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HomeMy WebLinkAbout0015 SEAGATE LANE - Health 15 Seagate Lane Hyannis P A = 249 144�- I III / s/— TO OF BARNSTABLE LOCATION / 5��5 A e•. /AA44 SEWAGE # tz_ VILLAGE 14 yA i i tS ASSESSOR'S MAP & LOT oZy9 l y 1l INS:. LLER'S NAME&PHONE NO. `1 SEPTIC TANK CAPACITY I M (541 J. C,4%l cry ' LEACHING FACILITY: (type) A4 (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching'ffacility) Feet Furnished by T� ' 4 G T�oln C T � , 3 A f3 C 1 3a ay d Tr aq O a 3 23 36 y ay 3 w TOWN OF BARNSTABLE Q-/ ,LOCATION -a Co�cv��e- SEWAGE # VII;RAGE A.p-&, ASSESSOR'S ``MAP &LOT 2 - 1 ' &PHONE NO. l` A C k 17&-C�f LER S NAME INSTAL I'� G ace �D � SEPTIC TANK CAPACITY '��� LEACHING FACILITY: (type) a. AJLA- (size) NO.OF.BEDROOMS BUILDER OR OWNER � &AA- 6 4� PERMITDATE: �� COMPLIANCE DATE: Separation,Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland 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 r $ 77D S .� 1 � TOWN OF BARNSTABLE LOCATION I S S Cia �. SEWAGE # VILLAGE .���:r�:,:s<S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. M r Cl C� SEPTIC TANK CAPACITY T i LEACHING FACILITY: (type) f c- U-;t (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: — II y�—ICOMPLIANCE DATE: � Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 No. O / .. !� ..� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Migo2af *p$tem Conelructiun 3dermit Application for a Permit to Construct( )Repair(t4upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.��'_S� �! 4�4*-Ier Owner's Name,Address and Tel.No. Assessor's Map/Parcel �,cel l �� � � j A j �1'() 5(,VD r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1.Design Flower b gallons per day. Calculated daily flow ICI gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t SZ t.. Type of S.A.S. 4 % (aTi Description of Soil lnny1�- 5 N4_" Nature of Repairs or Alterations(Answer when app icable) AA r n- ` :Q✓j / �cntOLa't-�a �,TVC,-M t STnP-0— n sc,fl S /tlft U 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 Co and not to the system in operation until a Certifi- cate of Compliance has been issue Boar Signed Date Application Approved by Date Application Disapproved for the fo owing reasons Permit No. Date Issued 7//9 No. / V / i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: lip" Yes PUBLIC HEALTH DIVISION =TOWN OF BARNSTABLE., MASSACHUSETTS Zippliation for Mttpaal *pztem Congtructton Permit Application for a Permit to Construct( )Repair Grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �`�j�� �4-6 Owner's Name,Address and Tel.No. 11 Assessor's Map/Parcel ^� l,I� � � 1 � s(,V r" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.RI'l O—C-0,P - (I F A - :+ ao t3 - _d Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) - Other Fixtures Design Flower y gallons per day. Calculated daily flow 3 ICI gallons. Plan Date Number of sheets Revision Date Title " Size'of Septic Tank 6el,I \C ZM 5 P Type of S.A.S. \KC�. Description of Soil iM 10 5\4w Nature of Repairs or Alterations(Answer when applicable) Sfi�ST f4 \ © Q— �6yc T rwy— Y5� S`Ir�r 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 Co and not to the system in operation until a Certifi- cate of Compliance has been iss oar Signed Date � Application Approved by _ Date Z 96117_ Application Disapproved for the following reasons Permit No. gel "J7 Date Issued Z 9 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the O - ' age Disposal System Constructed(. )Repaired( )Upgraded( V) Abandoned( )by r�o _ e �e v at Is S 5 A&114T 15 04-YF— t`( has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. `"gF—FY dated 2 Installer Designer The issuance of this permit:hall of be construed as a guarantee that the syste will function as designed. 01 Date t Inspector ------------------------------ -- No. 7 Q / Fee v vi THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS Miopooal 6potem Con.5tructton Permit 1 Permission is hereby granted to Construct( )Repair( grade( )`�kandon( )r System located at /S Sew kl 4..� K i S 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 this ermit. Date: 2 "'�� �� Approved by 1019197 1 j � 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 ENGINEERED PLANS) i hereby certify that the application for disposal works construction permit signed by me dated —I �� - .L concerning the meets all of the ! property located at / J S`� yam- "- Cs I following criteria: (/. Thera are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase in now and/or change in use proposed There am no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands the bottom of the proposed leaching facility will no be located less then fourteen(14)feet above the maximum adjusted i groundwater table elevation. { please complete the followings A)Top of Orou nd Elevation according to the Engineering Division•,.01.S.map) g)Observed Groundwater Table Elevation(according to Health Division well map) i . i DATE: SICINED E LICENSED SE C SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Atteeh sketch plan or proposed ryste+rt.Also if the licensed installer posesses a certified plot plan, f this plan should be submitted). j t q:Wilt tblda: Gp 1 V COMMONWEALTH OF MASSACHUSETTS 1 l ' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED APR 2 7 2003 BRNSTABLE TITLE 5 TOWHEOALTH DEPT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 Seagate Lane Hyannis, MA 02601 Owner's Name: Linda Gene Peterson Owner's Address: Date of Inspection: March 18, 2003 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Map:249 Mailing Address: P.O. Box 49 Parcel: 144 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 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 N ds Further Evaluation by the Local Approving Authority F it Inspector's Signature: Date: March 19, 2003 The system inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Seagate Lane Hyannis, MA Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Seagate Lane Hyannis, MA Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. . The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has 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 or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of 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 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Seagate Lane Hyannis, MA Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 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 SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 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 than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ the system is within 400 feet of a surface drinking water supply the system is.within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone lI of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 Seagate Lane Hyannis, AM Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 Check if the following have been done: You must indicate"yes"or"no"as_to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)J. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Seagate Lane Hyannis, MA Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: n/a 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): No Seasonal use(yes or no): No Water meter readings,.if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied 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: Unavailable Was system pumped as part of the inspection(yes or no): No If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Mar. 15198-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Seagate Lane Hyannis, M4 Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):- SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 2' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present The liquid level was even with the outlet invert. There were no signs of leakage. The inlet cover was approximately 2"below grade. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Seagate Lane Hyannis, MA Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete _metal fiberglass _polyethylene _other(explain): Dimensions: Capacity:. gallons Design Flow; gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. There were no signs of failure or backup from the leach field. PUMP CHAMBER: None 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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Seagate Lane Hyannis, AM Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 4 leach chambers-per as built card leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): The chambers were located but not dug up. There were no signs offailure in the D-box. The bottom to grade was approximately 5'. CESSPOOLS: None (cesspool must be pumped as part of inspection)(l,ocate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Seagate Lane Hyannis, M4 Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 Map:249 Parcel: 144 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 1.00 feet. Locate where public water supply enters the building. C�' A f3 o y 3 A Q c � 3aay a Tr a9 a 3 � 36• y ay 3 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Seagate Lane Hyannis AM Owner: Linda Gene Peterson Date of Inspection: March 18, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 20'+/-to ound water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 .Lb CAT IONS SEWAGE PERMIT NO. VI-VL'AG E I N S T A LLER'S NAME i ADDRESS 0 U I L D E R nOR OWNER p DATE PERMIT ISSUED �� ' DATE COMPLIANCE ISSUED r r r i� r �'� W �i �, � 1 a � .. `.. � W� v 1 ��N r M � � � J t f :do:....: 3 Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH / ...............OF...............................­....-,------­.........I............................... Appliratiou for Diipu,sal Worko owitrur#ion ramit Application is hereby made for a Permit to Construct ( C4/0r Repair ( ) an Individual Sewage Disposal System at: � ..... ............... ------------------- ----............................ -................................................... Lo atio -A ess or Lot No. a 2a�� Ca �.�`o L- -------------------------- . (1 �e�n_.. to err lit .•C Ow r y_ ess w 14 Installer Address UType of Building Size ......Sq. feet ,.� Dwelling—No. of Bedrooms...........3...........................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building ..... No. of persons............................ Showers — Cafeteria A-' Other fixtures ...................................................... W Design Flow-.......YY-_J`�.........................gallons per person per day. Total daily flow.....aa.ln........................gallons. WSeptic Tank/—Liquid capacity.�'..--._._.gallons Length................ Width................ Diameter--.-----.----_ Depth................ x Disposal Trench—No. .....I............ Width....A9.......... Total Length.................... Total leaching area--Y _3 .sq. ft. 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.....................--. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.------------_-_..-.---. a, .........•........••---••••••-•--•-••••----••••-••-••••----•••-----------------------•--------......---••-•----•----------••------••-------•----------....-- ODescription of Soil........................................................................................................................................................................ x V ..................................••--•-••---••-•-•----••-•-•••----------------••--•----------•-••••----•--•••-•••--•-•--•----••-•--•-----•----------•••••-•••--------••---•---------•--••-----•••-•- W ------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------•----------------------- UNature of Repairs or Alterations—Answer when applicable------•---------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIME 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h en issued by the b rd o health. tate Application Approved BY-------- -•----- --�//-- --------- •-• ---- � .. Application Disapproved f o the lowing reasons----------------------------------•-----•----•---•-- --•---•--••••••• ......................................... ---------------•--•••-••••-----••-------•••--•-••---••.........---•••-•----•--••-.....-•-•-•••-----•...--••••--•-----•---------•--•-•••••-•-•••-•-•-•--•-•••-•--•••-•--- ............................... '.•..Date Permit No......................................................... Issued-... ""�z -Q-'.` xz -� Date `� ci,✓ :r ii� _ .. • `• ;• i`�.$'... .................... , THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............ --- - --------------OF.......................................... Appliratiou for llhipoii al Works Toutitrnrtiun amit Application is hereby made for a Permit to Construct ( "/Or Repair ( ) an Individual Sewage Disposal System at: Lo do -Ad ss .... ...�Q ' --t?a' cE+c�N.E ���1 .�-' t �uc �1► ILIA, 0�+ r A d ess Installer k Address Type of Building Size Lot./04.0 .C......Sq. feet �-, Dwelling—No. of Bedrooms............ ...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) Other fixtures ----------••--- - -................................................... W Design W Flow.........A/li......................gallons per person per day. Total daily flow.......3,3 0......................gallons.Septic Tank l-Liquid capacity.... _...._gallons Length................ Width................ Diameter................ De th...._...__..._.. x Disposal Trench—No. .....I........... Width:....,......... Total Length.................... Total leaching area...Y�_ _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........................................ 4 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........................ ---•"-"---------------------"------•----...._..--"""---"---"•-""--"...•-••------....._...._......------•. ===- --------- •---------- ---------------- Descriptionof Soil..-----•-----"---"-".................""""•--"""--"----"-"--.........--"""-•"-""---------------------------------•-----•... ......................................... x V ......................•--•••••-•---•...............................•......_...•-•--•-•---........----•••----- ----••----•----•--••-••••-•-•---•---•---•••-•--••-•-•--•-••-------._......-•-•-•-•-•--... W x ---------------------------------------------------------------------------------------------•--•-------•--------------------•----•--•----•-•------•-•-----•-----------•----••--•---•---------••--..... V Nature of Repairs or Alterations—Answer when applicable__.-,. . ................................................................................. ...........................................•---....._..............._...._.............._........::- rt.............................. 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 ha en issued by the bo d of health Si •y.. Application Approved By........ ?- ..r^ 1�c , ... - - Date Application Disapproved for he f owing reasons:.....................................------------------------"--------------------------•--•-•--•......---•••-- •-•--•-•...........-•-----••-•-•.....-•-•••--•••----•---•----------•.........•--•...............•....•----••--•--._.........--•---••--- --•••-•---•-•--------••••--•-...----•-----••......---.._.____. Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........................ Trrtifiratr of ffuntplitanrr TH,I tkC TIF , That the Individual Sewage Disposal System constructed ( or Repaired ( ) byr =- .-- .�................ ............................. :,.. Installer at.....• a.. GC/ . .. . ..... ""-"-•"-•-----""----•......................•-------•--......------•.... .................. been installed in a&-�r ce with the provisions of TITLE 5 of T State Sanitary C de s ibed in the application for Disp orks Construction Permit No----- .......... dated_._:. .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........................."----"-"-"--......-"-•--....-•--------_.._...._..--.. Inspector.................................................................................... I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �/ / 3 . ...... OF................................................. L........................................... ............................. No. ..................... FEE.... a.... ....--...... Disposal 15"- 15 '"ion trout Permission is h y gran - to Construct _ Repair ) an I 1-S age Di . sal System atNo...�... r.................. ..:�...... .......-"................................................. Street as shown on the applicatio -fo isposal Works Construction Permit No..........._..._ p f'ated..r............................. •--"----•-•-•-•-------------•--..........y.q -u- . ........--""- oard-of Heelth ---... DATE. dY FORM 1255 HOBBS & WARREN, INC., PUBLISHERS a„ SOIL LOU NO. 1 NO, Z T E A N --- 3 _ TOP OF FOUNDATION EL.: t vca < Z f A ��� !a� -�>-� so r .� �°�� .� �� .. , 6 A. _ 10 • INAL. 7 a iN.Et. , - 2 COVER 1/8— 3/Bfr WASHED STONE `,� b • v �� i , r r "t. 1i & e—' 12 .:• IN.EL. +• IN.EL. `2--- u�=�+ �?tr rr p Rio ° ° °° q ri : t y bi t/ IN.EL. 4 " ��ma do a o o ° ° ��- 13 D/B W/ G SUMP ° d , ° U n n 3/4 - 1 1/Z WASHED STONE 4 LIQUID LEVEL . ° a 6 6 14 6"EFF. DEPTH ° bC> 15 • e PERC TEST RESULTS H ° oo PERC RATE: < �,/°, ,' ,� PRECAST SEPTIC TANK WITH foo°ea od • '�a w° PRECAST LEACHING PITS ,,� CAST IN PLACE INLET AND EL. �, � L°o©oo°� b � ° ND.: _ SIZE.: � �� r, � � �. _ �� ��t�Y� �YNITNESSED BY: - �= � OUTLET T"S PER TITLE Y BOARD QF HEALTH -- �` D I A - V 8" SIZES � o«o C DATE: , - - --=— r \ 12e5 i PROFILE OF PROPOSED SEWAGE SYSTEM to ! � P E4.1-JK. SYSTEM DESIGNED BY THE TOWN . Of � � `� � - =- REGULATIONS AND ' 1 , 25 38 v- STATE TITLE V . FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1l4 = 1 0 s V . B . 1. ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE 2. ALL PIPES SHALL BE SLOPED 1/4" PER .FOOT EXCEPT FOR ea I THE FIRST 2 FEET OUT OF THE 0 /8 WHICH SHALL BE LEVEL 3. DESIGN FLOW 3 BEDROOMS AT 110 GALDAY PER SR. o GAL/OAY _- ? // SEPTIC TANK SIZE __ X t, = 4.�` 5._ GAL. � u USE ► 000 GAL. Wloo-v GARBAGE yr DISPOSAL t( 1 �' 4�E i`,N l ep' G ' `�`G S W Rd1 I` JT r��Q��F , LO 1 Z t f1R)dKiC l44'1 1 ` �� / d � LEACHING SYSTEM: USE *l , r 07 ( ___f A vim. EFFECTIVE AREA. SIDE 3 7 6, _ -A -F a Acs ATF � Air �'!� tli`•�'` ` �`� BOTTOMS �-� _ _ _T __ �_ _ - r ,� 11 :A „\J, � �x .�i_t 1,14 ,. TOTAL FLOW sC_ALc TOTAL REQ'O FLOW 33p X = 3Vc> W1oor GARBAGE DISPOSAL RESERVE F L 4It `'',� I) GAL/DAY 1