED. ROTTED : 'co"
= OR OTHERWISE c,
-�;- COMPROMISED. w
LO
41
00 m
co
� I
NOT � � (n
STONE
_ q TO I3.5 {t & 5 {l 3 5 ft3 :.
SCALE - - ---f--- --- --I---- - -----' -------`---
�o SOO GALLON DRYWELL
8 6 --_ DIMENSIONS & DETAIL
ft in — - / p ® INSTALL ONE INSPECTION
RISER TO WITHIN THREE
INCHES OF FINAL GRADE
INLET OUTLET USE &"INDICATE LOCATION
COVER COVER H-)O ON AS-BUILT
UNI T
3 /N DROP 33
FLOW LINE
--► 0 i in
FROM =
BUILDING 10 in = gin, 14 TO
D-BOX /--_-- - - /
48 in 5�
LIQUID GA Se �. 102 ;, --__r/ -
LEVEL• BAFFLES
CROSS SECTION VIEW
INSTALL AN APPROVED GEOTEXTILE
6 in STONE BASE IF NEW FABRIC OVER STONE
SEPARATION BETWEEN INLET & OUTLET
TEES NO LESS THAN LIQUID DEPTH 1 1_. ■ ■r1s
CROSS SECTION VIEW 28 3/4 in TO 24 in ■ = 3/4 in TO sx
In ( 1 112 in GRAVEL i;. DEPTHrIVE. 1-112 )n GRAVEL t
------- .. --{ ----- ------ +-- -
46 in 58 in 46 in
DISTRIBUTION BOX 150 in
DIMENSIONSi• • RUN LEVEL
D DETAIL FOR 2 FEET BEFORE '•WN -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE
N STARTING WORK.
-, -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM
ldi�WOOO REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC
12 in CODE (310 CMR 15).
c MIN -INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND
T UTILITIES BEFORE EXCAVATING FOR SYSTEM.
Lr) —� -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION
FROM E OF LOW FLOW FIXTURES & APPLIANCES. AND PERIODIC
j N TANK (� TO PUMPING OF THE SEPTIC TANK.
O c; ^ SAS S -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING.
DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM.
6 in STONE BASE
21 ,� 2� CROSS SECTION VIEW
[[� Oo p G Oo [ E
TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE 4 in SCH. 40 PVC
EL = 47.21 +— 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN
42.25
I 1 II I I /j1 I II 1 1 I, rIl 1 II
DD—BO C 3'
E=TNG
USE H-20 39.25 M A X
EXISTING 1000 (GALLO PRECASTy .
0 0 39.50 y ',,.( -..h DRYWELL {
��p��� �Q�� bin ,� 38.63
EXISTING REFER TO DETAIL BOX 0 STONE SODL A°, BSORPTT ON
38 841
a BASE 38.50 ����C[�I�MI —REFER TO
Ln
EXISTING rdPxr6 in STONE BASE IF NEW�r�, O
_� 25 ft 5-12 ft� DETAIL BOX
> --- -" NO GROUNDWATER BELOW
36.50 MOTTLING OBSERVED T 30.70
GROUNDWATER AT EL = 12 PER GIS MAP
SEWAGE DISPOSAL SYSTEM PLAN 11,57 LUMBERT MILL RD CENTERVILLE, MA MAY 28, 2018 ETE-4291 PG 2/2