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HomeMy WebLinkAbout0037 MARK LANE - Health 37 Mark Lane Hyannis F/R A = 289 147 h v , TOWN OF BARNSTABLE cc_ 46� SEWAGE # ,AM.1"' 6�9 VILLAGE ASSESSOR'S MAP & LOT S - 1417 II INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) - d� ize) NO. OF BEDROOMS— BUILDER OR OWNER_' �!� J PERMIT DATE: T4_ _COMPLIANCE DATE: 7/�S/0 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 ___ s +� I . m J �',� c No. �^Cl�� , Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC.HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for &0 .9 Y *pgtem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 �h �.. L./�wJ Owner's Name,Address and Tel.No. 9 To Assessor's Map/Parcel Installer's Name Address,and Tel.No. t Designer' e,Address and Tel.No. czm��,� ta.,�•e. Type of Building: Dwelling No.of Bedrooms Lot Size 01 'A6� sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank IU*� Type of S.A.S. S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued bkthis Board o Healthy Signed Cry ` Date ? 10 ©"Z Application Approved by C. �- Date (YZ Application Disapproved for the following reasons Permit No. Date Issued -1 lbbEa _ .. "' a W Fee 50. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,MASSACHUSETTS Yes Zipprication for Migogar 6potem Construction Permit k Application for a Permit to Construct( )Repair( ;<Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 r) KP<f_V. V„NrJ_, Owner's Name,Address and Tel.No. i To Xt- j. Assessor's Map/Parcel S ,f ant•'L ff q ,(� t �7 . Installer's Name Address,and Tel.No. + Designer's, ame,Address and Tel.No. Type of Building: A� Dwelling No.of Bedrooms Lot Size 10 %AG.3 sq.ft. Garbage Grinder( t-3 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title j Size of Septic Tank Type of S.A.S. Description of Soil 6t&s q r�N1�S FM sy {�> ✓� ' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board o Health Signed Cry �- �•�-'o Date Application Approved by �- C eS Date v Application Disapproved for the following reasons Permit No. Date Issued 7 /I-c-) h-2 - ----------------------------- ------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIF ,that the On-site Sewage Disposal System Constructed( )Repaired ( ✓)Upgraded( ) Abandoned( )by 14 CeV Ct, ` " C_ at has been constructed 'n accordance with the provisions of Title 5 and the for Disposal System Construction Permitt No.'"'�Cl� ���dated "7 0 w2 Installer ��+ �l 3' ��w `� Designer 4�d,— (� The issuance I this permit shall not be construed as a guarantee that the syste will fu ction as d ig�ed. Date C" 7- Inspector . II No. �� ' — ----------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1=iopogaf *pgtem Con5tructiou Permit Permission is hereby granted to Construct( )Repair(VIl Upgrade( )Abandon( ) System located at 3 7 G -�... -,� r 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 permit.1 Date: -7 I III Approved by TOWN OF BARNSTABLE LOCATION SEWAGE #A0 VILLAGE ®i ASSESSOR'S MAP & LOT--2 — /V INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) elep ize) A:2 �D NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: Z!�IDZ4 COMPLIANCE DATE: 7I/S/U,2- 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 k� tUnt / t �j0 Y 6/21/02 ' DATE : ----------- 00 aGQTv ADORESS ' _37 -INlark-Lan.e_.___------- Hyannis ,Mass . 02601 -- --- ------- ------------ 1 �54� On the above date, I Inspected the septic system at the above a dress. This system consists of the following: 1 . 1-1000 gallon septic tank . . 2 . 1-Distribution box . 3 . 1-1000 gallon precast leaching pit . Packed in stone . Based on my Inspection, I certify the following conditions: tidy°� 4 . This is a title five septic system. ( 78 Code ) Ty9,f, 00. 5. The septic system is in hydraulic failure : ' ��`osX 6 . A new leaching area needs to be installed . 7 . Waste water is 2" below the invert pipe of the leaching pit . FAILED INSPECTION SIG NATURE :•,' Name Company : Joseph-P _-Macomber_& Son , Inc , address :--Box- 6b -- --------------- _—Center_vi11e _ Ma ,- 02632-0066 Phone : 508- 775- 3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC, Tan ks•Cesspools•Leachflelds Pumped & Installed Town Sewer Connectlons P.O Box 66 Centerville, MA 02632.0066 775.3336 775.6412 • COMMONWEALTH OF-MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 37 Mark Lane Hyannis ,Mass . Owner's Name: M Nee Owner's Address: Box Hyannis ,Mass . 02601 Date of Inspection: 6 21 0 2 Name of Inspector: (please print)Jose ph P .Macomber Jr . Company Name: J. P.Macomber & on nc . Mailing Address: Box 66 Centerville ,Mass . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes N eds Further Evaluation by the Local Approving Authority ✓ ails Inspector's Signature: Date: V`� The system inspector shall ubmit 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 I .***This report only describes conditions at the time of inspection and p yunder the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different ' conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 Mark Lane Hyannis ,Mass . Owner: M. Nee Date of Inspection: 6/21 /0 2 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: .t�d 5 I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 MR 15.3 4 ex0`-ist.. Any failure criteria not evaluated are indicated below. Comments: The present septic system is in hydraulic failure . Anew leaching area nee s to be installaed . B. System Conditionally Passes: IZ9_ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: - . Observation of sewage backup or break out or'high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: CVO The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propem Address: 37 Mark Lane Hyannis ,Mass . Owoer:Maurine Nee Date of Inspectioo: 6 21 02 C. Further Evaluation is Required by the Board of Health: ,10 Conditions exist which requ've further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. S,s•stem Hill pass unless Board of Health determines in accordance with 310 CMR 15.3030)(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 &P Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. S,Nstem Hill 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: ti� The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. ,o,O The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple. The system has a septic tank and SAS and the SAS is within-50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 5p feet or more from a private \pater supple well". Method used to determine distance Id 'This system passes if the well water analysis, performed at a DEP cenified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facilir) and the presence of ammonia nirrogen 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 anached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 Mark Lane yannis ,Mass . Owner: 6/21/02 Date of Inspection: M.Nee D. System Failure Criteria applicable to all systems: You must tndicalc "yes" or-no" to each of the following for all inspections: Yes is Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool /Discharge or pondung of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS of cesspool Swtic liquid level in the dismbuuon box about outlet invert due to an overloaded or clogged SAS or — cesspool j—/�,fX quid depth in ea.t:fpee.l is less than 6" below invcn or available volume is less than 'A day now equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped 9-1V—X 4e Any ponion of the SAS, cesspool or privy is below high ground water elevation. Any ponion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ t�y ponion of a cesspool or privy is within a Zone I of a public well, y ponion of a cesspool or privy is within 50 feet of a private water supply well. ponion 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. ITbis system passes If the well water analysis. periormed at a DEP cenifted 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 (he analysis trust be attached to this form.) eJ (Ycs'No)'The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15 303. therefore the system fails. The system owner should contact the Boa-: _ 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 now or 10,000 gpd to 15,000 gpd You must indicate either"yes" or"no" to each of the following: (7he following criteria apply to large systems in addition to the criteria.above) cs no / - -:/the system is within 400 feet of a surface drinking water supply e system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nirro en sensitive area (Interim Wellhead PToteetion Area — IWPA)or a mapped — — Y g Zone II of a public water supply well !f you rave answered "yes" to any question in Section E the system is considered a significant threat, or answered \es" in Section D above the large system has failed. The owner or operator of any large system considered a s:e^,ficant ttveat under Section E or failed tinder Section D shall upgrade the system in accordance with 310 CMR ;04 The system pwncr should contact the appropriate regional ofrice of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 37 Mark Lane Hyannis ,Mass . Owner:M. Nee Date of Inspection: 6 21/2 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No J 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 pan 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,-rKluding 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 ? Yhe_ Was the faciliry owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no / �/Existing information. For example, a plan at the Board of Health. — Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 37 Mark Lane Hy nnis .Mass . Owner:Maurine Nee Date of Inspection: 6 21 02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms (actual): DESIGN now based on 310 CMR 15.203 (for example: 110 gpd x q of b�eooms):;Wjb Number of current residents: 2 Does residence have a garbage grinder(yes or no): .!f'd Is laundry on a separate sewage system (yes or no):/ G (if yes separate inspection requved) Laundry system inspected (yes or no): PS Seasonal use: (yes or no): .UB A Water meter readings, if available (last 2 years usage (gpd)): � tdld Sump pump(yes no Last date of occupancy: ,�`y-Y COMMERCLAUINDUSTRIAL Type of establishment: Design now(based on 310 CMR 15.203): AO gpd Basis of design now(seats/persons/sgft,etc.): Grease trap present(yes or no):.40 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): iU/9 GENERAL INFORMATION Pumping Records Source of information: , Was system pumped as pan of the inspection (yes or no): D If yes, volume pumped: 0 gallons -- How was quantity pumped determined? 16!4 Reason for pumping: ,V,q TY�'E OF SYSTEM T Septic tank, distribution box, soil absorption system �Q Single cesspool ,VA Overflow cesspool Privy 5Shared 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) /llO Tight tank .U#Attach a copy of the DEP approval IVd Other(describe): Ap oximate aee of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 r — JUN-24-2002 16:04 BARNSTABLE WATER COMPANY 03 73a 1313 P.a1/Dk tay-Transmitta( To: Skip Fax: S08.790I578 From: Barnstable Water Co. ®ate: . 06/24/02 Re: Title V Inspection— Water Usage for Paged: 1 37 Mark Lane, Hyannis(Maureen.Nee) i Per your request,,the following page is a printout of the water usage for this location covering the period 08/13/01 to 04/05/02. JUN-24-2002 15:04 BARNSTABL'E WATER COMPANY 509 790 1313 P.02i02 From Date • . . NEE MAUREEN Status Serial Number. Service Address . 10.4107_ 37 MARK LANE DoMeter Position • 1 Account ID • Work Order . . . 0 Read Mtr Meter UM R R E S Account P Date 2.21 Reading nsumDtn I $ ID _ 04/05/02 1 287 ,� 5�- 700 FC 1 N 1 0a152886 _ 01/07/02 1 280 800 FC 1 N 1 00152886272 � _ 08I13/01 1 263 Ea7 y `1f2,000 FC 1 1 N 1 00152886�r r � ,O,p,t,:, , 1,=,R,e,a,d,s. , ,b,=,T,e,xt, , F,4,=,D,t,l,s. F,8,=,D,a,t,e, ,S,e,q. . .F,1,2,=,D,i,s,p,l,a,y, ,T,0,9,g,l,e. , ,F,2,4,=,M,o,r,e, . TOTAL P.02 Page 7 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addre0l. Nee 37 Mark ane Owner: Hyannis , Mass . Date of Inspection: 6 21 02 BUILDING SEWER (locate on site plan) Depth below grade: " Materials of construction: _cast iron /40 PVC 40other(explain): .4/4 Distance from private water supply well or suction line: 10S- Comments(on condition of joints, venting, evidence of leakage, etc.)): Joints appear tight .Mo evidence of leakage .The system is vented through the house vents . SEPTIC TANK: ✓ (locate on site plan) /,�w�, 'Avs Depth below grade: y y Material of construction: Yconcrete 40 metalZ/V fiberglass polyethylene d ro other(explain). /f�* If tank is metal list age:d),4 Is age confirmed by a Certificate of Compliance (yes or no)WA (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of Vge 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: �f1 How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels .as related to outlet invert, evidence of leakage,etc:): Once system is repaired .. Pump the septic tank every 2-3 years . -Inlet & outlet tees are in piace .The tank is s ruc ura y sound and shows no evidence of leakage . GREASE TRAPfk4locate on site plan) Depth below grade: lax Material of construction✓Aconcrete,&metaLf/4 fiberglass. 9i polyethylenec4Aother (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: 41 /J Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: 41 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present . 7 Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:.M. Nee 31 Mark Lane Owner: Hyannis ,Mass . Date of Inspection: 6/21 /0 2 TIGHT or HOLDING TANK(tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: ItO Material of construction: concrete metal ol,4 fiberglass a/ Polyethylene�other(explain): Dimensions .vA Capacity: VA gallons Desien Flow: 41.4 gallons/day Alarm present (yes or no): —4�f Alarm level: 41A Alarm in working order(yes or no): &14 Date of last pumping: .t1A Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present-. DISTRIBUTION BOX: Y (if present must be opened)(locate on site plan) Depth of liquid level above outlet inven: VO 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.): Distribution box has one lateral .There is evidence of solids carry over . No evidence-of lea age into or out of the box . PUMP CHAMBER (locate on site plan) Pumps in working order(yes or no): --tllf Alarms in working order(yes or no): _.I& Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Piimn chamber is not present 8 f - Page 9 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 Mark Lane yannis , ass . Owner: Maurine Nee Date of Inspection: 6 21 02 SOIL ABSORPTION SYSTEM (SAS): Zlocate on site plan,excavation not required) 1-1000 gallon precast leaching pit . 6 ' X10 ' If SAS not located explain why: Located ; See page T ype eaching pits, number: d� leaching chambers, number: , D leaching galleries, number: leaching trenches,number, length: _Q leaching fields, number, dimensions: (1 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.): _ . Loamy sand to medium fine sandLeaching pit is in hydraulic failure . A new leac ing area nee s o e installed . Scitis are damp . Vegetation is normal . Syst—e—m--TFie system presentiy needs to be pumped . CESSPOOLS (cesspool must be pumped as pan of inspection)(locate on site plan) Number and configuration: Q Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: �J Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools are not present . PRIVY44je,(locate on site plan) Materials of construction: 4 Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present . 9 Pat( Io of I I OFFICIAL TNSPECTLON FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORIvATION (cononvcd) Pfoperr7 Addcc1,: 37 Mark Lane IlLanni—s ass . ONocf: Maurine--Nee Inlpc<tioo: 6 21 02 SKETCH OF SEWACE DISPOSAL SYSTEM P10ridc I Ixctch of tnc Icwllc dilpo111 Iyltcm lnclvding dca to at Icast cwo permancni rcfcrcncc IanomarxS o, o<ncfvnuxl Locltc III wc111 w;tn;n 100 fcct. Loc►tc whm public watcr avpply cntcrl Uc bviloing 3'7 Mark L n , 4L,2nnIS ws�l(w�a to i Page I I of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 Mark Lane Hyannis ,Mass . Owner:Maurine Nee Date of Inspection: 6/21/0 2 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: AObtained from system design Dlans on record - If checked, date of design plan reviewed: t)'I— ?PJC0_bserv_ed site abuttin ro e /observation hole within 150 feet of SAS) ecked with local Board of Health-explain: ,/J/l Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: h t t p : 11 t own. b a r n s t a b 1 e .ma . u s . You must describe how you established the high round water levation: Used ; Gahrety & Miller Model . 12/1�A4 Ground-- water elevations above sea ieve.L . Used ; USGS ; Observation well data . June 1992 Used ; USGS ; Technical bulletin — — ateJanuary 1992 rou nd Annual ranges of ground water elevations . Leaching Pit �r`a:eet i Groundwater: F et Below Bottom of Pit I1 h,Groundwater Adjustment �.��.. J 1.8 ft per Fnmpter Method Therefore, the vertical separation distance between the boao Of the leaching pit and the adjusted groundwater table is fe&t. 11 + rr.*r+^-nrr+—rrrnram•n*-rrQ�er•:.re*r.rs-.n:-.r-.•.tmr•+.r-e+nm rr-ra .. •�, 1 TOWN OF Barnstable WARD OF HEALTH l T,.T SUBSURFACE SFHAGF DI I'OSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION -TYPO OR PRINT CIXAALY- PROPERTY INSPECTED STREET ADDRESS 37 Mark Lane Hyannis , Mass . ' ASSESSORS MAP , DLOCK AND PARCEL # OWNER' s NAME Maurine Ned PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J.P.Macomber & Son Inc::` ' COMPANY ADDRESS Box 66 Centerville Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 tT , CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa`1 system at this address and that the inrorination reported is true , accurate , and omplete 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 ; 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 16 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection wilicll I have conaacted has found that the system fails to Protect the j)ublic !realty and the environment in accordance with Title 5 , 310 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . -e , > Inspector Signature � ._ Date Xncopy of t)Iis c rt.ification must be provided to the OWNER, the BUYER re applicable ) and the BOARD OF HEAL7'if. If the inspection FAILED , the owner or " 'piarator shall upgrade - the eyetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CFJR 16 . 305 . partd .doc LO=CATION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME & ADDRESS B U IL D E R OR OWNER DA T E PERMIT ISSUED DAT E COMPLIANCE ISSUED�� W V'' �"' t .`/ No......... a l k�... 5................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F H L H _. ............OF...... .. ... .._...... ............. Appliratinn fur M-4pooal Workii Totuitrnrtinn Permit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � GN _ �v/t��;f R "----------------------------- --------------------------------------------------------------- f� c ti.'." ddr s ` o(r�Lo No. N,J ................................................ .. .�--`'-( .�sle la.bl� 7� ./11 ---------•------------ owner Add�fess f�--•-----------------------------------•--•---••---•-----------•- ............................... IPP.J../.............................................. Installer Address Type of Building Size Lot./.fOi__P_Ol3.............Sq. feet Dwelling—No. of Bedrooms---------�___.---____________________Expansion Attic ( ) Garbage Grinder (1VP a4 Other—Type of Building ._------------------------- No. of persons_-_____.--__-_____---__--- Showers ( ) — Cafeteria ( ) G4Other fixtures ----- --------- ------------- ----------------•-----•------------------------•--------•-----------------------•----------•-_---------- W Design Flow... (.................................gallons per pet-son per day. Total daily flow.....2-00..........................gallons. W Septic Tank—Liquid capacity-1QOPgallons Length---------------- Width---------------- Diameter_-.-___-..-_--_ Depth.__._-__-_--. x Disposal Trench—No. .................... Widtli.... _ al Length-----____-___-__--- Total leaching area....................sq. ft. Seepage Pit No-------/----------- Diameter. th below},'',nlet.......... ....... Total leaching area--.-.--.-._-___--sq. ft. z Other Distribution box ( ) Dosing tank ( ) /� /�G ° ' '-' Percolation Test Results Performed by.......................................................................... Date_-__,,,•,.........-................. .---. Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depto=ground water....__-__--_-.--..__.-. CL, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water......-..____--__---..__ .-- << ll,... - ----- -- ------ - Description of Soil-------------�..._ ..: IT. '. ... -----•---•------------------------------------ U ----------------------------------�-�- 1 u' -t�� `~% - ..�,__... ---•--------------_ ----------------------------------------- W U Nature 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 \I of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n iss ed.by the b r of alth. igne --------------- = �77---. ' t Dat� Application Approved. BY ------------------------------ Date Application Disapproved for the following reasons:----••------------•------------•-------------------- ................. •--•--------------- .............••----•---...--------------------------------------•------------------•--------•----------=------------------------------------------•----------------------•----------------------------- Date PermitNo......................................................... Issued...................... ................................. Date No .! .... THE COMMONWEALTH OF MASSACHUSETTS I � V BOARD F H H f I ' 1 -_....OF...... .'............................... � rlir�atiatt -far Disposal parka Tonstrurtian Vrrmit Application is hereby'made for a 'Permit to Construct ( :) or Repair ( ) an Individual Sewage Disposal Sy at '.: :.. I� c ion/ dr s o o I`o ------------------.............. Owner Address -'r.....-•-•----•-••--•-•----•-•--•............................... ..•---...................... "l .!'c!:! :_!c'f.............................................. Installer Address U Type of Building Size Lot.1-%�... feet Dwelling' No. of Bedrooms-_.-_----21-----------------------------Expansion Attic ( ) Garbage Grinder (NP a Other—Ty _ Type of Building ............................ No. of persons...____. _.........._....._ Showers ( ) — Cafeteria ( ) 04 Other, fixtures --------------------------------------------- W Design Fiow_-_.7r"� ....................gallons per person per day. Total daily flow..... __.._:___________........gallons. P4 Septic T..nk ' Liquid capacity 1QQ_ngailons Length---------------- Width.......... ..... Diameter_-.-__-..-_.-• Depth................ xDisposal Trench—No Width............. al Length--_-______-______- Total leaching area....................sq. ft. Seepage Pit No -f.. .. Diameter/�� th 6elownlet____ ___ ....... Total`'leaching area._.....___.__..sq. it. Other,,Distribuhon box - Dosing.tank Z ( )'- g ( ) a Percolation Test"'Results Performed by------- ---- ------ -----•----------------------------------------------- Date Test Pt No. 1...............minutes per inch Depth of Test Pit-------------------- Depth to ground water .----.-----.--_--_ . f=, Tesi,Pit No. 2................minutes per. inch De th of Test Pit.................... Depth to ground water--.-_---_-_-_--_.___.. �� .j� r .. Description of Soil �� r D"a! ---• - - V f ° "- W �'" - V Nature of Repairs or.Alterations Answer 'when'applicable..---------------------------------------------------------------- ............_-..__._._.__.-- ------•--•-------=-----• -------------------------•------- -------------- Agreement`­' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with Lathe provisions of Article XI of the State_Sanitary Co — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n s'"s d by the Wof alth. ignec .. •--••----•------------- ----``--- �--------•-----•-- ....r ♦3Data;,� Application Approved By- ' Date Application Disapproved for the following reaions:_-•----------------------------=----------•-....._...•----•--................._•-•-----.....-----....------•. --•---....--•----•-----•--"-'........................••--•--••.........-•----......--•---......-------•--------•--•------•--•----••-•------------••-•........----•-----------•-------------------------•. Date PermitNo........................................................... Issued------------------------------- ='=--------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O F. !� !!! (Trrtifirate of tftt rlianre THIS I CE IF That the Individual Sewage„Disposal System constructed ( ) or Repaired ( ) ..— Install - at -• ---- --------•----•--•--------••.................••-•-•----•--•......••-- has been installed in accordance with the provisions of Ar ' e ��I The tate Sanitary C e a�,_des in the 7.77 application for Disposal Works Construction.Permit No._ 7r.. " ... _ dated--.-_- ...... _ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. t yy �-7 .1 DATE............. ... ............... /.... , Insp ctor �� ----- THE COMMONWEALTH OF MASSACH VTTS - BOARD OF HEALTH f lr �F......:.... ���'�-+��. ................................... / No........... t ._ FEE �-$ ......... ark strurti it ermit ssion ireby granted...... . I`..Permi � ; _.:..........::- --------------------------------.---------------_---•---_.--------------,.: to Constr ) Rep 'r ) an d'vid Sew age Asa] Sy em at No.- '` Street- as shown on the application for Disposal.�IVork'§*Construct; Pe t s1�To... . Dated._..�_�s .. DATE_ -. . Aarof Heal .......................... u FORM 1255 HOSES Sec WARREN. INC.. PUBLISHERS-`, - - C