HomeMy WebLinkAbout0031 RICHARD'S LANE - Health �_-- _._ .
31 Richard's Lane
Centerville .
A = 230' 166
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No.4210 1/3 ORA
Emma R Us7E c
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
i DEPARTMENT OF ENVIRONMENTAL. PROTECTION
TITLE 5
OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 31 Richard's Lane
Centerville. MA 02632
Owner's Name: Marion Rum `5M 1
,,5
Owner's Address:
I r ^ ^�a
Date of Inspection: June 24, 2008 Ul,9(Name of Inspector: (Please Print) James M. Ford c
Company Name.: James M. Fordall
Information
Mailing Address: P.O.Box 49
Ostervllle,MA 02655-0049Telephone Number: (508) 862-9400CERTIFICATIONSTATEMENTI certify that I have personally inspected the sewage disposal system at this address and that the 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
C ditionally Passes
N e s Further Evaluation by the Local Approving Authority
i
Inspector's Signature: Date: June 24, 2008
The system inspector shall sub 't a copy of his inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this ins ction. 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 Coimnents
****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 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 31 Richard's Lane
Centerville, MA
Owner's Name: Marion Rum
Date of Inspection: June 24, 2008
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ 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 Boar_d 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:
2
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 31 Richard's Lane
Centerville, MA
Owner's Name: Marion Runs
Date of Inspection: June 24, 2008
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 of 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 aseptic 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 anunonia 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:
3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 31 Richard's Lane
Centerville,MA
Owner's Name: Marion Rum_
Date of Inspection: June 24, 2008
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is.less than 6"below invert or available volume is less than 1/2day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less.than 100 feet but greater than 50 feet from a private 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 System:
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.
4
1
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 31 Richard's Lane
Centerville, MA
Owner's Name: Marion Rum
Date of Inspection: June 24, 2008
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping infonnation was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ _ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ Was the site inspected for signs of breakout?
✓ _ Were all system components,excluding the SAS,located on site?
✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
✓ _ 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
✓ _ Existing infonnation. For example,a plan at the Board of Health.
✓ 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)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 31 Richard's Lane
Centerville, MA
Owner's Name: Marion Runt
Date of Inspection: June 24, 2008
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): N1a
Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required]
Laundry system.inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Unknown
COMMERCIAL/INDUSTRIAL
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
Source of information: Unknown
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
J 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:
Date of installation 413102-per as-built
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 31 Richard's Lane
Centerville, MA.
Owner's Name: Marion Rum
Date of Inspection: June 24, 2008
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _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: ✓ (locate on site plan)
Depth below grade: 24"
Material of construction: ✓ 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: 1000 gal.
Sludge depth: 2
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 3"
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: 10"
How were dimensions determined: Measuriniz stick
Comments(on pumping recommendations; inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage
The inlet cover was to Qrade.
GREASE TRAP: None (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.):
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: 31 Richard's Lane
Centerville,AM
Owner's Name: Marion Ruin
Date of Inspection: June 24, 2008
TIGHT or HOLDING TANK: None (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: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was clean. No solids were present.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alanns in working order(yes or no)
Continents(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
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Page 9 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 31 Richard's Lane
Centerville, MA
Owner's Name: Marion Rum
Date of Inspection: June24, 2008_
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: 3-Drvwells 9'x34'x2'per as-built
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.):
The drywells were dry and clean. There did not appear to be any signs of failure The cove was 15"below grade
CESSPOOLS: None (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.: None (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.):
9
s0 Page 10 of 11
OFFICIAL,INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property.Address: 31 Richard's Lane
Centerville, MA
Owner's Name: Marion Rum
Date of Inspection: June 24, 2008
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.
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Page 11 of I 1
OFFICIAL,INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 31 Richard's Lane
Centerville, MA
Owner's Name: Marion Ruin
Date of Inspection: June 24, 2008
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 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: Topographic and water contours maps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using Barnstable topographic and water contours tnans the maps were showing anproximate1y 20'+/ to groundwater at this
site.
This report has been prepared only for the septic system and components described herein. This septic system has been
inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will
function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,
relating to the septic system, the inspection, this report and/or any components of the septic system which have not
been located and inspected. -
I1
Town of Barnstable
F 1HE Tp�
o Regulatory Services
BARNSPABLE, Thomas F. Geiler,Director
y MASS. g
�p 1639. Public Health Division
jE'D MA'S A
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed b private inspector who is certified b
Y a P P y
the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division an with agree g y technical observations and interpretations containe
d ed within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number
of bedrooms approved at a particular property would be listed on the "Disposal Works
Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
J
Q:\SEPTIC\Disclaimer Private Septic Inspections.DOC
OWN OF BARNSTABLE
LOCATION 3 r rl(.�,L IAI SEWAGE#
VILLAGE QX t,rv,k ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY I
LEACHING FACILITY:(type) 3' �ryWU (size) �X NO.OF BEDROOMS 3
OWNER 1`U M
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) ) Feet
FURNISHED BY /�S F /G G a U
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B A
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TOWN OF BARNSTABLE�� �►
LOCATION .3I (?,tGkA(1-Q 1S J APJ c SEWAGE # P 002
VILLAGE CE'PJ+- K-Vt_�_�11- ASSESSOR'S MAP & LOT 2?0-
INSTALLER'S NAME&PHONE NO. RJOiN$01J 5C-t0 k16 77,�-9S 7 7(0
SEPTIC TANK CAPACITY 1 0V-0
LEACHING FACILITY: (type) —QWciJE its (size) 9,K 3 qX 2-
NO. OF BEDROOMS 3
BUILDER OR OWNER `Thv;vL*S d- MA VZ o r4 P`U&s-
PERMITDATE: `��''�� COMPLIANCE DATE: qh/aooz
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
4r,-
DC t t
\ t -
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e
No. 'r f ` Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2ppiication for &!6paal *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
312 Yi�rds Lane, Centerville Thomas / Marion Rum
Assessor's ap/Parce -0 11��.6y
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service Craig Short
P O Box 1044, Centerville P O Box 1044 S Dennis
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other 'Type of Buildingu as i a Qp i-i No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date 3 1-3 02 Number of sheets Revision Date
Title
Size of Septic.Tank Type of S.A.S.
Description of Soil: sand
Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system to--Flans
of Craig Short, #1 =904, dated 3-13-02
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 Certifi-
cate of Compliance has been issued by this Boa
rd of Health.
Signed ✓- — Date
Application Approved
Application Disapproved for the following reasons
Permit No. '�G� Date Issued ""
----—————————————————————————------------
THE COMMONWEALTH OF MASSACHUSETTS
Rum BARNSTABLEOMASSACHUSETTS
Certificate'N Compliance
THIS IS TO CERTIFY,.that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( )
Abandoned( )by Wm. E. Robinson Septic Service
at 31 Richards Lane, Centerville has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Pe t 1 W 4Zd'dated -'�. QZ
Installer Wm. E. Robinson Sr. Designer Cra i a Short
The issuance Pf this permit shall not be construed as a guarantee that the sy e will function as des! ned._
Date y 13 1 Inspector s *
No. �fi L 5:7-F Fee,$511
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
v�
Rum &gpogar *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( )
System located at 31 Richards Lane, C entP vi 1 1 P
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions. y
Provided:Construction must be completed within three years of the date oft ' e-fmit.
Date: �7 Approved
U 1
a '� No 1�V �'J�7 n. Fee,. /
�'`-�► _ z'" `" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V/
Yes
I. ,. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
i Zip plication for 33igomf permit '
Application for a Permit to Construct( . )Repair(X )Upgrade( )Abandon( ) O Complete System El Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
31 Richards Lane, Centerville Thomas / Marion Rum
Assessor's Map/Parce
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service Craig Short
P O Box 1044, Centerville P O Box 1044, S Dennis
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of BuildingR e s 4 A a n F; a No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 330 gallons per day. Calculated daily flow gallons.
Plan Date 3_ 1 3 92 Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Descrip oq of Soil
Nature of Repairs or Alterations(Answer when applicable) Tit 1 a-, 1 a a;rh s S t rim to r,1 a n g
of Craig Short, 10&t 6d4, dated 3-1 3-02
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 Certifi-
cate of Compliance has been issued by this Boa3d of Health.
Signed ✓-F- Date.3/F-d 77,
Application Approved b Date
Application Disapproved for the following reasons
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TOWN OF BARNSTABLE
LOCATION I A NG SEWAGE # �a
VILLAGE C�Y� Y�-y�� �� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. (ZabiNSOW 5C-f 4 775-9 7 NO
SEPTIC TANK CAPACITY 1 �b
LEACHING FACILITY: (type) its ' (size) '?A 31✓X Z
NO.OF BEDROOMS 3
BUILDER OR OWNER `C i v rvt,oES
PERMITDATE: COMPLIANCE DATE: 4/1000Z
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 -
® o lie fit''
LbtCATION SEWAGE PERMIT NO.
VILLAGE 1 -!O�4 0/0
INSTALLER'S NAME & ADDRESS
BUILDER OR OWNER
pro
inn o
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
- 8
EL I Af
• 7
3 e
SEMC TAN
co 13
�i
No..................... .........s..... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL H
............. .......OF.......� .. .... ..... ..--..............................
ApplirFation for Displaial Works Tow3tratrtion Vantit
Application is hereby made fo Per it to Constru ( ) or Repair (X) an Individual Sewage Disposal
o -
S stem at
La+r� b r la C l;-r, T a
... �
ocation.Address or Lot o.
µ�. ! .... .L.r-............................................... ..0...v �•� �•r R c, :f a.. a .�.�N.- -�;=`
Owner A es
L` 1 ��' T�..A.w --- Te�iv i�v2 r'I�.
Installer Address
d Type of Building Size Lot....Zlj..5452�......Sq. feet
Dwelling—No. of Bedrooms___......z-...............................Expansion Attic (16,/0 Garbage Grinder IC/p)
Other—Type of Building ____________________________ No. of persons____•_______---..__--_______ Showers ( ) — Cafeteria ( )
a' Other fixtur
W Design Flow..-z _..Gt._: _...A`:..........gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity 1 ..gallons Length................ Width................ Diameter.........._..... Depth................
x Disposal Trench—No. .................... Width._ .......... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........l----------- Diameter--------� .__..-_______
Z Depth below inlet........ Total leaching area..................sq. ft.
Other Distribution box (X ) Dosing lank ( )
~" Percolation Test Results Performed by....... ...Ci. .` %��......7A Date......
................
Test Pit No. .....minutes per inch Depth of Test Pit.... ........ Depth to ground water------................
Test Pit No. 2....t.L.....minutes per inch Depth of Test Pit.... .z........... Depth to ground water......!r................
------------------ ------------------------•-•-------•-------------- .-----••. - ........---.........
.-..........................
.----.••----
O Description of Soil..........Q•'_�4-------L0.A" " sys3 0 t-
U r �a J�.t1"D --------------------- ----•• •----• -
••-----•----•--•-.-- ----- . .. ._ - ------------------- ............. ....
W
U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------_.................................................
•-•-•-------••--•---•--•-•••---•-------• -----------••••----•••••••--------------••..........•------•-----------••-••----••-•---••-•----•----••---••-•-•••----•----••---••--•••----------._....---......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i 'I LE' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been . sued the ofll/ ct,It .
Sign //7/ .. .......T ................
Dat
Application Approved By.- . -.....Y01�t/!/1 + 2./_ / 7�;
JDate
Application Disapproved for the following reasons:----------•-----------------------------------------------------------------------------------------------------
-------------------------'---------------------------------------------------------..--...
1.
Permit No......................................................... Issued.......
Date
-7 _ ✓ 1 �_e)
No......-- » Fizz
............. ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
! .A...........OF...... f �!!!/a�t:� - .----------------------
ApplirFatinn for M-4poti al Works Tomitrnrtinn thrmit
Application is hereby made for f Per it to Const� t ( ) or.Repair ( ) an Individual Sewage Disposal
Svstem at* L 0 . ��
.....:`.. J -• b T I 1. r i . e. .. ..
. —Location-Address - - or Lot�I0
( li .. --..I....... + ...... .....
Owner Address
w ► � �. a< <�_pE_ .�,_v ll,.i.�... LB_.�,; w......��..:1�
........... .................................••----•••-•-.....-------•---•......---•-•--•--•-- -..._.._.__ _ ._ S feet
Installer Address
d Type of Building Size Lot---- q.
Dwelling—No. of Bedrooms......... -________________________________Expansion Attic (� Garbage Grinder j/,;)
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixture ........................................
w Design Flow...2.7-c_..Gt_: ----a_`�...........gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacitylo...D..gallons Length--_------------ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft.
Seepage Pit No........l------------ Diameter.......k......... Depth below inlet........�...._._.. Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank ( )
Percolation Test Results Performed by.___. .r?_ r'_6;L4-__._' !�`"'t_�!`�___ _i'� Date_._._` T_"��____�_�!.2 2/ �
.. .
Test Pit No. l. . ......minutes per inch Depth of Test Pit----!1._......... Depth to ground water....._................
Test Pit No. 2...4.L..._._minutes per inch Depth of Test Pit...!.�_......_.... Depth to ground water.......................
a --••------------------•--•-•-•------••-•---•--....•---..._........-•----------------....----.....---........................................................
F � �
O Description of Soil - ..._..�, a!=f .:............ ._..:!-�---......................................................
V --------------
•--•.........
W ----•--------------••-•-----------.....------......•-••-•-•-------------•-----•--•-------------•-------••-•-•--•---•-------•-••-------•-------•--••------••------•----•••••......-----•-•...---•...----
UNature of Repairs or Alterations—Answer when applicable................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT L; 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i iedVy th boai d of I
bealtk.
Sign d.._�-. _ `' ....l...a:. :-`�.==_��.r`�t-.....----••--•-
------ -------- ---------•---•--
(t Date
Application Approved By..�.-:' .:!-��.....__.._�____�� . ........................ 4 .f..1.4. 7
-------------------•---------•--........................•... Date---,Application Disapproved for the following reasons______________________________ _____.._
.........................................................---••----------•----------•-........._.........-----------•----•----------••------•-------•-----•-•-----------------------•-•-•••--•----------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH _
�!?3..............OF.......... .
(Irrtif irFair of Tumplttinrr
TH IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( � or Repaired ( )
by.... .._ ....`...............�+- •--.........---------------------------•---------•-•--....-•---•--------:-----.......................----• ------...._
y" ` / /, ! ��� Inst ter
at...........c=••=-t!7---_.!-=1- r`=i'A_...__._+ =h '_.•--•-. (---ll J- r�..!............
has been installed in accordance with the provisions of Tf, 5 0 he State Sanitary Code as described in the
application for Disposal Works Construction Permit No.__{{..�:.``_.......1- -:-__----_ dated..... !____i��:_._._.._...
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector------.----•------•-------------------•---•--------------•------------.------•----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
g7
-�_Z 7...........OF.......... ..:................
No........ ��� .. FEE .
.. - ----
�t �a �nr (1n1notrnrtion permit
Permission is hereby granted-- --- '--•-----... ----!----------•---------------------------•------------------------------------------.--------.--.
to Constrict C1 or Repair l ( an I ivid � 'ageDisp a Sy°w
'
, r ii> ..... . , -------------at No.. 4
Street
as shown on the application for Disposal Works Construction Perpn,fiv No.--- ..............i1 ated__J�. .I _ _
-
Boa a 0, ealth
DATE-------------------.............................................................
FORM 1255 OBBS & WARREN, INC., PUBLISHERS
`�`
1
... TEST H DLE S
y
5 � NOV. ;La. /977
LOT /0 CA DOUG McINTYRE NS PEnC7'O,_
�00 Q ± ELEV 14-aL
t`
l' N 0-a4 LOAM-
/OD
' AND SUBS01L
� i
W 9 144 MEDIUM S
SAND
POSE p . `..,a .,....
HoU5Et _
DRM - ..3� O ..J 9)R 4ESt +� ' • ,3+g P�pP O Jt E�.1:4/ o� .o�
Otis SIMILAR SO/
Ho ,sir 30 L CoNDl7'/DNS
BOTH TEST HOLE5
x �� NO ENCOUNTERED
�- s_184� Il � 4 f T01�vN WATER 15 /a1/AILl931,E
40 '
-2 5 F'24w T /� Si D� f d T�F�T 72
P2o,v0;S D
SEPTIC Sy57-&M CONST2UCT/ON BE'D1200/t.95
' SNA c_t_ CONF02M TO MASS . 17E5/G N FL O Gl/ --;��� GAL�r�,a y
E/V VAe o/vM L--.v 7AL. COVE. 7-/TL,E
, E v/ E "7- - 7 LZA C4V
. �fRA� G /A
TOP OF., NEALTN ��f lJLA 7/D/VS�, i�d2Q,[7p5 O
MAA/x/OLE�Cai/E,r-_' TO L-X TE/JZ> Tp 1i�'IpC.eV/OUS COVE�2
W/T.4l/A/ /� Or /c/A/145,AV L-L7 GTZA DLL TO p2E VEiVT JC/�/G--S
�20M /A/F/LTi2AT/�6
D157.
C STpn/
l O .� I M,N.
Co✓f� �°� G Ri99L�
'�a�i1ST ls0x Z/...�� O \/
4' Ij
M/N/MUn.Y /q. wA7E,la = • . ,.�; -..
p/TG.�/ Ft.01.✓ Li�sE �.
Y4,./FOO T /D"MIN M/ni /�i rc�i P/T / 3/41=/�2 ZD/A.
/4` 4�/foo7
-Y_ MinJ %"/Poor A o2.DDa WASH6U t
/ 3 SC)
a .2'OOO -r _ /.vv,f �:.. e STO NE
GA L e 0: / /N✓E�T C ALL
/n/vE.e r c,4 P.A c/ T y � -
SE c:;1T-/G TA .67f1-6i1.. Al DUn/O
45PMOM OF
/3 to CWATGrz7"/GHTJ /NVE,QT
//vvEzT G,2 c
NCB GA,eGAGE .C7,2�A/l�E,�.
pp
SE vA
LOCA7-/01V. /3AI?N�Ti9B/ FCC T Ri/I ) l�i/4
2 EFE 2 EnICE _ j E/N C2 T
_SHOWN IN PLAN BOOK 3/6 g� .�EX>7 rAn/.�, 4�/57-,2/BUT/ON BOX
�5 007-4.E7`5) AA/Z> La,4C,v/A/0 .117-
�O� TO .8E OF .�E/A/FO.2CEZ7 GOA/CTZETE
TO /j 1 , CONC2�TE. ST.2-_AA5r� 3000 ;5/ NI/N.
!Y a STEEL 20000
/O LOA D/A/G
69 t 4; 4 O -�-rz 7" vFWQy Nor To�.5E Loc47
0✓f- S.YS TE,". UNL E.55 �/- ZO
L:QaD/A/G /S !JS€D.
...........
SOIL, TEST p
mmcmim 20 FT. MINIMUM FROM CELLAR DATE OF SOIL'TEST
/02
TOP OF FOUNDATION SOIL TEST DONE BY
100.00 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE CLEAN SAND WITNESSED BY
ELEV. p VE SWQJN---
(ASSUME CONCRETE
OBSERVATION HOLE j ELEV,= 99-0
COVERS LOAM AND SEED OR GRAVEL
SCHEDULE 40 PVC-PIPE 4 PERCOLATION RATE I__K_2__ ,MJN../1NCH AT -4a=60- INCHES
MIN. PITCH 1/8 PER FT,
2 LAYER OF DEPTH. HORIZ TEXTURE. COLOR MOTT. OTHER
1/8" TO 1/2- 4"VeAd 7-
LEGEND:
WASHED STONE 100 , A LOAMY SAND 10YR4/4 . NO ROOTS
M AX.6 M 99.00 MAX EXISTING SPOT ELEVATION 00,0
4" CAST IRON PIPE MAX. 97.00 MIN.
EXISTING CONTOUR ----00----
-(OR EQUAL) MINIMUM FINAL SPOT ELEVATION 24" 8 LOAMY SAND 1OYR5/8 ROOTS
PER FT.PITCH 1/4 FINAL CONTOUR--,--..... MEDIUM
SOIL TEST LOCATION Q 51 C1 COARSE SAND 1OYR6/6 ,
FLOW LINE UTILITY POLE
loll 96.0 MEDIUM
E 9700 TOWN WATER -W 144" C2 FINE SAND 10YR7/6
LE\. _Mz__ -TMIN. 0 0 cl 0 ci 0 cl 0 0 0
CATCH BASIN
\-EL'EV. 96-50 0 . 0
----- LEVEL 0 0 13 0 El ❑ 0 GAS LINE
a 0 .L;"O.
ELEV. GAS ELEV, -M.20 GG
6, SUMP Fj FV 96.00 a CLEAN OUT
0 0 n❑ci ❑co ❑o ❑co ❑c c3 ❑o r_3 ❑c . 2'
BA co ❑r C.P. 0 BAFFLE CESSPOOL
DISTRIBUTION ELEV. 0 0 0 M 0 rl M 0 E-1 E-1 0 0
LIQUID OUTLET 0 c .0 0 0 ELEV. 93.25
A BOX
DEPTH TEE (TO BE PLACED ON FIRM BASE) TO BE, WATER TESTED.
3-500 GALLON DRYWELLS WITHM.
4 FEET 14 IN�HES
5 FEET 19 INCHES IF MORE THAN ONE OUTLET STONE IN AN NO WATER ENCOUNTERED AT --12-- ELEV.
6 FEET 24 INCHES 1000 GALLON (TO BE PLACED ON FIRM BASE) 8.5' X 33.5' X 2.V TRENCH FORMATION :i WELL NIA
FEET 29 INCHES 3 6.25' ZONE N/A
Ok IS FEET 34 INCHES SEPTIC TANK -3/4- To 1 1/2" CLEAN
SOIL ABSORPTION
INDEX N 4A
EXISTING DOUBLE WASHED STONE ADJUST N/A
�
FREE OF FINES & SILT SYSTEM (SAS). DESIGN CALCULA11ONS
NUMBER OF BEDROOMS 3
USES PROBABLE WATER TABLE ELEV. = A
GARBAGE DISPOSAL UNIT NO
SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ELEV. = /A TOTAL ESTIMATED FLOW
NOT TO SCALE BOTTOM OF TEST HOLE ELEV,
110 GAL./BR./DAY X 3 SR.) --NO- GAL,/DAY
REQUIRED SEPTIC TANK CAPACITY _I=_ GAL.
ACTUAL SIZE`OF SEPTIC TANK1000 GAL.
SOIL CLASSIFICATION
DESIGN PERCOLATION RATE �5 5_ MIN./IN.
EFFLUENT LOADING RATE OJ4-.: GAL/DAY/S.r,
LEACHING AREA SO. FT.
8.5'x33.5')+(2'x84')
LEACHING CAPACITY (AREA X RATE) -J-35-- GAL./DAY
452 X 0.74
RESERVE LEACHING CAPACITY _NZA_ GAL./RAY
NOTES:
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN RULES. AND REGULATIONS FOR THE SUBSURFACE
ISOLATED DISPOSAL OF SEWAGE.
_SHED 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
WITHIN, 6" OF FINISHED GRADE.
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHAH BE CAPABLE OF w
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
10 FT. OF DRIVES OR PARKING AREAS. "H-20 LOADING SHALL BE
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
4. ANY' MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL
BE MORTARED IN PLACE.
5. NO C,ETERMfNATION HAS BEEN MADE �AS TO COMPLIANCE WITH
DEEDED,,OR ZONING REGULATIONS. OWNER / APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
6. UTILITIES"SnWIN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR
IS TO CALU "DIG=SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS
'PRIOR TO COMMENCING WORK ON SITE.
7. CONTRACTOR IS TO,VERIFY GRADES AND ELEVATIONS AS WELL AS
00. SITE CONDITIONS PRIOR :TO COMMENCING WORK ON SITE. ANY VARIATION
LOT io IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER
AREA-22,MOtt &F. IMMEDIATELY..
8. PARCEL IS IN FLOOD ZONE
C
9. LOT IS SHOWN ON ASSESSORS MAP AS PARCEL166
10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND
FOR A MINIMUM OF-5FIEET FROM AROUND THE SOIL ABSORPTION SYSTEM,
AND BE REPLACED WITH SAND AS SPECIFIED IN 310 MR 15.255,
(I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT..
ro.r 11. EXISTING SEPTIC LEACH PIT TO BE PUMPED AND FILLED WITH SAND
OR REMOVED
100.0,
v,
SHORT
APPROVED: BOARD OF HEALTH ,
cb\vt
O.H. POR DEC
i-K
DATE AGENT
w
PROPOSED SEPTIC DESIGN
FOR
t M:A5 & MARION RUM
MIN. LOC
LOT 10, 31 RICHARD'S LANE
tte 7
EXISTING 4,40< CENTERVM., (BARNSTABLE
SEPTIC
V417,7 D.B. SEPTIC TA
F.
CRAIG R SHORT, X
235 GREAT WESTERN ROAD
S.A.S, P. 0. BOX 1044
508-
398-831 2660
SOUTH DENNIS, MASS. 0
-STONE-DMW
SCALE
20'
REVISED JOB NO.
t-904
REVISED
LOCATION MAP SHEET OF 1
cae 7-
0 2002 CRAIG R. SHORT, P.E.
ef