HomeMy WebLinkAbout0442 BAY LANE - Health 442 BAY LANE CENTERVILLE
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UPC 17534
No.2 1�3COR 'bsr
kASTINGS, MN
TOWN OF BARNSTABLE
LOCATION /-N SEWAGE# aCi1
VILLAGE,!�3JlerV P ASSESSOR'S MAP&PARCEL/66 8�'—
INSTALLER'S NAME&PHONE NO.'-D,A :—I� roc iSC@"`f -0—K ML
SEPTIC TANK CAPACITY 6q,5,r(,JN /'�-O O
LEACHING FACILITY:(type) CHcAKS (size) /�.83 3G33
NO.OF BEDROOMS
OWNER arr(wod
PERMIT DATE: yLIG /a/ COMPLIANCE DATE: b Z/
Separation Distance Between the: A)0,Jr mwav-�0*d
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 Z)A ►�G(jct
A 3 F,rov#
30
. I S� rese rV
33,s
`I
No. , 3 Fee den
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yew
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
4plitation for Disposal 6pstem Construction 3permit
Application for a Permit to Construct( ) Repair(e<Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.i141A hta�L;� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel �, Cowwclk.
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
V.A i (�� f5 �c� �cPxr�v
Type of Building:
Dwelling No.of Bedrooms �']\ _ Lot Size sq.ft. Garbage Grinder( )
Other Type of Building (('�{(;� (a1 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets I Revision Date
Title
Size of Septic Tank Type of S.A.S. �j� CC)Ck0jj ti-10 b=+(_5
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ln:j�L/ k New C)-bo:, e-tj1,MjpV
tno Cx IZ,�3'SX �, S:SA(P4
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date // c
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. � 3 l Date Issued
iiii t s
i e• � No. ,/�'"' ,/ �.l � ,. Fee / r
1 ! THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
a PUBLIC HEALTH DIVISION- TOWN..OF BARNSTABLE, MASSACHUSETTS Yes �� •. .
1 application for MIB�JOs.aYpstPllt COlYBtrUttlOnPrllllt
' Application for a Permit to Construct( ) Repair(+<Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
r: Location Address or Lot No.4(#A 1 (, e Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel /136 A Co(�vJt�l�
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
t
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building (Ps&oo N No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) H14() gpd Design flow provided gpd
Plan Date Number of sheets ( Revision Date
• e
Title
Size of Septic Tank (�~x���ti�t� { �Cti Type of S.A.S. q 1 qCA W-10 6knv,brK
Description of Soil
r:
Nature of Repairs or Alterations(Answer when applicable) .j,zJ/ G AW14 A 40Y r-I A ICY- <111,,6 0-fU i'f/It_.tqVTJ
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction,and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date 11 // a J
Application Approved by _ Date y
Application Disapproved by Date
for the following reasons
Permit No. f !f Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( v) Upgraded( )
Abandoned( )by rya ZaY Lk) Ce ka,fcjoill,?
at W N ( ;e 1,K) has been constructed in accordance
with the provisions'of Title 5 and the for Disposal System Construction Permit No; r—,/ /r dated
Installer Designer` a)er) Wn^w
r #bedrooms Approved design flow tI y'' U gpd
The issuance]of this permit shall not be construed as a guarantee that the system will fur Lion asfdeed.
Date 4 �� ��f��� Inspector
Fee /�Q
THE COMMONWEALTH OF MASSACHUSETTS r ;
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction 3permit
Permission is hereby granted to Construct( ) Repair(+✓)'1/ Upgrade( ) Abandon( )
System located at b/�/� /y�y nJ (ov tiPttJlIle � }
y,
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must
be do plelee'd�within three years of the date of this permit.
Date "T'�/(� OL, Approved byA`
Town of Barnstable
'THE t Regulatory Services
Thomas F. Geiler,Director
BARNSTABM Public Health Division
o Thomas McKean, Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
.. Date: 2 1 Sewage Permit#.;0-`21 -/V Assessor's Map/Parcel /66 -$61"
`` Installer &Designer Certification Form
Designer: ` , � Installer: ,
r
Address: C46 ��� Address:
On G �a was issued a permit to install a
date) (installer)
septic system at . I tCAr- 66,V d(e based on a design drawn by
,,rrAA (address)
Qb dated G 2
(designer)
® I certify that the septic system referenced above was installed substantial) according
n which may Y g to
the-desi
g , y include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were'found.satisfactory.
I certify that, the. septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system):but in accordance with State & Local u� ".4ions. Plan revision or
certified as-built by.designer to follow. Stripout (if ri- -cted and the soils
were found satisfactory. -�N OF MqS r
DAVID
(Installer's Signature) M �r
I _ a
a OVA
APR 1
T0`�'oF � 2oo0
�n,0�s�r,�
COMMONWEALTH OF MASACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET BOSTON MA 02108(617)292-3500
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 L10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Address of Owner: 1682 RT.132 HYANNIS MA.02601
Date of Inspection: 4/8/00
Name of Inspector: JOHN GRACI
I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000)
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636
Telephone Number: ;608-564-6813 FAX 608-664-7270
CERTIFICATION STATEMENT
I certify that 1 have personalty inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.The system:
X Passes
_ Conditionally Passes
_ Needs Further Evalu n y the Local Approving Authority
Fails
Inspector's Signature: Date:4/8/00
The System Inspector shall sujit a copyof this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection.If tystem is a shared system or has a design flow of 10,000 gpd cr greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
"The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My
inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life"
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE.
revised 9/2/98 Page 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 L10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 4/8100
INSPECTION SUMMARY: Check A, B, C, or 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 exist.Any failure criteria not evaluated
are indicated below.
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,or ND).Describe basis of determination in all instances.If"not determined",explain why not.
n& The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance
attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether
or not metal,is cracked,structurally unsound;shows substantial Infiltration or exfiltration,or tank failure is imminent.The system
will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health.
nLa Sewage backup or breakout or high static water level observed in the distribution box is 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 levelled or replaced
n!a The system required pumping more than four 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
revised 9/2/98 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 L10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 4l8/00
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
m Conditions exist which require further evaluation by the Board of 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis 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,Method used to determine distance n1a(approximation not valid).
3) OTHER
n/a
revised 9/2/98 Page 3 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 L10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 4/8100
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 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 Q.
X Any portion of the Soil Absorption System,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 I of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality
analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,
ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
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:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and
safety and the environment because one or more of the following conditions exist:
Yes No
X the system is within 400 feet of a surface drinking water supply
- X the system is within 200 feet of a tributary to a surface drinking water supply
_ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the
Department for further information.
revised 9/2/98 Page 4 of 11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 L10
Name of Owner: LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 4/8/00
Check if the following have been done:You must indicate either"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 - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.
Large volumes of water have not been introduced into the system recently or as part of this inspection.
X - As built plans have been obtained and examined.Note if they are not available with N/A.
X _ The facility or dwelling was inspected for signs of sewage back-up.
X - The system does not receive non-sanitary or industrial waste flow.
X - The site was inspected for signs of breakout.
X - All system components,excluding the Soil Absorption System,have been located on the site.
X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of
construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been
determined based on:
X _ Existing information,For example,Plan at B4O,H,
X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b))
X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal
Systems.
revised 9/2/98 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 L10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 418100
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom
Number of bedrooms(design): 4 Number of bedrooms(actual):
Total DESIGN flow: "0 gpd
Number of current residents:2
Garbage grinder(yes or no):NO
Laundry(separate system)(yes or no): NO If yes,separate inspection required
Laundry system inspected(yes or no): NO
Seasonal use(yes or no): NO
Water meter readings,if available(last two year's usage): n/a gpd
Sump Pump(yes or no): NO
Last date of occupancy: n/a
C_OMMERGIALflNDUSTRIAL
Type of establishment: nla
Design flow: nla gpd(Based on 15.203)
Basis of design flow:n/a -
Grease trap present:(yes or no): NO
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no):NO
Water meter readings.if available: nla
Last date of occupancy:nla
OTHER: (Describe)
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n/a
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped n/a gallons
Reason for pumping:n/a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorption system
_ Single cesspool
Overflow cesspool
_ Privy
_ Shared system(yes or no)(if yes.attach previous inspection records,if any)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:n/a
APPROXIMATE AGE of all components,date installed(if known)and source of information:
1996
Sewage odors detected when arriving at the site:(yes or no) NO
revised 9/2/98 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P86 L10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 4/8/00
BUILDING SEWER:X
(Locate on site plan)
Depth below grade: 36"
Material of construction: _ cast iron X 40 Pvc _ other(explain)
Distance from private water supply well or suction line: n/a
Diameter: 4"
Comments: (condition of joints,venting,evidence of leakage,etc.)
THE SYSTEM HAS TOWN WATER.
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 30"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: 1600G L 10'6"H 6'6"W 6'8""
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 33"
Scum thickness: 1"
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: n/a
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS.
GREASE TRAP: _
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
nla
revised 9/2/98 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 1-10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 4/8/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm present: NO
Alarm level:NIA Alarm in working order:NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
DISTRIBUTION BOX:X
(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
THE DISTRIBUTION BOX IS,STRUCTURALLY SOUND.
PUMP CHAMBER: _
(locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
nla
revised 9/2/98 Page 8 of t 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 L10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 418/00
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
n/a
Type:
leaching pits,number:(n/a)n/a
leaching chambers,number: (14)INFULTRATORS
leaching galleries,number: (n/a)n/a
leaching trenches,number,length: (n/a)n/a
leaching fields,number,dimensions: (n/a)n/a
overflow cesspool,number: (n/a)n/a
Alternative system: n/a
Name of Technology: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE SAS APPEARS TO BE FUNCTIONING PROPERLY.THE SOIL PROBED DRY IN LEACH AREA,SYSTEM SHOWS NO SIGNS OF FAILURE.
CESSPOOLS: _
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer. n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: n1a Dimensions: n/a
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
revised 9/2198 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 1-10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 418100
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
R
A � c
b D 0
AA �b� xn,�';1 r�► IoRs 71
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l
CFO3f
SIC '13
revised 9/2/98 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 442 BAY LANE CENTERVILLE, MA 02632 M186 P85 1-10
Name of Owner LEAH MOGAN C/O REALTY EXECUTIVES
Date of Inspection: 418/00
NRCS Report name: nla
Soil Type: nla
Typical depth to groundwater: n/a
USGS Date website visited: nla
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 12 Feet+
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
X Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
_ Checked pumping records
Checked local excavators,installers
g Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
USGS MAPS AND CHARTS-12+FEET
revised 9/2/98 Page 11 of 11
TOWN OF BARNSTABLE }
I ACATION &/'/I2 SEWAGE# J V '162 7
VILLAGE,, ASSESSOR'S MAP&LOT ,j /0
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACIT`<
t.
LEACHING FACILITY: (type) `i �. (size)
NO.OF BEDROOMS
BUILDER OR OWNER Fc.r.
PERMITDATE: &-6 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /Vif 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
y�.
00
r
i
No... . Fss...... ....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Apphratinit for Diripoiul Wor1w Toitotrurtion Famit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst . .. --j . _ •. [�hV� ,C llf l -•-... ..----•------ - -
r \�/� ........ or Lot No.
/�. ---------------------------------------
Address
------------------------•.......
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms.............�___.______---_--____---.---Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
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----.----------.--.--- -•-•- ......
as Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water:. . _
fs, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...._._....___.._.,./.!.
�.
.......................................................................................... ........---•--------------•---•--•--......... _•;;� .......
Description of Soil ------------- '
------------------------------------------------•----- . ... ------ -- ---- ----- -- •••... --•• ---- -•--••-------- ----- . ---- ......... --- • ...........................................
0 Nature of Repairs or Alteration —Ans w ap li e-------- - -- -- - --- -- __---------- --_.__. .........................................
Agreement:
The undersigned agrees Ins the afo es ib ivi ual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Envir n t Code-The undersigned further agrees not to place the
system in operation until a Certificate of Com i has b n issued by the board of health.
Sigried . ...!C ...... .... ............................ .:..---
Dace
Application Approved By --- --.... ...:.. . . .. . ..... .... -- -------- --------- .... ...
Application Disapproved for the following reasons: .......................... .......................................................................................................
.. ........................................ ... . .......................
ice
PermitNo. .. ........ ..--....... ... ..-..... Issued . ............ ............ ........-- ......
llare
fy✓�..��.;,w ..-ile',ti.�4......�-...,v-•y-.:-+i;..,v��.:::.-..�.......e.::4.w.-.�.:S�n+��.:�,.�.r..y-Y3.�Ws-v^u.�...d...._.,++..s.rrar..d.V.�oji..4a-.y-.-+.zibati.-L::a...�Je.-�u.r'�,yx::.y.+'L".."bV`ray✓`•"1fo1(�-.fv-v-+•--••,�,�e•-�
08- �6 a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diripwial Workw C onmrnr#ion Permit
Application is hereby made for a Permit to Construct .).-or,kepair ( ) an Individual Sewage Disposal
System at:
/L MNIV611_........ . ---•---------------- --
Len lion-:\d;d?cs . or Lot No ....---
.........._.� --- ...f..r_912
O�cnen Address
w � �/C�
- ..................................................... ---•--•--------••--•••-••-•--•-•-•-••----......-••-•--•-••----••..........•-•-...........------•-
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms............./_.____--_-.___-____-_.___Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons________-___-__--__-_..___- Showers ( ) — Cafeteria ( )
a' Other fixtures ......................................................
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity............gallons Length________________ Width---------------- Diameter................ Depth................
w Disposal Trench—No. .................... Width.................... 'Total Length.................... Total leaching area............_.......sq. ft.
x
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. I................minutes per inch Depth of Test Pit.................... Depth to ground water ........
(s, Test Pit \'o. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_ ............._..
0 ........
-----------------------------------------------------
•--•-•......---••....... ......-•-•---•-...........
Description of Soil-----•-------•-•...............•----.... '= _ _.. = _fn ....................
wx ... .......j•---•--•-- ------ '.. /1. - -�------------------------
---------------------------------------------------------------- - --------- / N ,I �► �I//
xr +� �- �,� �---------------- -------------------------� *.----
U __Nature of Repairs or Alterations—Ansk when ap licab7e.______.�...... .___1I-_� ...............................................................
-- •-••....•. . ... ��.. c
Agreement:
The undersigned agrees to-install the aforcedes ribe I d"ividal Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environ�ine-/ta4 Code—The undersigned further agrees not to place the
system in operation until a Certificate of Corn !I ce has beenissued by the boardof health.
Da
..... ...... .
Application Approved By ....:..... ���---- _.o../ T .t�1X, .. .e../ al. �T"1_f� ...........................
,✓�/ Y .� Dace
Application Disapproved for the following reasons: ............. ......................... . ................................ ..............................................
------------------- - --!-------......... ................ . ... ........................................-.........�.
Dace
I
PermitNo. ..............� ..... . ........... Issued ................ ....... .... ....................
1 Dare r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Tomplianre
THIS IS TO CERTIFY, That the I dividual Sewage Disposal System constructed ( ) or Repaired ( )
............ ................... -----------------.. ------- <..........._.......-........... ..... - -............................... ........
by L� 1 /' �� / i ,and }
at ......................... ....................._......... _....._�4 .. 1......._...�...�.�...� .:..._.................... ................. ....--..........
. w -
has been tins talled in accordance with the provisions ons of TITLE tif�ate Environmental Code as described in
P
the application for Disposal Works Construction Permit No. .... . ..... ....._ dated ....._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRUEA AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SAATTISE RY.
DATE_.............'•-,...L...�,/.: -..-`.://...�ti ............... Inspector,.._. �-�. ! .. I/.....-�.�/
� - r
--------------------------- ---------------------- _------ ------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE /�
9 / FEE......_............ .
DispasalAVorkii TaangfrArtion Permit
Permission is hereby granted -�------� ---..........� _.;V---------------------------------------------
1 to Construct ( ) or Repair (, 4an1,Individfia1-Sc4,age Disposal System �`at No.. ..........
.=�!.7�4 1`---•••af..........................
l c Street � '/
as shown on the application for Disposal Works Construction PermNo.!___!__......!."� ated. ..........................._........
� Board of Health 17
DATE----- / •'- ...............................FORM 36308 HOBBS 6 WARREN.INC..PUBLISHERS
N - •- ..._...... FE ............
' THE COMMONWEALTH OF MASSACHUSETTS ^
BOARD OF HEALTH l o�
.............................. oF...... 3l=%iS ------•---•••
Vpliration for Disposal Works Tonotrurtion Prrutit
Application is hereby or a erm' t Construct ( or Repair ( ) an Individual Sewage Disposal
System at: '
C�� �0 �-- � Zl I �' �� mS•-•........-•••.......--
............ _........ .......... ............................................... --- -
......
2_ Locaatti�onn-Address �y�J
.._..._..IL .�i ---•L-f- 1•'.r-._..�C.d� .1_.'.:�.n.✓(�L... l 'In cS�Lot
...................•-------......................................•.... .......... ...
Owner A re
a Ko tSt"l..,T t4... .1, .. vim
Installer Address
d Type of Build in Size Lot..� .c �.._._Sq. feet
U Dwelling—No. of Bedrooms...........4.................................Expansion Attic (po) Garbage Grinder (yS
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ..................-----•-----------•----------------••-••••-•-•--•••----•-•-----•----...•••••••-•••••-•....._......•-•--•••--...------.............
Design Flow..................�°.f'-....gallons per person per day. Total da}l flow..........6 ..............................gallons.
W
WSeptic Tank—Liquid capacity�_��U.ga]lons Length f0` b Width.__5------.... Diameter................ Depth.. t_¢`'....
x Disposal Trench—No...................... Width.................... Total Length.................... Total leaching area•-.------_._...__---sq. ft.
Seepage Pit No....._.�......... Diameter.._.......... Depth below inlet........ Total leaching area!�2a
...........sq. ft.
Z Other Distribution box ( ( ) Dosing tank ( ) _ _
~' Percolation Test Results Performed by._IAXT?=�.z:.0....................... .. ............ Date__5_. b.-9Z
----•--------
Test Pit No. 1_.j�___minutes per inch Depth of Test Pit......1 ........ Depth to ground water...OIL
Pzq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •••--•••••--......--••-•-••...--•---.......=••---•--•-- -----------------------•••••'---.------
t..._
O Description of Soil•-••0. .-_L �JYSSpb L.. Z _ S
t_
U ------.5.---•- •-1�=-------��Y� 5 -
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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued b the board of health.
FA
Application Approved BY ••---••-•-- .�__' '- ------------------------=- ---------••-- /�3�v
Da e
.....
Application Disapproved for the following reasons-------------------------•---•--------------------------•------•----------------•-----------••--••----.........
----------------------------------------------••--••••-----•-----••--•-•-----•••-----•••-•------••-•••-•-•-•-•-•••-----•--••--••------_._..
Date
JPermit No....:5 - -- Issued----------------•--
— — Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
IZN
..................OF..............................................................
........ n.wee..+. :1.�......................
QTprtif iratr of Tomplianrr
THIS4J OCERTIFY, That the Individual Sewage Disposal System constructed ( t�`or Repaired ( )
b)---------------•---- ._. ._.....'r...........)AY...:---........--------------.------------------------------.........----------.......------------....
py r2 ® In�st.Ilex
at -----1.'�--r v !�d-�+ ...-�_` C.. �►_T1' 51L1d -
has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code as described in tfie
application for Disposal Works Construction Permit No...............:
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO T R U A GitA TEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �' f
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF........... 10�
N .... FEE ...
Disposal Works Tonotrndion [prntit
Permission is hereby granted.........PAL�-�..._.__.0N1K ..............................
• •. .. .......... ....
to Construct ✓S or Repair ( ) an Individual Sewage Disposal stem I
at No.....(!nq.1.........)q...........-& ....L-•-•`-••-- CL
Street
as shown on the application for Disposal Works Construction Permit 114 .. ..Ze....... D ed.._.._..-:..........................
C=i�/yu_
............................. ...•----•-•------•-•--•••-•-•---• .............................
DATE................................................................................ Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
Vol
FA
�. THE COMMONWEALTH OF MASSACHUSETTS
-- .-. BOARD OF HEALTH , f vo
1
1 Applirataon for Disposal Works Tonstratrtton Vamit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at: `
t!Imo 1 ;.1 C' i'i L �'�5_)
......_... _......................•------•---•--------•-••----•---•-•...............---..... ---•-•--•---•.....---.•••--•----•----••....--•._...•-•••--•-•-----,•-•-----...........---••-
r Location-Address �.� !y f G /�1 G l It! S°r Lot No -I\j 1�1, U a L
L.t r_ i\F L �` ;YyU t R c:
__._._.....- - ..._....---•---------------•----•-•--•----•---•------ ..........--..............................................................................._.....
9wner ddress
W Jam_L r U 1
Installer Address ,
Type of Building Size Lot............................Sq. feet--
,-4 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (Y )»
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
aOther fixtures ---------------------------------------••---------------••---------------•---------------------------•---.....---•----•---......•••--....-••.....----
�
W Design Flow............�...............................gallons per person per day. Total daily,flow............................................gallons.
W Septic Tank—Liquid capacity....?.,`..gallons Length._10.
_.`...__. 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.`�v.'.._..._...sq. ft.
Z Other Distribution box ( I) Dosing tank ( ) _
Percolation Test Results Performed by-_..�'�.�'_L}_ t 1�'� Date..................................`� .�
a •-•---... .....---- -•-•-•.
Test Pit No. 1................minutes per inch Depth of Test Pit.........Z-._.__.. Depth to ground water____
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................
............................................-------------------------------------•
Description of Soil.... .... --.1.�.!��'`'1.- ........=--- '`fit Z - 5 �l�wt� , G Iwi> E�
------------------------------------------------------------------------------------
x i .. �.Z i11... ....) .
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 TIT1Z 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued b the board of health. j 1
--- -....
w / Date
Application Approved BY ...................-•-----•-----•--......--••--••.............• 2/�yy ,
Date
Application Disapproved for the following reasons-...............................................................................................................
------------------------------------------------------------•--------------------------------------------...---------------••-----•-------------------------------------------------------------...--•---
^- , Date
Permit No. = ...... Issued-.......................................................
D Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� t�> P ry-W—<-'T .t-. ......................
..................................
OF...
TurdifirFatr of Tontpli anrr
THIS S 0 CERTIFY, That the Individual Sewage Disposal System constructed ( Wor Repaired ( )
b)--------------�---- ..........0,M ..........------------------------------------............................----------------......----••----..,
has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit ___________�._ . , "t,,�'. dated„ _": ._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUE® THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. JVT�17EE
DATE.................................................................................. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
t
�-Z BOARD OF HEALTH
\ -TV W.NJ OF. ... M Pry-6 S
ww.r.... .. .............................I...... .............................................................
N --� t -� ;
v. � FEE... ........
Biovos al luorkil Quomitr ion rrnttt
Permissionas hereby granted.........K!.......----•...................�111K :----------•----------------•--- --- ...........---._/... ._. ----------------
to Const uc__t_� or Repair ( ) an Individual Sewage Disposal System
t(Gn/
at No.... .t...._....�.. ----C'A.. ...----Gt:,.?.:�.�uJ --•-•-
Street f0+
as shown on the application for Disposal Works Construction Permit No Dat d........'R
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
^y__..... .;.4:.r...:�.Y.TWL'++_..s.v. ....... .....,...__...�._ :1M.."'.R!'e'�^a0'.u'..3T-ati1Y9:1+..�-.. ^a!3YRL�1':':MTA:t^.C+•1,: •.f�i1YLC4i�'+,NYuR"fi.Liik:� ...1:'.+OS.:.....- ..b.'..•+'F•Y..1.-_'.XX:.:A'-'79-L•/:}3AS•.1CYlA'NE."T'-..1'v ..4a1MC .
,a h }fin �c�R�• � �.� _ �.� �-
5 The installation shall comply with the State Environmental Code-Title Van, Town o
�ioard of Health R(tgulations.
2) 7} n septic system as proposed on this plan shall not be installed until a licensed•town insta+ier
'7 receives approval .4nd an installation permit from the applicable town
_.__.� __ l . T�.• y 31 Pr►at to Installation,the installer shall verify the location of utilities,sewer ;nverts, sewer linILI
es
WDUO1 ON F4T'4' and existing septic components prior to installation.
!I All gravity sewer piping is to be 4 inch schedule 40 PVC at 1/8"pear foot. l�he first Z feet out Of
WA
114 t—
'� t'rie distribution box shall be level. All piping connections to be glued.
s 2 Q ' A I Ti-�is septic design plan is not to be utilized for pro rt Iine deterrnlnation car for an other
�: � p � 6 p Pe y a Y
purpose other thz a the proposed septic system installation.
--
_�_ All Title V components are to meet Title V specifications.
� . ,� �^ Parking shall be pcofiibited over Title'U components unlea,rnrnpo«cnts are H2O loaded.
L.t�'>4T I
i 81 The existing leaching cr cesspools shall be pumped and filled with material per Title V
�
abandonment procedures leaching and cesspool(s)and contaminated soils within the
proposed SAS shall be removed and replaced d Title V specifications.
pace w clean san per e
;
9; Septic components are to be la'from a water service line. Sewer lines crossing a water line sip
• I be sleeved with an appropriate-ty sized schedule 40 PVC with ends grouted. The water service
—1 ` i� yam,/ '•`
Ilnu or the septic line can Ine sleeved with the sleeve ling a distance c !C' or bot',sidp� r" r.
�.
✓� crossing the line. f
101 if a garbage grinder exists ire the structure, it is to be removed if the seprlc {ystem is not �
�i o \ designed to accommodate a garbage grinder, 5
Tip,--installer is responsible for care of excavation around all 'Alilities on the property and
1 - -•- _______ protecting the structural integrity ar all structures during the installation process of the sei t - 1
system.
12; This pian only represents that a septic system can be installo.1 on the property meeting Title'V
requirements.
t .r
The property owner shal! review design criteria to approve tl,e total number of bedrooms and
.'fesign flow. installation of the septic system as proposed and receipt of payment for the design
shall be deemed approval of the design criteria by the properly owner or agent of.
'.4+ Tne validity of this plan sl all expire with they expiration of the tuwri installation
_ - X � .,- -a-C��►�.., y P p p� Permit issuPc: Fc i
_ ` TZ• ��:� T11r\� this an or the validity of this plan shall expire on the expiration of the Cm Msate of Compllanc--
is-sue for the iristallai si I!e .a SYSTI-Ir vol this plar'.
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