HomeMy WebLinkAbout2-12 LOUISBURG SQUARE - HYANNIS CONDOS 2-12 Louisburg Square (Bld'g 4)
Center Village
Hyannis
A = 274014 ;
S M E A D
No.H163OR
UPC 10259
smead.com • Made in USA
gf-m-y-4
e �
� pp
ROSANO DAVIS i
9 ROCKY LANE
COHASSET MA 02025 `'
(781)383-1234 (781)545-2800 (781)749-6178
, � FEB ? 1 A!1 8: 26
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A _
CERTIFICATION
Property Address 2- 12 Louisburg Square
Building 4 -')
Center Village,Hyannis,MA
Owner's Name Multiple Owners
Owner's Address Huntingest Property Management
40 Industry Road—P.O.Box 340 'O�
Marstons Mills,MA 02648
Date of Inspection Completed 1/19/06
Name of Inspector Jeffrey F.O'Connell
Company Name Rosano Davis Sanitary Pumping,Inc.
Mailing Address 9 Rocky Lane
Cohasset,MA 02025
Telephone Number 781-383-1234
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: Date: 02/02/06
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty
(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.
1
Title 5 Inspection Form 6/15/2000
f
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (61.7)545-2800 (61.7)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property: 2-12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D:
A] SYSTEM PASSES:
X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 or in 310 CMR 15.3(
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.
Indicate 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 breakout 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. The system will pass inspection if(with approval of the Board of Health):
_ broken pipe(s)are replaced
_ obstruction is removed
_ .distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with
approval of the Board of Health):
_ broken pipe(s)are replaced
_ obstruction is removed
ND explain:
i
2
Title 5 Inspection Form 6/15/2000
i
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property:2-12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
C Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the Board or Health in order to determine if the system is failing to protect the
public health,safety and 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 Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a
manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or
tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet of more from a private water supply
well". Method use to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile
organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and
nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis
must be attached to this form.
3) Other:
3
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property: 2-12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
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
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
_ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is than 1/2 day flow.
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_ X Any portion of the SAS,cesspool or privy is below the high groundwater elevation.
X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. [The 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 I have determined that one of more of the following failure criteria exist as described in 310 CMR 15.303,
fails. therefore the system fails. The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E.Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"Yes"or"No"to each of the following:
(The following criteria apply to large systems in addition to the criteria above.)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a
public water supply well)
4
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1.234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION(Continued)
Property:2-12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners '
Date: Completed 1/19/06
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 with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department.
-r UME) nMge MM9eM n®MMHy Iles I &Mlk
5
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART B
CHECKLIST
Property: 2-12 Louisburg Square/Building 4
Center Village,Hyannis,AM.
Owner: Multiple Owners
Date: Completed 1/19/06
Check if the following have been done You must indicate"yes"or"no"as to each of the following_
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the prevous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were the septic tank manholes were uncovered,opened,and the interior of the septic tank inspected for condition of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum?
_ X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of
subsurface sewage disposal systems?
The size and location of the Soil Absorption System on the site has been determined based on:
Yes No
X _ Existing information.For example, Plan at B.O.H.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
[15.302(3)(b)]
i
6
Title 5 Inspection Form 6/15/2000
i
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-61,78
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION
Property: 2-12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
FLOW CONDITIONS
RESIDENTIAL:
Number of bedrooms(design): Number of bedrooms(actual): 16 units.
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Number of current residents: Number varies but typically 17 on average.
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No (If yes separate inspection required)
Laundry system inspected (yes or no):
Seasonal use(yes or no): No
Water meter readings,if available(last two(2)year usage(gpd)): Water usage records were not available at time of inspection.
Sump Pump(yes or no). No
Last date of occupancy: 01/19/06—Units were still occupied at time of inspection.
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:Property currently under regular maintenance schedule.
Was system pumped as part of the inspection(yes or no): Yes
If yes,volume pumped: 2,000 gallons-how was quantity pumped determined?Sight glass on vacuum truck.
Reason for pumping: To determine structural integrity and water tightness of septic tank.
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
No 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)
No Tight Tank. Attach a copy of the DEP Approval
Other(describe)
Approximate age of all components,date installed(if known)and source of information: 36 years per previous inspection.
Were sewage orders detected when arriving at the site(yes or no): No
7
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (61.7)749-61.78
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 2-12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
Dan@ nMg6e nmtemi comMEEy Ilel DDEMMIk
8
Title 5 Inspection Form 6/15/2000
f
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (61.7)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 2- 12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
BUILDING SEWER(locate on site plan)
Depth below grade: 53".
Material of construction: X cast iron 40 PVC other(explain) Cast iron inlet pipe.
Distance from private water supply well or suction line: No known wells in immediate area.
Comments:(on condition of joints,venting,evidence of leakage,etc.)
All piping appeared to be clean and flowing freely.No evidence of leakage.
SEPTIC TANK: YES(locate on site plan)
Depth below grade: 45".
Material of construction: X concrete metal Fiberglass Polyethylene
other(explain)2,000-gallon precast concrete septic tank.
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes or No):_(Attach a copy of certificate)
Dimensions: 6' deep X 4' wide X 12' long.
Sludge Depth: 21".
Distance from top of sludge to bottom of outlet tee or baffle: 33".
Scum thickness: 3".
Distance from top of scum to top of outlet tee or baffle: 3".
Distance from bottom of scum to bottom of outlet tee or baffle: 11".
How dimensions were determined:Measured with a tape.
Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet
invert,evidence of leakage,etc.)
Septic tank was pumped at time of inspection.Inlet tee and outlet tees in place as required.Tank is structurally sound and water
tight and all effluent levels were at an appropriate height.There are no repairs recommended at this time.
GREASE TRAP:NO(locate on site plan)
Depth below grade.
Material of construction: concrete metal Fiberglass Polyethylene other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments:(on pumping recommendations,inlet and outlet tees or baffle condition,structural integrity,liquid levels as related to outlet
invert,evidence of leakage,etc.)
9
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 2-12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
TIGHT or HOLDING TANK: NO.(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal Fiberglass Polyethylene other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm Present(Yes or No)_
Alarm level: Alarm in working order _(Yes/No)
Date of last pumping:
Comments:(condition of alarm and float switches,etc.)
DISTRIBUTION BOX: YES.(If present,must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 0_'.
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,
etc.)
Box was structurally sound and water tight and providing even distribution of effluent.Carryover was moderate There are no
repairs recommended at this time.
PUMP CHAMBER: NO.(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.)
I
10
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 2- 12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
SOIL ABSORPTION SYSTEM(SAS): YES.(locate on site plan,excavation not required)
If SAS not located,explain why:
Type:
X leaching pits,number: 2—6'X 6' leaching pits.
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system. Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):
There was no surface wetness,breakout or signs of hydraulic failure observed.Leaching appears to be in good working condition.
There are no repairs recommended at this time.
CESSPOOLS: NO.(Cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(Yes or No):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PRIVY: NO.(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
11
Title 5 Inspection Form 6/15/2000
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C ,
SYSTEM INFORMATION(Continued)
Property: 2-12 Louisburg Square I Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
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.
1
W
A =4
jo
g c ram^
- D - 3t ` F= = 33
�3 -( = 4u, r
� - L = 13` C - 29 `
nC f t� sca& Buddog 4
12
Title 5 Inspection Form 6/15/2000
. .
ROSANO DAVIS
9 ROCKY LANE
COHASSET MA 02025
(617)383-1234 (617)545-2800 (617)749-6178
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART C
SYSTEM INFORMATION(Continued)
Property: 2-12 Louisburg Square/Building 4
Center Village,Hyannis,MA
Owner: Multiple Owners
Date: Completed 1/19/06
SITE EXAM
Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to groundwater: Greater than 19 feet
f
Please indicate(check)all methods used to determine the high groundwater elevation:
Obtained from system design plans on record. If checked,date of design plan reviewed:
X Observed site(abutting property/observation hole within 150 feet of SAS)
X Checked with local Board of Health-explain:Previous Title 5 Inspection dated 03/29/03.
Check local excavators,installers-(attach documentation).
Accessed USGS database-explain:
You MUST describe how you established the High Groundwater Elevation:
During a previous inspection on 03/29/03 the high groundwater was indicated to be 19' 11" below grade Clearly there is separation
from the bottom of the SAS to the high groundwater elevation.It was by this non-intrusive method that it was estimated that
separation exists from the bottom of the SAS and the high groundwater.
13
Title 5 Inspection Form 6/15/2000
William (=, ielerman"
141 STETSON LANE "
HYANNIS. MASSACHUSETTS 02607 "
617-771-1341
March 8 , 1977
Barnstable Board of Health
397 Main Street
Hyannis, Massachusetts 02601 Reference: Barnstable Subsurface
Sewage Disposal Proposed
30 Condominium Unit
Addition to Center Village
Condominium Complex, Old
Strawberry Hill Road
and Route 132.
Job No. 73-410--Approval
Letter dated October 18 ,
1973 (Mass. Dept. of
Public Health) and Sewage
Permit #59.5 (Town of
Barnstable),
Gentlemen:
This i"s to certify "that, the disposal facilities for :building #4 has
been inspected this day and found. to be constructeddin accordance
with the approved .plans in two sheets , ' the first of .whch is titled:
JULI:US DOLINER CONSTRUCTION CO. ,
850 Boylston Street
Chestnut Hill, Mass . 02.167
SCALE: 1" = 30` DRAWN BY: . T. LEVRONI
DATE: 8/24/.73 DWG.NQ:, -- SP t
5r
DWG. TITLE• OF h14
SITE PLAN sgC,y
CENTER VILLAGE: CONDOMINIUMS
HYANNIS; MASS. WILLI' AN
w
LIEBERNIHN v,
No. 239710
V Y u 1 o r A �
U� I STE
�SS QtVAL E�
is iebe:rman,' P'
cc: Department of Environmental Quality Engineering, Mr. Fred L.
De . Fe Feo, P.E. , Regional Sanitary Engineer, ,Southea'stern
Health Region, Lakeville Hospital, Lakeville, Mass. 0.2346
Strawberry Kill Realty Trust, Mr. R. Anderlot, 477 Main St. ,
Yarmouth Port, MA 02675
30 00
No.... -.1 ,. Fas...............'.............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH � A 7q 6
TOWN OF BARNSTABLE
�' ,�#� trtt�. '� ur �ir��j�ul 3�i larli,� Cn>�at��r�r�tun rrutit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
2-12 Louisburg Square Centerville �C�Y1VIIr�
........................... -------------------------------------- ................................ •---------------...------.-•----
Location-:\ddress or Lot No.
Center Village Condo Trust
......................-.......................................................................... -----------•---------------••-•................-•---------._..........-----.......-----------•....
Owner Address
W J .P.Macomber Jr .
---------•------ ---------------------------•-------•--------•------•---•--------•-.......---
Installer Address
Type of Building Size Lot.------.--•--•-_----___-_Sq. feet
.. Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.--.---...--................ Showers ( ) — Cafeteria ( )
QOther fixtures ----------------------------------------------------------------------- ............. ...............................................................
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.
3 Seepage Pit No..................... Diameter----............--. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date..--------------...........----....:
a Test Pit No. 1................minutes per inch Depth of Test Pit...---.....--....... Depth to ground water.......--.....--.........
f= Test Pit No. 2................minutes per inch Depth of Test Pit--.---.............. Depth to ground water....................--..
9 --------•........................•----------...----------------...-•----.........------..._..................---------•--•-•---.......---..................--
0 Description of Soil.........................................................................................................................................................................
W .................................................Sand&---Gravel------------------------•-----------------------------••--
W
----------------------------------------------------------------------------------------•----------- -----------------------------------------------------------------------------•--•-•-------........
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
....----•-•---•-----•-•-----•---•----------------------------------------------- 1-1 G_00.--g a 11 on l e a ch i n_q...p.i t..............................................
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 iss ed y board of h lth.
Signed ...... ... .. ..(.. . ........812.419.1.....
Dare
Application Approved BY .. ......................... ...... ........... .F...
Application Disapproved for the following r asons: ............................... ..... . ............................................................................... . .....
.................................... .. .q. . ............................... - - .................................................................................. ........................................
Dac
..... e
Permit No. /,� - `..� ,3------------------------- Issued ...........................-- ..................................--
Dare
No...T9?= �"�;�.3 Fas 30 00
.... . ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
y �} TOWN OF BARNSTABLE
Y- 7
a pphratiun for Dirpnsai Workii Tnnitrnrtinn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
2-12 LouisburSquare Centerville 14 11"111111
..................................................••- ••••-••--................•---••--••--•. -•-•••---•--------•---•-•---..... -•••..... •. ......-•--••......••-•-....•- ••-•--•-
Location-Address or Lot No.
Center Village Condo Trust
--------------•-•-•--•-----..... --•••••--•--•--•-••--••--••-..................-•-•-••••••....-•-•............---•---••-•..........
owner Address
aJ.P.Macomber Jr....................................................
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
QOther 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.
3 Seepage Pit No..................... Diameter...........-..------ Depth below inlet---................. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
4� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t
P4 ----•------------------------------------------------------------------------------------------------------•----•---------•---.......... ....•...
0 Description of Soil.................................................................................................... ---....---•--•-------------•-------••-•--
V ....-••-•--•---•-•-----••-•-•-•••--•-•-•-•-••-..Sand&...Gravel---------------------•-•-----------------------------------------------•-----------------••••........-•-•-...........--
W
---•----------------------------------------------------------------------------------•-•-------------------------.................--------------------...............................................
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
...:.----•-------------------------------------•••-----••- 1-1OQ0.--gallon---leachin-q... i_t.
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 y t board of health.
Signed ....... ...a..... . ?... . ................... ........812419.1.....
Dare
Application Approved BY ...........�.- -- - ...... � MFe1 f_......
Application Disapproved for the following re sons: ...............................
...... ............................... ... . ..................... ....... .................................................................................................. .. ............ ..........................
Dace
PermitNo. ......��..-..... ..tl� ............................ Issued ............................... . . ........................
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
V6.1Ertifirate of Q-TompXi? nce
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX)�
by .......J..P.Macomber Jr.
.......................... ............................. .......... ................ ..... ............ ... .......-.
Ineml ler
Louisburg Square 2-12
at ........... --- .------------ ........ .................................................................................................................................
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. .._c� ..-_ ����..._...__.. dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---------------.- ............_------------------ Inspector ------------------- .�� .----........_..----- ....--------- -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No... ... TOWN OF BARNSTABLE
FEE..
30...00. ..
.�-.���..'� �..............
�i��n��t1 nr�� �un�trl�rtuan �rrmit
J.P.Macomber Jr.
Permission is hereby granted-------------------- ------- -------------_------------------------------------------------
to Construct or Repair (X� V
an Individual Sewage Disposal System
at No.....2.-1. ouisburg quare Centerville Center illage Cobdo' s
PP P street
as shown on the application for Disposal Works Construction Permit No ..,3yU:. _:.... Dated...........................................
0 N
`Blm;T of Health
DATE . '= ----------•••••-
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS '