HomeMy WebLinkAbout0017 THACH LANE - Health 17 THAVCH LANE, HYANNIS
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Town of Barnstable
Department of Regulatory Services l //
s wwarnnr� 1 Public Health Division
MA8.4.
�A nm7P 200 Main Street,Hyannis MA 02601
rErt t�lKt�
Date Scheduled �
Time U � tee Pd._1424)
Soil ui lii ity Assessment for Sew rge ,Disposal
Perfo I ' II
rtncd•By: Witnessed By:
LOCATION&.GENERAL Wi �
ORMATI N
Location Address . 17 7N_4 /_ __4 Owner's Name
L/LS�" Address 171 dt
Assessor's Map/Parcel:` � — (� Engineer's Name 5 -5 (/0Z I/
NEW CONSTRUCTION REPAIR 4�_a ?'f—31'GL.J
//Telephone# , �L4tl ,LC,U
Land Use. _5C. l Slopes(96)- ' !o Surface Stones s'L'Q I/
Distances from: Open Water Body ft Possible Wet Area�ft Drinking Water Well
Dralhage Way tK/4- ft Property Line It�_ft Other ft
1
SKETCH:(Street name,dimensions of In exact locations of test holes&pero tests,locate wetlands in proximity to holes)
lvb
l
l T 2
t ty: x
Parent material(geologic) 4:1 sr� /4-' qi—XA—Depth to Bedrock
Depth to Oroundwater. Standing Water in Hole: ��'`P Weeping from Pit Fnea ,,, _____����•
Estimated Seasonal High Oroundwater (2'
DETERMINATION FOR SEASONALMIIGI1 WATER TABLE
Method Used: `
Depth Observed standing in obs.hole: �" In, Depth to soil mottles.,
D0th t wreping from side of ob .hole: e , Groundwater AdjuAtnient
Tndex Well tr Reading bate: A41 Index Well level Adj,•faetbr N Adj.drUundwater-Level,, I Z
PERCOLATION TEST �i L41
Observation
Hole# 2 Time at 9"
Depth of Pero f.,491 Time at 6"
Start Pro-soak Time 0 G�1' S� � S� � Time(9"•611)
End Pro-soak
Rate Miu./Inch
Site Suitability Assessment: Site Passed Si to Failed: Additional Testing Needed(Y/N) Nv0
Original: Public Health Division Observ'stion Hole Data To Be Completed on Back---
p V�
***If percolation test is to be conducted within 100' of wetland,you must first notify the. V
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:ISEPTICIPERCFORM.DOC
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DEEP-OBSERVATION HOLE LOG Hole#
Depth from Sol(Horizon Soil Texture Still Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,Boulders.
• , ,,� tsistency.%'t3ravo1l
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A!6 C.t— z e ��... r ti
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
lv
10 j Z��/ 2
Co l�U of cv dQ ,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.,
Conslfit=3�
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soli Color Sell Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Siottes;Boulders,
Flood Insurance Rate Map:
Above 500 year f lood boundary No— Yes
Within 500 year boundary No+ Yes,; :.
Within 100 year flood boundary No.
Depth of Naturally Occurring Pervious Materlal
Does at least four feet of naturally occurring pervious watorial exist in all areas observed thrpughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring per ous material? ..
Certification
I certify that on �i. i99S� (date)I have passed the soil evaluator examination approved by the
Department of nvi nmental Protection and that the above analysis was performed by me consistent with .
the required tralnin exp rtise and experi nce descr bed in 10 CMR 15.017.
Signature
Q:WBPTlMBRCPORM.DOC
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DATE: 6/21 /99
PROPERTY ADDRESS:-- - -------------
1 7 Thatch Lane
Hyannis, Ma.
------------------------
On the above date, I inspected the septic system at the above address.
This system consists of the following:
1 . 1 -1500 gallon septic tank
2. Leaching area 8-:-infiltrators
3. 1 -Distribution box GG
Based on my Inspection, I certify the following conditions:
4 . This is a title five septic system. 95 Code )
5 . The septic system is in proper working order
at the present time .
6 . Stone surrounding infiltrators are dry .
SIGNATURE:1 _ G �
Name: -------
Company: Joseph_P. Macomber_& Son , Inc .
Address: Box 66
Centerville , Ma . 02632-0066
--------------------
Phone: 508-775-3338
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
8
`� l0
JOSEPH P. MACOMBER & SON, INC.
Tanks-Cesspools-LeachtieldsEIVEO
Pumped & Installed r
Town Sewer Connections J U L 3 1999
1"0
N
P.O. Box 66 Centerville, MA 02632-0066. TOWNoF�►NST
775.3338 775-6412. ` HFALTHDEPT
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COMMONWEALTH OF M.A,SSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500
TRUDY COX
Sacreta
ARGEO PAUL CELLUCCI DAVID B. STRL:}1
Governor Co:�.—._ss:oc,
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM
PART A
CERTIFICATION
Propany Address: 17 Thatch Lane Narrw or owner Cynthia Henning Executor
pectiHya''Inn/ii ss Addrazs or Owner:
Date of In spocron: IPSa�sB PrCrtt7 P
Name or tnspector:M Jose h P. Macomber Jr.
I am a DEP approved system Inspector pursuant to Section 15.340 of rrda 6 (310 CMR 15.000)
company Nam.: Joseph P Macomber & Son, Inc.
µasuV Address: 2 6 3 2-0 0 6 6
Taleptwrse Number: �n R 7 S_3��8 '
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 Inspection. The Inspection was performed based on my training and experience in the proper hrnction and
maintenance of on-site swags disposal systems. The system:
yP asses
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ F e'
Inspector's Signausre: Date:
The System Inspect shall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department ohfnvironmental Protection. The original should De sent to'MM
system owner and copies sent to the buyer, If applicable, and the approving authority.
NOTES AND COMMENTS
i.
revised 9/2/98 Page I of II
tr) Pnnled on It"led Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
PropertyAddrass: 17 Thatch Lane, Hyannis
Owner: Cynthia Henning, .Executor
Date of 4up--1k-:6/21 /9 9
INSPECTION SUMMARY: Check A, B, C, or A
A. /SYSTEM PASSES:
[13 1 have not found any information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are Indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:
One or more system components as described In the 'Conditional Pass' section need So be replaced or repaired. The system, upon
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes,•no, or not determined(Y, N, or NO). Describe basis of determination In all Instances. If 'not determined-, explain why not.
The septic tank Is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of
Compliance (attached)Indicating that the tank was Installed within twenty (20)years prior to the date of the inspection; or
the septic tank, whether or not metal, Is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is Imminent. The system will pass Inspection if the existing septic tank Is replaced with a complying septic tank as
approved by the Board of Health.
�d Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction Is removed
distribution box Is levelled or replaced
The system required pum*More than'four—times a•yeardue to broken or obstructed pipe($). The Tystem wilYyassr
Inspection If(with approval of the Board of Health): -
broken pipes) are'replaced
obstruction Is removed
revised 9/2/98 Page 2or11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (con**-+#d)
Frw-.tYAddr►ss: 17 Thatch Lane, Hyannis
0"r"d' Cynthia Henning, Executor
a`ta 'l lkupoc 6/21 /9 9
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 It felling to prot►ct me
public haalfh, salary and the environment.
1) SYSTEM FRJ.I
WILL PASS UNLESS BOARD OF HEALTH DETWES W ACCORDANCE WRIT 310 C1dR 16.303 (1)(b) THAT THE SYS
IS NOT IRJNCT1ONW0 W A{.CANNER WHlCJ-LWILLPRQjWT THE PUBLIC B.EALTAAND SAFE"fY AND THP DC, H0NJ4;
Cesspool or privy Is within 60 foot of surface water
Cesspool or privy Is within 60 feat of a bordering vegetated wstiand or a salt marsh.
2) SYSTD3J W U FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIFR, IF ANY)DETOWLNES THAT THE SYS-M
FUNCT1ONU40 W A i.Lk"ER THAT PROTECTS THE PUBUC HEALPI AND SAFETY AND THE ENVIRONMENT:
/0 The system has a septic tank and loll absorption system(SAS) and the SAS Is within 100 feet of a surface water supply
ulbutary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public waist supply well.
The system has a septic tank and loll absorption system and the SAS Is within 60 lest of a private waist supply w.U.
JIA The system has a saptic tank and soil absorption system and the SAS Is leas than 100 loot but 60 foot of more ftom a
private waist supply will. unless a will water analysis for coUform bacterls and volauls org►nic compounds in6cetse vac
Will Is ties from pollution from that facility and the presence of immonla nluogen and nluate nluogen Is ►qual to a Iss,
than 6 ppm. Method used to detormine distance �/ (approxJmadon not valid).•
71 OTHER
revised 9/2/98 pate 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CFATiFiCATiON (continued)
Property Addrau: 17 Thatch Lane, Hyannis
owns.: Cynthia Henning, Executor
Data of Inspecdon: 6/21 /9 9
D. SYSTEM FAILS:
You TtVst Indicate either 'Yes' or 'No" to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination Is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup oFaewago Into iacili"' r-sr"tem componenrdueno an overloaded orcbgged-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 lev I i} n th clLstribution box a ova outlet I� due men overloaded or clogged SAS or cesspool.
n / Liquid depth in eearpaolls ass than 6' below Invert or available volume Is less than 112 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($).
Number of times pumped_.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy Is-within a Zone I of a public well.
1/ 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organio-compounds, ammonia nitrogen•and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
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:
-IV The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No /
the system Is within 400 lest of s surface drinking water supply
the syslem•is-within 200 (eato(-a-tributary-to a eurlaocdrinkir+g v+aler supPlY
_ v 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)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
Office of the Department for further Inforittation.
revised 9/2/98 Page 4ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 17 Thatch Lane, ' Hyannis
Owner: Cynthia Henning , Executor
Date of Inspection: 6/21 /9 9
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
Y. -None of the systemcompoautts.bau�haon pucnped4oFstJeast two•aweaks aadthe'rystem hasbaeazaceitaag.rraal 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 plena have been obtained and examined. Note if they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or Industrial waste flow.
4 _ The site was Inspected for signs of breakout.
_ All system comp onents,4)luding the Soil Absorption System, have been located on the site.
4 _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffle
or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on•the site has been determined based on:
Existing information. For example, Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)
115.302(3)(b))
The facility owner.(and.occupaats,if diffwaat from..osanw).tn w&praxided.wlth IaL=matioaDn +ham primer r nta��^ ^1
Subsurface Disposal Systems.
revised 9/2/98 Page 5of11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
PropertyAddrass: 17 .Thatch Lane, Hyannis
Owrw: . Cynthia Henning, Executor
Date of hupection:6/21 /9 9
FLOW CONDITIONS
RESIDENTIAL:
Design flow: /l a g.p.d./bedr m.
Number of bedrooms(d slg o Number of bedrooms(actual)
Total DESIGN flow
Number of current residents
Garbage grinder(yes or no): a
Laundry(separate system) es or�o If yes, separate.lrupaction.required --.
Laundry system inspected or no)
Seasonal use(yes or no): ,_
Water meter readings,if av table(last two year's usage(gpd):
Sump Pump(yes or no)
Last date of occupancy
COMMERCIAL/INDUSTRIAL:
Type of establishment: A41
Design flow: 4A aad ( Based on 15.203)
Basis of design flow
Grease trap present: (yes or no)
Industrial Waste Holding Tank present: (yes or no)11�9
Non-sanitary waste discharged to the Title 5 sys e: (yes or no)�, -
Water meter readings,if available:
Last date of occupancy:—"
OTHER:(Describe)
Last date of occupancy: 141,19
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)
If yes,volume pumped: gallons
Reason for pumping: 4—
TYPE OF YSTEM
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)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank W,4_Copy of DEP Approval
Other
APPROXIMATE AGP of IV components date installed ' known)•end s urea of information: -• =` �/�
Sewage odors detected when arriving at the site: (yes or no)
revised 9/2/98 Page 6ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (corrtirwod)
NoportyAddr&-: 17 Thatch Lane, Hyannis
Owner: Cynthia Hennipg, Executor
Daze ofvu%o'�:6/21 /9 9
BUILDwo SEWER:
(Local$ on sit$ plan)
Depth below grade:1
Matsrlaf of construction:_14/.It Iron Z40 PVC_other(explain)
Distance hom prlvata water supply wall or suction line
Diameter
Comments:(condition of Joints,venting, evldsnce of 1"k4ge,-etc.)
Joifl , .
Q -ell
S C TAN K:
(local$ on site plan)
Depth below grade:Ite,
Malarial of construction:concret motel 'tFiberglass�Polyethylene��othar(explaln)
It tank Is trtatal, list age Js.ag$.conrvmed by Certificate of Compllance (YestNo)
Dimsnslons:
Sludge depth:_ .ytf -
Distanc$ from top of rplg$ to bottom of outlet tee ortrat(let �D•
Scum Wcknass:L_m �r,f�f
Distance fro top of scum to top of outlet ts$ or baffle:--- t/
Distance from bottom of scum to bon l$e r of outlet baffle:1�
How dimensions were dsl$rm)nsd:
Comments:
(recommendation for pumping, condition of Inlet and outlet tsea or.batfles, depth of liquid Isvel In relation to outlet evert. rvucwre::nteon
svidsnce of leakage, etc.)
' Thc— tailk ±5-- ZSt7FUCLU_r-aT_Ly sound anct snows
age .
llocats on site plan)
Depth below gr►de: I/
Matarlaf of constructlo I concretegmsteL &Iberglesa4�Poly$thyl$nsIWotherlexplain)
Dimsnslons:
Scum Wckn$ss: ��.�
DistJncs from top of scum to top of outlet ise or baffle-AL
Distance from bottom of sc m to bottom of outlet too or baffle: g
Oats of last pumping:
Comments:
lrscommendatlon lot pumping, condition of Inlet and outlet tees or batfles, depth of liquid level In relation to outlet in,en. rtrucc,rel inr.pn
evidence of leakage, etc.)
is n5t present .
revised 9/2/98 Patc7ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (cocWnued)
PropaMAd&ess: 17 Thatch Lane, Hyannis
Own,": Cynthia Henning, Executor
Dote of Lupecdon: 6/21 /9 9
TIGHT OR HOLDWG TANK: (Tank must be pumped prior to, or at time of, Inspection)
(locate on site plan)
Depth below grade:,
Material of construction/Tconcretedmetal.0(4Fiberpless,"Poiyethylene,2other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm present
Alum level: Alarm In Working order:Yes f Noe
Date of previous pumping:
Comments:
(condition of Inlet tee, condition of alarm and float switches, etc.)
OISTRIBLITION BOX:
(locate on site plan)
Depth of liquid level above outlet Invert: -6
Comments:
(nots•lf level and distribution is equal, evideno-e of solids carryover, evidence of leakage Into or out of box, etc.( — —
carry over n ev, ence n ea aQe , nto mrknnt gf t P
box .
PUMP CHAMBER:-d.�dwe'
(locate on site plan)
Pumps in working order:(Yes or No) y
Alarms In working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
revised 9/2/98 Page 8of11
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i
SUBSURFACE SEWAGE DISPOSALC SYSTEM INSPECTION FORM
PART
SYSTEM INFORMATION (corrdrwed)
�, ,Address: 17 Thatch Lane, Hyannis
0Wrser: Cynthia Henning, Executor
Dst.e of Inspecd«t: 6/21 /9 9
SOIL ABSORPTION SYSTEM(SAS): roxlmated by non-intrusive methods!
(locate on site plan,If possible: excavation not required,location may be app
It not located, explain:
Type; /�� ✓�" �� �
leaching pits, numbsr:_?�
leaching chambers, number:
leaching galleries,number:
leaching trenches.,number, length'.,
fields,nmber, dim Ions' (J
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
s of hydraulic failure,level of ponding, damp soil, condition of vegetation,.atc.,i
(note condition of soil, sign
Loam si ns o
r e
CESSPOOLS:
(locate on alte plan)
Number and configuration:
Depth-top of liquid to inlet Invert: /
Depth of solids layer:
Depth of scum layer:
dimension's of cesspool:
Materials of construction:
Indication of groundwater:
Inflow (cesspool must be pumped as part of Inspection)
no resen
Comments:
(note condition of $oil, signs of hydraulic failure,level of ponding,condition of•vegetation, etc.)
o resen
PRIVY: /brie,
(locate on site plan)
x"A Dimensions:
Materials of constru qn:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, revel of ponding, condition of vegetatJon, etc.
no E rase
i .
Pee 9 of 11
revised 9/2/98
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM LNFORJJAnON (C01 .wd)
P,oG�tYaae�.�►: 17 Thatch Lane, Hyannis
Owrw: Cynthia Henning, Executor
°i' °rl`"°"ld�: 6/21 /99
SKETCH OF SEWAGE DISPOSAL SYSTEM:
lnclvd# tlaa to at'laaat two p#rman#nt r#1#r#nca landmark, or enchmar thour�)
local# all walla wINn 100' (Local# white publlc waft supply
comij 1�1
� t� al
31
j
revised 9/2/98 Pi<< Iooru
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Prop-tyAd&—: 17 Thatch Lane, Hyannis
Ownw7 Cynthia Henning, Executor
Date of kupection: 6/21 /9 9
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep _
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed.Site(Abutting property observation hole, basement sump etc.)
_L---Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
:�
Zked pumping records
ked local excavators, installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
Used Water Contours Map.
Gahrety & Miller Model
1 2/1 6/94
revised 9/2/98 Page 11of11
1 •r.n r,r-n Ire.-.-n-5rnrmr•nswrarT+annrrRn�.•+�-�.�rm�+nn n>re+,y sr�'e*+..Inn
I TOWN OFBARNSTABLE BOARD OF 11EALTII I
11 SUBSURFACF ,SF,WAGF DISPOSAL SYSTF,M INSPECTION FORM - PART D •- CEI{TI FICATION
11 -Tf'i�T••••.:t—r.11M1�.T.TT'1JR r511'If.T'ITRI'fT/.11"'InT1r—.57r'SVTTY RRfrTAA'Ar/.�TTfA Tan'IInTITnT�TTTTI••r5•..-.�T'1+-�. —..�
-TYPL OR PRINT CI.EARL1'-
PROPERTY INSPECTED
STREET ADDRESS 17 Thatch Lane, Hyannis
ASSESSORS MAP , BLOCK AND PARCEL #
OWNER' s NAME Cynthoia Henning
_ o
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P. Macomber• Jr.
COMPANY NAME Joseph P. Macomber & Son, Inc.
COMPANY ADDRESS Box 66, Centerville, Ma. 0263.2-0066
Street Tovn or City Scat. t,p
COMPANY TELEP1iONE (508 )775 -3338 FAX ( 508 )790 -1 578
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 .
Chec one
;
7Systeui PASSED
The inspection l+hich I have conducted has not found any information
which indicates that the system fails to adequately protect public
healLh or Lhe. 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 which I have conattcted has found that the system fails to
protect the public health 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 ,
Inspector Signature r�
Date
One copy of this rtification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF 112ALI'll.
• It the inspection FAILED, the owner orlhoperator shall u
within one ,year of the date of the inspection , unless alloweddortrequired
otherwise as provided in 3.10 CMR 16 . 306 .
partd . doc
TOWN OF BARNSTABLE
LOCATION f'' gCa �d1 .SEWAGE #�•%'� ,
VILLAGE,�/�/�¢�� ASSESSOR'S MAP & LOTS, ��1
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY j dO
LEACHING FACILITY:(eype)
NO. OF BEDROOMS "'! PRIVATE WELL OR PUBLIC WATER
BUILDER OR, OWNuR
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: AV—
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABL.E
Applirativit for Di-liponFal Workii Toutitrurtion Frrmit
Application is hereby made for a Permit to Construct ( ) or RepairX(XX) an Individual Sewage Disposal
System at:
1 7-Thatch•Lane-•-Hyannis,Mays.••••-•-•-
•-------------
Location-:\ddress or Lot No.
....------.$.permcm....•------------------------•----•-•--------•--
Owner Address
a J.P.Macomber _Jr.
Installer Address
Type of Building Size Lot-----.-••-_••••-_•••••••.•..Sq. feet
., Dwelling X-No. of Bedrooms----------------3--------------------------Expansion Attic ( ) Garbage Grinder (I )
Other—Type of Building --------------------------- No. of persons------3-------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures -------•-- ------- ------ - --
Q
W Design Flow...................5.5....................gallons per person per day. Total daily flow---------1-6.5.......................--__gallons.
044 Septic Tank—1 Liquid capacity--1-5-01talIons - Length---------------- Width---------------- Diameter_------------- Depth................
Disposal Trench--No. ......1............ Width.....5............. Total Length..__5_4.!_. --- Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter--------------------- Depth below inlet-_----_----_----_- Total leaching area------------------sq. ft.-
z Other Distribution box ( 1 Dosing tank ( )
Percolation Test Results Performed bY------- ------------------------------------ ----------------------------- Date........................................
a
Test Pit No. 1----------------minutes per inch Depth of Test Pit_----------------- Depth to ground water------------------------
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
94 ----•------------------------------------ ..................................................................................................................
0 Description of Soil..........................................................................................................................................................................
USand �t Gravel •--•-••-•----•..•....--•---•----•---n ® ---r --
W
UNature of Repairs or Alterations—Answer when applicable..-._QMit__.ces_s_poflls_!____Insta1_l___1__-I_509___•_.
galloB t«nkl l -distribution -box•- and•-•8_ nfiltrator_s _ ackeL! instgnP-_•_.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compli nce has bee issu d by the o d of health.
��. ..
Signed -_- '''-- - 5 f, 6�.9 5
Dare
Application.Approved By ..---- --- �,�,.,,.-� ..--L... ..-.. .5-
-,-- -- '-------'------------- -------'--------'----------------- Dace
Application Disapproved for the following reasons. ..............---------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------.:_-----------...---------------------------------------------------------------------:----------- --------q-- -
-----------------------
Permit No. ----- - I�� -----_ Issued ------- Lj.:^.....1.. 7...- ---�z
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
ILPrtifiratjE of compliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired kXX )
by ----`o P.,Macomber---Jr...---- -- ----------------------- ---------- ----------- --
1—alle,
at ........7....That.ch---Lame----F rann.is,Mas-s.--------------- ---------- ----------------------------------------------------...---------------------....--------------
has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ---- 1. dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------:--..............----- ---------- ---- -------- ---- ---........ Inspector --- --- ------- -- - ----------------------- ----
M No...� _.:_ ..............
THE COMMONWEALTH OF MASSACHUS'ETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
A . liratialt for, Di!jpwiFal Work.6 C ontitrurtinn Viriftlit
-ri Application is hereby made for a-Permt"to Construct ( ) or RepairX(XX) an Individual Sewage Disposal
Y
S stem at:
G> (\
t...
1 7 -Thatch Lane HYannis�Mass.-_-......
Location-Address or Lot No.
5r)erco
Owner Address
W J.P.Macomber Jr.
Installer Address
d Type of Building Size Lot............................Sq. feet
U DwellingX- No. of Bedrooms-------------.__3--------------------------Expansion Attic ( ) Garbage Grinder (q )
p, Other—Type of Building ___________________________ No. of persons.-.----.--__y__f:-.--- Showers ( ) — Cafeteria ( )
Other fixtures ------------------ ......................................................
W Design Flow................1.6.5....................gallons per person per day. Total daily flow.........1-6_5...........................gallons.
r' 0� Septic Tank-1 Liquid capacity.-1.5.00gallons Length---------------- Width--------------.., Diameter_-............ Depth----------------
Disposal Trench'—No. ------1------------ Width.....5_1----------- Total Length----S4.'.._._._. Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total rleaching area..................sq. ft.
z Other Distribution box ( 1 ) Dosing tank ( ) / .
~' Percolation Test Results Performed bY-------- ........................................................Date Date------------------•-•---•----•......---
.� W
Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth tbwground water---------------__-.._..
GX4 Test Pit No.2----------------minutes per inch Depth of Test Pit__________________- Depth to ground water-.......................
�+ •-••---------••----------------------------------••-•----•---......-----....---••-----------.....---.........................................................
0 Description of Soil..........................................................................................................................................
x Sand & Gravel
U ...................................... ...............-••-••--•--•-•--•••-•-•-•---••••--•-----•----••---•-••••-----•------•••-•-••--•----------•--•-....................-..............................
W
---------------------=----------------------
U Nature of Repairs or Alterations—Answer when applicable_--QRit-_Coss1)ools.--Insta�`l1 1 -1-50.0•-•...
gallon tank, l -distribution box and infiltrators packed- in stone-•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees r1t to place the
-- system in operation until a Certificate of Compliance has bee issu d by the l o d of health. t
Signed - - L...- .r------ -- ---t---------------- ------- -------5...L.1.61..9..5---------
Date
II r
Application.Approved BY ---- ---- -------------------------------------------------------------------------------- Dace
Application Disapproved for the following rea.ronr: ---------------------------------------------------------------- .. . .. ....... ._.....................
-------------- ----------...._--------------------------------------------------------------------- ----...._--------------------------_------- ---------------------- ------
qq r � �.
Permit No. cj I� �*-/------ Issued ....._.._... ..'....L..7-----� ....
Dare
ar,
—.•..— o®--_•.a----.a+e-------a------ -------.�.��
THE COMMONWEALTH OF MASSACHUSETTS f a
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertiftrate of Qlnmpliance `
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired.CXX )
by J.P.Macomber Jr.. _--_-----------------------------------------------------------------------------------------------------
...............................---------------------------------------------....._-----------------------i� :ii
at 17-..Thatch.---Lane.--s-Tva:nn.a..s-,.Ma_ss--- ----------------------------- ------------------------------------------_-------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ...___7 .-.--. f>-r��.�dated ....fir-'_r. .?
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
1
DATE .--------- ---------------_...._...------------...--.. . ...... ...----- Inspector ---------------------------..-------_---------- -------------------- -------
---------
THE COMNIIW>EALH OF MASSACHUSETTS
BOARD OF HEALTH
CJ TOWN OF BARNSTABLE
No../.,........
1hopotal Evrhii �nat�tra rtUari erattit
Permission is hereby granted_.:J.P•,MaCo her---jr-._..----•--•------------------------------------------------•-----------------------..........
to Construct ( ) or RepairX(XX) an Individual Sewage Disposal System
17 at No........... Thatch Lane fiyannis•,Mass:.---•---------------- ----------•---•-••-----••-----......•--••••---- --------.................--.....--
Street /
as shown on the application for Disposal Works Construction Permit No. _1:2 Dated_...-� -_l_7.... r?.........
? S-� U Board of Health
DATE---------------- ----- /..
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, J.P.Macomber Jr. , hereby certify that the application for disposal works
construction permit signed by me dated 5/16/9 5 , concerning the
..,. property located at 17 Thatch Lane Hyannis,Mass meets all of the
following criteria:
/ There are no wetlands within 300 feet of the proposed septic system
There are no private wells within 150 feet of the proposed septic system
The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
/There is no increase in flow and/or change in use proposed
i� There are no variances requested or needed.
A. 3—bedrooms R. No garbage grinder C. Sand & gravel
D. Omit existing cesspools. Pump fill in.
SIED :GN DATE: _5/16/9 5
LIC NS SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plotplan,
this plan should be submitted].
Qe.y�9 Inf iMn d
1500 tank.
O
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