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Home My WebLink About0043 GARDEN LANE - Health 43 GARDEN LANE HYANNIS A = 292 083 r Ili II v i i TOWN OF BARNSTABLE LOCATION.= 5f 3 G-6P-&P l Arje SEWAGE # olOI06 -601 YII:f;AGE ASSESSOR'S MAP & LOT a INSTALLER'S NAME&PHONE NO. 9&ic,3sc5J 5'�,o�ie 77S-877C SEPTIC TANK CAPACITY I S 6 6 LEACHING FACILrI Y: (type) 'Q v w t=((4 Z (size) t Zx 2 ic -Q S NO. OF BEDROOMS 3 BUILDER OR OWNER_ GAkr,)68— ,.PERMTTDATE: t 6 I t om,120001 COMPLIANCE DATE: 1O ,I aoo:::) >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 v Y - v G � d � 1. y n No. !:d�' ?/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS TippYication for Migpogaf *pgtem Cowaruction Permit Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot NO. Ow is ame,Address and Tel.N /-13 ��rOFy /,� �� PEf'EN AAe nr . Assessor's Map/Parcel Jf`? 04#-0_ 1 k h In��l�rn� Addt[s �[►dl.N�� Designer's Name,Address and Tel.No. O �O-4-/,b ?c77 77�= Type of Building: Dwelling No.of Bedrooms L3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ++ Type of S.A.S. Description of SoilTidJ� Nature of Repairs or Alterations(Answer when applicable) / �f�/` � �"► L � 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 of Health. ` Signed i�i �A Date,AQ 16--G 'J Application Approved by l Date Application Disapproved for the following reasons Permit No.. AZI!410 Z cq":Z Date Issued 4 Ztta TOWN OF BARNSTABLE LOCATION "/3 GAgACj 1ANG SEWAGE # aaa �b0`1 VILLAGE_ t-1 yAr-ry�i S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE N0. ;+v�o:.1 S�nt-,i 775-877C SEPTIC TANK CAPACITY 5 O LEACHING FACILITY: 7 (size) -- NO. OF BEDROOMS 3 BUILDER OR OWNER r.A I,\);6 2— I PERMI TDATE: 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet i i � n M);41 s 1, �fiS' No. G�7 mot!f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y " Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS`- 2pprtcation for Migpogal * gtem Congtruction Permit s Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Ow er's e A ress an Tel Assessor's Map/Parcel py Af4 _7 n�0411� l&le 's,.Name dr7s ,xWel.N&r Designer's Name,Address and Tel.No. vvrfe��llt 7?� �77(0 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. r Description of Soilh� Nature of Repairs or Alterations(Answer when applicable)_,,r11j*// 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,&oplfof Health. / Signed Date �~ J Application Approved by ` Date ' Application Disapproved for the following reasons - — r ' 1 Permit No. o?,* a'C' Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS e Certifilcate of 'Compliance THIS IS TO CERTIFY,that the On-site Sew ge Disgosal�Syste Constructed( )Repaired(A )Upgraded( ) Abandoned )by k✓nl-- E /�uI/h 10" .;Ixlhc - JYS �h®"e n /�'l f� �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit 44'0 V O_Vdated ` ""` Installer Designer ierm � � The issuance of this P jh t 1 Ve construed guarantee as a uarantee that the s steml wi �functi dosi ned. } Date l�' ��/ Inspector1 �� V No. + (,� -------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wigpogal *pgtem Construction Permit Permission is hereby anted Construct( Repair( Upgrade( )Abandon( ) System located at y S 1`'!I•er? rl /7/•1 .F 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. Provided:Construction must be completed within three years of the date of thip1p5rmit. Date: Its � v�� G Approved y ^r 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated /D —166 , concerning the property located at L/ �-��2��;�i L� meets all of the following criteria: • This faile system is connected to a residential dwelling only. There are no commercial or business uses associ ted with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are o wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The ottom of the proposed leaching facility will not be located less than five feet above the maximum adj sted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when a licable] • f the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) a B) G.W.Elevation +the MAX.High G.W.Adjustment. _ J 0 D DIFFERENCE BETWEEN A and B SIGNED:�� '/ �� DATE: 6 - [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert II 9-f sj :A CO\L110.\MT..ALTH OF WSSACHLSETTS EXECUTIVE OFFICE OF F VIROXIMNTAL AFF.AJR.S - - DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE RMTER S'TRT'L'-.BOSTOA MA 0210c t62'i 243S&K, MMY COL Seere:Z-. ARGEO PALL CELLUM DA14D B STF^Hc Govemo: Conumss:onl- SUBSURFACE SEWAGE DISPOSAL SYSTEM M6PEcTou FORM PART'A CERT54CATIM PropertyAdd►ess:43 Garden Lane, Hyannis NO0OfO-w ue Pn ,arnier Date of (�� Address of Owner aasoe Lion: / U—&--ri of motor:fPlaase PrerU in�al. E. Robinson Sr. 1 am a DEP approved s irssF rtor to Section 15.340 of Title 5 010 CUR 15.000) ce�mpartyu. Wm• E. Robinson eptis Service Meng Address: PO BOX i 0 9. Centerville, MA Telephorte Number: CERTIFICATION STATEMENT I certify that 1 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 inspection. The inspection was performed based on my training and-experience in the proper funcuon and maintenance of on-site sewage disposal systems. The system: asses Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: 1 F Din: d _60 The System Inspector shall submit a copy of this inspection report to the Approving 'Authority[Board of Health or DEPlwithin thirty 130)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 Department of Environmental Protection. The original should be sent to tfte system owner and copies sent to the buyer. if applicable. and the approving authority. NOTES AND COMMENTS f c' �� O J PyP!I of 11 w a SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTWN FORM PART A CERTIRGTWN feendrared) NopeftyAddees4:3 Garden Lane, Hyannis awner: Garnier Date of Inspection: NSPEC`nON SUMMARY. Check B, C, or D: A. SY PASSES: - 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. COMMENTS: B. S)Ve M CONDITIONALLY PASSES: e or more system components as described in the 'Conditional Pass'section need to be replaced or repaired. The system.upon mpletion of the replacement or repair,as approved by the Board of Health,will pass. Indicat ,no. or not determined(Y. N.or ND). Describe basis of determination in all instances. H 'not determined*.explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of —j Compliance latteched)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 at exfitcration, 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. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipets)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass inspection if Iwith approval of the Board of Health): broken pipets)are replaced obstruction is removed _ev1Se 5/2/96 Page 2of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontint" ProWWAdd►ess: 43 Garden Lane, Hyannis Owner: Gamier Date of Inspection: D. SYSTEM FAILS: You m t indicate either "Yes' or `No" to each of the following: 1 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 taiiure Yes o Backup of sewage into facility or system component due to an overloaded oreiogged 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 112 day 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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 then 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. LAF GE 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 facihty 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 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 11 of a public water supply well) The ow er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office o the Department for further information. =�-• _5� Ci � �� PaRr4of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontira+ed) Property Address: 43 Garden Lane, Hyannis Owner: Garnier Date of Inspection: 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 it the system is failing to protect the public health,safety and the environment. I YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES N ACCORDANCE W rH 310 CMR 15.303 11)(b)THAT THE SYSTEM 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) SY TEM WILL FAIL UNLESS THE BOARD OF HEALTH IAND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FU CTIONING 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 (approximation not valid). 3' OTHER Page 3 of 11 III U' tr • - SUBSURFACE SEWAGE DISPOSAL SY'STBN INSPECTION FORM PART B CHECKLIST • ?roWnyAddress: 43 Garden Lane, Hyannis Ownw' Garnier Date of Inspection: Check if the following have been done: You must indicate either "Yes- or 'No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of health. _ None of the system components have been pumped for at least two weeks an&the system has been receiving nerntal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. t! As built plans have been obtained and examined.. Note if they are not available with N.A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System, have been located on the site. 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: _ Existing information. For example. Plan at B.O.N. _ Determined in the field(if any of the failure criteria related to Part C is at issue.approximation of distance is unacceptable) / 115.302(3)(b)) The facility owner land occupants,if different from owner) were provided with information on the propermaintananr."f SubSurface Disposal Systems. PaRr 5 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION hop"Address: 43 Garden Lane, Hyannis owner:Qa rni e r Date of pecoon: FLOW CONDITIONS RESIDENTIAL: Design flow: S.0 g.p.d.lbedroom Number of bedrooms Idesign):�7 Number of bedrooms lactual):,,Z�, Total DESIGN flow.YK' 0 Number of current residents: Garbage grinder Ives or no):.41-40 Laundry(separate system) (yes or no)-Ad; If yes.separate inspection required Laundry system inspected (yes or no; Seasonal use Ives or no):/L, O Water meter readings, if available Ilast two year's usage Igpd): , ., n n4no 0 �yQo gal. Sump Pump(yes or no): D 9 Last date of occupancy: e , 66-0-.0 1 998-1 999 38,' ) gal. V +�+ J CO ERCIALANDUSTRIAL: Type i establishment: Design low: ood ( Based on 15.203) Basis of design flow Grease t ap present: (yes or no)_ Industria Waste Holding Tank present: (Yes or no!_ Non-son ary waste discharged to the Title 5 system: (yes or no)_ Water eter readings.if available: Last d e of occupancy.- 0 : (Describe! Last ate of occupancy GENERAL INFORMATION PUMPING RECORDS and sour a of information: System pumped as part of inspection: (yes or no)�d If yes. volume pumped: gallons Reason tot pumping: TYPE OF SYSTEM Septic tank%distribution boxrsoil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records.if any) VA Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components. date installed lit known)and source of information: 1, Sewage odors detected when arriving at the site: (yes or no) U G, �, � _ Page 6(if II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM WFORMATION IeaN+�rt.+edl 'ropertyAddtess: 43 Garden Lane, Hyannis Owns =Garnier Date of Inspection: BU G SEWER: llocatn o site plan) Depth b low grade:_ Material f construction:_east iron_40 PVC_other lexplain) Distance from private water supply well or suction line Diamete Comme ts: (condition of joints, venting, evidence of leakage.-etc.) SEPTIC TANK:_ (locate on site plan) 1 Depth below grade: Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: [ ��t� 10 tz I Sludge depth: 0 y Distance from top of sludge to bottom of outlet tee or baffle:,<O Scum thickness:_ t Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle flow dimensions were determined: A& 1,�'�it�- :omments: Ire commendation for pumping. condition of inlet andS outlet tees or baffles. depth of liquid level in relat on to outlet invert, str etural integrity, evidence of i akage. etc.) f 6 ,s ,� '�" J . ��e- I's GR SE TRAP: (Iota on site plan) - Depth elow grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene otherlexplain) Dimensio s Scum thi kness. Distance rom top of scum to top of outlet tee or baffle: Distance rom bottom of scum to bottom of outlet tee or baffle: Date of 1 st pumping: Commen s: irecom endation 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.) y,'[, Cc PsRe7of11 e . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Ieantiramm 'roperty Address: Owner: Date of Inspection: GHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) Ilo to on site plan) Dept below grade:_ Mater I of construction:_concrete_metal_Fiberglass_Polyethylene otherlexplain) Dim tins: Capacit gallons Design ow:_gallons day Alarm resent Alarm evel: Alarm in working order: Yes_ No Date f previous pumping Co en (con tion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan; AA Depth of liquid level above outlet invert: c� Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PU)eondition MAMBER:_ (locn she plan! Pumworking order: (Yes or No) Ala working order(Yes or No) Cots: (not of pump chamber. condition of pumps and appurtenances,etc.) ev_Se Page 8or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM NFORMATION leattinuid) 'top"Address: 43 Garden Lane, Hyannis °"'nef: Garnier Date of Inapmuon: /a - cv / SOIL ABSORPTION SYSTEM(SAS)' llocate on site plan,if possible:excavation not required.location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number:` leaching galleries. number:_ leaching trenches.number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: Incite condition of soil, signs of hydraulic failure, level of ponding. damp soil, condition of vegetation, etc.) e „ S , CESSPOOLS:_ (locate on site plan) Number and configuration. Depth-top of liquid to inlet invert:_ Depth of solids layer: + )epth of scum layer: Dimensions of cesspool. Materials of construction Indication of groundwater. inflow (cesspool must be pumped as part o1 inspection; Comm nts Incite condition of soil, signs of hydraulic failure. level of ponding. condition of vegetation, etc.) PRIVY: (iocate o site plan) Materials of construction Depth of solids: Dimensions: Comme s: Inote c nditron of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ------------- PAR(9 of 11 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION feononued) 'rop"Address: 43 Garden Lane, Hyannis .#Wnw: Garnier ante of Inspection:/6—/6.,.V-6 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) a ?&I IC:lie S m /G—16--0--<7 PidRc 10 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART C SYSTEM NFORMATIOM Icondwilidl rop.ay Address` 43 Garden Lane, Hyannis Owner: Date of w.Wu-6j;Ai e r -1 4t>—0--o NRCS Report name Solt Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells n Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property.observation hole. basement sump etc.) Determined from local conditions V Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 13`ic U(l® Y _c . _SE: 9/2 9E Pa¢cI1of11