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Home My WebLink About0324 NOTTINGHAM DRIVE - Health WI324 N077INgliAll DR, CEN7ERVILLE �A- 171-043 - i , i No. 42141/3 ORA ESSELTE 10% TOWN OF BARNSTABLE LOCATION NEW GE# VILLAGE��o� �`�l ASS SSOR'S MAP&PARCEL -7 1— D�f INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �— LEACHING FACILITY:(type)�7 PA (size) /6®0 NO.OF BEDROOMS ,,1 D-)c: 6/\ OWNER Eti, PERMIT DATE: f J 3 I I 1 COMPLIANCE.DATE: 1 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 �A r 3.2 �3 s y O No. 9gl qLZ4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for MispoBal *pBtrm Construction i3ermit Application for a Permit to Construct( ) Repair(<Upgrade( ) Abandon( ) ❑Complete System Rfrdividual Components Location Address or Lot No.2 A,,A t j pk}%r,9 t,,c M Vr Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 0LI Installer's Name,Address,and Te.No. Designer's Name,Address,and Tel.No. l`�C, ,4oe�ti Type of uilding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) QP jpAr—t.Q czA�s5 r`a 11 I U f 3 (_0 i n�� !—k 1 U P a CDC 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. Signe Date l l 4 f Application Approved by Date Application Disapproved by Date for the,following reasons Permit No. — Date Issued - I No. �5.11q Fee l�� THE COMMONWEALTH OF MASSACHUSETTS Entered i eom ter: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYication for Disposal 6pstem Construction Vermit Application for Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. t./okl\r\ c k Or Assessor's Map/Parcel Installer's Name Address,and Tel.No. esigner's Name,Address and TeLNo' b Type of uilding: * Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) ' Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date las 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. �, f r Signe Date '�7� Application Approved by f ' Date Application Disapproved by Date for the following reasons Permit No. 73 Date Issued 72, --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS U �j Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by at rhas been constructed in accordance with the provisions of Title 5 d the for Disposal System Construction Permit dated W �T Installer Designer #bedrooms Approved design flow V gpd The issuance of this perm' I ha I not be construed as a guarantee that the system will ction es�gned. C Date � (q Inspector � 1 �J ----- ------------------------------------------------------------------------- [�NO. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS r3isposar *pstem Construction permit Permission is hereby granted to Construct( ) Repair lv ) Upgrade( ) Abandon System located at Nk o W,,� .,,�� 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 co pleted within three years of the date of this Qby f Date 19 Approved � i AsBuilt Page l of 1 LDT F A TOWN ON BARNSTA13LE LOCATION_`5-9 y lV0771/791 yryJ SEWAGE# �,/- VRI AGE Vr // ASSESSOR'S MAP&LO INSTALLER'S NAME&PHONE NO.�- kh t9copn rem S 41 J l7C SEPTIC TANK CAPACITY 1"62 LEACHING FACILITY: (type)�&9 rL 5 (size) /G a U NO.OF BEDROOMS ,3 OR OWNER rya Z�w�. ' PERMITDATE:__ �^ ! COMPLIANCE DATE: " �lx;� Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 o Nc� http://issg12/intranet/propdata/prebuilt.aspx?mappar=171043&seq=1 8/23/2019 Town of Barnstable Regulatory Services Barnstable CF ZNE Tp� c Thomas F. Geiler,Director A"mericaCity Public Health Division I I BARNSTABLE, 9 MASS. Thomas McKean,Director 200� 200 Main Street BD MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 1, 2010 Dean E. & Olga L. Smith 28 Waters Edge Time:Inspector S Marstons Mills, MA. 02648 Meet Val/ RE: Assessors (map-parcel) 171-043 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register in accordance with Chapter 170. of the Town of Barnstable Code with the Town of Barnstable Health Division. According to our records, you own the rental property at 324 Nottingham Drive, Centerville 02632. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2010 fees included. Please contact me to schedule inspection of the property as soon as possible. If there are tenants presently occupying the property please provide the contact information being sure to include a daytime phone number for all tenants. For your use an occupant's permission form has been included to allow for inspections to be performed in the tenant's absence. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of $100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4072. Thank you in advance for your cooperation. Teresa Wright Division Assistant Health Division Direct#508-862-4072 °i 1'M• 17:alth Master Detail Page 1 of 1 e r. Health Master Logged In As: TOWN\wrightt Health Master Detail Friday, Octo Application Center Parcel Lookup Parcel Septic Perc Well Fuel Tank Parcel: 171-043 Location: 324 NOTTINGHAM DRIVE, CENTERVILLE Owner: SMITH, DEAN E &OLGA L Business name:' �- 1 Business phone:'— Rental property: F Deed restricted: C Number of bedrooms :, 01 J Contaminant released: 1-1 Fuel storage tank permit: Save Parcel Changes I Return to Lookup Parcel Info Parcel ID: 171-043 Developer lot: LOT 24 Location:324 NOTTINGHAM DRIVE Primary frontage: 100 Secondary road: Secondary frontage: Village:CENTERVILLE Fire district:C-O-MM Sewer acct: Road index: 1104 Asbuilt Septic Scan: 171043 1 Interactive map kt: Town zone of contribution:GP (Groundwater Protection Overlay District) State zone of contribution:IN Owner Info Owner: SMITH, DEAN E & OLGA L Co-Owner: Streets: 28 WATERS EDGE Street2: City: MARSTONS MILLS State: MA Zip: 02648 Deed date: 2/3/2003 Deed reference: 16339/107 Land Info Acres: 0.38 Use: Single Fam MDL-01 Zoning: RC Neighborhood: Topography: Level Road: Paved Utilities: Public Water,Gas,Septic Location: Construction Info Building No Year Built Gross Area Living Area Bedrooms Bathrooms 1 1980 3568 1840 13 Bedrooms2 Full + 1H Buildings value:$162,600.00 Extra features: $3,300.00 Land value: $106,400.00 Vw�- ,t�► Ce ��a w�- �� 1 i-}a�l -t a sIce http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=171043 10/1/2010 Er . , tr r 0 Postage $ 0 Q Certified Fee p Return Receipt Fee Postrsna ILcI (Endorsement Required) Q! Here 7 O Restricted Delivery Fee O� (Endorsement Required) ^rq Total Postage&Fees $ \� Lrl \ i� .a t^� OSent To r%- - -------------`-'-----------------------1----------------------------------- Street,Apt.No.; or PO Box No. CP V ""A 1 t� 6�D Q 6, -----.--.._. C��p.{state. IP+4 -p.. p � ` `�S��S lwJ " ` (3alYj JR PS Form :ob 00 Certified Mail Provides: o A mailing receipt (esi-ed)moz dccr'cTer wjod Sd ® A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. ® Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. • For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. s For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". • If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. SENE ER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sig e item 4 if Restricted Delivery is desired. P Agent ■ Print your name and address on the reverse X ' 20 Addressee so that we can return the card to you. B. eived b (Printed Name) C. a of D ivery ■ Attach this card to the back of the mailpiece, f \ ' or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Dean E. & Olga L. Smith 28 Waters Edge 3. Service Type I Marstons Mills, MA. 02648 EO�CertifledMail D Express Mail ❑Registered B-Retum Receipt for Merchandise 0 Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yds 2. Article Number t 1 t 10 0 0 0` 019.O 119 7 7 911 (transfer from service label) ,11111117001511 ,1160 PS Form 3811,Februay 2004 Domestic Return Receipt 102595-02-M-1546 UNITED STATES POSTAL SERVICE ,,Flrg ,tag.Mail -Rostage-&'fees-Paid Sender: Please print your name, address", an-d21P-+*Jn-ffiis Town of Barnstable Public Health Department 200 Main Street Hyannis, MA. 02601 W.Dean Smith I 324 Nottingham Dr. t '? Centerville,MA 02632 a ' i Iled'°'as., p L �y. D w d F' ��N.S?i4 r3 e� i 1 IVMAlxll5 01,4 0260I Wa c,H•�"4 i L' 1 2'=�ist� �te'ess�s�r�:f3�rtseat��trt:��ese� :istr�.e.�s�ss+� sass:�s�s� [fit if f !it if ; SSfill f if f fii ! ! f ii?FF ii ��' ' Existing leach pit r.. New distribution box Existing 1000 tank C� C a 4 324 Nottingham Drive Centerville CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, J.P.Macomber Jr. , hereby certify that the application for disposal works construction permit signed by me dated c � , concerning the property located at 324 Nottingham Drive Centerville meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: 9/5/9 5 LICEN SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. �\ o T - J -23 80 / f 9 / LOT -/OOA/T -/O � G2O DO SF� -3 B�-Dl2ootil5 SEPTIC 5 y5 TE�9 COv�/S T2 UG T%ON S.�IA L L- CpNF�2M TO MA SS - DES/G/v FL 0 w .jam CG GAL o+�vtif ten/rc� Cook Ti rL L y � 5!s Y '�` 7 7:_ <.:=:.�`;.��; c L E,4 C Al . 2 A TE 7-A >z�0UL,4 7-/On/S tLO # TOWN OF BARNSTABLE ' LOCATION �02 61D7721r2AIAM SEWAGE # •1,f- 74— -C;MrLL--LAGS. r- eii ASSESSOR'S MAP &LOT/I —e, -3 INSTALLER'S NAME&PHONE NO.�I �Y)I DL'Yl��s� .S O M e_ SEPTIC TANK CAPACITY '2 LEACHING FACII.TTY: (type) Q2 (5 (size) /400 NO.OF BEDROOMS OR OWNER PERMITDATE: �' ' 6 "' -COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 _ ,� _. 1 \ '� �/ � \ ,��, ,. � � � �'i� `�' / ' �� a / � a� �Lt� �� o ,��``J 171 0 No........ .5• Fms......$....3 0.-.0.0 THE COMMONWEALTH OF MASSACHUSETTS � BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinit fnr Dinipwiu1 lVarlm Ton,51rur#inn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair YX)D an Individual Sewage Disposal System at: ..................32l-..N.a.t.Lj ngham-._Dxi V e----C.exi term i l le..------------•------•----••-----------••---•-------•--•••..................................Locatcon-:\ddress or Lot No. Grey- -------------------••-......--••------•----•-----•- Owner Address -----------------JI a.E..Ma c Qahex---JIx....................................... ------------------------------------------------------- Installer Address Type of Building Size Lot............................Sq. feet -, DwellingYX No. of Bedrooms--------3_------------------------------Expansion Attic (NO) Garbage Grinder (N0) aOther—Type of Building ---RONE------_------- No. of persons..----3------------------- Showers ( ) — Cafeteria ( ) Other fixtures . ............................................................ W Design Flow---------55--------------_-.--__-_--..gallons per person per day. Total daily flow..-.33-0--.-..-_-_---..---.-.-.,------gallons. WSeptic Tanta a—Liquid capa6tyl.0-0.0-gallons Length-a i-6!!--:- Width_4._!.1.Q-!l. Diameter---------------- Depth_rj.L7!!..... 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........................................ 04 Test Pit No. I----------------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...-------..--_-........ Poi ------------------ ------------------------• ------------------...•----•-----...---•----...._..........-•-----•---•---......_•--•-....-••---..__...---•--... 0 Description of Soil._3.!.---Laam....&...Slab.s.Qil_.-..31.=.7.-'----Re.dium... .a.axee...s.�nd...w._i-t -_-I lit ---•--••--• vgr.a ze1-� ..7.!.-.1� ' Me_ilium•-•.Q.ax.se...---white---aand.. w x -------- --------------------------------------------------------------- - V Nature of Repairs or Alterations—Answer when applicable.-.Addinggallon. lea.chix�g 1�it tQ en...e_x.�..st�.ag..-tank.-&-- Pit.----�-.-D-Box........................ 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 board of health. Signed .. / - ------- ---------9/.5..1..9-5.--------- Dare ApplicationApproved By ...................... ..... ... .. . .......r..... ----------------------------- ------------------------ ... e Application.Disapproved for the following reafons: -------------------------------------------------------------------......................................................... Permit No. .............. .�./..?/.3................. Issued .. - - ...�5 oa e Dace LJ ,> o. ( Rs.............................. N :...... FI THE COMMONWEALTH OF: MASSACHUSETTS� BOARD OF HEALTH TOWN OF BARNSTABLE Xpli iratinn for Eli-tipmial Work,g Tomitrnr#ion ramit Application is hereby made. for a Permit to Construct ( ) or Repair )(X)� an Individual Sewage Disposal System at _e ................32-lt---1-0-ti i-n-9118_1r+...Drime..G-emla ille Location-Address or Lot No. .................Gx_G'•a!7�m................................... Owner Address ............................••---••-•------• .........•................................ Installer Address d Type of Building Size Lot............................Sq. feet Dwellings_'_ No. of Bedroom ��`.3---------------------------------Expansion Attic (NO) Garbage Grinder (140) per, Other—Type of Building .............. No. of persons------ _..---------------- Showers a i -- y ( ) — Cafeteria ( ) Other fixtures ....: --- ••-----------------------•- W Design Flow._ ......5.5_____: gallons per person per day. Total daily flow_._330____-_-•---••-----•---•-•-------gallons. WSeptic Tanl�--L-iqu d capa6tyl_0_00galIons Length_a1_61!..__ Width-l► 1-0-!!- Diameter-_._---------------- Depth.!_V!.__.. x Disposal Trench,No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pi4b--.-___-..-.__-_- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation, Test 't/ o.st;Result \Test Pit�r 11 s Performed by-------------------------------------------------------------------------- Date........................................ 0-1 �l________________minutes per inch Depth of Test Pit-_-._..___---___- Depth to ground water........................ fi Test-Pit No. 2.........Z_:.aminutes per inch Depth of Test Pit_________________- Depth to ground water........................ Description of Sois------- O.M .__.u.- 3- 7- Med3.uC ah1 htv w _-- .................ora ? ..,_.. ....%arwh t •_. and.W U Nature of Repairs or Alterations—Answer when applicable.--Adding---An__additional -1.000 gallon ......----------.�..e&ek>��...p�t-. t,o...:a.n.-ex �t3n�__tank__R� _pit. � D-Box .....-•-......_. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with a 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 board of health. '. nn Signed .....lam- -., - - z--- ---------------------- ---------9l.5/.9.5 ., ,:.. Dace ---:...... Application.Approved BY �� ---.- -----.--- ------------- ... 1n Application Disapproved for the following reasons: .. ... . .... ----_-----._--.-------_---_-_--------_----_ Permit No. �.�----- ��3_... . ....--.. Issued -_------------ - ---- ..... --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C ertif ra e of Compliance t THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by -------_-- tT.,..g.?�!^cc�m�ae ----Jr-.------------------------------------------ --- ----- --- ----------------------__ -------. _ ---------------------------------........ at .-----------3.2/+. Vcttingham Drive CenterIMallr e. � _..-......._... -----------------------------------------------------------------..----- has been installed.in accordance with the provisions of TITLE 5 of The State Environmental Cod as escribed in the application for. isposal Works Construction Permit No. -..P,�`�L-.-J..?1; .._._....-.- dated .---��....;21Xr.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------') , ..... ---------------- Inspec :- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE $ , No.._1..:�:�a..�+L-a FEE- 3p --.......--• 0p-•---...... �i��a�ttl vrk,� �nat,�tr�tr#i.�n �rrntif Permission is hereby ---------------------------------------------------------------------------------• ........ to Construct ,( ) o R p4irRVa Iridividu 1 Sewa e V posal System :2f+ ...ot��.n ham nDrlve �snte�vi....I.a atNo. •. ----- -•-•-.. •. -- -••-•---..... ----•------------- Street ,r ` as shown on the application for Disposal Works Construction,Permit N .!'_Dated....... � ._.._.....: --------------------------- --/ ------ ....................................... Board/of Health DATE--------------- --------------------------------------------------------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 0�13 DATE: 3.1"'3/°5 PROPERTY ADI:DRESS.:_'�24 Na.ttiinci.ham Dl Lve [WISNIM1.40 WAQL ad3a H11113H Cen.te/"vi..L.Pe l'1a< 6 966T fi Z and r�26 3? On the above date, I inspected the septic system at the above address. This system consists of the following: 1 1-1000 ya'e-flon. .6ept is ta-ak.. 2. 1 -1000 'gaeion. ez2ch.4_'n-1 /?jL. Based on my Ins.nection, I certify the following conditions: �3 cc t: .tl_'n_ vp �e./� ic. �y,.�t n. ( 7S Cole 2. %he ae/2,t,.e 3 , Cov-e,,, mu6t za%.hed o�z t�`ze '.tank and 12.t. 4 . on,?. 1(jF3C' g:zel o;�. �E.lr_z �.t.t 'a6.tczP_gi d 5 . No Nei,, o,-,e when- ae") SIGNATURr, : Gl�/ Name:_J . P .Macomber Jr.._____ __ i Company: J. P_Macomber &—Son-_Inc . Ad d re s ------------,-- Centqrvill,e LMass__0.2632 Phone:-- ' 5Q8—Z7_S_3338------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY WEXEM JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped L Instsiled Town Sewer Connections P.O.] .Q. Box 56 Centerville, MA 02632_0066 775-3338 775-6412 K� 7 CE 8L"WAGE UIBAO6AL SYSTEM 1rx'��^ten_z 0 P4opv_� ` r 3�4 Noi t.L:nghan, D.,?.iL v_ Owner ' s name Di.a:,?.e gaei; Date of Inspection 8118..95 PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back—up. The site was inspected for signs of breakout. __ZAll system components , Acluding the SAS, have been located on the site. _ZThe septic tank manholes were uncovered, opened, and the interio r of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determin ed based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance '.of SSDS.' Reco.m.mendr, t&i inz 1 . New 1.00;) ga ion .eef.c.�_C^.9 12.i.t ncu 6t_ e e i.nait.a.Uad. 2. -r/�.st2.,:�r. flan ?or.. .tr_zi. a. _ecd. 3 . Rai,,e covet:, on ;h,z .tank and Qeach.lny•, 4 .. Rai.ze Il or,. coven w,f e n i.n tax Lc d. SUBSURFACE SEWAGE DISPOSAL SYSTEM .INSPECT.ION FORM PART B SYSTEM INFORMATION V FLOW CONDITIONS: ' L If residential number of bedrooms . number of current residents _A0_ garbage grinder, yes or no yas • laundry connected to system, yes or no ' VQ seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: 7993=96 , 000 ya.0_..3=� 3. 02' gPD %994-:7', 000= Last date of occupancy GENERAL INFORMATION ' Pumping records and source of information: °/J7-'R?. 716190, 5 24193 . 7114/95 9 /� /rl ,rnm0. on P Snn Tor . _A/0 System pumped as part of inspection, yes or no �- if yes, volume pumped Reason for pumping: Type of system Septic tank/ /soil -absorption system _hJ0 Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) _ ) other (explain) Approximate age of all components. Date installed, if known. Source of inf ormation . ......... ._. ------------------ -4XL Sewage odors detected when arriving at the site, yes or no 1 9 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: t_¢n..k. (locate on site plan) depth below grade: 2R" material of construction: concrete metal FRP other(explain) dimensions:_R' U"Lnn 5 ' / "/Ligh � ',40#O de _Q_ sludge depth 0 _ distance from top of sludge to bottom of outlet tee or baffle 0 scum thickness 0_ distance from top of scum to top of outlet tee or baffle 0 distance from bottom of scum to bottom of outlet tee or baffle No Puii d u,96. 7an.k 'pumped mont/1 ago. Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet. invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) 7rink 4j1 gpr/ #n and .,).,)ol7 in-egi X rmiPggi n1no,c_ No v_.v�idence. o, •-Jeakage. Zee-, a.2e in R.Qace; lank. .i,3 it�cuct;�2r�1'y 7ank, nri-6.t_ L . Rumoed,. Once n..epaiaed; lank eh.ou.id Ae r,.,urRo.d n_Uelzy .t.hzen_. yeaa.a. ' DISTRIBUTION BOX:N >nc (locate on site plan) NONF- depth of liquid level above outlet invert Comments: .(note if level and distribution is equal, evidence Of. solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) NONE . PUMP CHAMBER:NONE (locate on site plan) NO1V;r pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, . recommendations for maintenance or repairs,etc. ) N''NF SUBSURFACE SEWAGE DISPOSAL SYSTE2i PART 8 INSPECTION ?ORH SYSTEX' INYORKATION continued SOIL ABSORPTION SYSTEM (SAS) : I_0n0 qa-Uoa 1,(cach. `•'.c.t (locate on site plan, if possible; excavation not° requi.red, but 'may.•be - approximated by non-intrusive-. methods) If not determined to be present, explain: • Type leaching pits and number 17_� � leaching chambers and number 0 leaching galleries and number 0 leaching trenches, ' number,* length 0 leaching fields, number, dimensions 0 overflow cesspool , ,.-number ;10 Comments: (note condition of soil, signs of hydraulic failure, level of pondirig., condition of��egetatioln', ecom endatior�s �or�manrAter ance or rppairs�etc. hyd.�a�a .zc �Q1..21t2c oa. /?oad,in��. /on .h %nn r�!_.t :1-LeYe:;C o c2�12�,.c:LT_ 'a• Nero 2e .ch.-jr_y n. ct_ m._,.ht_ try a ncz CESSPOOLS (locate on site plan) : number and configuration 0 ._ depth-top of liquid to inlet invert 0 depth of solids layer _0 depth of scum a er 1 p y n dimensions of cesspool materials of construction r) indication of groundwater 0 inflow (cesspool must be pumped as part of inspection) NO Comments: (note condition of soil, signs of hydraulic failure, level 'of ponding, .condition of vegetation, recommendations for maintenance or repairs etc.) PRIVY: NONE (locate on site plan). .. . . ._.. ... _._ . materials of construction NONE. dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, ' level of.ponding, condition of vegetation, recommendations for maintenance or repairs,r' NO SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION •BORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' T,,�,� i DEPTH TO GROUNDWATER 20' f depth to groundwater method •of Bete ination or approximation:pproximatlon: See attached Page- 7e�3t. Aoii� 789.7.uaay 1-•1930 To- ioate2 <n^.ounie2r-rL 12' Parse 11,4 23 p ��5� p• . � J �F;7JL MUD;�L�4 % - T�;t�N/�STf�To�' `- :�� E L�sue: Zo•,S � 1 .� AGE✓ -ifl co 00 7372—/ /s LOT .2 !e /.3 Cu/4-0//vG S ETP5ACA.-f 2EQ�/,2�ME�l/T� _ F'24/v T �� Si nE �� rzE✓n ', P.2 0 X.:,o SE-Z:�) -3 .BED{eooMs • SE P T/C 5 y5 TE.M C�/S T2 UG T%ON SHALL CpNF02M TO MA SS D i •N FLD[�/ 3.3G AL. • E N v/ on/n f E,v r a� T/r ES G �2 �[_ Go R`, ✓'�`'��'}! '-�'` 7 7-- G` / Tom,g E L E,4 G N . .2.4 TE- G 'Z ,•7/N l//VCN TOP OF All— 7-Al UL.4 7'i ONS r-.. LE.4C.t1:i'�A1? ten, fry 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Backup of sewage into facility? AIM Discharge or ponding of effluent to the surface. of the ground or surface waters? 0 Static liquid level. in the distribution box abov e outlet invert? Liquid depth in cesspool ;<6" below invert or available volume< 1/2 day flow? _.dIQ_ Required pumping 4 times or more in the last year? number of times pumped �i4r, ir,1 A4S7 So 09YS _dam. Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: 1_ below the high groundwater elevation? A& within 50 feet of a surface water? _ 61 within 100 feet of a surface water supply or tributary to a surface water supply? AI& within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt, marsh- (cesspools and .privies only, not the SAS) ? 1�sZ within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has 'been analyzed to be acceptable, attach copy of' well water anal; .for coliform bacteria, . volatile organic compounds, ammonianitro e ' and nitrate nitrogen* g n TOWN OF BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D .- CERTIFICATION -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 324 Noz'.Lingham Dltive ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME Diana GA.29 PART D - CERTIFICATION NAME OF INSPECTOR jo.A_eph P. (1ac(,m.e,.,et COMPANY NAME COMPANY ADDRESS 13ex r66 e, N a.-A,3. 02634' Street Town or City State ZIP COMPANY TELEPHONE 508 775 `1338 FAX ( 508 790 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage dispos6l system at this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. XZZZZ System FAILED The inspection which I have conducted has found that the system rails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C FAILURE CRITERIA of this inspection form. Inspector g n a t u r e 14644d,'4 Date 8118/9.5— One copy of this c Vrtification must be provided to the OWNER, the BUYER ( where applicable) and the BOARD OF HEALTH. If the inspection FAILED, the owner or"I.o,pe'rator shall upgrade ' t' he system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doc Cc^^mcnwearr cf Masscc^:aerrs ExecuTive Office cf EnvirCrmenTc, r',ftc„S Department of Environmental Protection ' Water Pollution Control Tecnrnccl Assmonce and Training Sections VAWAm F.WOW Gown mr Trudy Cox• S•aumv.EOEA Thomas&Powws A"Caimr•Qrr 06/12/95 ATTN: Joseph P. Macomber, Jr. Joseph Macomber and San PO Box 66 Centerville, MA 02632- Dear Joseph P. Macomber, Jr. , _ I am pleased to inform you that you have attended training, met the experience qualificatioris, and have passed the Title 5 System Inspector exam, pursuant to 310 CMR 15. 340. The passing grade for the exam was 39/52 or 75%. This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15.340. You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at the following address : Kimball Simpson D.E.P. Training Center 50 Route 20 Millbury, MA 01527 ! Thank you very much for your time and consideration in this matter. Sincerely, , l Kimball T. Simpson, DEP Training <: ::ter Director [2405) Routs 20 • Nitibury, MA 0": FAX 506-755-9255 • Tel•onon• 508-756-7701 Water ` Conservation SAVE Tips . . . ME! CHECK FOR LEAKS Water Loss in Gallons Due to Leaks Leak this Loss Per Day . Loss Per Month Size • 120 3,600 • 360 10,800 • 693 20,790 • 1,200 36,000 • 1,920 57,600 3,096 92,880 ® 4,296 .128,980 ® 6,640 199,200. 6,984 ' . 200,520 8,424 252,720 9,888 296,640 AIM . 11,324 339,720 0 12,720 381,600 Aft 14,952 448,560 l'0 -CATION SEW GE PERMIT NO. oe VILLAGE ®` nAA�-10e� O INSTA�LLEM'S NAME„ i ADDRESS BUILDER OR OWNER d . . 2 DATE PERMIT ISSUED , ,� � DAT E COMPLIANCE ISSUED ;J � a � No.. .— s.. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........T... . ......OF..../`� �.%��. .E................................ Appliration for Dispniial 10orkS Tnntiirnrtinn ramit Application is hereby made for a Permit to Construct (►J) or Repair ( ) an Individual Sewage Disposal System at: ......�d.�. � t�a....I � .�1.�jlld5......... ............ ....................................................... Location Location-Address --.- -• •--- - -•-• ----or Lot No. .� --•----- -- :... ............. ............ Ow ...................••......_.._........Address Installer Address d Type of Building Size Lot../'. _. r,�. ...Sq. feet U Dwelling—No. of Bedrooms-__:.-.-3.................................Expansion Attic ( ) Garbage Grinder Wo) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures"................................. . W Design Flow....... ..........................gallons per person per day. Total daily flow_..........�-3_._....................gallons. WSeptic Tank-Liquid capacity-/.gallons Length.S.195.L._.. Width__'/. a... Diameter..4 ... ..". Depth..�.,.'?'_`�._ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area----------_.._._:____sq. ft. Seepage Pit No......./_'........... Diameter......6.......... Depth below inlet-Ae-SJ........ Total leaching area..:/.XG; sq. ft. Z Other Distribution box (P") Dosing tank ( . ) Percolation Test Results Performed by............C f11.f-......ZYV.t'.?..7................... Date----- ............. ,aa Test Pit No. i_15A.....minutes per inch Depth of Test Pit------11ele....... Depth to ground water—eV.j?4Z.Z. Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------------------------------------------•------....-•--•-----------.......---------------------------------------------...... ODescription of Soil-----------------. ..... ------_-------------- --........................................................... -----------------------------------------------7.1 ................................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------••-•-••-•••••-•••--•••-•••••--•••-••••••--•-••-•••-•-••--•----•--------•••------••---------•••----...........•••-•••••-••.....-•---••--•-•--••--•••••-•--•-....••-•-.•.•-- Agreement: The undersigned agrees to install the aforedescribed Individua Sewage Disposal System in accordance with - T Pt� the provisions of f't T L z 5 of the State Sanitary Code— The de gned further agrees not to place th syst in in operation until a Certificate of Compliance has e issue y rd of health. - - Si •• .��--•=..... "...................... ••-••--•--- at ApplicationApproved By....� . -• • • ••-•--•.....•-•-•••...••-•-•-•--•-••....................•-_... .. .... Date Application Disapproved for the following reasons------------------------------------------------------------------------------------------------_------------ ---•-••-••-••............................................-•--••--•--•-•...•----••-•-••--•-••-----------••••-•--........--•••--•-•-•-•-•-•-••-••-•------------•--------••----•......--•--•-•••...•-•--- Date PermitNo.....................--.................................. Issued...................................................... Date Fxs.. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..::f:).... OF................................................... ................................ Appliration for Uispnaal Works Tonstrnrtinn amit Application is hereby made for a Permit to Construct (.1 ) or Repair ( ) an Individual Sewage Disposal System at: {� ......... .:!..e'f.j../............ .............j_...s......_...:... ,.................................................... or ...._ Location:Address --------- --•---Lot No. ow t Address W "I a -------•----- � k Installer Address UType of Building Size Lot.._::1..`...: .`: ,..._Sq. feet Dwelling—No. of Bedrooms.......1.................................Expansion Attic ( ) Garbage Grinder (4,t)) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p' Other fixtures ..........--•--•................ .. W Design Flow......... ..........................gallons per person per day. Total daily flow............. ?9___--_-----------_---gallons. W Septic Tank—Liquid capacity.%? gallons Length_:'_^_. Width.. :/.!`v"j_ Diameter._ . x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... '------------ Diameter------6---------- Depth below inlet-_a >......_. Total leaching area..-/9.2.sq. ft. z Other Distribution box (A-) Dosing tank ( ) ~' Percolation Test Results Performed by............. -110-!S?_16'..__: f`. _%..................... �Date_...r � "�' a ..._.. l Test Pit No. 1.15_ .....minutes per inch Depth of Test Pit------ ....... Depth to ground 1-4 1 Test Pit No. 2................minutes per inch Depth of Test Pit....._.............. Depth to ground water........................ ----------------------------------------------------------------------------------------------------........................................................ 0 ` u r 1 .1 /_ Description of Soil--------•----------------=�---------------------------------•----------------------------------------•--------------------------------------•-------- .....--•----- x p =l' 7 ' /)I,/4'1,9Af t?tA f� .SA�,f w 7lv /:! 'sa'2'- ,rlf . U ................................................•._..._............_...._.. .........__......._:�c....._.............-1_......._........._....._._._._......_......�_.a_ ::.__________.____.. f Z •----•--------- -- ----s7 r I��'��!</_ 'c2A.? F Lci�j/ `� rS?/L/ U Nature of Repairs or Alterations—Answer when applicable.-.............................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individua Sewage Disposal System in accordance with f'1 T�'1.'.-.. the provisions of T -. 5 of the State Sanitary Code—The de signed further agrees not to place th Sys in in operation until a Certificate of Compliance has •'Ze issued.b t and of health. Si . •. -•-•• -- ---------------•---.................................. ....... •----................. / ate Application Approved By.._ . ................... {- � e__ =- Date' Application Disapproved for the following reasons-.........................t................................................................................... ..-•----•-•-----------------------------------------------------•-•--••-•---------------•----------•.......----- ------•-------•---------•-----••••------•-•----------------•--- ..................... r Date •9 PermitNo.............................. r Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ q!Ll/U..........OF............3 ./'�.�'1/S.Z:' ..... ° ......................... Trrfifirttfle of Tomplianrr THI IS TO CERTIFY, That the Ind v'dti l Sewage spo 1 System constructed or Repaired ( ) by... ----------� Installer ,,� at-----------------e`r_-— - •-----7. '--------- t' ----------•------------------------------------------------------ has been installed in accordance with the provisions of TITLE - �j^'of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..B.Q.�-.A!f 8----------------- dated----- .......................................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.'...:_�_�.�..... f -------•----------•---------------- Inspector_..f:'..,/ ....,<-- THE COMMONWEALTH OF •MASSACHUSETTS BOARD OF HEALTH Tod:'f :...:.`:OF..... 1<`.,?e /�rl'./ .. ......... Off? FEE._ d............. Permission is hereby granted.... ------- ----------------------------------- ..................................... to Construct ( Repair ( ) n Individual Sew ge Disposal System at No.. 02-9.....--- n - . ' re. ----- -----•------- .......... Street as shown on the application for Disposal Works Construction Permit No.-.- - -:_ Dated.._.__.. � ---------•------------------- -------•------------•...._----- ...... Boadr of Health - .. DATE--------- ..--- . ..... l.../D-.00..-•------------........ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ,,,. 17. 51 y ,.J�, �� - ��`�`lZ ��6;jY�.�S�. � P'-�, +..77�4/L✓' /r�L.�C3!'l:,I 'li`/r.;.!'T�.. ,y^� XI LodZ4r t . a d 4. 40 � �I .,• -' � .y• ix is " I �ZP• 4'. " , .. '`' ram¢, ETL3A CA; (1/ E:i�? •�/7 _ S ,d�L E — F20N T ! S/a� _ Ll2E '72 g SEPTIC 5 Y5 T&M Con/S T2 UC7-/UN SHA D L CpNF02M 70 MA SS L?4E5/0lAJ FL 0 w .30 GAL:`p,4'Y ENV44OnNMENTA[- C�7D� 7/TL Y S EX/,5T/n/C . ; s :x:;! 77 -� �q M/1vPl/mac L G 47-1-1 GU,4-A 71DNS .�L �.TOP D; Z. 4-M1 ?A 3-= �7>. 4A 23.6 OL � ' E� O F TE ND O ✓/DUS 0 VE.2 PV1 TN./A/ QF r G� TO X>2EV&�&17—/G-S � F2o�ti /NF/L T/2.a Z"/itlE, rA iur.v - � ,�' Z.� `Co✓G-iz5 � , - � DfST.. ,.�. . ' _ � 57"oNE CO VAZ V 4,CAST//Zo,� - -- �- , Box ! z/"w�Dc odE,e t# piTc,�i —Fcow Miv v TC D/a LCq ,4 FOOT M� /'>irc Al MiN OT r �C� / WA 5 ED f lr GA L L DIV /N vF,-er /N.VEr2T _ CA P C/ x �E pT/G 7-A.�/� � :. 1 h/ /} '`ELEV• i A2:DuN0 L- TZT/GA/T) � SoTpinf CIF " ; Pi.T /n/vE�r GARBAGE G,e/ivDE;� D C-( C C ► < + >< 6 ti r �. S / TE ALA'nl s L O C<17,"/O/�/ Ff1iElEh-11/14 4 T-S7 Ham. ✓ . " ,SEpr-ie TAA.1*— .2/BG1T/ON . a � s ,p �S OUTLET�� AND Z-EA' CA11A1G ': /r H �O'� I�• �'`� �, TO •8E OF .TZEin/Fa�EED GONCT�GT 4 { + 5t x , CO/�/C2�TE ST2E•vvT��/ 3000 ems/ :M/N.No 27483 y `4 20000 x "-io �oA D/n/G � Y •�' °:; k:/VE WAY NOT To gE LOCArZEJ �' `�' T / --�• OV.,�e 5 yS TE M ui�/L E s s f/- ZO �7/FY �"N DE_S/6�/ L OA D/.vc� /� CJS�D. ; ;. Z CE,� E� FOU/V15�17')OI, / S/-/OWA-1 ON T,-11S ^Z-4AJ /S X,i �' r Aj ON THE GLeoUivD �/ s T.=�� .�.Ji��;ti/u= .SE T�,4 C.E. �F CJ;,�`.� ,�/7S � *•��• . :�6" DATE fj 7/Y0010 ,