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HomeMy WebLinkAbout0080 LAKESIDE DRIVE - Health 80 LAKESIDEVc�iL MARSTON MILLS A = 102 014 J-j 4� i I ,j TOWN OF BARNSTABLE .LOCATION �D Ll4l�/,S'��G_ D���r SEWAGE# 2a/y- /G8 iLAGE`yILgpSfDrf_f W,115 ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. L?WA,^yS SEPTIC TANK CAPACITY / r,90 LEACHING FACILITY:(type) NO.OF BEDROOMS OWNER DE4✓/C� 1.5H4E y —� PERMIT DATE:, COMPLIANCE DATE: Separation DistanceBetween 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 Edgepf Wetland and Leaching Facility(If any wetlands exist within -rMO feet of leaching facility) Feet F FURNISHED BY r �,� t�kl-=S[Y rs Dn A5 ( i No. 1 Fee W� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plitation for Misposal 6pstem Construction permit Application for a Permit to Construct Repair(lXUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.,go Vi"iVl; Owner'st4ame,Address and Tel.No. Assessor's Map/Parcel/191.;1*11 W//lam ✓ 0,#Vld !?7/' Installer's Name,Address,and Tel.No.S03-28d�77 D igner's Name,Address,and Tel.Noses f- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 O gpd Design flow provided, c) gpd 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) 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 Certificate of Compliance has been issued by this Board of Health. Si Date Application Approved by Date ��Zl�2oiy Application Disapproved by Date for the following reasons Permit No. 2014 " /68 Date Issued 5-L2.11 No. 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nplitation for disposal 6pstem Construction Permit Application for a Permit to Construct(4-�' Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.190 1 � Owner's Wayne,Addre�sss and Tel.No. Assessor's Map/Parcel/01(�/y , 411-V1 Installer's ame,Address,and Tel.No.S 0,3- 3:02Deesigner's N me,Address,and Tel.Noses-?6l/-OS9�l 144ie-I Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 s O gpd Design flow provided '3 j0 gpd 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) Z.°/Sr,*11�GCU�" /�'!l� 70 16111 Date last inspected: J Agreemient: 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 Certificate of Compliance has been issued by this Board of Health. SSi ,V zpidG_1 ��r�?����__ Date. _ Application Approved by Lam - Date 5M/7-01y Application Disapproved b Date for the following reasons Permit No. ?01 N — 168 Date Issued 5121/Zo l f T THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance 1 THIS IS TO C//ERTIFY,,that the On-site Sewage Disposal system Constructed(L} Repaired Upgraded( ) Abandoned( )by 105 -C 01-1 o-5- at 66 Lwkr--,5/ /:r On V/5' e44e5rOO5 IW/1�S'haS been constructed in accordance t with the provisions of Title 5 and the for Disposal System Construction Permit No -/6,9 dated Installer JT /reQ-5 Designer &Zy #bedrooms Approved desi6nc'o 33 gpd The issuance of this p rV a construed as a guarantee that the system as desig ed. 4 1,11 Date Inspector O ------- ------- ---- -=-- --------------- ------------------------------------------------- No. 701"1— '68 Fee /VV e1J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction hermit Permission is hereby granted to Construct(L--)- Repair(4-)- Upgrade(. ) Abandon( ) System located at 80 Z,04 s/y, d/,-1 ✓/= and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her ly with Title 5 and the following local provisions or special conditions. Provided:Con/structon must be completed within three years of the date of this permjfi'� Date (� t{ Approved by��- / 1 ' Town of Barnstable Regulatory Services I Richard V.Scali,Interim Director BARAM M Public Health Division 7� 1639.p1 O'Fo3. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form ' Dater 12 tf Sewage Permit#cx2d 1-11,g6 Assessor's Map\Parcel Designer: f Installer: Or - Address: !".D DX 42G 6 Address: (�! Z�gz � 01V G � & On �J as issued a permit to install a (date) sta r septic system at Az;i )/ J`1/J based on a design drawn by address) dated .Jr off/ ( pdesigner) i certi that the septic stem referenced above was installed substantially according to fY the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required) was inspected and the soils were found satisfactory. [ certify that the system referenced above was constructs ce with the terms of the AA approval letters(if applicable) v� �iH �Ssgc o� DAVID yG�+ D. a COUGHANOWR (I�tailer4signature) No. 1093 S4N1 TAR11`� (Designer's Signature) (Affix Design ' amp Here) 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. QASeptic\Dcsigncr Certification Form Rev 8-14-13.doc SAIL TEST Lm Mu oft � �' � D � SI N C�� L cC�UL � TIOO N5 G f 0 9 SOIL EVALUATOR: DAVID D. COUGHANOWR, LSE-461 DESIGN FLOW: 3 BEDROOMS X 110 GPD 330 GPD WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. SEPTIC TANK, 330 GPD X 2 DAYS = 660 GALLONS COUNTERD TEST PIT 1 p RC AT NO 060DWAT in -2 MN/NCH NEC SOILS USE EXISTING 1500 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT, INSTALL NEW 1500 GALLON SEPTIC TANK. INCHES HORIZON TEXTURE (MUNSELL) MOTTLES 87.15 0-12 Ap SANDY LOAM 10 YR 4/2 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 12-38 Bw SANDY LOAM 10 YR 5/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: l 83.98 THE LONG TERM ACCEPTANCE 38-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE RATE TE FOR A CLASS ONE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES 75.65 PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. TEST PIT 2 NO GROUNDWATER ENCOUNTERED THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY DEPICTED BELOW CAN LEACH: ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER BOTTOM AREA = (24 x 125) = 300 s ft. INCHES . HORIZON TEXTURE (MUNSELL) MOTTLES q 87.10 SIDEWALL AREA = (24+24+12.5+12.5)x2 = 6 so. ft. 0-12 Ap SANDY LOAM 10 YR 4/2 NONE FRIABLE TOTAL AREA = 446 sq. ft. 83.88 12-38 Bw SANDY LOAM 10 YR 5/6 NONE FRIABLE FLOW CAPACITY = 0.74 x 446 = 330.04 gal/day 38-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED 75.55 BELOW. FLOW CAPACITY = 330.04 go[/dog WHICH EXCEEDS THE 330 gal/dog REQUIRED FOR A THREE BEDROOM DESIGN. 1500 GALLON SEPTIC TANK DIMENSIONS -IF IN STRUCTURALLY USE EXISTING UNIT SOUND CONDITION SAIL BSOPPTIdN l STEII/1 CONSTRUCTION 1 in NOT .• .. GALLON LEACHING .•YVIIIIELL TAPER �:y TO DRYWELL 24.0 ft SCALE UNIT c� 0, r .� 0 5 f t Y h ' c: 8 in N ® ® v- N �L c) \� STONE 3.5 ft 8.5 ft 8.5 ft 3.5 ft i /0 ft- 6 ;,, 5 500 GALLON DRYWELL DIMENSIONS & DETAIL INSTALL ONE INSPECTION RISER TO WITHIN THREE INLET CENTER OUTLET USE INCHES OF FINAL GRADE COVER COVER COVER H-IO ..; & INDICATE LOCATION ON AS-BU►L r _ UNIT 3 IN DROP p 33 -► I� FLOW LINE o .. k p0 FROM - oQoa, OSO� in BUILDING' 10 in = 41-� D O-BOX 48 in LIQUID GAS 102 !� LEVEL BAFFLE CROSS SECTION VIEW INSTALL AN APPROVED GEOTEXTILE 121 NEW; FABRIC OVER STONE 6 in STONE BASE SEPARATION BETWEEN INLET & OUTLET 3 in TO o 24 in o TEES NO LESS THAN LIQUID DEPTH 28 ►-vs in GRAVEL .o EFFECTIVfa . in ® DEPTH a CROSS SECTION VIEW 46 in 58 in 46 in 150 in -INSTALLER TO OBTAIN DISPOSAL'WORKS PERMIT BEFORE • %• STARTING WORK. •• • • -ALL COMPONENTS INSTALLED .SHALL MEET THE MINIMUM O REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). " INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND T UTILITIES BEFORE EXCAVATING FOR SYSTIM. NOT TO 12 in -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION SCALE MIN E OF LOW FLOW FIXTURES & APPLIANCES, AND PERIODIC a PUMPING OF THE SEPTIC TANK. C -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. FROMC TANK Tp DO NOT PARK:OR DRIVE VEHICLES OVER,SEPTIC SYSTEM. sas 10 6 in STONE BASE 5 /S.S 1n �� CROSS SECTION VIEW SEWAGE DISPOSAL SYSTEM PLAN 80 LAKESIDE DRIVE MARSTONS MILLS. MA APRIL 15. 2014 ETE-3807 PG 2/2 NOTE EXISTING INFILTRATOR SYSTEM TO BE ' t 85 ABANDONED IN PLACE. REMOVE ANY CONTAMINATED SOILS IN AREA OF 86 PROPOSED LEACHING GALLERY AND • REPLACE WITH CLEAN MEDIUM SAND 87 PER TITLE 5. aw G I EXI5TIN10 15p0 GAL 1 i SEPTIC 1 1 G Q K_ SHED A O BE REUSED T ON ND Z� IgUT SOUND TR f IS I DISTRIBUTION I • PROPOSED 10 ft LEACHING MI" I to GALLERY ° Q��Q�� 10 20 ft -SEE DETAIL ON BACK DW�I� Ib-P Al SOP F 65 o I COLOR IS A TEST COL-OR PITS TP2 o / PLAN USE COLOR PLAN ONLY / m L�OO T 11 1 FOR INSTALLATION Q�' / PLAN BOOK 138 PAGE 25 1 FULL DETAIL IS BEST AREA -10,500 sft VIEWED IN O w ASSR MAP lOZ PCL 14 FULL COLOR O CL .1Q1 a 1 'V �F� Z � ,� m GAR MINIMAL E GRADING / G R 1 S TON PROPOSED WED DRIVEWAY G C)15.00 do85 GATE 8 0 _ap 85 E OfPAVEMENTEDG0vg D� GIS D ELEVATION LOAKE 87. 65 PLAN lOp OF FOUNDP SCALE: I in = 20 ft THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM 20 140 DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS. OWNER O 10 20 SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. F L O W p r% 0 F L C TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE SCH. 40 PVC EL = 87.65 +— 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN 13-1302� 3' USE H 20 MAX RATED EXISTING UNITS 1500 GALLON aoo�oM O o ooa PRECAST oo , EXISTING ��p�0� ��� 83.80 83.10 °g° DRYWELL � a o EXISTING SEE DETAIL ON BACK STONE SSOL ABSORPTION - 83.27 BASE 83.00 _ 4- SEE EXISTING ������ ON BA DETAIL m 6 in STONE BASE 40 ft a) 5 ft Li 81.00 NO GROUNDWATER b) 12 ft MOTTLING OBSERVED _ 75.55 A RPORT MARSTONS MILLS. MA RACE LANE s9ry DAVID 9ryG a SEWAGE DISPOSAL DAVID GJ, �` NOT Dv COUGHANOWR N COUGHANOWR y SYSTEM PLAN LAKESIDE p TO -TO SERVE EXISTING DWELLING 92F SCALE No. 1093 No. 461 f-2 DAVID & ELISA j m m �FGISTE��° s q �°o ASHLEY Q m r- Sq 1 �� P� ' • OWNERISI OF RECORD cc T ^+ Z 80 LAKESIDE DRIVE MARSTONS MILLS, MA P.O. BOX 1265 PROPERTY ADDRESS WEST CHATHAM. MA L O C U S M A PY 508 364 9 DATE, 0894 2 PRLIoe# ETEo 806 J � i11[i�L1YC0 r1 MAY 1 8 1999 TOWN OF BARNSTABLE HEALTH DEPT. COMMO TH OF MASSACHUSETTS FFICE OF ENVIRONMENTAL AFFAIRS John Grad NT'OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 80 LAKESIDE DR. MARSONTS MILLS MAP 102 PAR 014 Name of Owner MR.PANTON Address of Owner: SAME Date of Inspection: 6/11/99 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: n/a Mailing Address: n/a Telephone Number: n/a 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 The inpection is based on criteria defined In Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further E I tion By the Local Approving Authority performing at the time of the inspection.My inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:6/14/99 The System Inspector sha 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 of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEMS'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 �I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 80 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:6/11199 INSPECTION SUMMARY: Check A, B, C, Or D: A. SYSTEM PASSES: _ I 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: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: n1a 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa 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 exfiitration,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. n(a 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 Wa 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 80 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:6111/99 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)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 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 ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance nla_(approximation not valid). 3) OTHER D& revised 9/2/98 Page 3 of 111 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 80 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:5/11199 D. SYSTEM FAILS: You must 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 X Backup of sewage into facility or system component due to an 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. X 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 1/2 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 n&. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a 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 I 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. 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: 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located Ina 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 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 80 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:6/11/99 Check if the following have been done:You must indicate either"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 None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As 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,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: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)J X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 60 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:6/11/99 FLOW.CONDITIONS RESIDENTIAL: Design flow:-Q g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):2 Total DESIGN flow: 2 Number of current residents:. Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): YES If yes,separate inspection required Laundry system inspected(yes or no):JMQ Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): E& Sump Pump(yes or no): MQ Last date of occupancy: n/a GOM MERGIALlINDUSTRIAL Type of establishment: nla Design flow: nLa gpd(Based on 15.203) Basis of design flow: Wit Grease trap present:(yes or no):JM Industrial Waste Holding Tank present:(yes or no): MQ Non-sanitary waste discharged to the Title 5 system:(yes or no):MQ Water meter readings.if available:n& Last date of occupancy: nLa OTHER: (Describe) nLA Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: nta System pumped as part of inspection:(yes or no):MQ If yes,volume pumped nLA- gallons Reason for pumping: n& TYPE OF SYSTEM X 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 Copy of DEP Approval Other: a& APPROXIMATE AGE of all components,date installed(if known)and source of information: NEW SYSTEM WAS INSTALLED IN 1996 Sewage odors detected when arriving at the site:(yes or no): MQ revised 9/2/98 Page 6 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:6/11/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 1'6" Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n& Comments: (condition of joints,venting,evidence of leakage,etc.) n/a SEPTIC TANK: X (locate on site plan) Depth below grade: 1 Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) n& If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ nLa Dimensions: L 10'6"H 5'7"W 6'8" Sludge depth: L" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: JE How dimensions were determined: MEASURED 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. GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) nLa Dimensions: n& Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:-n& Distance from bottom of scum to bottom of outlet tee or baffle n& Date of last pumping: n& 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.) n& revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:6/11/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) IVA Dimensions: nLa Capacity: nLa gallons Design flow: nLa gallons/day Alarm present: NQ Alarm level:jiLa- Alarm in working order:Yes_No—: NO Date of previous pumping: Wa Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nLa DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIQUID LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:6/11/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Wa Type: leaching pits,number: nla leaching chambers,number: 4-INFILRTATORS leaching galleries,number: jn(a leaching trenches,number,length: WA leaching fields,number,dimensions: nla overflow cesspool,number: n(a Alternative system: n(a Name of Technology: -La Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SAS IS FUNCTIONING PROPERLY. CESSPOOLS: _ (locate on site plan) Number and configuration: WA Depth-top of liquid to inlet invert: Wa Depth of solids layer: nfA Depth of scum layer. WA Dimensions of cesspool: Wa Materials of construction: WA Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)nta Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) WA PRIVY: _ (locate on site plan) Materials of construction:nta Dimensions:n& Depth of solids: nla Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla revised 9098 Page 9 of 11 } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:6111/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a I (A A b b o p I I 14A�b� Ac 35 �A -pl a 3i revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 LAKESIDE DR.MARSONTS MILLS MAP 102 PAR 014 Owner: MR.PANTON Date of Inspection:5/11/99 NRCS Report name: n(a Soil Type: n& Typical depth to groundwater. n& USGS Date website visited: nLa Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installars X Used USGS Data r - Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS j revised 9/2/98 Page 11 of 11 TOW/N�OF BARNSTABLE LOCATION SEWAGE # VILLAGE/yd,"S�Q �s' A411 ASSESSOR'S MAP & LOT�Q�- INSTALLER'S NAME & PHONE NoAllj�10W; (102oS1. 46�?Q %2KD SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 2Q %/r-, CSi (size) '7' NO. OF BEDROOMS_ PRIVATE WELL CRPUBLIC:W�ATEW - B UILDER O OWNERS- JP��70,;U DATE PERMIT ISSUED: 1!? 2���'� DATE COMPLIANCE ISSUED: r VARIANCE GRANTED: Yes No i �AC}� �� tic Lsy- - a r .22 tOOp, - �' (oil mg-e 4 P',d 1©z , No......................... FIzs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , pphratiou for Divi-p ial Worlui Cna mitrur#intt ramit Application is hereby made for a Permit to Construct ( ) or Repair (>< an Individual Sewage Disposal System at: .....- ---- ----- .......... .................................................. ---------------•----•-----••-•-•---••• --------------------------•--------•-- Location r ✓T��—ES �J� o t - A Owner < - f a �CY` cJ GL.h?.1Tj...... ......`��....��-/Lf4 ---------- ---- ^ ^ -14s. ....... Installer Addres Type of Building Size Lot...........................Sq. feet Dwelling—No. of Bedrooms---------------- ----------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------------------- - W Design Flow...................._..........gallons per person per day. Total da*1 flow...............r7 ------------------gallons. 04 W Septic Tank—Liquid'capacity_P...gallons Length____,F�Width------------ Diameter-_._...._._.... Depth....._..f...._ x Disposal Trench—No. ........Z....._. Width___...7.__--__-- Total Length----- Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet---_................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---------------------------•----------••.....-•----••---------•-••---•... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit------___...____-_- Depth to ground water........................ a •-•------•----------------•-------••--•-•--••------------•-•--------•----•--•--•----......_.............-••---•---•-•---------------------------------•.:.:. 0 Description of Soil........................................................................................................................................................................ x U .................•......-•-•---------------------------•--•----•••----------------------------•---•-•--•••-•-•------•-------••--•-•----••-•....--••------------------•-•----•--------•---•-•-•-•--------- W - ------ - --- - -- --------- --- ----- - --------- - ---- ----------- - -- --- --------- --------------------- ------------------------- . . - Nat u re o-f--R epairs-or Alt e ration s—Answe�r w he n a�p l icable_ « ��'K __� Z&IX 1) - C��UA' �� c.�` � z�s L T , - -- ................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h ee is ue y t oard of health. Signed ............... .. --------- .._._. . . ....................... -------------- 66�el!�Y----- Application Approved B .. y .................... .. ._`'.�. Date Application Disapproved for the following reafonf: ----------- -------------- ........ ......... .............................. -- . .... . ................ ............. . . ....................... ........................................ PermitNo. .------------------------------------ Issued .......... ..". .. ..... - ...... Z� Date No................. `"` FEs.... 5.�.. ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Divi-VntiMl lVnrltg Tonstrurtion Prruld Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal \System at: Location drr s or Lot No. i+ cs'r c ria coy��.s N4� p�c ,J� �t�►��s�?�s ......................_.._....----•---------------..... ------...._._.... ------•-------------------••-•--•-•-------------•----- .. owner _ 1 Ad ress c G.�1 `7(,� (.J� 1 L�4"l .. Installer Address d Type of Building •-� Size Lot............................Sq. feet U Dwelling— No. of Bedrooms._................J.___-__--___-.------_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons______-__._-_____.____-____ Showers ( ) — Cafeteria ( ) QI Other fixtures ------------------------------- - - - ----- W Design Flow....................`5_�............gallons per person per day. Total daily flow................7 ..............gallons. WSeptic Tank—Liquid capacity-�euu---gallons Length__._�i Width...... Diameter---------------- Depth....�........ x Disposal Trench—No. .........4....... 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 ( ) � Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit__-___---__-__-__- Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ x 0 - Description of Soil................................................................................................ -4— ------------------•--------------------------•------------•---.....---- x U w --------------- ------- ----------------------------------------- ---------------------- ------------------------------------ -------- x ------------------- --------•---------•---------•---------•••-.A- U Nature of Repairs or Alterations—_Answer when aP�Plicable..../N��-�l=_________________�C��G/�. 7s¢.!`�.►.� ...........n-z S '-'-...... E�1? -�.-•------._. .............................................. =� r�i �=Yi...................f T S �JE, 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 Compliance has beers is ue y tl 41 oard of health. J- .. ..........t,+ Signed .................. ----- --------� —---- � ----- .. /..:...... ' �'`' � Dace Application Approved BY _ -�-� �i: `--------L/.-. .... �,.�-2 . .............................. ...�.....".'.�'�. Dare Application Disapproved for the following rearonr: --------------------------------------------------------- ............................................ ........j- ........................:-----------------------....------------------------------ ........................................ Permit No. -`�. %'... r .........._... Issued - - ��.." ....��.....�.... 4....�, Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE l Vl er`tifirate of N"Llampli2 nre THIS IS TO CERTIFY—T)ii-at the Individual Sewage Disposal System constructed ( ) or Repaired (p<) F1/Lt'—Gt_ � C_"��. J. .�. u c1....- .................................... by------------------------------------------------------- at - ........... _.- L.!v r.- 5.(✓J. - j J- ,, _... _../ .l........................................ has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .. . ....�4_er fl -.-.. dated / .--..`�. .:_.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BfCONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r.-, Qa DATE -.-.��------------------------------------ ���/-� � .- ...... - Inspecto...-----.�! .�. ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No....... ............... FEE --------............. � nx�,� �utt,�tr�rti�rn �rrinit Permission is herebygranted......__._..._.,__..........................................u� L...-C�n1 .iv�CU�V t��II�M to Construct ( ) or Repair (. _ an Individual Sewage Disposal System at No...............................................;- ....-----•-- C/ fL Sa- Lim, t/lL-i-'�L. ....7 ' ✓1-`---�-............------...... Street as shown on the application for Disposal Works Construction Permit�4o Board of Health DATE=--•--• '~ `.._. Ls. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS