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HomeMy WebLinkAbout0029 CONSTANT LANE - Health r� .'. -:y �-•wa.`"�"-'.^tom-> ^ �.h IL tant L,.a n e: 66 - - -- --. 1 No. Vv � `l0� 1 Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZIPPrication _for lVell Cow6tructf ors 3permit Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: L.^) C.o r.,IT Location-Address Assessors Map and Parcel N MG Cr .79. CowSrct..,r LIy COT! /N Owner Address DeNrylc srtinzt U LiL �S1 �iy8. 00'4.agS /?J /n'taSln�e+ /kQ o�cS�9 Installer-Driller Address Type of Building Dwelling v1 Other-Type of Building No. of Persons Type of Well I/ « Capacity Purpose of Well {//'r Ga•1-1ew Owl Y Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Co m lianc as been issued by the Board of Health. Signed ��„,,,,�-7 3 � t Application Approved By l L� Date Application Disapproved for the following re ons: �A� l `� 'l Date Permit No. VV 2�'ou Issued Date ------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(vf, Altered( ), or Repaired( ) by QC NN!S JCaNwG l� R Installer at has been installed in accordance with the provisions of the Town of Bamstaple�Board of Hea4 Ptivate Well Protqction Regulation as described in the application for Well,C_onstruct ion Permit No. V U124 -01 Y!�FDated L y THE ISSUANCE OF THIS CERTIFICATE SHALL?NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector i No. U" � t� 1 Fee BOARD OF HEALTH ' TOWN OF BARNSTABLE 0[ppltration f'or Yell Coh5truction Vermit Application is hereby made for a permitto Construct(v); Alter( ), or Repair(,) an individual well at 9 co a Location.-Address Assessors Map and Parcel r 7 s 7- Liv C!�T,iJ .n4 Q ` ev M�a e �, Owner Address nPhwP'.,.r; CC,.. ,, �l L7L• �SJ /�,G J./L'(� iCRSS .+,'C� /`</lycjG41.w Al Installer-Driller Address Type of Building Dwelling i y ,s'�......�.....� ... p :a�". ,.�,�. . .. ! Other-Type of Building No. of.Persbns r ' Type of Well Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the i Town of Barnstable Board of Health Private Well Protection.Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance,has been issued by the Board of Health. Signed - yZ`& 12 Date Application Approved By --- - Date Application Disapproved for the following reasons: Dat .�__ _ Peffn No. _ _. __ :. ?. - - Issued e Date ------------------------------------------------------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE , Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(v); Altered( ), or Repaired( r by r,n..�kAt r l� p r _ .'Installer ' at has been'installed in accordance with'the,provisions of the Town of Barnstable Board of Health_ Private Well Protection g pp {/ -CAL'! Regulation as described in the application for Well Construction Permit No. (�1� Dated 3/7- c � r THE ISSUANCE OF THIS CERTIFICATE SHALL_NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date 'Inspector BOARD OF HEALTH TOWN OF BARNSTABLE l t./ Yell Con.5truction Vermtt No. • w ��/t ��r i Fee `j— Permission is hereby granted to t72NAJ(S C A Installer to Construct(v), Alter( ), or Repair'O an individual well at: .<. No. Street J as shown on the application for a Well Construction Permit No. G -� `Q� Dated°'�2 ! Z Date 3//7 L4 /-i I Approved By I ­-W4 4 N . r + � - ff�..__ z $ - '9;0 TREE LINE J " - - - ` LOT 41 T 43 LOT 4 , , CAPE e(:: Es . c6 = �° �� 71 RES. ZONE. R= F jj , c0 FLOOD ram'1 LO V(f��D ZONE,c 112-5100 iD. 1 CONSTANT LANE THIS MC3M rCACE_: J NSF5! CT X Chill PLAN IS FOR � BANK b_SB QNL:Y_. BARNS-- T_ABL _ REGISTRY iI 1N R _n0NA_Dj_W1 FQRC�RQ91Dpu _99.907 _ BUYER -- 4 r2 68 PLAN PFF:--.L G.-_22a2_d SeAL� , -- - - -- re y cart. ty that t, d e ui ink ---- on Lhis plan is IceaLed air 0 OF - - YANKEE SURVEY ground as shorn and it � �__ �C��SU�T�iVTS Lien does Eonfor�o to ti is_ 'AUE v► 70 RASPRRRRY LANE IS haw sethack re Wrerment of ff � lAR TON MILS RlVST'A - - M�ArIW y f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John & Cassie Maher Owner Owner's Name information is COtUit required for MA 02635 November 7, 2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out , forms on the computer,use 1. Inspector: `� l� only the tab key D � .lam to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name rab 189 Cammett Road Company Address Marstons Mills MA 02648 emm City/Town State Zip Code 508-428-1779 Telephone Number License Number B. Certification 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 St'ction 15�340 of. Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Uq 00 _ r u November 7, 2007 Ins ector's Signature Date 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. ****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. 07-265 Maher.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John & Cassie Maher Owner Owner's Name information is required for Cotuit _ MA_ 02635 November 7, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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: Tank has liquid only and is not in need of pumping at this time. Infiltrators have no P 9 standing water or evidence of saturation. Recommend replacing d-box in next year or two. 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 07-265 Maher.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 29 Constant Lane Property Address John & Cassie Maher Owner Owner's Name information is required for Cotuit MA 02635 November 7, 2007 every page. Cityrrown State Zip Code Date of Inspection B. Certification (Cont.) B) System Conditionally Passes (cont.): ❑ 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: i 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. 07-265 Maher doe-08106 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John & Cassie Maher Owner Owner's Name information is required for Cotuit _ MA 02635 November 7, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (Cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "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_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. 07-265 Maher.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °� a,.• 29 Constant Lane Property Address John & Cassie Maher Owner Owner's Name information is Cotuit required for MA 02635 November 7, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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 Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. 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 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. 07.265 Maher.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 If Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John &Cassie Maher _ Owner Owner's Name information is Cotuit required for MA 02635 November 7, 2007 every page. Clty/rown State Zip Code Date of Inspection C. Checklist 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: ® ❑ 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(5)] 07-265 Maher.doc•08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John & Cassie Maher Owner Owner's Name information is required for Cotuit MA 02635 November 7, 2007 every page. CitylTown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: 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: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage Inaccurate due g ( y g (gpd)) to irrigation syst. Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): ---- - - 07-265 Maher.doc•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John & Cassie Maher Owner Owner's Name information is required for Cotuit __ MA_ 02635 November 7, 2007 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped August 2007 Was system pumped as part of the inspection? ❑ Yes ® 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: Compliance date for leaching system: 7/13/98 Were sewage odors detected when arriving at the site? ❑ Yes ® No 07-265 Maher.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 29 Constant Lane Property Address John &Cassie Maher Owner Owner's Name information is required for Cotuit MA 02635 November 7, 2007 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle - Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Visual 07-265 Maher.doc•08/06 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John &Cassie Maher Owner Owner's Name information is required for Cotuit MA 02635 November 7, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank has liquid only, no solids. Tees are intact and clear and liquid level was at bottom of outlet invert. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 07-265 Maher.doc-08/06 Title 5 Official Inspection.Form.Subsurface Sewage Disposal System-Page 10 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John &Cassie Maher Owner Owner's Name information is required for Cotuit MA 02635 November 7, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): Liquid level was found at bottom of outlet pipes. Structural integrity of box is marginal, recommend replacing. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 07-265 Maher.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�u a,•y'� 29 Constant Lane Property Address John & Cassie Maher Owner Owner's Name information is required for Cotuit MA_ 02635 November 7, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: Four 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.): Infiltrators have no standing water or signs of surcharge 07-265 Maher.doc•08106 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John &Cassie Maher Owner Owner's Name information is required for Cotuit MA 02635 November 7, 2007 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (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.)-. 07-265 Maher.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 / � . Commonwealth of Massachusetts . ��°��N�� �� ��x�����~��N N���������*��~���� Form �| U�N�� Title �� ��'wmw~�w�mN Nm ����~�����W��mm �-��wwmw Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 2A Constant Lane pmnen����"'��---'----------------- ------------------- '-------------------------' John & CaanieMaher Owner --'---'--'----------'-----�--'—'__-_'__-_-__-___---____----- Na, .nfonnanon/s required for Cotuit ___ _________ __ MA 02635 Novpmber7 2007 every page. u/v/»w» state zip Code—' Date of Inspection - D. System Information (cont.) Skotch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties hoat least two permanent reference landmarks or benchmarks. Locate all wells within 100femt Locate where public water supply entesthebuilding. Constant ~~~~..~~ � � � � VV@t8 Service 56 56 � � ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Constant Lane Property Address John &Cassie Maher Owner Owner's Name information is required for Cotuit MA 02635 November 7, 2007 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: More than 20 feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ 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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 25 and topo map shows property at or above e1.50. 07-265 Maher.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable Regulatory Services - - , SrnarE ; Thomas F. Geiler,Director t6 Public Health .Division rEDMAyA Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental.Protection: Although the Town of Barnstable Health Division received the original/copy of this report;,this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. A TOWN OF BARNSTABLE LOCATION //r-99 (2ons'1Y� Lone )S E�^5P VILLAGE l:y--ku,'t- ASSESSOR'S MAP&PARCEL FRS NAME&PHONE NO �ti�©�� tI SEPTIC TANK CAPACITY )Gy o � LEACHING FACILITY:(type)-73�A J`-T (size) NO.OF BEDROOMS OWNER PERMIT DATE: CO - DATE: Xn 5P Cn o b Ico 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 . Constant Lane Water Service [[[ I G�r�$ 4 27 56 56 i - � r AsBuilt Page 1 of 1 Ct TOWN OF BARNSTABLE LOCATION oL l COv-N 64CWI 1_ C,�. SEWAGE#�A_V 3 VILLAGE Cnlui_�_. ASSESSOR'S MAP&LOT 6 4n 0-y 5" INSTALLER'S NAME&PHONE NO._,M-6 C6,ec 720'!Lf SEPTIC TANK CAPACITY j Ohs.Z LEACHING FACILITY: (type) �' /1i-Ca 4 r rwilf r&,, (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMrrDATE: `7 E� COMPLIANCE DATE:-Tk'��9� 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 f• --aching facility) Feet Furnished by i Zear eF C oui C 0 J %.ate 0 t 0 0 o http://issgl2/intranet/propdata/prebuilt.aspx?mappar=039066&seq=1 9/5/2017 TOWN OF BARNSTABLE ATION e� CA COVN 84CYN- " SEWAGE # � 37 VILLAGE �c��'ui ASSESSOR'S MAP & LOT QVr INSTALLER'S NAME&PHONE NO. M;6 Caac sa" 770'��� SEPTIC TANK CAPACITY � 5 Z' ; E LEACHING FACILITY: (type) ' f�i'C� r ► � f (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: `7 ff' COMPLIANCE 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 e. `-aching facility) Feet Furnished by :+ �e��� �cx��- �'� ° `I -a, �7 `3 a . ��� � � _ 6 �1a � f3� o �� `� o a � 3 . Sb . , o -(oc `,off 1/2 $3 - 2�� w C A;T ION 60'7 e4lfte S E W A� PERMIT NO. VIIIAGE:� �C IN)STA hER'S NA ("01).E i ADDRESS ova /s'o U1411, 91rh S441.. ' a U 1 L Df R OR rOJWN ER." :DATE P.ERINIT ISSUED yd- 25 3 DAT E COM,P'LIANCE ISSUED s_o21-8y e ^f I I --3 s ! a Fx$VA..... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ..................OF.......................................................................................... Appliratiun for Diapuaal Works To atrurtiun Vrrtnit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - .2........Ce-n tv" .....Ln....... .........................................V.1 ...- lion• ddress o �wner Lot N / 0................................. ess ..... Installer Address dType of Building pp Size Lot............................Sq. feet 0-4 U Dwelling—No. of Bedrooms.___ .C.._______________________Expansion Attic (N'p) Garbage Grinder (ft aOther—Type of Building ___ .____.A No. f rsons____________________________ Showers ( �) — Cafeteria ( ) dOther fixtures ---•-•--�"- ..........k&j.. .........4...=-----------------...........-------------------------------------------------- W Design Flow.......... _____ ___._ _ gallons per person per day. Total daily flow______. 7� �-.....-- --g P P P Y• Y -:�'•.Y-- -.°.__.�-------•-----gallons. WSeptic Tank—Liquid capacity_1-00. gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...1--t _Q_.__. Diameter......1_Q------- Depth below inlet____________________ Total leaching area..................sq. ft. Z Other Distribution box ('V) Dosing tank' ~' Percolation Test Resul Performed by ----•---•---0-` s'.cm Date aTest Pit No. 1----- --------minutes per inch Depth of Test Pit-------------------- Depth to ground water_x1d_- �� Test Pit No. 2..__ ........minutes per inch Depth of Test Pit____________________ Depth to ground water........................ �+ •-•-•---•----•------•----•--- •----•----------------••....-•---•----------------•--------•-••--••-•---••••••--••----.......-------•------•••-------•--------- 0 Description of Soil........................................................................................................................................................................ x c, 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 TI]PU 5 of the State Sanitary de—The undersigned further agrees not to place the system in operation until a Certi- to o n has b n i ued by the board o iealt Sign ...... .... . .. .. .... - ------- -------------- e Application Approve By.... ........ - ------- ............................ --••••-------------------..._.:__..__ ..__�� _ te -----••--•--- Da Application Disapproved r th following reasons:................................................................................................................ ---•..................•-------•---...----•-----•-------•---._....._...---------•-------•---•---------•---.••-------------..------------•-------------•-•-----•----------------------------------...._..._ Date PermitNo......................................................... Issued....................................................... Date c NO....3e_��1.-. Fim- -_-------------_ '• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................ ..............OF................''.... ............--------- Appliraftan for DisposaliVoiks Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ....�.�. ' _... .n. . ..... ------ . ................................. lion- dress o Lot No. 7 ! ' ... __ wner Add ess a .--•-•---4n.,taller ------- --------------- w ��. Address UType of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms... .....:.:. ...........-.............Expansion Attic Garbage Grinder,060 p, Other—Type of Building .... 3ff�tC �______. No. p rsons_ ._.__ Showers ( ` ,) — Cafeteria ( ) Other, fixtures • .. i. .........Itj.t. °.- ------------------------- DesignW Flow.......... / .. gallons per person per day. Total dail flow__._.... �.,t•....�---------g P P P Y• Y �---f---�R----�------•-----melons. WSeptic Tank—Liquid capacity_./V-O.Ogallons Length-----_.......... Width................ Diameter________--_-_- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__�.10_Q_6---- Diameter..''__�_Q...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( � 'Dosing tank l /��/ _ Percolation Test Result Performed by...... .........0 A44.. �! : .._.1�. . a Date r Test Pit No. 1..... _------minutes per inch Depth of Test Pit.................... Depth to ground water.._�'?d__Wa 44 Test Pit No. 2.....t......_minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil..................................................................=" - W -••••••-••••-•••••••---••••••-•-••---••••-----•-•-•----•-••-......----••............. ....- ............-•---•....... •---_....- ----•--••-•••••-- -----••••-- •- U 'l ,Nature of Repairs or Alterations Answer when applicable................................................................................................ ----------------------------•-------------------....----•--•-----------••--•••••••-•..........•-••-•--...--•------------....----•-•-•-••--•-•-•--•-----•-•--•--•-•-••••-••--•••••--••-••.....•----•-•••- ..r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITAIL- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ,operation until a Certifi to o m has be •s ed by the board%alth igne •••-• ------- ---- -- ----- ......... - D e i Application_Approved BY---•• ------- - ------------------------.---------- ----------.---------••-------------- f� ' Date ......•-- Application Disapproved f r the ollowing reasons-------------------------------------------------------------••--------------------------------------.........._ •..................................•-•--..`-••-••--•-......-----•-•-••......-•------•--••----•-•-•.•••-- ' I 1%, Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H`)E�A4 ........... .................OF........:... ..:.... .. ..................................... Tnrtif irate of Toutpliunrr T IS CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by .. ........--- ------------•--------------------------••------------------------ Installer at-•--•- -------- -------L�._�'"'.�......_----t -•- . ,� has been installed in accordance with the provisions of TITLE 5gf State Sanitary in the application for Disposal Works Construction Permit No----ry, ...... •- I 3" f ------------ dated._.....X. ------••••-• THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION S�ATI�SFACTORY. DATE.................. °2 I �FSL........................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS w BOARD OF HEALTH F, opt ', ...........................................OF............................................................................... ...... .,. No.... ............. FEE.....L.27............ - t u %5onutrudion rrutit P,e_"Imission 1sbefeby granted....... ----•• ........... -•••••...................•-•--•••-•••-•....-•-••--•........••-••........................ to Construe or air ( n ual evt 1 p sal System at No. Z �� ✓. G .i' Street `. / as shown on the application for Disposal Works Construction Permit No._____.v,:41;raV�d'j!�a� ....................... �_ �� f Boar ' f Health DATE.....................- - ----•----------•----•--......------ ({!, FORM 11255 HOBBS & WARREN, INC., PUBLISHERS S y Sso ao , r quo 0 vp 0 IN , IN o o N c" GpPCCo Vt►JE�/ARD rEF�► �dIDD PIT voo 9 (Ab* � 3 P�Sea aG°�vt. �► OAJ N = V1 d. o� LA S 'boo- �7=O 5 �1 t Z �� i 5 l 3 ARQS Le. M . 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