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Home My WebLink About0058 WAGON LANE - Health 58 Wagon Lane Hyannis P j A = 270 205 3.. TOWN OF BARNSTABLE "LOt�AT10N -5 8 CUA� SEWAGE # 99' 83 VILLAGE o-?n n �" �' ASSESSOR'S MAP & LOT o?fie)-o?0•T INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 5 Oy 6,-//ori '/n k LEACHING FACILITY: (type) // A(d. Y (size) 30 J(17.1 o, NO. OF BEDROOMS .? BUILDER OR OWNER I'>V 4;ad Dias C. Ii'�g % PERMITDATE: J,Z5 � COMPLIANCE DATE: e//?/ 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 �� . I' i �� = �''� moo' � _ a Y • � +� e' \ i �r .�i � � �i ��; - �. �� 1 �' ,� �; .. .� .. �� , n GWENS N I NC Zk • • - 1 ■ ME MINME OEM 0110,11 0 ► ►' ®® QQ QQQQiDgDQ�iTQ■■■■■■■■■■■■■■■■■■� ��■�/r' , ,,! ��: ,.;�. ■e ■■ ■■r� ■L*s�.■ ■■■In IN NMI s. ■� ■ ®■r■ i■ ■■ ■■■ ■■■ ��i (�■■■ ■■■ ■■■■ ■■ Q �0101/ M El IN I ME11" IN oil ti7� ll , J• rL'7/■ � I ■ ■ ■ WRAPPM 9WMMJ�YABB - r. F s � o 'X t ' '• .rt v+s6t 5 6-C, TOWN OF BARNSTABLE } LOCATION dh.., 'SEWAGE # VILLAGE —d �, -��5{` ASSESSOR'S MAP & LOT IZo- AoC- INSTALLER'S NAME&PHONE N0. 21�00 C-- SEPTIC TANK.CAPACITY LEACHING FACILITY: (type) _-44az (size),, 4' NO.OF BEDROOMS } BUILDER OR OWNER �-totivttild�� PERMITDATE: "J� COMPLIANCE'DATE: -� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility. t . Feet Private Water Supply Well and Leaching Facility (If y e11s 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 t, a No. Fee P THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migogal *pgtem Congtruction 3permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 60 fJAGUN _kW-e_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel �; -?® ,— Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 13 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �3_3,0 gallons per day. Calculated daily flow `3461 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ram}5T. !jc-\OV-0 Type of S.A.S. tA(,kU�j26''i!,�4rL Description of Soil 04. r, 0 S 14 -0 Nature of Repairs or Alterations Answer when applicable) _�S 4A �� ` �� '►V,,]p LT irv�v o(LS _-A� Sto -C ow SiI yew 7- /Y" rice,.h.e!E 4 OK� I S I I 5`r*a go A la 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 Bo s Signed I Date Application Approved by CCs Date Application Disapproved for the following reasons Permit No. F3 Date Issued z— " 9 TOWN OF BARNSTABLE q �3 � LOCATION _Jr� WV4�fl•0v'-' SEWAGE# VILLAGE_Tl. ,-4 L,4,t ASSESSOR'S MAP & LOT 2 0-- ADCr INSTALLER'S NAME&PHONE NO. SEPTIC:TANK CAPACITY LEACHING FACILITY: (type)L". (size) ') Y. ] NO.-OF 13EDROOMS ' BUII;p OR OWNER `fi'I�h./ItiOM� I PERMIT- DATE:_.DATE: " COMPLIANCE DATE: SepaOa n'bistance Between the: { Max=.W,Adjusted Groundwater Table and Bottom of Leaching Facility S • Feet ; Private:'Water Supply Well and Leaching Facility (If any wells exist o :tite;or within 200 feet of leaching facility) Feet Edgeajf Wetland and Leaching Facility(If any wetlands exist wtivn.300 feet of leaching facility) Feet Furnished, by • S� TO1 �fl Tfr V I wr �t t. 1 p�j/r No. Fee `�.._7 0 - b� THE COMMONWEALTAOF MASSACHUSETTS Entered in computer:, `- Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(ppYtcatton for Moogar *pgtem'Congtructton Permit Application for a Permit to Construct( )Repair( (/ Upgrade( )Abandon( ) El Complete System ❑Individual Components 'Location Address or Lot No. (k)j4G0iN kAVJ-e__ Owner's Name,Address and Tel.No. Assessor's Map/Parcel C4015- Installer's Name,Address,and Tel. o. ` Designer's Name,Address and Tel.No. Type of Building: ; Dwelling No.of Bedrooms 3 Lot Size sq. ft. Gaibage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) t� Other Fixtures Design Flow 33O gallons per day. Calculated daily flow 34� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Z�n r 5T Type of S.A.S. ��-Description of Soil 1/y F V) Nature of Repairs or Alterations Answer when applicable) A- a'�\ k�`^� W"A1- 6-1I 2A= lY. LZ ��U t2. L.,_ �--(t `'T o Ow SiYJFs -y- Date last inspected: v 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 e and to place the system in operation unti'La Certifi- cate of Compliance has been' s Bo a Signed Date 9 ZJ \\` Application Approved by - Date Application Disapproved1or the following reasons Permit No. 3 ' Date Issued 7-6 g ----------------------------------=---- 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 at �.t!�� '�► L w Ze., ha been constructed in accco�rda e with the provisions Qf Title 5 and the for Disposal System Construction Permit No. 9 dated 7 `6 /''Installer Ct G � Designer i The issuance of this p t shall not a c strued as a guarantee that'the system 11 function as designed. Date �- 7 0 Inspector ---� ----------------------------------- No. 7 Q y J-3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwtgpogar *p! tem �Congtructton Permit Permission is hereby granted to Construct( )Repair(✓)Upgrade( )Abandon( ) System located at - �ct:2&.,i 1�ya_-+" /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: Z — Approved by eq O �6< 1tU9N7 I 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 concerning the j located at (• �`4 -- ```'`"```O meets all of the r property following criteria: ` Znere are no wetlands located within wo feet of the proposed leaching facility �• h ere are no private wells within 150 feet of the proposed septic system j ' crease In flow and/or change in use proposed • The ro is no to Z1 • ere are 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 na be located less than fourteen(14)feet above the maximum adjusted j groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) a� DATE: SIGNED LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed'system.Also if the licensed installer posesses a eertltled plot plan, this plan should be submitted]. q:health folder.art ,� ,�v �_-� � � � i 4 �60 COMMONWEALTH OF MASSACHUSETTS x EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS i DEPARTMENT OF ENVIRONMENTAL PROTECTION A d OW TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS—. SUBSURFACE SEWAGE DISPOSAL SYSTEM F`�RN E�EIVED PART A CERTIFICATION MAY 2 1 2002 Property Address:58 Wagon Lane Hyannis TOWN OF BARNSTABLE Owner's Name: Mr. Curtis HEALTH DEPT. Owner's Address: Same Date of Inspection: 4/18/02 $ �l ® d Name of Inspector: Timothy Lovell '11'�OT Company Name:Accurate Inspections Mailing Address:550 Willow Street MAP Z-7 ri W.Yarmouth,MA. PARCEL, • 2 t 5 Telephone Number: 508-771-3700 _ LOT _ 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: X _Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority -fails Inspector's Signatu Date: 4/18/02 The system inspector shall submit 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. I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:58 Wagon Lane Hyannis Owner: Mr. Curtis Date of Inspection: 4/18/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_I have not found any information which indicates that any of the failure 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: _N/A 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. NIA 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 infiltration 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: N/A 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: N/A_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: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:58 Wagon Lane Hyannis Owner:Mr. Curtis Date of Inspection: 4/18/02 C. Further Evaluation is Required by the Board of Health: _N/A 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(i)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _N/A_Cesspool or privy is within 50 feet of surface water N/A 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: _n/a_ 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. _n/a The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _n/a_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. n/a 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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 58 Wagon Lane Hyannis Owner: Mr.Curtis Date of Inspection: 4/18/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _x_Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _x_Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _x_Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool N/A _Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow _x_Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _x_Any portion of the SAS,cesspool or privy is below high ground water elevation. _x_Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _x Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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 1515.303,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 Systems: N/A 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 11 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:58 Wagon Lane Hyannis Owner: Mr. Curtis Date of Inspection: 4/18/02 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _x_ —Pumping information was provided by the owner,occupant,or Board of Health _x Were any of the system components pumped out in the previous two weeks? _x —Has the system received normal flows in the previous two-week period? — _x_Have large volumes of water been introduced to the system recently or as part of this inspection? _x_ _Were as built plans of the system obtained and examined?(If they were not available note as N/A) x Was the facility or dwelling inspected for signs of sewage back up?—x_ —Was the site inspected for signs of break out? —x _Were all system components,excluding the SAS,located on site? x_ _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? _x —Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no —x —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)] r Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:58 Wagon Lane Hyannis Owner: Mr.Curtis Date of Inspection: 4/18/02 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:_2 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):_n/a_ Seasonal use: (yes or no):_no_ Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):_no_ Last date of occupancy:_Current COMMERCIAL/INDUSTRIAL N/A 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: Ownere 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 _x_Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _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: 1998 Were sewage odors detected when arriving at the site(yes or no):_no_ • Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:58 Wagon Lane Hyannis Owner:Mr.Curtis Date of Inspection: 4/18/02 BUILDING SEWER(locate on site plan) Depth below grade:_3' Materials of construction:_cast iron x_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:_x (locate on site plan) Depth below grade:_8" Material of construction:_x_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: 1500 Gallon Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_4" Distance from top of scum to top of outlet tee or baffle:_8" Distance from bottom of scum to bottom of outlet tee or baffle:_14" How were dimensions determined: Field Measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): No evidence of leakage the water level is at invert out,tank is fairly new very structurally sound GREASE TRAP:_N/A (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.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:58 Wagon Lane Hyannis Owner: Mr.Curtis Date of Inspection: 4/18/02 TIGHT or HOLDING TANK:_N/A (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:_x (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_0"_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Water level is at invert out,no evidence of leakage no evidence of solid carry_ PUMP CHAMBER: N/A (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.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type Leaching pits,number:_ _1 Leaching chambers,number: 4_high capacity infiltrators Leaching galleries,number: Leaching trenches, number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): No sign of hydraulic failure vegetation normal no ponding CESSPOOLS:_N/A (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_N/A_(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.): I 1 • Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 Wagon Lane Hyannis Owner: Mr. Curtis Date of Inspection: 4/18/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Front Of Home 25' 35 1 ' 41' 25' ti Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 58 Wagon Lane Hyannis Owner: Mr. Curtis Date of Inspection: 4/18/02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 727 LO CAT 10 SEWAGE PERMIT a �S VILLAGE I N S T A l ER A ME i ADDRESS t U 1 L D EA R OWWVER r 4 i DATE PERMIT ISSUED a DATE COMPLIANCE ISSUED 6 �. �.y 4 e `W N � ..3 I � ('J �� . y � � ,,_ < �� era oZa3 Nock..,?-.:'--27_ Fps../..0................ THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH 0.. .............OF.... �A..�../`�J5`..!f�_L�L -----•--•-----•---•-----•. S� Appliration for Disposal Works Tousirurtivaa Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............." -. ...........wJ.-.QQ./V.:..14j?.C__---- ....................... je!.c'?'! ....... ............. �1 Loca' n•Address or Lot No. ?'s --- A.L._Z).e_ '-.,Si------------------ �• .+�S.t�ISt t�X D..r J�. = .f��4�..-------- Owner Address ---- Inst Address Type of Building Size Lot.............................Sq. feet aDwelling—No. of Bedrooms._ -------_---________________Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ............................ /� W Design Flow............//0....................gallons per person per da 4f. Total daily flow........ gallons. WSeptic Tank—Liquid capacity__ yjaa gallons Length.-�/-_-... Width_ _--___--.__ Diameter________________ Depth.iS'k._---... x Disposal Trench—No..................... Widthr_.................. Total Length......._/._.._.I..... Total leaching area....................sq. ft. Seepage Pit No------/----------- Diameter-__7.............. Depth below inlet.....4�.......... Total leaching area.....2,.d...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----------------------••••--------------- .................... Date....................................... aTest Pit No. I----f.-..Zminutesper'inch Depth of Test Pit___ .�._----- Depth to ground water....�::�_if- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' •-••----------- ;.......... �W7...... , O Description of Soil--•--� .2 L•---------- •O.A.mq.-•--��-•-• �v ------ °ua o _ :�--%_SK, . .. ....................•-----•-•---------•-•--•--------•-----.....----•-•---•-----•----••--••--------•---........-------- ••--•-•-•----------------------------------------••--•--------.....-•-•-------------••--.._...--••.----•--•--•----------•.....--------•----•--•----••-•--------------•--........-----•........--.--••-- 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 TITL%, 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. ]/ L I ed :. Application Approved B " .............................. ........................ •• Date ......••.. Application Disappro or a following reasons:................................................................................................................ ....-•---•---------------•-•----------•-.....-----------------....---------------•----......-•-•----•-•-.------•--•-•---•••-••------•-••••-----•-•-•--•--------••----••---...---•--•-•------•-••-•_•-•-- Date PermitNo......................................................... Issued----.......------- ............. Date '. N.!..?---2 .7 Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH . I ..............OF......:. .. .. ' _ .......................... Appliratiaan for Eh-qp.aii al Works Tnnitrnr#iun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Local' AddressLot Owner ,'fir / Ad ssr�y -•••............ .. „!� !!►1 1�+/ k�. '- ? ..................................... .' .. �r Inst ei Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms ._ .....Ex Expansion Attic �-, g— ______________________ p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ............................................................. ....................•------------------ ........................................ w Design Flow...... , l ...... .........gallons per person per dW. Total daily;pw.._...._ `_-...................... 119ns. WSeptic Tank—Liquid capacity ;gallons Length �._.. Width. r.� .. Diameter________________ Depth. xDisposal Trench—No..................... Width.................... Total Length....... ._ ..._ Total leaching area........ _._...... ft. Seepage Pit No......./---------- Diameter.._.. f.......... Depth below inlet......:_........ Total leaching area........ A.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.. A --------------- Date Test Pit No. l.....L.. _minutes per inch Depth of Test Pit......... _".'......... Depth to ground water........................ 4� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ d+ O Description of Soil..... ' "-- � f �� !!��j' ' w UNature of Repairs or Alterations—Answer when applicable....__.........................................................-.........................._..._.. -•---------------------------------------------------------------------•------------•-••--••-•--------------...------------•------•-------------------•---=----------------------------.............._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance.has been issued by the board of health. , k .................. a v - � g �,,�„ D to e Application Approved B} - .......--•------------------- ---------------•-----------------------....._..-- . ..Da t .............. ---------•-----------------•-----------•--•---•........•-----...--••••--•---------...........•••-----....••--•-------•--•-•--•-••-•-•---•--------•••-•-•--••---•-------•••••••--•---••-•••••-•-•--.----- Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF(HEALTH ..........................................OF................................................................................... THIS & 7 Q CERTIFY That the Individual Sewage Disposal System constructed ( '")or Repaired ( ) y e. 1' .ZZu Installer at. ..._..... +� .._..-••-•-...� / � ............il.................•-••----r--•--••---•••-•----•---•-•---.....•-•-•-•----•------_......_....Z 4 has been installed in accordance witsl°the provisions of TI7,LE 5 of The State Sanitary Code ;f des abed in the application for Disposal Works C Construction Permit No.__ ._.._. .. dated .. �' ` ` 4 ,, �, -------------------------------- THE ISSUA C OF THIS CERTIFICATE SHALL. NOT BE CONSTRU S A GUARANTEE THAT THE SYSTEM VEAL F TION SATISFACTORY. Inspector::' DATE ................. ...............•-...•-------.......-------••-...._.._ ......... •••--------------------••-----•--.............._........•--.--•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF `,HEALTH ..........................................OF................................---...............-----.............•••..........._.. No.. _ ^,, FEE......................... . �i��n��al{ � ��nn��rnr�tiDrn rrnti� Permission is ereby granted__._ . a ---------•---------•------- --•-•--•-• ...............------------------------------------------- to Construct,.(',' or epair ( �i jnvYdual�Sewage Disposal System at No `t � f'a. 'f ' Street as shown on the application for D sp Works Construction Permit No. `r .... Dated "'- r ,� .... ................... ........ .._._..._..._...._-._..w....__.'__.....____. / � !"} --•^ Board of Health DATE...................... v �f,•7 ...._:......... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - - -1 - _ � A9 S1GL1 �at►�G�C-. FAMIt-Y - � B[.otzraoM - ►JO GARBAGE• �jWNDE2 � : � pA1LY FLOW :. I10 A 3 = 73o6.P ' i jEPT1G TP►�JK = 33oxi5o% = �19%G.RQ U5� l000 GAS•-. i o►5Po5A►- P17 v5E 1000 SAL-. 37 5 G.Po ►ris �' ' /3S. C►a ` — BOTTOM AREA- , 50 5r". 5 o s.� x i• o = 5 oG Q -TOTAI-. C'ESIGN : ,425 1 -TOTAL 1DA 1 LY Ft-C)W ' 330 G.Po `l l I v Zu"/ 916 ps 0 PER.coLATlo►J RATE : I"lrN 2MIN oP-Ll~5S u ' h! 9e Z �Q "VIA. `ZH OF M•tss4c y J ALAN RICHARD W. �, `� Fx� � Ste•Z A. uy JON£SBAXTER ,n 1 I q I 97.7 No.24048 ♦. B /STE,�p + Ib % SURD 6 �I T6�T y Top FNU =1oo.0 r ylxY i 1000 lN�• I; ` JN(�$O✓L DUST. IN•/. ,EPT,C 9/ 96.g o�x Z ' 1Uvo �N�/, I TANK !( �y1�✓ GAL. 6Q.a✓� LP T� ;NV. INV. w�Tu z 9� �f /L�C� VJA��16 D ICOZA&sa 6 rvNE saw �, - �,:�I,� 9�•� - -- �� Ga2TIF.IGD PLOT PL.A1.1 /Z •O _ Loca,� loN ,yygy,�is Imo!O SCALE 5CALG „_1/10 , pAll, a 9 P L A r-I 9-E Sze►.t GE � C>= RTtFY 'THAT 'Tµ�ExtiS�nrl6 FNDSNov�(N NER SOW COMPL`(5 YJITN �T HE S 1�F L1I� � � bT SC3 i A► P 56=15ACK � (L6G?u1R.EM6N7`� oFZµ� Q,�ZE37 �'G Z9 -Tr>Y4w o $��.1.✓Yt 1�31.� ANo ►S I.IvT' LOCATE WITN11�1 T1-1E GLOOD PL4-,ItiJ D AT !✓J7�;7— R.EG T1�15 PL�tiI 15 N� '3n5t=D ob AN 067G -VILLE- 1 W Tt2.uMF--NT SU9-VEY -rNE nI=�SET� 'Sl10UL3> /•c/G- ��._ t�1_T