HomeMy WebLinkAbout0006 CAMMETT WAY - Health 6 Cammett Way, Marstons Mills
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TOWN OF BARNSTABLE
LOCATION � ����c��.- �"C
..' SEWAGE #
VILLAGE ASSESSOR'S MAP LOT
INSTALLER'S NAME & PHONE NO. tact kg-�,-4 (64-sy-
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 4 ii1
DATE PERMIT ISSUED: cl
DATE COMPLIANCE ISSUED: L.
VARIANCE GRANTED: Yes No J
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Fz8......2.a.:..
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
..........................OF..... � .......................................
Appliration for UiapngFal Works Tonstrurtinn ramit
Application is hereby made for a Permit to Construct ( ). or Repair an Individual Sewage Disposal
System at: /
Location-Address J_ or Lot No: -•.------
Owner
......................a i �4 9ASr--------------___-•--------------------
___
a ...........................� a ....4M-.
- -------------------------------------- .....@ •.. ` Address......... ...............................
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ...
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth..........
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by..............................,........................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•---------------- --------------
----------
------ ----•••----•-••-• -----------------------
•------
-...............
O Description of Soil----- -• ---$�-'---i-3--•--•--:.. -------5
U •-•------------------------•---------...-•-----...._•-------••-----•---•--••------------.....•-----••--••-----•-----------•i•----------•---•----------•...•----------------
W
x ..........................................•-----------------------------------•--------------.--_._._..------------------------------••-------------•---------•-------------•-----•-----•- ••••........
U Na�tJuFe o�Repairs gor�Alterations—Answer when applicable..,. ` ..........\_tC ��...__.__�� _....___._._ .............
--------------•-.._...._..---•-•......._.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITU. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has jeeen issued by the board health.
Signed 4 . L�1-•................U-"� ------ � ate �`�....._
--...-•----•... ................ ate
Application Approved BY ___________________------•-- .............. __
Date
Application Disapproved for the following reasons:................................................................................................................
..---•--•-----------•------•-•------•----...-•-----------•-----...--•------•--•-------•-----•---------------•---------------------•----------•-•------•••------------••-----•--------------•-------••--
Date
��Permit No.---•-•-•• -- ---':......... . ......•---------.. Issued-------•---•--...----------.....-•-•---•----•---------..
Date
`lp... Fizz......A?1................._
^� Tf
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�...!l_t 1._.... ................OF...... 'J..Z .,. . _.`�\ ........................................ f .-
............. .
Appliration for Dispas tl Works Tonitrurtion Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( 0) an Individual Sewage Disposal
System at: !
T ....._..W '�c .......................................................li7p'+r��i`On13 /�' ...........................................
Location_Address or Lot No.
111�►1--------..:-(.. ?�....................................................... -.._...c�._...r......------•--------...--•-----....---•---•-•--•---------.............--•-----..
Owner Address
W N.e.lc....4 t'e... ��'. ...0 -------------------------------•------•- = �3d ....2 3 e ewe► �.�I-�
Installer Address
Type of Building Size Lot____________________ _____Sq. feet
�-, Dwelling.—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aa Other—T e of Buildill
YP g ............................ No. of persons............................ Showers ( ) — Cafeteria_(_..-->-
d Other fixtures --------•---••---••---•••-----•. -•••••-•-•-••••••--•--•-••-----••----••--•----•---••-•••-•---•--•-•...._-•---
.-
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................
W Disposal Trench—No_ ____________________ Width......_............. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
LX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ••-•-•-•---•••••••-•••-•-••..................•------•-•-....--•-•--•.......---------•-••••-••_-••-••.........................................................
DDescription of SoiL_._ `__L ...................•--____....='�-? �-r� 2 ` f L SA_"-. '..__•••-••------...----•--•� -•----•----•---•----••----•••••---•--•--••••---•--••---•••••--------•-_-•---
W
U -•--•••••-•-••---••••--•--•---...----•-._....._..•--•-------------•------.........-•----•-.....••--•....----•-•----•--•••••••••----------------•-------••----••••-•._.__.•-•-------•----••------------•-
W
.............................. ----------------•--------•------------------------------....---------- -----------------------------------------------------------------------------------------------•--
U Nat e of Repairs or Alterations—Answer when applicable_._ =��._.______.�_`= �_...-___. t 4 ^�...........N`.�.............
-__ ...................................----_.......................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ))een issued by the board Q,f health.
Signed --------------------= ...........- -•-------•-••••-- ••••--•-••••, ---•-....._..----
Date
Application Approved BY ............. 4` -e! 7 -• 5--•t
7 `
Date
Application Disapproved for the following reasons---------------------••-•---•----------------------------------•--------------------------------------........._.
-•...............•--•-----------------------•------••--------.....-----•--------.._...--•----•-----------•----•-•-------•--------•••------•••---••••••-----------------••••...••----•-••-•--•-••--------
Date
PermitNo.........il-..... ---------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... UW►',................OF... .. CZ '{+,S\1R(>V .
. .. .. . ...h..................................
Tntifirtttr of Tomplianrr
THI�4S TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired
by.. �l I�--------t4 !c\C-Z .
--------------------•=-------------------------------------- -----...-----------------........._....._-- =
Installer
................-.........................
has been installed in accordance with the provisions of ?'ITIZ�� of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No........... __ _ __ ___. dated__..............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.. .... V. V}�..-•---...--•-•_..__. Inspector.................... ----••--.................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....................OF..... �--
No..... .. .._.. FEE F.....c'.............
�i��o��l urk� �ono�riun rrntit
Permission is hereby granted_..__!«_V _ }+lC\< _.________
--------------------------------------------•----------•••--••••--•............_
to Construct( ) or Repair t�)_ an Individual Sewage Disposal System
at No.......... 'P^.�'� %"3 A
.................................•-••-•-----------••---••-•••--•---•-•---•••••--•---•••--• .....................................
Street %/r j�,,.
as shown on the application for Disposal Works Construction Permit No._-_r_=: _._r}__ Dated..........................................
.............................. --------------------------------------------------------
..— z ti Board of Health
DATE------------------- ---•=--J C1_:... ...............................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
f;
Comnwweatth of Mos=husetts John GradExecuflve Office of ErMromwintal Affairs John
Title V Septic Inspector
Department of P.O. Box 2119
Environmental Protection Teaticket,MA 02536
l' s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .� 1 c rtrcl/[g I f
PART A AI
CERTIFICATION ,V�V z 0 199,
Property Address: 6 Cammett Way Marston Mills Address of Owner:
Date of Inspection:11/06196 (If differerit)
Name of Inspector:John Gracl Mr.Lopez:245 Old Yarmouth Rd.Hyannis
Company Name,Address and Telephone Number:
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 function and
maintenance of on-site sewage disposal systems. The system:
x Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: ,i Date: 1116196
The System Inspector shall sub/itacopy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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 of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B,C,or D:
A) SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion
of the replacement or repair, passes inspection.
Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.)
The septic tank is metal, 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 conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street 9 Boston,Massachusetts 02108 9 FAX(617)556-1049 9 Telephone(617)292-5500
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 6 Cammett Way Marston Mills
Owner: Mr.Lopez:245 Old Yarmouth Rd.Hyannis
Date of Inspection:11/06/96
_ Sewage backup or breakout or high static water level observed in the distribution box is 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 leveled or replaced
_The system required pumping more than four 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
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN.A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water
supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined 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.
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 11115/95)
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 6 Cammett Way Marston Mills
Owner: Mr.Lopez:245 Old Yarmouth Rd.Hyannis
Date of Inspection:11106196
D] SYSTEM FAILS(continued)
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers 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 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
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:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further Information.
(revised 11115195)
3
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CH ECLIST
Property Address: 6 Cammett Way Marston Mills
Owner: Mr.Lopez:245 Old Yarmouth Rd.Hyannis
Date of Inspection:11106196
Check if the following have been done:
X Pumping information was requested of the owner,occupant, and Board of Health.
_A__None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
n►aAs built plans have been obtained and examined. Note if they are not available with N/A.
x The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,have been located on the site.
x The septic tank manholes were uncovered,opened, and the Interior of the septic tank was Inspected
for condition of baffles or tees,material of construction dimensions de
pth of liquid, depth of sludge, depth of scum.
X The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
x The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
i
Property Address: 6 Cammetifty Marston Mills
Owner: Mr.Lopez:245 Old Yarmouth Rd.Hyannis
Date of Inspection:11/00198
RESIDENTIAL: FLOW CONDITIONS
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: n1a
Last date of occupancy: 6 months ago
COMMERCIAL/INDUSTRIAL
Type of establishment: n1a
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no).No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: nla
Last date of occupancy: n1a
OTHER:(Describe) nla
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped in the last two years
System pumped as part of inspection:(yes or no)Yes
If yes,volume pumped: 1000 gallons
Reason for pumping: Maintenance.
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes, attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
1972
Sewage odors detected when arriving at the site:(yes or no) No
(revised 11115195)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 6 Cammett Way Marston Mills
Owner: Mr.Lopez:245 Old Yarmouth Rd.Hyannis
Date of Inspection:11106/90
SEPTIC TANK: X
(locate on site plan)
Depth below grade: r
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions: L 8'8'H 5'7"W 4'10-
Sludge depth:4'
Distance from top of sludge to bottom of outlet tee or baffle: 23'
Scum thickness:2'
Distance from top of scum to top of outlet tee or baffle:6'
Distance form bottom of scum to bottom of outlet tee or baffle: 14"
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance
GREASE TRAP:
(locate on site plan)
Depth below grade: Na
Material of construction: _concrete metal FRP_other(explain)
Dimensions: n1a
Scum thickness:nfa
Distance from top of scum to top of outlet tee or baffle:n1a
Distance from bottom of scum to bottom of outlet tee or baffle: n1a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
Na
(revised 11115195)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 6CammettWa Marston
us
Owner: Mr.Lopez:245 Old Yarmouth Rd.Hyannis
Date of Inspection:11106196
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: nla
Material of con struction:_concrete_metal_FRP_other(explain)
Dimensions: nfa
Capacity: n/a gallons
Design flow: Na gallons/day
Alarm level: nla
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
nla
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n►a
Comments:
(note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.)
nla
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
Na
(revised 11/15195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 6 cammen Way Marston mills
Owner: Mr.Lopez:245 Old Yarmouth Rd.Hyannis
Date of Inspection:11/06196
SOIL ABSORPTION SYSTEM (SAS):X
(locate on site plan,If possible;excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Na
Type:
leaching pits,number: 2-1,000 gallon teach pits
leaching chambers,number:n1a
leaching galleries,number: n1a
leaching trenches,number,length: n1a
leaching fields,number,dimensions:n1a
overflow cesspool,number:nla
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
The leach pits are structurally sound and functioning properly.
CESSPOOLS:
(locate on site plan)
Number and configuration: n1a
Depth-top of liquid to inlet invert: Na
Depth of solids layer: Na
Depth of scum layer: n1a
Dimensions of cesspool: n1a
Materials of construction: n1a
Indication of groundwater: nfa
Na inflow(cesspool must be pumped as part of inspection)
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
Ma
PRIVY:
(locate on site plan)
Materials of construction: Na Dimensions: nfa
Depth of solids: n1a
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.)
PrivyComments
(revised 11115/95)
8
L
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 6 Cammett Way Marston Mills
Owner: Mr.Lopez:245 Old Yarmouth Rd.Hyannis
Date of Inspection:11106196
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
U � it
�l
4 A,36
� c
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9