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HomeMy WebLinkAbout0150 SHELL LANE - Health F150 SHELL LANE,COTUIT _ AA 019 161 I f ISU -.- -- --- ---,- 0 (01V LOCATION : 5EW06C,E PERMIT MO. afAt kh./C - - - - - - - - - - ILL/iGE WSTA&LER•5 1J&NAE DDRES BUILDER 5 Q I MF- AD RESS DINE PER"IT 155UED D ,.TE COKAPLI &I ICE ISSUED ; it r d10 o AL ol 0 _ D JJ No...... -- ------ F��....f... ............... THE COMMONWEALTH OF MASSACHUSETTS }- BOARD OF HEA TH. .......-..OF....... ..... ...... .......,.....------- l(j Aplilirativaa -for Dtiivviiaal Works Tongtrurtion Pprillit Application is hereby made for a Permit to Construct Y) er 4tep.& ( ) an Individual Sewage Disposal j System at: Y Locatio - ddress � - or Lot o. /�° F _ .�� 9. ���Qms kf ---------------- 1f - i�eST-i_�'�Y ....... Owner Address a ..........At, �, ,. k..................................................... ----N.Ak%%rAA11....MW S--------...------•----------................. Installer Address Type of Building Size Lot.. ®......Sq. feet U Dwelling No. of Bedrooms--.-____ __ .Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons..___..___--.__-__-_.____.__ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------- -------------- - - w Design Flow.....r0..............................gallons per person per day. Total daily flow ------ ©_ 3___-__- gallons. WSeptic Tank I Liquid capacity_`S��allons Length---------------- Width..____..._..... Diameter___._......-___. Depth.___-._.____._. x Disposal Trench—No_____________________ Width-------------------- Total Length------------------.. Total leaching area--------------------sq. ft. Seepage Pit No.t------------------ Diameter.__I000_____ Depth below inlet. Total leaching area---------.........sq. ft. z Other Distribution box ( ) Dosing tank ( ) d 4, /Oc= Percolation Test Results Performed by------------- -------------------------------=---------------------------- Date-------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.._._._._-__-._-__,_.... f� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water...-__---_____.-___.._._ ;.. ------ -� Kr Description of S----- �y V -------- . _a.,---/_2-•----------- x �� F� U •-••-••--------•----------• --- -- .tom.--- -- -- • ., h ram. 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 Article NI of the State Sanitary Code— The undersigned further reel not to place the system in operation until a Certificate of Compliance has been issued by e boa of e h. sue' gned-- . . .................. '= - -----•--------• ----- Date Application Approved By---------- — --- ----- = ---- Q Application Disapproved for the following reasons------------------ ---------------- ---------------------------------------------------------------------------- ---••...••-•••---•-•-•--•••-••--••----------------------------------------------------------------------------------------------------------------------------------------------- ------------------- Date E. Permit No......................................................... Issued.......V ----�-------=---� ....4........... Date ��_ ---------------------------------------------- -- - 143 . c ! mot; r i No. =� ............... THE COMMONWEALTH OF MASSACHUSETTS - BOARD BOARD OF H EA .... ..OF...... ---------r------------- � �irtttiuii fir D-4p isat lVarks Tonfitrurtiuu Prrutit Application is hereby made foAa Permit to Construct ( ) pl ( ) an Individual Sewage Disposal System at: -----------:% -tjk-R-------AAA A:.----- ` w t' "'------------- Locatio ddres or Lot ix Owner Address p Installer Aahress Q Type of Buildin Size Lot__ 'kIT_�Q------Sq. feet U Dwellin No. of Bedrooms-_____._ Expansion Attic Garbage Grinder U g �------- -- P ( ) g ( ) p, Other—Type of Building ............................ No. of persons_-__________________________ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------- ------- ----------•-••- - - W Design Flow..... -----------------------_------gallons per person per day. Total daily flow------- 0•0-------------------------gallons. W4 Septic Tank 4 Liquid capacitv_`6 allons Length---------------- Width................ Diameter........__-.... Depth-----.____-__--. xDisposal Trench ' No-__________________:_ Width-------------------- Total Length_.___._.__._______.. Total leaching area--------------------sq. ft. 3 Seepage Pit No._�__________________ Diameter.__1Q _0_____ Depth below inlet_ 44m Total leaching area-----_ -------___sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY--------- ------------••--••------•••••-•--••--•••----•__...-•--•-•••--••• Date.............. ----------------------:- ,� Test Pit No. L...............minutes'per inch Depth of "Pest Pit.................... Depth to ground water.-_-___________-__-__--- GZ•, ' Test Pit .No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__-__-.______ ______-- P4 •- � ��// --------- #----- ` � w .............•P•-•--•-•-•-•-- r D Description of Soil . G!f/_�i`' � --------V ------ - - V _.._... l�[� W. --------------------------------------- ----------------------------------------------------------------------------------------------------------------------------•--------•••..-.--• ............... VNature 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 Article XI of the State Sanitary Code—The undersigned further rees not to place the system�in operation until .a Certificate of Compliance has been issued by e boa/ of h. S r fined- -a�---- •- -- ---=- -=---------- ------ - ----- --------------- Date Application Approved BY -- -- .-• • -- - - ------ ----- y ��•. ' > Application Disal5,proved for the following reasons: .:.---' :__. --•-•-•-•--••---•-•-----------------•...----••------------------................-----..------------...... Date PermitNo.......................................................... Issued..............................:.......................... Date - THE COMMONWEALTH OF MASSACHUSETTS �...��` BOARD OF HEALTH 2 OF......... .. e.............. ati$irate of Tlimptiaurf Mi 0 C RT T e Individual Sewage Disposal System constructed ) or Repaired ( ) by------. ........................ -------- er has been installed in accordance with the provisions of_article XI of The State Sanitary Code As d s;OOWrithe a lication for Disposal Works Construction Permit No... dated::' p ------------------ y, •• •- PP Pf " : ..__.... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GWARANTEE THAT THE- SYSTEM WILL FUNCTION SATISFACTORY. A< »a DATEInspector ----------•--------•--•---•-------------•----------..._---._...--- •'- THE COMMONWEALTH OF MASSACHUSETTS BOARD. OI HEALT �='� all— / ........... OF: . .... ----- ... --;.. �.•� No.--- ---- FEE_ X .. ' i_s mvu&IU a- strurtilau Orrmit Permission s ereby granted -`' - ---- D to Con str t Vo epair ( ) a Ind iv' uaI S e osal stem at r . r treet .y as shown on the application foi Disposal.Works Construction mit.... ............. ..... _?1W4 Dated_..t G Board of Healt DATE. ..............------ ------- ------ FORM. 1255 HOBBS & WARREN.-,,,I,NG:.-PUBLISHERS - I- f y f > a f --O 0 �- p - -.. m_ _ F__ .. r--- •• _. _ _ ..- _. r c : 1 r !!TOWN OF BARNSTABLE LOCATION /,-( 511e,/1 4Y. ,fie 'SEWAGE # VILLAGE Gip / ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ' rs'� S// eX 4 G A C ®--' -77 DATE:_(�L195 --- PROPERTY ADDRESS:_150 Shell Lane Cotuit,Mass, ------------------------ e! q t 02635 ------ ----------------- On the above date,A inspected the septic system at the above address. This system consists of the following: A. 1 -1000 gallon septic tank. B. 1 -1000 gallon leaching pit. Based on my Inspection, I certify the following conditions: A. This is a title five septic sytem. B. The septic system is presently in proper working order at the present time. SIGNATURE: Name:—J.P.Macomber Jr- Company:__ J.P_.Macomber & Son Inc. Box 66 Address: Centerville,Mass_ 02632 Phone:— 508-775-3338 -------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JUN lu�� JOSEPH P. MACOMBER & SON, INC. o� Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections • ., P.O. Box 66 Centerville, MA 02632-0066 9 b 775-3338 775-6412 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PORN , Address of property 1 SC) Owner's name CST Date of Inspection � PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, Health. P and Board of -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 N/A. � The facilit y ,or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. A11 system components,, excluding the SAS, have been located on the site. , The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance .of SSDS. 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION J FLOW CONDITIONS If residential 3 number of bedrooms 3 number of current residents garbage grinder, yes or no E laundry connected to system, yes or no Yg=� seasonal use,, yes or no If nonresidential, calculated flow: Water meter readings, if available• 9��` 1`� �bCO Q--or _ '77G f p . 93 16, Oao �•�����S $ga��17 Last date of occupancy VC— -Y L_o4.4 US A&E GENERAL INFORMATION Pumping ecords and source of information: PO wtv % N rU e;: S T C,e System 111 �S T)-+eu Y pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Tyke of system ,,�� Septic tank/ istribution bo /soil absorption system Single cesspoo Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: .� Sewage odors detected when arrivingat the site, yes or no i 9 MSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: tWO (locate on site plan) depth below grade: material of construction: . k concrete metal FRP other(explain) dimensions:— 13 6�y e � sludge depth distance from top of sludge to bottom of outlet tee or baffle 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. 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 leakage, recommendations for repairs, etc. ) 1 M L C i DU 1�.l.1 �� 1 H Z.bo lG O ' l DISTRIBUTION BOX: (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) PUMP CHAMBER: O �' (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) :_ (locate on site plan, if possible; excavation not re approximated by non-intrusive methods) quired, but may be 2 ; If not determined to be present, explain: I� Type leaching pits and number O leaching chambers and numberi^- leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number_ Comments: (note condition of soil , signs of hydraulic failure, level of ondiri condition of vegetation, recommendations for maintenance or repairs etc. ) 6 r L le Cn _ CESSPOOLS (locate on site plan) : number and. configuration Q v N C 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 (cesspool must be pumped as part of inspection) . Comments: (note condition of soil, signs of hydraulic failure, level 'of pondin condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY: (locate on site plan) 1�1C�►V materials of construction t dimensions depth of solids Comments: (note condition .of soil, signs of hydraulic failure, - level of.ponding, condition of vegetation, recommendations for maintenance or e repairs, ,etc. ) 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM y PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' \A_j b SSG s11eZ4 4 ,4 c d_r DEPTH TO GROUNDWATER depth to' groundwater '�Ot C20u p Sv method of determination or -a pproximation: E�L 3� 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Backup of sewage into facility? "+ Discharge or ponding of effluent to the surface of the ground or surface waters? . dO * Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available vo < f lume 1/2 day low. Required pumping 4 times or more in the last ear? number of times pumped y Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? within 50 feet of a surface water? within . 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? within 50 feet of abordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a' private water supply well? less than 100 feet but re g ater 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 grganic compounds, ammonia nitrogen and nitrate nitrogen. L_ TOWN OF 1JA2 A:�S-MSX_S BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D_- CERTIFICATION___ '=------_._—._.—.____�..---------------.— __ _TYPE OR PRINT CLEARLY- ��—._.._—...�------•------__.. PROPERTY INSPECTED STREET ADDRESS 1 Sn 'S 4CLl� LAYU� ASSESSORS MAP, BLOCK AND PARCEL # MGp �L�, OWNER' s NAME Almon F. Townsend 3rd PART D - CERTIFICATION NAME OF INSPECTOR ' �E' 2 'GULL.(UP'&) FG COMPANY NAME ��SULT 1rl�T Z� pSC-Qt-} 'F M/�C1C�'AA SO �'}C COMPANY ADDRESS Box 66 Centervil7efMass _ 02632 Street Town or City State ZIP COMPANY TELEPHONE ( 775 ) 3338 - FAX (790 ) 1578 - CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and complete as. of the time ,of inspection. The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and. experience in the proper function and maintenance of on- site sewage disposal systems. Check one: X System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* ..et "'�> The inspection which I have conducted h �0o'kiQ" hat the system fails to protect the public `health and the env ' Ir_cordance with Title R; 5 , 310 CMR 15 . 303 , :and as speci f icall#, I t DdrIbn RT C - FAILURE CRITERIA of this inspection form. rjSllf.!.,{APi �1 c No. 29733 zt� Inspector Signature `�y' T � One copy of this certification must be provided to the OWNER, the BUYER (where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doc 13� SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART D CERTIFICATION Inspector : Peter Sullivan PE Location : 150 Shell Lane Cotuit Date :June 6,1995 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. Please note the summary of recommendations as presented in this form. Lastly please note 310CMR:15.302 Criteria for Inspection(1) "The inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be placed upon it:by the new owner. " tr ly yo Peter Sullivan PE SULLIVAN "y Distribution: f1O. 29733 Original to system owner BuyerVs�cna� Board of Heath