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HomeMy WebLinkAbout0058 LOOMIS LANE - Health 58-58A L ` Centerville Loomis Lane A = 230 111 TJJced, 1 llll UPC 12543NO,53LOR HASTINGS, MN TOWN OF BARNSTABLE LOCATION. SEWAGE # X-ILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY e LEACHING FACILITY: (type) (size) NO. OF BEDROOMS / BUILDER OR OWNER �JcSlf6� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table.to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fee of I chin ciliry) Feet Furnished b 6 1 ' _ f � /'//� /� �w i � / i � / / � � / / � � � i ' / / /' / 1 / \/ \ /� _ ^V � �• . a DATE : /8/02----------- A 0 ID R E S S -a 8.-Lo-orris-L.ari-e--------- Centerville ,Mass .__ ---- - 02632 -- - -- ------- ------------ On the above date, I Inspected the septic system at the above address, This system consists of the following; RECEIVED 1 . 2-5 'X7 ' cesspools . 2 . 1-1000 gallon precast leaching pit . 3 . These are in series . JUL 1 7 2002 Based on my inspection, I certify the following conditions: TOWN OFBARNSTABLE HEALTH DEPT, 4 . This is not a title five septic system. 5 , This is a sewage that was upgraded in 92 Leaching was added to the two existing cesspools . 6 . Waste water is 5 ' below the invert pipe of the pit . Cps rJ 7 . Pumped main cesspool at time of inspection . 8 . The sewage system is in proper working order at the present time . - SIGNATURE :., Na ,,e Macomber rJ—_—__— Company ; Joseph-P _-Ma-comber-& Son , Inc , -- - -- - MAP address :- Box- 6b------------- PARCEL . 1i 1 Centervi l le , M8_- 02632-0066 LOT phone : 508- 775- 3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC, Tanks•Cesspools•Leachflelds Pumped & Installed Town Sewer Connections P 0. Box 66 Centerville. MA 02632.0066 • 775.3338 775.6412 � II COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY. 9StSSMENTS SUBSURFACE SEWAGE DISPOSAL,$Y-9' E1 f!QRM PART A CERTIFICATION Property Address: 58 Loomis Lane Centerville , Mass . Owner's Name: Enid Bodensiek Owner's Address: Same Date of Inspection: 7/8/0 2 Name of Inspector: (please print) Joseph P .Macomber Jr . Company Name: J. P .Macomber & Son Inc . Mailing Address:Box 66 C n v; 11P , Mass _ 02632 Telephone Number: 908-7 7 5-1,11R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: &Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: IDate: The system inspector shall s mit 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 ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 58 Loomis Lane Centerville , Mass . Owner: Enid Bodensiek Date of Inspection: 7/8/0 2 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A Sys=Passes: I have not found any information hich indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The sewage system is in proper working order at the present time . B. System Conditionally Passes: _,j)J2 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. 44e&The e tic tank s 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: 4141&e Observation of sewage backup or break out or high static water level in t distribution bo ue 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: ei�xplain: /U17' 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: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 58 Loomis Lane entervi e , ass . Owner: Enid Bodensiek Date of lospectioo: 7 8 02 C. Further Evaluation is Required by the Board of Health: Vj9 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 "ill pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner wbich will protect public bealtb, safety and the environment: !4 Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 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. IVO The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply µ•ell. 4 The system has a septic tank and SAS and the SAS is less than I 0 feet but 0 feet or more from a private \+ater suppl\ well I'. Method used to determine distance j,-Z "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. ther: This is a sewage system. 2-6 ' X7 ' block cesspools and 1-1000 gallon precast leaching pit . are in series . Main cesspool was pumped at time of inspection . 3 Page : of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIF]CATION (continued) Property Address: 58 Loomis Lane Centerville , Mass . Owoer:Enid Bodensiek Date of lospection: �R/fig D. System Failure Criteria applicable to all systems: You must Indicate eyes" or "no" to each of the following for all inspections: Ycs !�o _ Backup of sewage into facility or system component due to overloaded or clogeed SAS or cesspool Discha.rgc or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid Icvcl In th distribution box bove outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 'A day now Required pumping more than 4 times in the last year NOT due to clogged or obsnrucicd pipe(s). Number / of times pumped �. s/ Any portion of the SAS, cesspool or privy is below high ground water elevation. : / Any ponion of cesspool or privy is within 100 feet of a surface water supply or tTibutary to a surface water supply. Any ponion of a cesspool or privy is within a Zone I of a public well. _ any ponion of a cesspool or privy is within 50 feet of a private water supply well. Any ponion 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. ITbis system passes If the well water analysis, pert,rmed 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 trust be attached to this forma ivv (YeVNo) The system fails. I have determined that one or more of the above failure criteria exist as • described in )10 CMR 15 30). therefore the system fails. The system owner should contact the Bo!!-- Health to determine what will be necessary to correct the failure. E Large Systems: To oe considered a large system the system must serve a facility with a design now of 10,000 gpd to 15.000 gpd. You must indicate either "ycs" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) es no _ -Zthc system is within 400 feet of a surface drinking water supply �thc system is within 200 feet of a tributary to a surface drinking water supply v the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mappee Zone II of a public water supply well !f yov nave answered "yes" to any question in Section E the system is considered a significant threat, or answered cs- in Section D above the large system has failed. The owner or operator of any large system considered a s:en!f:cant threat under Section E or failed under Section D shall upgrade the system in accordance with 3 10 CMR ` ;0- The system pwner should contact the appropriate regional ofTtce of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 58 Loomis Lane Centerville ,Mass . Owner: Enid Bodensiek Date of Inspection: 7/8/0 2 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No/ �/ Pumping information was provided by the owner, occupant, or Board of Health —Z 4Iere any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period ? ZHave large volumes of water been introduced to the system recently or as pan of this inspection ? ZWere as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for signs of break out? _ Were all system components,4 luding the SAS, located on site ? AJdX� Were th septic tank anholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, materia of construction, dimensions, ,depth of liquid, depth of sludge and depth of scum ?P 9 P g P 42 _ 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 _ 2Existing information. For example, a plan at the Board of Health. 0 _ Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 58 Loomis Lane enterville ,Mass . Owner: Enid Bodensiek Date of Inspection: 7 8 02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): 9,; DESIGN now based on 310 CM}j 15.203 (for example: 110 gpd x P of bedrooms): Number of current residents: _ 7 Does residence have a garbage grinder (yes or no): 4,0 Is laundry on a separate sewage system (,yes or no),;Ud (if yes separate inspection required) Laundry system inspected (yes or no): S Seasonal use: (yes or no): otV Water meter readings, if available (last 2 years usage (gpd)): 2000-94 , 000 gal lons=257 . 54 GPD Sump pump(yes or no): 2001-235 , 000 gal Ions=643. 84 GPD Last date of occupancy: These readings include 64 Loomis Lane . ( Cottage ) Water runs from COMM ERCIAL/WDUSTRIAL the main house to the cottage . Type of establishment. IVA Design now(based on 310 CMR 15.203): M gpd Basis of design now(seats/persons/sgft,etc.): 4J4 Grease trap present(yes or no): V 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: ^/4 . OTHER (describe): 114� GENERAL INFORMATION Pumping Records g Source of information: A/Al i Was system pumped as pan of the inspection (yes or no): If yes, volume pumped: D gallons -- How was quantiry pumped determined? u�9Sl/i�°� Reason for pumping: A�i9 TYPE OF SYSTEM Septic tank, distribution box, soil absorption system _ Single cesspool L Overflow cesspool- 40 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): Ap /rr, xima ee o all components d to insta d (if known) a d sourc of information: Were sewage odors detected when arriving at the site (yes or no): 6 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: 58 Loomis Lane Centerville ,Mass . Owner: Enid Bodensiek Date of Inspection: 7/8/0 2 BUILDING SEWER(locate on site plan) Orangerberg pipe from the �� house to the main cesspool . Depth belowgrade: � to theoverflow cesspool . . Materials of construction: cast iron 40 PVC other(explain): S e h.i�g I,�r �i-pti from t h e Distance from private water supply well or suction line: A 3�— ez r f l o w cesspool to the pit . Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight . No evidence of leakage . System is vented through the house vents . SEPTIC TANK./ locate on site plan) Depth below grade: WO Material of construction;, concrete,I/AmetaLM fiberglass, /0 olyethylene —other(explain) 14W If tank is metal list age: z/r Is age confirmed by a Certificate of Compliance (yes or no)�, (attach a copy of certificate) Dimensions: d�9 Sludge depth: "V11 Distance from top of sludge to bottom of outlet tee or baffle: 6— Scum thickness: Distance from top of scum to top of outlet tee or baffle: i1Jr� Distarce from bottom of scum to bottom of outlet tee or baffle: 40 How were dimensions determined: 14J/9 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is not present . GREASE TRAI)44�C (locate on site plan) Depth below grade:.1/ Material of construction: concrete i#metal 0 fiberglassay/9polyethylene.gk other (explain): A4f Dimensions: 1W Scum thickness: 160 Distance from top of scum to top of outlet tee or baffle: 4)0' Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: wz� Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): _Grease trap is not present . 7 Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 58 Loomis Lane Centerville ,flass . Owner: Fni d RodPnGi Pk Date of Inspection: 7 /,gf()2 TIGHT or HOLDING TAN 'e3 (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete,(y metal��fberlass 4 polyethylene A other(explain): AM Dimensions: Aq Capacity: „!4 gallons Desien Flow: 141a gallons/day Alarm present (yes or no): —X Alarm level: Alarm in working order(yes or no): Date of last pumping: 4_ Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present . DISTRIBUTION BOX (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _22,40 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box is not present PUMP CHAMBER4&__(locate on site plan) Pumps in working order(yes or no): .60 Alarms in working order(yes or no): ,� Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump c am er is not present . 8 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: 58 Loomis Lane Centerville ,Mass . Owner:Enid Bodensiek Date of inspection: 7/8/p 2 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) 2— cesspools and 1-1000 gallon precast leaching pit packed in stone . If SAS not located explain why: ocate ee page 4p, leaching pits, number: leaching chambers, number:_ AO leaching galleries, number: Q Xff leaching trenches,number, length:Q2 leaching fields, number, dimensions:0 overflow cesspool, number: I AV innovative/alternative system Type/name of technology: 0�'; '�jIJ / C7� Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to medium fine sand . No signs of hydraulic ai ure or pon ing , of s is normal . Pumped main cesspoo a ime o ins CESSPOOLS: Z(cesspool must be pumped as part of inspect ion)(]ocate on site plan) ) Number and configuration: _ft:;o Depth —top of liquid to inlet invert: Depth of solids layer: y" Depth of scum laver: Dimensions of cesspools 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.): Same as aboee . PRIVY(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present . 9 Pdgc 10 0( 1 1 OFFICLAL (NSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSUR ACE SEWAGE DISPOSAL SYSTEM INSPECTION FOB PART C SYSTEM INFORMATION (continvcd) Proprrry A00rt11: 58 Loomis Lane 0„Dcr: Enid Bev e , S . OM of Intp<11700: SKETCH OF SEWAGE DISPOSAL SYSTEM ho"Ot 1 1kmh 0(thc 1<wi Tc 0i1p0111 1y11cm Including 11c1 10 11 Ictsl rw0 permancn! rcfcrcnce Ian6_ma/k1 0, 0<ncNnukt Lo<ttr 1u wt111 ~;thin 100 ((Cl. Locitc wherc pvblic welcr lvpply cnlcrs the bviloing. vV 10 I .. Page I 1 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 58 Loomis Lane Centerville ,Mass . Owner: Enid Bedensiek Date of Inspection: 71 K/n 9 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water v'd feet Please indicate;(check)all methods used to determine the high ground water elevation: YES Obtained from system design plans on record - If checked, date of design plan reviewed: 7/8/0 2 YES Observed site(a u tng�aro bservation hole within 150 feet of SAS) NO Cheer e`d wtt oca Health-explain: NA Yes Checked with local excavators, installers-(attach documentation) YES Accessed USG S database-explain:h t t p : l l t o w n . b a r n s t a b 1 e .ma . us You must describe how you established the high ground water elevation: Used ; Gahr_et_v P, Miller Model _ 12/16/94 Ground water eleations above sea level . Used ; USGS Observation well data . June 1992 Used ; USGS -Technical hulletin 92-000-1 Plate #2 Annual ranges of ground runo water elevations . January 1992 Leaching 91 Pit .eet Groundwaterf/ Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom ,/ of the leaching pit and the adjusted groundwater table is � � feet. 11 r.nr+.-nnr*-„- rn-mr•mm�`'++r•.+tn.mr.•.•r+•+ernr•+.r.s*+mn .. SO rss-tau r+a-�mr..rT .gyms-r- r-•-'..-...r • t Barnstable '1'UNN OF UOARU OF HEALTH S011Sl1RFACF 9ENA(;F DI SIvJSAL SYSTF;M IN�SP CTION FORM - PART D CERTIFICATION l —TYPE OR PRINT CI.CARL1'— PI?OPERTY INSPECTED STREET ADDRESS 58 Loomis Lane Centerville ,Mass . 02632 ' ASSESSORS MAP , BLOCK AND PARCEL # 230-111 OWNER' s NAME Enid Bodensiek PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P .Macomber, Jr . COMPANY NAME J. P.Macomber & Son Ind: % COMPANY ADDRESS Box 66 Centeriille ,Mass . 02632 Street Town or city stet" LIP COMPANY TELEPHONE' ( 508 ) 775 - 3338 FAX (508 790 -1578 R CCR'CIFICATION STATEMCNT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time ofeinspection . 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 , Chec one ; 7)__1'__ 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 16 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED$ The inspection which I have cony'acted has found that the system fails to Protect the j)ublic )health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date Xn6copy of this rt,ification must be provided to the OWNER, the BUYER re applicable ) and the DOARD OF IiEAL1'll . * If the inspection FAILED , th`e owner or"hopo-rator shall upgrade ' the system within one year oC the date of the inspection , unless allowed or required otherwise as provided in 3.10 CHR 16 . 305 , partd . doc � ., �' • ` A, TOWN OF BARNSTABLE LOt ATIGN l � � 5 �y SEWAGE # VILLAGE ASSESSOR'S MAP & LOT1: O 1 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY ,406 4a LEACHING FACILITY:(type) 2 i, (size) ),GVe ct NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 'DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4 4 ellly�d � �1 c� 3 0 // No... Fas�-..32.s.22..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPROVED TOWN OF B A R N STA B L E Barnstable Conservation DepaRa>R me 93 Apphratiott for Diripooul Work,i Tonfitru on at - Date Application is hereby made for a Permit to Construct ( ) or Repair x(XX) an Individual Sewage Disposal System at: 5� Loomis Lane Centerville .............................................................................. ...................................................- Location-Address or Lot No. ..Bad en.aaik....................................................................... ---•-------------------•-•------------••-•-----------•-•-•--•--....---•-•---•-----................ J.P.Macomber Jr,��ncr Address W _ Installer Address Type of Building Size Lot............................Sq. feet t-t Dwelling X No. of Bedrooms......................................._...Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) A4Other fixtures ---------------------------------------------------------------------------------------- -------------------••------------------------................ W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.........---gallons Length---------------- Width---------------- Diameter...-_---._-.-_ Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.------..----------- Depth below inlet..--................ Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f.Z4 Test Pit No. 2................minutes per inch Depth of Test Pit......--............ Depth to ground water........................ 04 ----------•---------------------------------•......--...-•-•-------•------.._.....••-------•--...................••-•-.....------..............-••-••....---- 0 Description of Soil---- ....................... ...................------------------•-••-------------' x Sand & braver v ----------•-----•--••--••-•------------------•.......------------------•--••----•--•-•.....--------------------------------------••--------•-----------------•------------..................•-•-........ W x --------------- --------------'--------------------.......................................................................... -------------------•-----•---------------------....................••---- U Nature of Repairs or Alterations—Answer when applicable..l-_1000---i7allon___tank 1--1000 gallon p.j�t...lmdistr hution..box,-.•-Omitti,n� exlstin _ cesspool ........................ 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 iced y the board o health. Signed .... ' --- - - --- ---- =--- .... ...................... .5/5193................. Dare ApplicationApproved By .................. .. ........ ..... .....-...............-................................................... Application Disapproved for the fo lowing reasons: .................................................................................... ..............`.----.............-.......... ... ........ 1.111 ---'-----.........--...........................-......Dare................. Permit No. Dare x } �f F 3 No.. Fizsl....32•,22..... + THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripwial Works Tnnlitrnr#inn Wrmft Application is hereby made for a Permit to Construct ( ) or Repair Y(XX) an Individual Sewage Disposal System at: t " 5PA Loomis Lane Centerville ...........................................................••-------...._-----................... ..--•---------•-------...------•-••--•---------------••----...--••-------•-------...........-•-... Location-Address or Lot No. ... nd-E'n ual.1...................................................................... ................................................................................................. W J.P.Macomber Jr.Oa ner Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling X- No. of Bedrooms._-----------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building -----------------_--------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' 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........................................ W Test Pit No. l................minutes per inch Depth of Test Pit--....-_.........--. Depth to ground water........................ fTq Test Pit No. 2................minutes per inch. Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------------------------------------••---•-----••---------•-................--...................................-..................... O Description of Soil.............................. xSand & Gravel ------------------------------•..........................-••••---------------- V ....................•---...•••••••-•••----...........---•----••-•--------•--•-••-••••-------------••----•------••......••--•.-•--- W UNature of Repairs or Alterations—Answer when applicable..-1-100�J____PE�llon___tank___1_-1_�J__�J_,0 -allon_, Leackx.npt...l-dsthuon ©x_,--•-Qmttn�__existin�-_ ceSspoola .......................................... 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 o health. _ f Signed ---1�. i. !l,�9 / 54593................... D­ Application Approved B + Application Disapproved for the f�Iow ang reasons- ----------------------- ------------------.._...........------------------------------------------- 1------_---....... .................................. -- . ... a Dare PermitNo. ------_/..�......_�..1..' ---------------- Issued ------------------------- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by .J.P.Macomber Jr. ............................... ... .................. ... ....... r.............. . ................... . ...................... .................... ......... ... " InscJlc at ......5RA Loomis Lane Center�-ille ........ ........................................ ...... ......----------------.....----.------------------------------------------------..........................---......-------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......�?J.-..9,.F.)--------- dated ........._................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ............... 1-,f..- c� � .................... Inspector v,..............-- ----------------------------------THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 TOWN OF BARNSTABLE No......�.�..-.�.!r�-. FEE... ....�.��..,..��.�. Rapaual Workii Towitrudivrt rrmit Permission is hereby granted-----J .Mac0111 e Jr-........................................................................................... to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at No...5RA..L0 jQM!!-..Larae-- .............................. ................. Street ecyy as shown on the application for Disposal Works Construction Permit No -�_ Dated........................................... Board of Health DATE--------------- �� ---------•-•--•---------...... FORM 365oa HOBBS&WARREN,INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION J—?fir, 1,S L—,ol SEWAGE # VILLAGE ' ,,, .�:�- �Z''i' �'��� ASSESSOR'S MAP & LOTS- G' lf/ INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ��% (size) /,Gy qza NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER � , DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No / 0 y 'I �� i '�I � � � \ �` '! \ N! � p�� ` `� /� ��� 1��\ ,� y ,� , - . i � .3 a � = e � No..... Fps. $ ... ..... . ...... E COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A66�t;WN OF BARNSTABLE Appliratiou for Dhipatial Works Tomitrurtion ranfit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 58 Loomis Lane Centerville ....................... .... ...............................................3��;'K7........................................... Fred Bodensie �ocation-Address or 0 ................................................................................................ .................................................................................................. J.P.Macomber Jr. owner Address Installer Address Type of Buildin Size Lot............................Sq. feet Xf Dwelling_No. of Bedrooms............3---------------------- -------Expansion Attic Garbage Grinder - A4 Other—Type of Building ............................ No. of persons...._...____.........._.._.. Showers Cafeteria Otherfixtures ........................................................................................ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width._......_......_ Diameter__-_......__._._ Depth_............_.. 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........................................ 1-4 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..__._..............__.. 9 ............................................................................................................................................................. 0 Description of Soil WSand &...9P�j:Vel....*--------------------------------"-------------*--------------------------------------------------------------------------------------------- U ......................................................................................................................................................................................................... .................................................................................... ............... 1:---10-0-0----&8:12:un----1_e8CZ1Y_t71_g---pTv--------- U Nature of Repairs or AlterationI—Answer when applicable-------................ .................................................................... ............................................................................................................................................................ ........................................... 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 Compli nce has b issued �te/boa d of health. has y Signed .......................­........ -1/28/9-2.......------- Date Application Approved By ....... ... ... ------- --- --------- ...........................................I_..................... Application Disapproved for the reasons: ...................e ................................................................................................................... ......................................................................I.............................................................................................................................. ---------------------------------- Date PermitNo. ....... ----------V C)---_--------------------- Issued ........................6....................................... Date A plicate n ij approve jor t e o c war7g reasons- ------------- - --.-.:: `- - - - ............ ................................... ... ........... ........................................-...........----- ..... .....------- ------............-•--------- - -. p .............. .--- - .... Permit No. ..........i--- -.-----.-V0- Issued ....-.--_.. .....----.-----........Date........................ Date.---- 1 THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE QuIedifirate of Graylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX))( by-------J ?-:l? e 3 ?I3�r T r ---`--------------------------------------------------------------------------.......------------------...---------------------------------------------------------.------- Installer at -----F-R Loomis....Lane....�.en.t-exv..ille............. .................. .. ...........................---........................................------------------------------------------------ has been installed in accordance with the provisions of TITLE 5 oAThe State Environmental Code as described in the application for Disposal Works Construction Permit No. ............ .....-�Y-C.------.- dated .............-------......................-.-.-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--..--... =�(� ------------------------------ Inspector C) THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ .. v TOWN OF BARNSTABLE $ 30 .00 No......•• •-•92•.... FEE........................ Disp out Worhi5 Tulanstrur#ion anttt Permission is hereby granted.-__ -.P-.Ma�omb e r Jr. - •••.••--- ---•-- to Construct ( ) or Repair (Xy). an Individual Sewage Disposal System at No..... 8...Lonuaaa.•.�rle•--Center-:111e............... Street as shown on the application for Disposal Works Construction Permit No...f_a- _�_.. Dated.......................................... .._ ... . -•---- DATE. . - — ��`.--•.................................. Board of Health FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS 30 00 No Fxs... ............'........_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Bispoiial Workii Cnrrntrnr#'inn Vanfit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal 'System at: ....L.3Q%_Asi ...................... ..................................................•---.........--•---............................. Location-Address or Lot No. Owner Address xT-:Lz:.�E ------------- ---------• -------•- --•------------------------•----•---..----*"Ad-----------------•---.--......................... Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling�}CNo. of Bedrooms_____________3............................Expansion Attic ( ) Garbage Grinder ( ) �`4 Other—Type T e of Building No. of persons........................ Showers YP g ---------------------------- P ---- ( ) — Cafeteria ( ) dOther fixtures ---------------------------------•-----------------------••-••---•----------•-----•••-------•----•-••••........._...------------••----•--•••......•-• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-� Percolation Test Results Performed by.......................................................................... Date-------- a ------------------ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.:_-_.__................ rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................._. Depth to ground water........................ P4 -•---•-•••-----------------------------------------------•--------•--••...------•----.••...-•-..........---•--•-•-------------......----------•-•••--.•.---- O Description of Soil............................. V ,Ca•nS c�S�.. 3 .aye-------------------------------------------------------------------------------•-------•-•-----•---------------•--------•-•--------..........-- W UNature of Repairs or Alterations Answer when applicable......1-1000 gallon leaching pit_______________ -------------------------------------------------------------------------------••-•.._...---------•-•-•--•-------------------•----•-•------•••-----••-•-•----•----•-••••...._...---•----•--••----•..---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b.�e�eniissued by the,b.o�d of health. Signe ........ . R./n... / - . ..... Date Application Approved By - ... . ---------- `.. -- -- . ....�.a