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Home My WebLink About0065 MAGGIE LANE - Health 65 MAGGIE LANE, W. BARNSTABLE d A= 217 047 TOWN OF BARNSTABLE Z 17 , Q) I' LOCATION 114-y.2. , /L, SEWAGE # VILLAGE0, s ;I'A � lam, - ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 16 o}L? 4 t �- LEACHING FACILITY: (type) T T . (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a 0 ,� is«. ,- J 12 1 �✓ oyl TROY WILLIAMS SEPTIC INSPECTIONS APR 2 . 3 1996 �' LW Certified by MA Department of Environmental Protection moon Q (508) 760-1819 40 Old Bass River Road t South Dennis,MA 02660 9 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department .of Environmental Protection William F.Weld Trudy Coxe Co error - .seavtw Argeo Paul Celluccl David B.Struhs LL Governor coav,r.4or»r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: (05 MayG�t 1 h, �cs+ l�G�rh>,6- L Address w r.�aofOne �rvfo Date of Inspeotion: Y//G /9 S- (If different) Name of Inspector. l��yj vZ G S W y �f /20A. . Company NameAddress nrSd Telephone Number- , Se- c..bcV & . T� 611CI- l7vE� 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: .� rases - Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inapector's Date: 5,1,E AA 16 The System Inspector shall submit a y of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: I have riot found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below BI SYSTEM CONDITIONALLY PASSES: A/M One or more system components need to be replaced or repaired. The system, upon completion,of the replacement or repair, passes inspection. Indicate vee, no, or not determined (Y. iN' or ND i Describe basis of determination in all instances If"not determined', explain why noti The septic tank is metal, cracked- etnicturally unsound, sho-s substantial infiltration or enfiltration, or tank failure is tmm;nent The system -ill pass inspection if the extstirtg septic tank is replaced with a ponfornung septic tank as approved by the Board of Heaht ,, r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A c CERTIFICATION(continued) Property Address: u Owner. t) S o iC Date of Inspection: f B1 SYSTEM CONDITIONALLY PASSES (continued) 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 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 C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N�I1 Conditions exist which further evaluation b the Board of Health in order to determine if the system is failing to protect the require Y 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 water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I 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 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. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner. Date of Inspection: D] SYSTEM FAILS: 6 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 into 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 SAS or cesspool. — 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 leas than 1/2 day flow. — Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(a). 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. — 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 codform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: N//4 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: 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 lI 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 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: G s M ck y y ; Lo L Owner. Date of Inspection: V/i<. Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. V 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. !✓�A As built plans 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. JL/The system does not receive non-sanitary or industrial waste flow V The site was inspected for signs of breakout. ZAl] system components, excluding the Soil Absorption System, have been located on the site. 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. V 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. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: (o S /'' a 7 7 L Owner. Date of Inspection: S o RESIDENTIAL: FLOW CONDITIONS Design Bow:122 �11ons Number of bedrooms: 3 Number of current residents: O Garbage grinder(yes or no):_4:- S Lary connected to system(yes or no):,y�S Seasonal use(yes or no):�Tlc--5 Water meter readings, if available: Last date of occupancy: D c,c. COMMERCIAL/INDUSTRIAL, N��q Type of establishment: Design flow:_ =llonalday Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 4W 4.�S E'.� I y !n.� �( ,� �7.L 7-O✓� r�[.Y r.. SY�m Pumped as part of Inspection: (yes or no) XJ b t . h c If yes, volume pumped: �(ony Reason for pumping. TYPE E SYSTEM Septic tank/dw6rib�sieoil absorption 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 of information: Sewage odo- detected when arriving at the site (yes or no) (revised 11/03/95) 6 C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: s /t'i A ; Lin . Owner. a S v Date of Inspection: SEPTIC TANK (locate on site plan) Depth below grade: r Material of construction:_concrete_metal_FRP_other(esplain) Dimensions: k- 6 / 6 o L a /(��• Sludge depth: 3 f. Distance from top of f sludge to bottom of outlet tee or baffle: Scum thickness / S%ti I a.y c✓ '_ it "N e Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 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.) Goa. ✓ �` t s ✓ (e- c& f I vl S17-7 O JG ✓ �-�-r/Y a a� ✓ ✓ tJ c_ v✓-Qi� .h W w S o N �� o f i✓hL , GREASE TRAP-.,WA (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 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.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Addrem 6 S 1 V r w e. Owner: Dane of Inspection: TIGHT OR HOLDING TANK: L\//,1 (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP_other(explam) Dimensions: Capacity: ¢allons Design flow: ¢allons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOY- ( locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) 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.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C // SYSTEM INFORMATION(oontinued) Property Address: (p 5 144 a- Owner. / Data of Inspection. SOIL ABSORPTION SYSTEM(SAS): (locate on site PIMA if Possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching Pita, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number,dimensions: overflow cesspool, number:_jnLo Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,eetcJ S U I J 4. ti c.,In c k f- o G w U LJ �• [ /_ - p JO 1� ,.✓4s .ra b c. oc w4-� r..fr` CESSPOOLS ��4 �. �y �Us a� �.�. 6t o.,} �X .rw/.,,w+; 1 o c�� ✓�w.� �4�� f '�9 �r u✓ h.A (.J 6.�-c,i YN ' `'�- �'✓�'✓ ��?�o:+n W t/l c...A (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: 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.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) 8 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property 6 5 M Address. c,y 7, owns: Date of Inspection: 1761 SKETCH OF SEWAGE DISPOSAL SYSTEM:- Include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' vj rra I r DEPTH TO GROUNDWATER — 0 C 0✓.✓F/s .-✓ )epth to groundwater: feet adjusted high groundwater level method of determination or approximation: ;++ I I ✓'L N lM J ✓L. Or✓rJ� `C— IL- W cl T L [� CS /� /�a ` C H o J S �" S I J In J o /a L teAh Li 4 ` l 4 /�c�✓ h t� .-f t ✓ 9 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ( � Parcel Wta I Application it H Date Issued . s Ith Division . _ 6 Application Fee Conservation Division Permit Fee Planning Dept. ' 7�Ih'".ING DES'I. Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Nov Z�1� RNSTABLE Project S eet Addre -0 Village Owner . Address 7 ' Telephone Permit Request � 'CiAQ s ►�-� 2nd floor: existing proposed Total new Square feet: 1 st floor: existing_proposed Zoning District Flood Plain _ :,.Groundwater Overlay Project Valuation A$ Construction Type ' Lot.Size '30 � Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family A" Two Family ❑ Multi-Family(# units) Age of Existing Structure I 7 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: lull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing .3 new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing _new First Floor Room Count Heat Type and Fuel: ❑Gas , Oil ❑ Electric ❑Other_ Central Air: ❑Yes ❑-Ko Fireplaces: Existing I New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:A existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 2<o.� tt If yes,site plan review# �S` �"..� Proposed Usen..� Current Use 6 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �-•`Name �..�it Telephone Number � � � 7 License# C 0 a a G -� Address � 3 g- 5 Home Improvement Contractor# Email rL.w, r.ayw, Worker's Compensation # ALL CONSTRUCTION DEBRIS RES ING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE . 1 ) � TOWN OF BARNSTABLE BUILDING PERMIT-APPLICATION Map _ Al'7 Parcel0 7 Permit# Health Division :/wZ g �9 g Date Issued —c Conservation Division :=.- _ ee Tax Collector Y Treasurer PTiC SYSTEM MuST DE Planning Dept. INSTALLED IN COMPLIANCE WITH TITLES Date Definitive Plan,Appro'ved by Planning Board CODE AND Historic-OKH Preservation/Hyannis (OWN REGULATIONS Project Street Address �� ►�� Village Q;l). Bdi43STR64E Owner gf�� cSGt-SA'R� :�� r Address 6Q6 ]10-661 .1d, &Y976i 0--SOW r Telephone 2q6 — Q9 Permit Request — a ~ 1/5 4OaJig" o,J ) ads � vacary s d S — Dui /9-.3 Or IS 72 Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Estimated Project Cost 30D Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation.. I Family Two Family ❑ Multi-Family #units Dwelling Type. Singe y y Y l ) Age of Existing Structure Historic House:*es WNo On Old King's Highway: WYes ❑No Basement Type: ElFull ElCrawl ❑Walkout ❑Other Basement Finished Area(sq.ft,) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel:.•❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals ��Authorization Ell Appeal# Recorded❑ Commercial ❑Yes eTNut�o If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Z 2i fbM E ] f;M F - Telephone Number Address l o q 5 Al eU RAI 1 l 0- License# CS Q 212 7 3� Home Improvement Contractor# �� Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C1R'P�2Z_1 Yz��J � SIGNATURE DATE _ fi)- C";ua