HomeMy WebLinkAbout0005 MARYALICE LANE - Health 5 Maryalice Lane
Hyannis P
A 29) 074
r
0
n
A
TOWN OF BARNSTABLE
LQCATION S -`/�.�' A 4 �' �'� SEWAGE #
VILLAGE � � s ASSESSOR'S MA$ & LOT
INSTALLER'S NAME&PHONE NO. ?
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) ��'
ell (size) �-
NO.OF BEDROOMS
BUILDER OR OWNER
LL PERMITDATE: r"/ COMPLIANCE DATE:
Separation Distance.Between the:
Maximum'Adjusted Groundwater Table to the "ttom of Leaching Facility Feet
Private Water Supply Well and Leaching acility (If any wells exist
on site or within 200;feet of lF�a
hi facility) Feet
Edge of Wetland and Leaching ' ':ty(If any wetlands exist
within 300 feet of leaching ,facility) Feet
Furnished by
��
��
by C
�� � --
�� --
,� � �,-.
_ ._.
� ,
��
g - �
i
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
,E
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpprication for Digozat *pztem Con!5truction Permit
Application for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) 0 Complete System 0 Individual Components
Location Address or Lot No.5 Mary Alice Lane Owner's Name,Address and Tel.No. 7 7 8—0 6 0 7
Assessor'sMap/Parcel Hyannis, MA Ellen Chahey
291 -74 5 Mary Alice Ln, Hyannis, MA .
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4
Wm E Robinson Sr Septic Eco—Tech
PO Box 1089 Centerville, MA 43 Triangle Cr, Sandwich, MA
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
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 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Install new Title 5 septic system
to plans of Eco—Tech #ETE 1566
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 Tide,5 of—the—Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu of Health.
Signed Date o7 9"0
Application Approved by Date
Application Disapproved or the following reaso
Permit No. Date Issued
No. Fe�S O.O O
x- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
: +�=a Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
k Application for Migotar 6potem Construction Permit
Application for a Permit to Construct( )Repair( X)Upgrade( ,)Aband n( ) El Complete System . C?Individual Components
Location Address or Lot No. Owner's-Name,Address and Tel.No. 7 7 8—0 6 0 7
5 Mary Alice Lane
Assessor'sMap/Parcel '`Hyannis, MA Ellen Chahey
'291 -74 5 Mary Alice Ln, Hyannis, MA
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0$9'4 1
Wm E Robinson Sr Septic Eco—Tech
PO Box 1089 Centerville, MA 43 Triangle Cr, Sandwich, MA .
'ITypeo,f�Building:
D—elling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
ether Fixtures
� s'
Design Flow ;= gallons,per day. Calctilated'daily flow gallons.
Plan Date Number of sheets Revision Date
Ty.itle
Size of Septic Tank Type of S.A.S.
Description of Soil
,r
Nature of Repairs or Alterations(Answer when applicable) Install new Title 5 septic system
.to plans of Eco—Tech #ETE 1566
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 Titlen�,
of the-Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue Roard of Health.
Signed j
'"--��� /i n13 tl. Date
Application Approved by _ Date
Application Disapproved for the following reasons
Permit No. A Date Issued „
---------------------- -----------------
THE COMMONWEALTH OF MASSACHUSETTS
Chahey BARNSTABLE, MASSACHUSETTS
/ (Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal Systerrt Constructed( )Repaired( X )Upgraded( )
Abandoned( )by Wm E Robinson Septic service l
at 5 Mary Alice Lane, Hyannis, MA has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer
The issuance of this.pDem,ut shal not be construed as a guarantee that the yste nc ion as designed.
Date Inspector
Inspector
N Fee
0.
Chahey " THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
lioczat 6potern CCon!6truction Permit
Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( )
System located at 5 Mary Alice Laney -Hyannis. MA
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:Construc on must be/completed within three years of the date of this p,r
/ ,.
!� n /
Date: ; v) �'�I t Approved b
+tHE Town of Barnstable
O� 1p� -
o Regulatory Services
Thomas F. Geiler,Director
* BARNSTABLE.
9 A a3 MASS. 1m� Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 �. Fax: 508-790-6304
Installer & Designer-Certification Form
Date: "Pt4� 24, 24"J
Designer: Co U81101t®w r k Installer: `
Address: 4� TrJ'C4t G Address
On ^�4 � I �b�rttl was issued a permit to install a
(date) (installer)
septic system at 1lyht.CY41(l� L� q'Yg4:0't, r based on a design drawn by
(address)
`J)Ct�od Codq, r,g pr✓r dated
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. -s
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
/
I CJ - ✓ o DAVID y
D c
(Installer's Signature) p COUGhbr,t,',,.r m
F �o
,�• s C/STEeAAJ
(Designer's Signature) (Affix Designer's Stamp Here)
r
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
I
TOWN OF BARNSTABLE
LOCATION
SJ ,- /r�C2 �� SEWAGE #6Y'
I VII.LAGE s ASSESSOR'S MA$ & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY. ��✓ ,�
LEACHING FACILITY: (size)
NO.OF BEDROOMS
BUILDER OR OWNER ��'� �✓
COMPLIANCE DATE �3 <
®
PERMIT DATE. ✓
Separation Distance Between the: Feet
Maximum Adjusted Groundwater Tato the ttom of Leaching Facility
Private Water Supply Well and Leachid acility (If any wells exist Feet
on site or within 200;feet of leachi facilitywetlands exist
Edge of Wetland and Leaching Fa ' . (If any Feet
within 300 feet of leaching cility)
lFurnished by
i
�� i
COMMONWEALTH OF MASSACHUSETTS 1 „
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
a DEPARTMENT OF ENVIRONNItNTAL PROTECTION
350 MAIN SHEET RECEIVE®
WEST YARMOUTH,MA
508-775-2800 I A N 1 1 ZOO 1
TITLE 5 TOWN
HEALTH DEPT. BLE
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 5 MARY ALICE LANE
IIYANNIS,MA 02601
Owner's Name: MINOTT SAFFORD
Owner's Address: 5 MARY ALICE LANE
HYANNIS,MA 02601 ��
Date of Inspection JANUARY 4,2001 �(•
Name of hispector:(please print) JAMES D.SEARS 'Cx
Company Name: A&B Canco S�®
Mailing Address: 350 Main Street
West Yarmouth,MA 02673
Telephone Number: 508-775-2800
CERTIFICATION STATEMENT K
I certify that I have personally inspected the sewage disposal system at this address and that the information
reported below is true,accurate and complete as of the time of the inspection. The inspection was
performed based on my training and experience in the proper function and maintenance of on site sewage
disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310
CMR 15.000). The system:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: , _ Date: 1-5-01
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 die system owner and copies sent tot
lie buyer,if applicable,and the approving authority.
Notes and Comments
AT THE TIME OF THE INSPECTION THE SYSTEM IS WORKING. SYSTEM IS TWO (2)
CESSPOOLS. THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM.
****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.
Title 5 Inspection Form 6/15/2000 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAFFORD,MINOT"T
Date of Inspection: JANUARY 4,2001
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes: X
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes: N/A
One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.
The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"
please explain.
_ 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 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:
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:
Title 5 Inspection Form 6/15/2000 2
Page 3 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A .
CERTIFICATION(CONTINUED)
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAFFORD,MINOTT
Date of Inspection: JANUARY 4,2001
C. Further Evaluation is Required by the Board of Health: N/A
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is
failing to protect public health,safety,or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CAM 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 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 public water supply.
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 50 feet or more from a
private water supply well". Method used to determine distance
"" This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility
and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided
that no other failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
I
Title 5 Inspection Form 6/15/2000 3
Page 4 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAFFORD,MINOTT
Date of Inspection: JANUARY 4,2001
D. System Failure Criteria applicable to all systems: N/A
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded
or clogged SAS or cesspool
N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
X Any portion of the SAS,cesspool or privy is below high ground water elevation
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a
surface water supply
X Any portion of a cesspool or privy is within a Zone 1 of a public well
X Any portion of a cesspool or privy is within 50 feet of a private water supply well
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. (This system passes if the well water
analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic
compounds indicates that the well is free from pollution from that facility and the presence of
ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.)
NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CUR 15.303,therefore the system fails. The system owner should contact
the Board of Health to detern ine what will be necessary to correct the failure.
E. Large Systems: N/A
To be considered a large system the system must service a facility with a design flow of 10,000 gpd to
15,000 gpd.
You must indicate either"yes"or"no to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a
mapped Zone 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 is 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.
Title 5 Inspection Form 6/15/2000 4
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAFFORD,MINOTT
Date of Inspection: JANUARY 4,2001
Check if the following have been done. You must indicate"yes"or"no"as to each of the following
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X Was the facility or dwelling inspected for signs of sewage back up?
X Was the site inspected for signs of break out?
X Were all system components,excluding the SAS,located on site?
X Were the manholes uncovered,opened;and the interior inspected for the condition of tees,material
of construction,dimensions,depth of liquid,depth of sludge and depth of scum.
X Was the facility owner(and occupants if different from owner)provided with information on the
proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)has been determined based on:
Yes No
X Existing information. For example,a plan at the Board of Health.
X 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(3xb)]
Title 5 Inspection Form 6/15/2000 5
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAFFORD,MINOT
Date of Inspection: JANUARY 4,2001
FLOW CONDITIONS
RESIDENTIAL
Number of Bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms: 330
Number of current residents: 1
Does residence have a garbage grinder(yes or no): YES
Is laundry on a separate sewage system(Yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): YES
Seasonal use(yes or no): NO
Water meter readings,if available(last 2 years usage(gpd)): 1999 708 CU.FT./2000 739 CU.FT.
Sump pump(yes or no) NO
Last date of occupancy: N/A
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203):
Basis of design flow(seats/persons/sg8,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: JULY 1996,SEPTEMBER 1998
Was system pumped as part of the inspection(yes or no):
If yes,volume pumped: gallons—How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
X Cesspool
X 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 copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
UNKNOWN
Were sewage odors detected when arriving at the site(yes or no): NO
Title 5 Inspection Form 6/15/2000 6
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAFFORD,MINOTT
Date of Inspection: JANUARY 4,2001
BUILDING SEWER(locate on site plan): N/A
Depth below grade:
Materials of construction: Cast iron _ 40 PVC _ other(explain)
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK(locate onsite plan): N/A
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene
_ other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance from top of sludge to the 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:
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.):
GREASE TRAP(located on site plan) N/A
Depth below grade:
Material of construction: _ concrete metal fiberglass _ polyethylene other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
Title 5 Inspection Form 6/15/2000 7
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAFFORD, MINOTT
Date of Inspection: JANUARY 4 2001
TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain)
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no)
Alarm level: Alarm in working order(yes or no):
Date of last pumping
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
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.,):
PUMP CHAMBER: N/A (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Title 5 Inspection Form 6/15/2000 8
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE_ DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAFFORD,MINOTT
Date of Inspection: JANUARY 4,2001
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number
leaching trenches,number,length
leaching fields,number,dimensions:
X 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.)
ONE 6'6"BLOCK CESSPOOL.COVER 10"BELOW GRADE.T WATER IN POOL,NO HIGHER STAIN LINE.
CESSPOOLS: X (cesspool must be pumped as part of inspectionXlocate on site plan)
Number and configuration: 1
Depth—top of liquid to inlet invert: 6"
Depth of solids layer: 4"
Depth of scum layer: F,
Dimensions of cesspool: 6'8"DEEP
Materials of construction: BLOCK
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.):
ONE 6'8"BLOCK CESSPOOL.COVER 12"BELOW GRADE.POOL AT WORKING LEVEL.ONE INLET NO
TEE.ONE OUTLET WITH TEE.
PRIVY: N/A (locate on site plan)
Materials of Construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
Title 5 Inspection Form 6/15/2000 9
r . .
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAF FORD,MINOTT
Date of Inspection: JANUARY 4,2001
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
a3
0
Title 5 Inspection Form 6/15/2000 10
r
r
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 5 MARY ALICE LANE
HYANNIS,MA 02601
Owner: SAFFORD,MINOT"T
Date of Inspection: JANUARY 4,2001
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to groundwater 25.7 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observation site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation
X Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USGS WELL DATA—WELL AIW 230
Title 5 Inspection Form 6/15/2000 11
G
b
TOWN OF BARNSTABLE
LOCATION J /��it°1°' ,��/C £ SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
wS�£
NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY
` LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
O � ___..
a
g
w
y-a
,+�
R.
r i �
9
'.
1.
ASS SOR-S MAP No. )-Cl/ 7�(PARCEL
LOCATION SEWAGE PERMIT NO.
5
VILLAGE
I N S T A LLER'S NAME i ADDRESS
R U I L D E R OR 0 NER
DATE ,PERMIT ISSUED
DATE COMPLIANCE ISSUED
l�
pc
�''� rS)
P�
� e
� � �
�� �
ZL+ �Q � �
�� ® s �,
J� � �� N
a
o
r g,
� G �
�� �
� c o k� �
Ln Y
�� �� A
.+
�.i�
4
� i .� �
1 . FLOW PROFILE
4 TOP OF FOUPDATI4N RAISE COVERS TO WITHIN
6 in OF FINAL GRADE
EL - 46.65
D-BOX
3- DROP 2" LAYER OF 1/8-
FLOW LINE TO V2_ STONE
10' = 14'
48- GASH 3/4" T I I/ ST N 42.00
BAFFLE =BOTTOM OF
a ' 43.00 42.50 STONE SO ABSORPTION
13
BASE 42.oe LEACHING
6 in STONE BASE 42Is TRENCH ,� a.00 rr+
I500 GALLON 42.00 j
SEPTIC TANK 2� 39.87 v
27.9 ESTIMATED
HIM
!0 it 6 ft 10.3 ft EACH 01srRIBUTION LINE GROUNDWATER
r...
it -
c
Cfll--I �
I , N f<-V z r
>> _
\ �
zo Z 1} 80 �,�� ND r
m Z
z d y o mp
lJ�z \� I Q > vi�
<000 m "
i p ` ) O D'p
m ,,717Ln
fll
v^'Z,.- m
N A tO p` Z
W n
' 4 � M
rn
COA �o a
UZI
r r
a0m� y Z m 0 O O Din
4. z=
rri
rn
r n' N 6
b /
m >
60 Z r
rol�"c (n / r u, _�_> Z
m y mmmm
m
a � n m
x x 3m
m9�� Z =mom ` zx
x r-Z
N x ���o -
�o mom G) z .
Q Z =��m o O
o>m N mi � ('j'� U' m-� o
��-4 r m —{ —I
�'Ti'_ 0> 'O '� Z x� Ill �, m� `" 00 O m O
m?4m T O mn m I'Tl � < �_ aE'nm Z OG� FTJ
k ��
7gwbn W_ 01)
= r r m m M.
`C/LeN � "J' > tap O rnrn ;Y
_ �° !J 0) fT1 Z N O S T. CA THERINE Z
to v 0 z3 � � y Z.
VE
o . A
vrT Mi•. r^, C -3: �J fie^ ® ® O
-1 c m (0 = 3 ='.� z f Tl �> � y v► . m
% -�� -< 2 m f- 3
a n O ~
A�, 3 m a' rn
r r- Z
" s z ITM O:� Z �. G) r m m ,
m KENT CANE
Ln, 3
-
f ,
L
S.O_IL - TE-ST : LOG14
'
E) E1 N -CALCULATIONS
DATE OF TEST: FEBRUARY 12. 2004 , 1
.SOIL EVALUATOR: DAVID D. COUGHANOWR. RS DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD
WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT '
NO GROUNDWATER ENCOUNTERED SEPTIC ^TANK: 330 GPD X 2 DAYS - 660 GALLONS
TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH ;
ELEVATION - 45.58 +-
PERC AT 5j in 2 MIN/INCH IN C SOILS � INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
R DISTRIBUTION BOX: USE 6 OUTLET D-BOX
DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL A B S O R B T I O N SYSTEM: A 54 ft x 4 ft x 2 fi LEACHING TRENCH CAN LEACH
0-6 A LOAMY SAND 10 YR 2/1 NONE FRIABLE A s o t - ( 5 4 x 4 ) - 2I 6 s f
P Asdw - ( 54 + 54 + 4 + 4 ) x 2 - 232 sf
6-40 B LOAMY SAND 10 YR 5/8 NONE FRIABLE A t o t - 448 s f
40-126 C MEDIUM SAND 10 YR 6/3 NONE LOOSE V t 0.74 x 448 - 3 31,5 G P D
USE A 54 ft x 4 fi x 2 ft TRENCH. Vt - 331.5 GPD > 330 GPD REQUIRED
GROUNDWATER
LE
ADJUSTMENT � ACHING TRENCH DETAIL - 2 fT EFFECTIVE DEPTH
EXISTING GROUNDWATER LEVEL -NOT TO SCALE
54 ft
BASED ON BARNSTABLE GIS
DEPARTMENT RECORDS 27 ft 27 ft
OBSERVED GW: 24.0
INDEX WELL: AIW-230 CAP
ZONE: DJOIN PIPE END
READING: JAN 2004
LEVEL: 23.4 `r
ADJUSTMENT: 3.9 fi
ADJUSTED GW: 27.9
VENT D-BOX
PIPE
NOTES
1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN
2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM.
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS -
SEPTIC CODE (310 CMR 15)
TT C
OF MASSACHUSE S TITLE 5 SE
G UT
ILITIES
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND D UTILITI
BEFORE EXCAVATING FOR SYSTEM,
5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED—AND FILLED. OR REMOVED SEWAGE DISPOSAL SYSTEM PLAN
T IN PLACE ,
WASHED L CE
6) ALL STONE TO BE ED AN DOUBLE S D FREE OF IRON. FINES AND DUST
X T RUN LEVEL FOR 2•-0' BEFORE PITCHING DOWN -T4 SERVE EXISTING DWELLING
7 IN EXITING -BOX O U _LINES E G D
8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES EDWARD I IARONE I . . _ ,.-E-E.l
AND .APPLIANCES. AND BIANNUAL PUMPING OF THE .VEPTIC TANK
9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHIQ-.V AR'LOADING. DO NOT AND ELLEN CHAHEY �'
PARK OR. DRIVE .VEHICLES OVER SEPTIC :SYS;TEM?_ 5 MARYALICE LANE HYANNIS. MAC_'
10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK.
11) 'SEPTIC •TANKS SHALL'..BEINSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL ECO-TECH ENVIRONMENTAL;
STABLE BASE THAT -HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH
SIX -INCHES OF CRUSHED STONE HAS BEEN PLACED TO .MINIMIZE .UNEVEN SETTLING 43 TRIANGLE CIRCLE SANDWICH MA 02563
ETE-1566 FEB 13 2004 ;�: =r'W: 2/2
''A J