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HomeMy WebLinkAbout0064 VANDERMINT LANE - Health 64 VANDERMINT LANE;,HYANNIS a A -y r I v a i L TOWN OF BARNSTABLE p LOCATION b �,�iq'/►/,rj�sQZ�f/l���jls1EWAGE# "�O�`�— / VILLAGE ASSESSOR'S MAP&PARCEL-2 INSTALLER'S NAME&PHONE NO. eg -:17-1, oa jo 7 SEPTIC TANK CAPACITY o�Cr(:�'-/ C•o�''c0Zl�r� ' LEACHING FACILITY. (type) (size) 3 X NO. OF BEDROOMS 3 OWNER PERMIT DATE: Jot ''-' COMPLIANCE DATE: Separation Distance Between the: O 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 L�J 4`. Z � u1= s � 5 S. C� aca � o w �O ri ct N ram, r6 h No. Fee / ®0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Disposal *pstrm Construction Permit Application for a Permit to Construct(111-"'Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Si��Jy,�LP� lj✓��w Owner's Name,Address,and Tel.No. s�-Q 6i f-` Assessor's Map/Parcel ,Z r7 �/`�i6� ��,7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ejp. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ® gpd Design flow provided gpd Plan Date 7"` 511 Number of sheets Revision Date Title Size of Septic Tank ix-e�_4e' /S`�'p G��Type of S.A.S. �`� C®�eater/ Description of Soil1,10001 ��" a��ii°/✓ � ��� OP' Nature of Repairs or Alterations(Answer when applicable) 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 Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. `� U l�l Date Issued D- Entered in computer: G K_ THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplicatiou for Vsposaf *pstrm Construction Permit Application for a Permit to Construct(Repair( ) Upgrade..( j Abandon( ) •Complete System ❑Individual Components Location Address or Lot No.��/!s/4,e✓Q�`�,/y+/ysJ"L Owner's Name,Address,and Tel.No. Assessor's Map/Parcel of SO —o 4'7 6 "Ov Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ��� G�`"�o c�'r•/r' �,s' ®7v' 4�.�i�vi.Q Q�✓y�1J'O�'3.�/��,� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building GIT G 1p, No.of Persons Showers( ) Cafeteria,( ) Other Fixtures r, Design Flow(min.required) �` ® gpd Design flow provided 3�'� gpd Plan Date f/— /''—/ r Number of sheets Revision Date Title Size of Septic Tank /vim'Iei /T'41 O 6 44 Type of S.A.S. �-� Description of Soil „��er/ i//✓ e,e.`� qui Nature of Repairs or Alterations(Answer when applicable) J��d"��A AOO' j Date last inspected: j Agreement: Y � , �+• 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 hasxbeen issued by this Board of /� Signed Date Application Approved by Date If Application Disapproved by Date for the following reasons Permit No. Date Issued ----------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Repaired( ) Upgraded Abandoned( )by L7✓lBJ at gfjr§/ , L­1�/✓/„7��/,/rj` �i••+'. etas been constructed in accordance -with the.pr-o�v^'isions of Title 5 and the for Disposal System Construction Permit No. - 3 q dated / ) 94) Installer y J 1W -e Designer �w/ /✓ �✓� #bedrooms Approved design w gpd The issuance of this p'rmit shall not be construed as a guarantee that the system wil . nctio designed. r Date 1 „ t Inspector No. °�C� — 3q Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION— BARNSTABLE,MASSACHUSETTS Disposal *pstrm Construction Permit Permission is hereby granted to Construct f0:::0j Repair( ) Upgrade( Abandon( ) System located at 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 completed within three years of the date of this ermit. Date � � f�- 5 Approved b Town of Barnstable y Regulatory Services Richard V.Scali,Interim Director 4MAS& Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Desiener Certification Form Date: I� 7005 Sewage Permit#J©�S �9Aswssor's viaplParcel Z� �7 I - - Designer: ' - Installer: �T-IA U)_!M�L Address: Address: On �& /S' 6L� was issued a pernut to install a ( e) (installer) septic system at A)AAf,>F2A ( based on a design drawn by (address) _DAV l'D B q AIJOW11dated it Zcl� (designer) 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils p 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'vith State& Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co niiance with the terms 44 of the RA approval letters(if applicable) r'S-j�+lf' s�, r off`` U BVIU G (Installer's Signature) o iV1f1So1`l �0 No.1066 0 Q►SFE?& s�snrt ra�,,a (Des or's Signature) (Affuc Desi ��«sw amp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q\Septic\Designer Certification Form Rev B-14-13.doc I , ViE Town of Barnstable . P# Department of Regulatory Services Public Health Division Date Z3 C 200 Main Street;Hyannis MA 02601" `. Date Scheduled u a "may Tifine `M Fee Pd._ Soil SuitubMiy Assessment for Sewage Disposal Performed By: Witnessed By: ✓. ` LOCATION&.GENERAL INFORMATION Location Address ^4 Owner's Name To v e 1 "f Address 7��n1'S Assessor's Map/Parcel: ` 2S0 — OS- Engineer's Name '✓ A✓ Jl/IACtlH� NEW CONSTRUCTION REPAIR \ ' .t Telephone# '✓- Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands-in proximity to holes) I F Parent material(geologic) Depth to Bedrock -"-• ' ' �'-Depth to t7roundwater.`Standing Wa[er mHole:_` '" ""-�'� �--�'""`- Weeping f1'oiA Pit FnCe Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL'HIGH WATER TABLE Method Used: • %, Depth Observed standing in obs.hole: In, Depth to soil mottles: Depth to weeping from side of obs.hole: In, Groundwater Adjustment fik. Index Welf- Reading Datc:. ]ndex Well level Adj.thetor AtIj.Groundwater Level a PERCOLATION TEST Data,______ Tfine Observation, I Hole# Time at 9" Depth of Pere • P � ji�.� Time at 6" Start Pre-soak Time @ _ Time(9"-6") End Pre-soak '` •��` Rate MinJlnch '• Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division , Observation Ho"le:Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conselrvation Division at least one (1) week prior to beginning. Q:XSEPTICIPBRCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Shcl Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,,Boulders. anAtency.%'Oravell If Z�S L DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (hiunsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseil) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soll Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes v Within 500 year boundary No Yes Within 100 year flood boundary No.r_ Yes.,;,_,,,._. Depth of Naturally Occurrim Pervious Material Does at least four feet of naturally occurring pervio s,�yatarlal exist in all areas observed throughout the area proposed for the soil absorption system? C�' .� If not,what is the depth of naturally occurring pervious material? .... Certifiication ,my� I certify that on /v. (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the .above analysis was perfo ed y me consistent with . the required traini40xpe ' e and p rie ce described in�10 CNIIt 15.017. Signatur Date l0 5— Q:WEMC`\PERCFORM.DOC Il SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION RECEIVE® 64 Vandermint Lane Property Address.-Hyannis,Ma - AUG 7 2000 Address of Owner: (if different) TOWN OF BARNSTABLE Date of Inspection: 16 June 2000 HEALTH DEPT. Inspected by: James Holler I am a DEP approved system inspector pursuant to Section 15.340,of Title 5(3.10 CMR 15.000) Company Name: Holler& Son Construction LLC Mailing Address: P.O. Box 702,Marstons Mills,Ma 02648 Telephone: (508)420-0280 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 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: Passes ❑Conditionally Passes ❑Needs Further Evaluation by the Local Approving Authority ❑Fails 'Inspectors Signature z Date: The system inspector shall su it a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the 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. INSPECTION SUMMARY: Check A, B, C, or D. A) SYSTEM PASSES: ®I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below: Comments: B) SYSTEM CONDITIONALLY PASSES: ❑One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes,no,or not determined(Y,-N,or ND). Describe basis of determination in all instances. If"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 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 conforming septic tank as approved by the Board of Health. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (Continued) Property Address:64 Vandermint Lane,Hyannis Owner:Zecchione Date of Inspection: 16 June 2000 B) SYSTEM CONDITIONALLY PASSES (continued) ❑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). Describe observations: ❑ broken pipe(s)are replaced ❑ obstruction is removed ❑distribution box is leveled or replaced ❑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 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 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 APPROPRIATE)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 to 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 1 of a public water supply well:. ❑The system has a septic tank and soil absorption system and the SAS is with 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:64 Vandermint Lane,Hyannis Owner:Zecchione Date of Inspection: 16 June 2000 D) SYSTEM FAILS You must indicate either"Yes"or"No"as to each of the following: ❑I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to 15.304.determine what will be necessary to correct the failure. 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. 3 ❑ ❑ 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 Yz 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. i ❑ Any portion of a cesspool or privy is with 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑ Any portion of a cesspool or privy is with 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. 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" as 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 ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:64 Vandermint Lane,Hyannis Owner:Zecchione Date of Inspection: 16 June 2000 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 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. ® ❑ As built plans have been obtained and examined. Note if they are not available with NIA. ® ❑ 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 or the Soil Absorption System on the site has been determined based on: ® ❑ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System.. ® ❑ Existing information,Ex.Plan at BOH. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)] I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property address:64 Vandermint Lane,Hyannis Owner:Zecchione Date of Inspection: 16 June 2000 FLOW CONDITIONS RESIDENTIAL Design flow: 110 gpd/bedroom for SAS Number of bedrooms 3 Number of current residents:3 Garbage Grinder:No Laundry connected to system:Yes Seasonal use:No Water meter readings,if available (last 2 years usage in gpd):No Sump pump:No Last date of occupancy:Currently COMMERCIAL /INDUSTRIAL Type of establishment Design flow: gpd Grease trap present: Industrial Waste holding tank present: Non-sanitary waste discharged to the Title 5 system Water meter readings,if available r Last date of occupancy OTHER:(describe) GENERAL INFORMATION PUMPING RECORDS and source Owner System pumped as part of inspection No Volume pumped: Reason for pumping: TYPE OF SYSTEM ❑Septic tank/distribution box/soil absorption system , ❑Single cesspool ®Overflow cesspool ❑Privy ❑Shared system(y/n)(if yes,attach previous inspection records,if any) ❑I/A Technology etc.Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information: 10 Years,BOH Sewer odors detected when arriving at the site:No • � f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:64 Vandermint Lane,Hyannis Owner:Zecchione Date of inspection: 16 June 2000 BUILDING SEWER (Locate on site plan) Depth below grade 18" Material of construction®Cast Iron❑40 PVC❑other Distance from private water supply well or suction hneN/A. Diameter 4" Comments:(condition of joints,venting,evidence of leakage;etc.) SEPTIC TANK (locate on site plan) Depth below grade Material of construction❑concrete❑metal❑Fiberglass❑Polyethylene❑other If metal list age is age confirmed by certificate of compliance Dimensions: Sludge depth: Distance from top of sludge to bottom of tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Comments: GREASE TRAP (locate on site plan) Depth below grade Material of construction❑concrete❑metal❑Fiberglass❑Polyethylene❑other Dimensions Scum thickness Distance from top of scum to top of outlet tee or baffle Date of last pumping 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 leak,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) Property Address:64 Vandermint Lane,Hyannis Owner:Zecchione Date of Inspection: 16 June 2000 TIGHT OR HOLDING TANK:❑(Tank must be pumped prior to,or 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: GPD Alarm level: Alarm working?❑yes❑no Date of previous pumping Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION$OX:❑ (locate on site plan) Depth of liquid level above outlet invert: Comments(note if level,and distribution is equal,evidence of leaks or solids carryover,etc.) PUMP CHAMBER:❑ (locate on site plan) Pumps in working order: (yes or no) Alarms in working order:(yes or no) Comments:(note condition of pump chamber,pumps,and appurtenances,etc.) E x f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:64 Vandermint Lane,Hyannis Owner:Zecchione Date of Inspection: 16 June 2000 SOIL ABSORPTION SYSTEM:(SAS) (locate on site plan,if possible,excavation not required,but may be approximated by non-intrusive methods) if not determined to be present,explain: Type; leaching pits,number leaching chambers,number leaching galleries,number leaching trenches,number&length leaching fields,number&dimensions overflow cesspool,number:one cesspool,one 1000 gal overflow Alternative system: Name of technology Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation,etc.) CESSPOOLS: (locate on site plan) Number and configuration:one,with overflow leach pit Depth-top of liquid to inlet invert: 1 Depth of solids layer:6 inches Depth of scum layer none Dimensions of cesspool 500 gal Material of construction stack block Indication of ground water inflow(must be pumped as part of inspection)no Comments:(note condition of soil,signs of hydraulic failure,ponding,and vegetation,etc.) PRIVY❑ (locate on site plan) Materials of construction: Dimensions Depth of solids Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:64 Vandennint Lane,Hyannis Owner:Zecchione Date of Inspection: 16 June 2000 SKETCH OF SEWAGE DISPOSAL SYSTEM Include ties to at least two permanent references,or benchmarks,locate wells within 100'and where public water supply enters house. � S3 Z 24 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION. (Continued) Property Address:64 Vandermint Lane,Hyannis Owner:Zecchione Date of Inspection: 16 June 2000 ' Depth to Groundwater>20 feet Please indicate all the methods used to determine High Groundwater Elevation: ❑ .observed from design plans on record ❑ observation of site(abutting property,observation hole,basement sump) ❑ determine it from local conditions ® check with local Board of Health ® check FEMA maps ❑ check pumping records ❑ check local excavators,installers ® use USGS data Describe in your own works how you established the High Groundwater Elevation. (Must be completed) TOWN OF BARNSTABLE t/ LOCATION Laklk SEWAGE VILLAGE " ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO .1 t SEPTI.0 TANK CAPACIT`I LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER r BUILDER OR OWNER DATL PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 i� Y I /JJ .I I I Fss.....�E_o.w. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF Y�YZ. S�. A ............................. Appliration for Disposal Works Tonstrur#ion rrrmi# Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: .._.....1�. ....--�l. �t.(.L? 1. dV..T.....L.1 dYL.. ....... 14y..l4hlNZ, .................................... .............•-•---•---......_.......... Location-Address or Lot No. •----------� .� ...�51 ........................ ------------------- Owner .�.� ........... Adress . . ............... �..---•-.. ....._.._...-- .........' --•............. ._/S Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---- .Expansion Attic ( ) Garbage Grinder ( ) a`W Other—T e of Building No. of persons............................ Showers YP g -•------•--------•--•--..._. P .-(---->---•--.Cafeteria ( ) dOther fixtures -----------------••--------------........._......-----------•---... ---- ---•----•-••----...... Design Flow....... .l f.?--------•----•-----.._...gallons. W 'gn � ............................gallons per person_per day. Total daily flow...._ WSeptic Tank—Liquid'ca.pacity.....__.....gallons ,Length..............:. Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......i............ Diameter.....i. ....... Depth below inlet.....(Q........... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by------------------------------------ ----................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi. Test Pit No. 2..__....--..._nnutes per Inch Depth of Test Pit.................... Depth to ground water _ x --------------------------------------------------------------------------------•---......................------------------............_......--_. ..... 0 Description of Soil.................................................................................................----•---•----•----..................................••--.............. ....... •-•-•---•--••--•-----•---•----•...................•---•--.....-•--•---.....---........•-•-••••------•---•---••--••••---•••--••-------------........._......---•--••----......... U Nature of Repairs or Alterations—Answer when applicable__-.f4--b4)....6h!�.._.a� ......;f1r:.T...kv.. _...__..... &.r.0.c�.....1_I - ..... ,ll s ....S.�rs r-}......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI.'U 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 by t and of liealth. Application Approved By................ ��- . ............... ......... Date - Application Disapproved for the following reasons: ..............................................................•-•------ - ........................................••---.....----------------•-•-----•--------.................--------•----•••-......•--•-----••------------••---•-------....-•-----•----..............__.......-- g� Date Permit No.......X% ..........._.__ Issued.__._._ �---- Date ... ti-..r•+••,,r•.�' ,f�'r'r ts�..�"r'".'.� r"'a-'� �:'�'"r�c .i4.i "M. :�- .-c-`t .., -.� ,•�--�••• 9 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF- ..... 4-tQ k-Qom ............................. Application for Disposal Works Tonsu*tion rrrmit Application is hereby made for a Permit to Construct ( ) or Repair (\/)an Individual Sewage Disposal System at: .........14 �___ A - =..14N_. .. ....._.. l�,l':i iq sic .............................._...... �- Location-Address or Lot No. _......__- �'_�- .__\l,c•L cM lR L_in- !.l".•..................... ....... ......... C x fnN• .. ..........-------...._..----_......_. Owner Address a ----- •------- lA®tom...le K1 W Y7 .�.�.-y p�•o, U k. :?_.._..__.�+:.�?.: p� Installer Address Q7i Type of Building Size Lot................ Sq. feet U Dwelling -'No. of Bedrooms___..7.......i..........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ..............................................................;:...................................................................................... W Design Flow......._�:5. ..........................gallons per person per day. Total daily flow....Z.1 ?........................gallons. WSeptic Tank—Liquid capacity_._____.____gallons Length_._...........:. Width.........._..... Diameter................ Depth................ x a Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq.,ft. 3 Seepage Pit No.......I............ Diameter.....1_0........ Depth below inlet.....& ......... Total leaching area..................sq. ft. Z Other Distribution box.( ) Dosing tank ( ) j � Percolation Test Results Performed by.......................................................................... Date........................................ � Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ® `Description of Soil................... * V - ... ----------------------------------= -----•-• ---•`-=------•--.._..-•-------•------------•--------........_........_•--•--•--------- W x t� ' . �......... U =Nature of Repairs or Alterations—Answer when applicable__._�-.1Q,1�_.__��._._.__4 F _�__.._...�J_i _ ............................... 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 by the—board of health. Signed.. � ...-` ..t.`!........1.1 . `._ ,! •, - Date Application Approved BY �_ = al....._...... _...._...,f fl1 j Date j Application Disapproved for the following reasons-....................................I.................................................................... .............:............................................................................................................................................................................. _......Date Permit No----- ----------- --- y 7 ........_..---._. Issued------- .__�...c... Date THE COMMONWEALTH OF.MASSACHUSETTS BOARD OF HEALTH `X �n.w.&..........OF........a.SY�..I�'.t�Ls .5c? `............................. Trrtif irtttr of TrImphaw THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired b C V G LA lU S�e Installer at...... -� _.-�.._.. f�►.(1�1L1F - � - b- --------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI N SATISFACTORY. DATE...�a h �', .-f�...................................... Inspecto .:..9-^h" .�� _..... ...a......... THE COMMONWEALTH OF MASSACHUSETTS o BOARD OF HEALTH --• " �1 .d.Yt/........OF �1A1 ? �''C fl bt- ............................. r No ... ...... � FEE. Disposal Yorks Tonstrortion rrrntit Permission is hereby granted......... ....... l to Construct ( ) or Repair O an Individual Sewage Disposal System at No...._...-..0..!.-L._....�,Aa �l1. tM�.h!T._..I ! ::...... F 1-'-' f ..................................................... Street as shown on the application for Disposal ��'orls Construction Permit No - �fD'ated_... 4�'.. ' .. :.0 e� Board of Health DATE-•• ••. �/"� �- ----------------------- ASSESSORS MAP : TEST I-I o L E L o G S �k PARCEL: 1) 'I he ins(rtllaliort shall comp ly ►villi 'Lille V and Town of I oard 01 FLOOD ZONE: /`lo%_ AT-P,©GIG•�8L � SOIL EVALUATUII: I lealtlr Itegul<<liuns. 2) 'Hie installer shall verify the location of utilities, sewer inverts and septic REFERENCE: _ DICCL2 e-4/5ZI�j_�.?1� _ Z DATE: components prior to installation null selling Inise cleva(ions. 7 PERCOLA 1014 RA I'E: C 'Z. 1 1 3) All gravity septic piping to be 4 inch SCIr ,10 I'VC a( 1/8" per I00t. I lie lust l T two feet out of file d-box to the teaching shall be level. �l) This plan is not to be utilized for properly line determrinalion nor any other TFl- ( 111'2 purpose outer than the proposed system installation. lA t tJJW �pC`I,I� 5) All septic components must meet Title V specifications. j G) Parking shall not be constructed over If 10 septic components. 1L kdkAp PAVA 7) The property is bounded by property corners and properly lines. 2 to � $) The property owner shall review design considerations t0 approve of(Dial C�V)kj —_I >�,, LOCA r I ON MAP �� ° ��o� design flow and number of bedrooms to be considered litr design. Receipt of payment for the plan and installation based on (lie plait shall be deeuted approval of the design flow by the owner. n � 9) The existing leaclihig or cesspools shall be pumped and filled with material lJV 4 1 per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V specs. 11 O 10)System components to be 10 feet from water line. Sewer lines c►ossing the water line shall be sleeved with 4 melt SCI 140 PVC with ends grouted if Q b� applicable. The proposed SAS is being installed below the water service o rm Z� I line. 'I'hre lime is (o be sleeved as al'oreendoned and maintained in place. SEPTIC SYSTEM DES I Gil 11) If a garbage grinder exists it is to he removed and is [lie responsibility of the ,I I25.00 'Ip �t"1 1 owner to ensure such. 00 FLOW ESTIMATE 12)'l he installer is to take caution in excavation around (lie gns line if such 2 exists. y BEDROOMS AT //0 GAL/DAY/BEDROOM •3�70L/GADAY 13)Tire installer shall verify the location, quanli(y and ehevalion of the sewer o O�Oe3 lilies exiting the dwelling prior to the installation. SEPTIC TANK 14)'I his plats is representative only that a system can lit oila property meeting cc) V requirements. GOO 5?0 GAL/DAY x 2 DAYS - J GAL �� �- USE /5CO GALLON SEPTIC TANK O SOIL ABSORPTION SYSTEM b fti o177 DAVID r,l�gss.'.T, M N I DE AREA: 1�,. 6 G E BOTTOM AREA: r�.1 �3 (41ASON `�I Ti�t�r-�L q �Z c' P No. 0 +; ` \J SEPTIC SYSTEM SECTION 0,00 IIT LiC�7'l) "a,c ���,� `'i a — GALEL b2 76 11 !1 �, I d _ I F iASEPTIC TANK ,p SITE AND SEWAGE PLAN LOCAT 1014 : \!R ,42EAr 4'(� SAW PREPARED FOR : ---a P W M A 1 l C, o r SC LE: Ce DAV I D. B . MASON R� DATE: Ce DBC ENVIRONMEN AL DESIGNS 4 a EAST SANDWICH . MA Z DATE HEALTH AGENT ( 508 ) 833- 2 177