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Home My WebLink About0312 NOTTINGHAM DRIVE - Health 312 Nottingham Drive Centeiville A= 171 042 No. H1630R UPC 10259 smead.com • Made in USA m TOWN OF BARNSTABLE ;':O,CAI ON VILLAGE ell ultu- ASSESSOR'S MAP&PARCELy'ya- ~I RS NAME&PHONE NOe `V NL k-Q&o r1J 1 n /o I?'7 Cj SEPTIC TANK CAPACITY !O oO LEACHING FACILITY: (type)"- (size) J000 NO.OF BEDROOMS OWNER Gm'M-5 PERMIT DATE: Cam- -DATE: t) Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY I Nottingham Drive 4J 42 I 34 25 ...:... .:...::::.....:::.:..:...:..................... ,7 5 30 25 Lot- TOWN OF BARNSTABLE LOCATION 3C '7 � �QSEWAGE # VILLAGE ASSESSOR'S MAP & LOT ]/ z J INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1000 LEACHING FACILITY:(type) t (size) NO. OF BEDROOMS,>PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �I A �� L SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. G ❑Agent ■ Print your name and address on the reverse XR d V Addressee so that we can return the card to you. B. Received by(Printed Name) I C. Date of Delivery ■ Attach this card to the back of the mailpiece, -j L V '1 A or on the front if space permits. D. Is delivery address different from item 1? 0 Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No 3 l2 r�L i C �r� c a k 1\e 'oA A OZIo 3 C 3. Service Type 19 Certified Mall ❑Express Mail O Registered 13 Return Reoeipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?y/Pft Fee) ❑Yes 2. Article Number i 17 0 0 6 '0.810 0 0 0 0' ,3 5 2 5 3114; ;j l (rmnsferrfrom service laheq j PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE ["I R,.OVI 1D lam:N C E I 1 e,& P iid • Sender: Please pdnt your name, address, and ZIP+4-firs Is box I I I � I I I I Town of Barnstable I E Health Division 200 Main Street Hyannis,MA 026011 I I Certified Mail#7006 0810 0000 3524 3114 Town of Barnstable Regulatory ServicesIARN� ABLE, f` 1 MASS. g Thomas F. Geiler, Director Public Health Division 16 - 3 ' - o Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 16, 2007 Netto Silva 312 Nottingham Drive Centerville,MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 312 Nottingham Drive, Centerville was inspected on October 12, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by the Town of Barnstable. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 & 310 CMR 15.00—,Sanitary Drainage System Required. Observed six bedrooms within home when septic capacity is only for three bedrooms. Furthermore, home is within the Zone of Contribution which only allows for three bedrooms. Three (3) were observed on main floor of home and(3) were observed in the basement. 105 CMR 410.450-Means of Egress. Observed mattresses within two of the three bedrooms within basement. Both said rooms are lacking second means of egress. NOTE: SLEEPING NOT PERMITTED IN THESE ROOMS. MATRESES TO BE REMOVE IMEDITATLY. The following violations of the Town of Barnstable Code were observed: Prohibition. Only(4) four cars are allowed to be parked at this home overnight. QAOrder letters\Housing violations\312 nottingham centerville.doc You are directed to rr h correct the violations listed above within fourteen (14) days of your receipt of this notice by removing bedrooms. (This must be done by removing bedroom door and making opening into room 5' wide and casing openings.) You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ZAMcKean.,HR.S., OF E BOARD OF HEALTH homas C O Director of Public Health Town of Barnstable Q:\Order letters\Housing violations\312 nottingham centerville.doc Citizen Web Request Page 1 of 3 TOWN'loconne"t Citizen Rt-1-aqwest Management € k'p rcc IE quests Request Information Request ID: 21334 . Created: 10/1/2007 11:59:55 AM Status: Assigned To Staff Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: Chapter 170 : Housing Overcrowding - Night Only edit ..............-_......_._..............................._............._._.._....._..._._....... ....................._._.._..... Estimated 10/ 2007 Change Estimated Se October 2007 Nov Completion 14 15 16 17 18 19 20 21 22 23 24 25 126 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 --_ _ ...._._.........._....._._._.___.._........._..............................._....._......................_..........__..._..___................_..................._...........-...._......._..................................._......._........................ Created By: Wadlington, Ellen Priority: Medium edit Health Office Citation. Numbers: edit equetor Information Requestor .. _.............._._...._............. Request Parcel Number i Map: 171 Block: 0427 Lot: 000 ' Overcrowding, at night there are at least five (5)cars. There are at least five (5) adults living in house, Parcel Lookup commercial vehicles parked on lot and lots of ladders and other work- : related materials. http://issg12/intemalwrs/WRequest.aspx?ID=21334 10/12/2007 Citizen Web Request Page 2 of 3 Email: Edit_Re..q..uestor._Information. Track Request Progress i Request Work History: . ` Internal Note History: Entered on 10/5/2007 7:46:03 AM System entry on 10/1/2007 11:59:55 AM: by O'Connell,Timothy I Assigned to O'Connell,Timothy On 10-4-07 went to said location and j knocked on door but had no answer. There has j been a building permit to finish basement into gym and library?Talked with building inspector about project. JL from building said it did not j appear to be bedrooms in.basement but you never know. Will stop by property again. i update delete Enter work progress: Enter internal note: (dewed by everybody) (Viewed internally only) i 1 i i i l £ I ,r i I 3 f e $j 1 �S ell Chectc�� i �' Add document or image link: y Browse '�T° You can also tyre in a folder name to see evetythi g in the foider Current Links: Time worked on request 0.50 Response time: 24 00 Time entries are in hours, Exarnples of tirne entries: 125, 0,5, 0,75, 1, 3,5, 0,25, 0 0 Response spaonse t'irne: Measured from the creation date to your first actions on the r:equesi:. o not irt€'k.id£e r fights, 1�pekendSrs and holidays in response tsrr c formost dep artrnents. _ ......_......__........._.._.._..--....................._._..........................----..-........— ._.._........__............_._-..-.......-................-....-....................._................__........_......_._......................_-_... http://issgl2/intemalwrs/WRequest.aspx?ID=21334 10/12/2007 Parcel Detail Page 1 of 3 _. � ' MAW. x s L:>c'jed In As: Parcellnfo Parcel,ID 171-042 Develo LotLOT 23 _... Lot Location 1j312 NOTTINGHAM DRIVE Pri Frontage j 125 Sec Road Sec; i ...__..�.�..�.._.. _._...._ .._._.... ....__.,_�. Frontage _._... ..........- ..------ . ----- ----..-- - ---------- Village CENTERVILLE Fire District'C-O-MM Sewer Acct= Road Index'1 104 ,.;ram . . Asbuilt Septic Scan: ¢ Interactive 171.042 I Map . �.` tx ......._.. Owner Info owner iDOHERTY JAMES R Co-owner %SILVA, RENATA V _......... ___......... ___ ......... _. _..... .... Streeti '312 NOTTINGHAM DR Street2 city CENTERVILLE State:,MA zip Q2632 Country Land Info ......... . ....... .__.. .............. ._... ...... .. .. Acres;0.36._.._.. - Use Single Fam MD 01 zoning RC _ ._ - Nghbd0105 Topography Level Road Paved Utilities;Public Water,Gas,Septic Location Construction Info Building I of I _., Year _....-. .,. Roof . ....... _ . Ext Built€1972 struct Gable/Hip wan Wood Shingle Effect _.._._. _. _. _ �.._. ofj Area 12435 Co -'_ Asph/F GIs/Cm p Type None Be Style Ranch Wall Dr wall Rooms 3 Bedrooms Model'Residential Int " " Bath 2 Full Floor Rooms Heat Total Grade Average Type,Hot Water Rooms 7 RoOlT1S http://issgl/Intranet/propdata/ParcelDetail.aspx?ID=11522 10/12/2007 Parcel Detail Page 2 of 3 TO la 10" � ...--- _._..,- y .. Heat. _.. _...., .._-_ . _... Found- ,_... � Stories 1 Sto _ . , Fuel Gas ation Typical _ Permit History .. ........_...... . ......... . ........ _ ........... ........ .................. _.._. .. _...__ _. .............._.......... _ _..__.... Issue Date Purpose Permit Arriount Insp Date Comm 2/25/2007 Finish Basemen 200701058 $10,000 5/13/2003 Re-roofing 68713 $5,485 10/21/2003 12:00:00 AM 9/1/1990 B33975 $25,000 1/15/1991 12:00:00 AM CE SU Visit History Date Who Purpose 10/21/2003 12:00:00 AM Martin Flynn Drive by inspection only 1/20/2000 12:00:00 AM Paul Talbot Meas/Listed Sales History ..._..... _. -------- ...---__------ _ ............ Line Sale Date downer BooklPage Sale P 1 12/14/2006 DOHERTY, JAMES R 21608/273 2 8/1/2005 DOHERTY, JAMES R 20108/217 3 11/14/2001 DOHERTY, PATRICIAA 14441/291 4 10/15/1983 DOHERTY, PAUL F & PATRICIA A 3899/023 5 1/4/2007 SILVA, RENATA V 21673/37 ; - Assessment History _... . Save# Year Building Value XF Value OB Value P'Land Value Total Pare( 1 2007 $202,000 $5,200 $400 $148,400 2 2006 $184,300 $5,200 $400 $150,500 3 2005 $167,600 $5,100 $400 $136,400 ; 4 2004 $136,100 $5,100 $500 $115,900 5 2003 $123,700 $5,100 $500 $45,100 ; 6 2002 $123,700 $5,100 $500 $45,100 7 2001 $123,700 $5,100 $500 $45,100 8 2000 $90,900 $2,300 $200 $30,600 9 1999 $90,900 $2,300 $200 $30,600 10 1998 $90,900 $2,300 $200 $30,600 http://issgl/Intranet/propdata/ParcelDetail.aspx?ID=11522 10/12/2007 AsBuilt Page 1 of 1 I TOWN OF BARNSTABLE LOCATION a wl, g. OVOr VILLAGE ASSESSOR'S MAP&PARCEL INNMQaeZS NAME&PHONE NOS' SEPTIC TANK CAPACITY tO 00 LEACHING FACILITY:(type) t (size) NO.OF BEDROOMS 3 j OWNER � PERMIT DATE: •.,.- -- i COiGDATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and.Leachin Facility If an PP Y g ty( y wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching-facility) FURNISHED BY Nottingham Drive 40 42 34 �r ' .:G:••ti•: ':>fi23r q;;ii�22:>1�Y`iA?:6%\ 17 5 25 s http://issql/intranet/propdata/prebuilt.aspx?mappar=171042&seq=1 10/12/2007 i COMMONWEALTH OF MASSACH USETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 4 d DEPARTMENT OF ENVIRONMENTAL PROTECTION t `W V W TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 71 Property Address: 312 Nottingham Drive L� ndry System Centerville MA 02632 Owner's Name: James Doherty 041107 Owner's Address: 112 Heritage Drive Fast Falmouth MA 02536 Date of Inspection: October 10,2006 Job#06-277 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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 experienc,: 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: i Passes ��P •;��'� __ Conditionally Passes __ Needs Further Evaluation by the L al Approving Authority _ P M IC :. Fails L Inspector's Signature: - Date: 10/10/06 �r F1��'oP�.�� p��IFS s NSPEG;\0`� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Leaching pit had previously failed,however is functioning properly for laundry only. Tank is not in need of`pumping at this time. ****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 1 I OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:312 Nottingham Drive,Centerville Laundry System Owner: James Doherty Date of Inspection: October 10,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank:is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of I lealth): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with,approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page-3 of 11 OFFICIAL,INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBST IRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A + CERTIFICATION(continued) Property Address:312 Nottingham Drive,Centerville Laundry System Owner: James Doherty Date of Inspection: October 10,2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not;functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for 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 must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:312 Nottingham Drive,Centerville Laundry System Owner: James Doherty Date of Inspection: October 10,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X Discharge;or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow —X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X— 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 must be attached to this forma _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 fails,. 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:312 Nottingham Drive,Centerville Laundry System Owner: James Doherty Date of Inspection: October 10,2006 Check if the followint;have been done.You must indicate"yes"or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health _ _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J Page 6 of 1 I OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:312 Nottingham Drive,Centerville Laundry System Owner: James Doherty Date of Inspection: October 10,2006 FLOW CONDITIONS RESICDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): Yes [if yes separate inspection.required] Laundry system inspected(yes or no): Yes Seasonal use:(yes or no):No Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INIDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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 Other(describe): Approximate age of all components,date installed(if known)and source of information: Early 1970's Were sewage odors detected when arriving at the site(yes or no): No 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:312 Nottingham Drive,Centerville Laundry System Owner: James Doherty Date of Inspection: October 10,2006 BUILDING SEWER'.: XX (locate on site plan) Depth below grade: .I' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XIX (locate on site plan) Depth below grade: 6" Material of construction:_X_concrete_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:8.5'long;x 5.2'wide—1000 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimension,3 determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Liouid level slirlhtly below outlet invert(4-511due to evaporation Tees are intact and clear. GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAI.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:3,12 Nottingham Drive,Centerville Laundry System Owner: James Doherty Date of Inspection: October 10,2006 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade:__ Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no):._ Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i Page 9 of 11 OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:342 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. _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.): Leaching pit had Previously failed under full flow of entire house Pit appears to be functioning for laundry only. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): -Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks`or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Nottingham Drive Water Service 49 42 34 25 17 5 30 25 r "Page I I of I I OFFICIAIL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 SITE EXAM Slope Nome Surface water Nome Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from:iystem design plans on record-If checked,date of design plan reviewed: _Observed site(abutting property/observation hole within 150 feet of SAS) _Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.35 and topo map shows property at el.60. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION d t OW V 5� 171 - 00- TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 312 Nottingham Drive Centerville MA 02632 Owner's Name: James Doherty Owner's Address: 112 Heritage Drive t East Falmouth MA 02536 Date of Inspection: October 10,2006 Job#06-277 Name of Inspector: PAI'RICK M.O'CONNELL { k Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 c Telephone Number: 508-428-1779 CERTIFICATION STATEMENT r- r I certify that I have personally inspected the sewage disposal system at this address and that the informat on reported below is true,accurate and complete as of the time of the inspection.The inspection was performed base on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP... a roved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: �� OF PP Y p p `` , _—X— Passes Conditionally Passes MIC :�G� Needs Further Evalu tion by the Local proving Authority O1 :m Fails yr ;c� 1 'C ELF co Inspector's Signature: Date: 10/10/06 The system inspector shall submit a co of this inspection s l�`;P�G``\\�`� copy p report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Leaching pit has never had more than one foot of standing water.Tank is not in need of pumping at this time. ****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:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced . ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: r, Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:312 Nottingham Drive,Centerville' Owner: James Doherty Date of Inspection: October 10,2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. — The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for 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 must be attached to this form. 3. Other: ti Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or. cesspool — _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X— Any portion of a cesspool or privy is within a Zone I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ 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 must be attached to this form.) _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems:. To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone If of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _ _X_ Has the system received normal flows in the previous two week period? — _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ — Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ — Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X _ Were all system components,excluding the SAS, located on site? _X — Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information.For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): Yes [if yes separate inspection required] Laundry system inspected(yes or no): Yes Seasonal use:(yes or no):No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 178,000 gal.=243 gpd. Sump pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL a Type of establishment: Design flow(based on 310 CM 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X 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 _Other(describe): Approximate age of all components,date installed(if known)and source of information: Compliance date: 11/5/92 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron X40 PVC_other(explain): Distance from private water supply well—or—suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 6" Material of construction:_X_concrete_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:8.5'long x 5.2'wide—1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:28" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Liquid level slightly below outlet invert(2-3")due to evaaoration Tees are intact and clear. GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): • Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction:—concrete—metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: ' gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No solids or high stains Present liquid level at bottom of single outlet pine PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X leaching pits,number: One 6x6 pit. _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.): Leaching pit has no standing water and has never had more than one foot of standing water. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): • Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. Nottingham Drive Water Service 49 42 34 25 17 5 30 25 • Page I l of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:312 Nottingham Drive,Centerville Owner: James Doherty Date of Inspection: October 10,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site-(abutting property/observation hole within 150 feet of SAS) _Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.35 and topo map shows property at el.60. %—rn C.STIMATE Proposed Layout for: a a c a lls - Ab'DRESS * k �� d�� & '�h"uD� r✓`(c +Y�� r' fit'`y4'��t��' 5 PHQNE NQ ESTIMATOR DATE Scale 1/4" = C� 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1,8 19 20 21, 22 23 24. 25 26 27 28 29 30 1 I 2 3 4 5 U 6 7 ) 9 10 DI 11 12 13 14 � I 15IL 16 17 18 19 20 ++tit 21 22 23 24 25 Notes al s DC8511 edarns MADE IN USA / Oyu Fim$.A...30.00� THE COMMONWEALTH OF MASSACHUSETTS ROAR® OF HEALTH TOWN OF BARNSTABLE Avv trat@Tur r iipnsal Works Tomitrnrtiun Errant Application is hereby made for a Permit to Construct ( ) or Repair X(XX) an Individual Sewage Disposal System at: 312 Nottingham Drive Centerville ..:............-................................................................................ ................_....•---------.......--••••-•-•--•---..........--•---..........................-- Doherty Location-Address or Lot No. ........................................................................... •••-••.............•-•••---...............-•--...•..... W J.P.Ma e o mb e r Jr,Owner Address Installer Address d Type of Building Size Lot............................Sq. feet V Dwellin No. of Bedrooms ...............................Ex Expansion Attic�_l p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons...............-----........ Showers ( ) — Cafeteria ( ) d Other fixtures ---------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity.....---....gallons Length................ Width................ Diameter--.--........... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.............--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.-----........---... Depth to ground water..---...---.--.......... 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---................. Depth to ground water........................ K .....-•----------------------•-----.........-----•-•---•......••-•••......-•-....- ---------------—----..... 0 Description of Soil............................................................................... ...................................................... .................................. v _Sand & Gravel . -•••••••-----•----•••-•-••-•••-•--•••--.....-••••-----•-•------------•---•-•-•------------•--•----------•••--•------------•----•---•-.._....----••----•--- w x ---•-----•----------------------------•-•-------•-•-------------------------------------•-•.••----•---•----•--•--------•---------------------------•-•----•-------•-------•••---•-••---..........••--- U Nature of Repairs or Alterations—Answer when applicable gallon tank -TO00---gaTS6h -pig. --------------------------------------------------•--•----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has ben ' sued by the b rd o ealth. Signed -, .. K.. .. - ....11�5�92 Dace Application Approved By ................. V � .. 1f." �r�e �� Application Disapproved for the following reasons- ---------------------------------------- -- ---- -- ------------------------------ -- ------ - ----------------- --------- ---------te---- ------------ PermitNo. --... .�......-...�-t -------- --------- Issued .......................�-e---- ----.......------.Da -- No.... Fss.A....30-.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �TOWN OF BARNSTABLE . ppliration for Uhiposa1 Works Cnnnstrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair rX4 an Individual Sewage Disposal System at: 322 Nottingham Drive Centerville ................_........... ---........ ------------------------------------. -_-•--•-------------------•-•---••----•---------•----------------•----•--•-----•---------------- Location-Address or Lot No. _Doherty' ....................... --------••••--•-•-••-• ...........__..---------....-•-------•------.._ ------........................................... W J.P.Ma e omb e r Jr,Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms.......... ....... ..........•-............Expansion Attic ( ) Garbage Grinder ( ) aOther Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) (Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 4.1 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a1 •-..................................................................................................•-----•-••-•-------------•-•-•---•------------••••••----- O -- Soil------------------------------------•-•----.....----------•--•-••-------....---•-----------------------•--------------------------------------------------.._.......---- V Description of Sand & Gravel ...-•-•-------------•--..-...---------••-------.....--•--..._.....-----------•-----------•---•-------•-----------------------•---------------••-------------. W ---•---•••••----......•--•---------•----------------------••-•--------••---•----•---••...-----•--•--------••-••---•----•---------------•----------••----------••-••-••----•----------•--•-•..._........ U Nature of Repairs or Alterations—Answer when applicable_________________________ ___________________________________________________________________ 1-1000 gallon tank 1-1000 gallon i ----------------------------------•--- ----------•••• --•-•----------••----•....-------••-------•-------_-----P Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has been issued by the board of. ealth. Signed ...,. ..7� / . //be�l ...... -..-... 11/5/92 Date �rl,-..-5 -.- � ^-� ----------------------------....................- ------ -- Application Approved By �f' ...�.,1 'Date Application Disapproved for the following reasons- ---- ------------ ------------------------------------------------------------------ ......................................... Dace PermitNo. ;.... ,. --� ...... Issued ........................................--- ----------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Te>rttftra e of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairedX(XXX) by J.P.Macomber Jr-. - ----------------------------------------- ------------------------------------------------------------------------------------............................................. Installer 3� Nottin-.hamDr Drive Centervilleat ... . ... ... --- . --------------------------------------------------------------------- ------------------------------------------------------ has been installed in accordance with the provisions of TITLE 5 +The State Environmental Code as described in the application for Disposal Works Construction Permit No- --------- ---- -----.47-V-2 dated ..---------.--.................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISGF�ACTORY. DATE............................ ...1... -�/- .. --./.- .----..............------- Inspector ...... �-._._ /- r � t„� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1� TOWN OF BARNSTABLE FEE...$ '--30-•--.-..00 -•--- • - ..... Disposal Workii Tomarnrlinrt amit Permission is hereby granted....... J.p.Macomber J r. ---------------- ----- to Construct ( ) or Repair (X ) an Individual Sewn a Disposal System at No... 12 Nottingham Drive Centerville . - - __ - Street as shown on the application for Disposal Works Construction Permit No.__ -•S��_ Dated.......................................... DATE.._...-•------�1--".--�---=..�.�._� .......-•------••-----------•--._ :_ .................•---•-------•--------•-•---•••••- - •--•................................ Board of Health . �.. FORM 36508 H088S 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION BIZ~ /j/GT%�h� c� n/�, SEWAGE # , VILLAGE ASSESSOR'S MAP & LOT h/ U L/ 4 INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY 4�_m/" liG LEACHING FACILITY:(type) ��% 7— (size) 4,zv4�2 - NO. OF BEDROOMS -3 -PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �. �� y.a.''; J #.� '� - r�.+:. ^.d� - �':;, :� �� e / � � � �� . � ,, �. _, - .