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HomeMy WebLinkAbout0122 CRANBERRY LANE - Health 122 CRANBERRY LANE, BARNSTABLE A _.. ' Av TOWN OF BARNSTABLE LOCATION C e2 Gru 6edvy L.., SEWAGE # VILLAGE_ ASSESSOR'S MAP & LOT�Sq U g INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY /6 o G LEACHING FACILITY:(type) /k') (size) 6 'od NO: OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER !V���® '6n _ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i'N P- ov t00% it t • 7 SUBSURFACE SEWAGE DISPOSAL SYSTEX INSPECTION gORH Address of property 1;?� C y6,- 4cr,-Owner's nameAfr . / r� Date of Inspection 5 R `� Ip �' N�� PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, Health. , occupant, and Board of None of the system components have been pumped for at least two w and the system has been receiving normal flow rates during that eeks period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 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 g sewage back-up. _ The site was inspected for signs of breakout. A1'1 system components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered o ed l And the septic tank was inspected for condition ofbaffleshoritees,or of material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. -Z The size and location of the SAS on the site has been det on existing information or approximated b ermined based y non-intrusive methods. _A:f'_ The facility owner ('and occupants, if different from owner) were provided with information on the proper maintenance of* SSDS. s 10. dy9� � o� r E SUBSURFACE SEWAGE DISPOSAL SYSTEM -INSPECTION FORM PART B SYSTEM INFORMATION FLAW CONDITIONS If residential _ number of bedrooms number of current residents .1�Ly garbage grinder, yes or no' YEs laundry connected to system, yes or no A10_ seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: OCR- Last date of occupancy GENERAL INFORMATION Pumping records and source of information: �-)- 10 Hd System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system —3� 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) ' Other (explain) Approximate age of all components. Date installed, if known. Source of informal i� q / lc 0 3a t h r�✓ 4 .` �h 6., t 1 t �[� Sewage odors detected when arriving at the site, yes or no r 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK (locate on site plan) depth below grade: / material of construction: V concrete metal FRP other(explain) dimensions:_ S X sludge depth distance from to of sludge to bottom of P 9 outlet tee or baffle HONE 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, recommendations for repairs, etc. ) '-c ,.��P t v , A o J, J /'�I et.e.�Fe k W4C H oT ih Nr4a( OT •� K'1 d i Vl . r LL IG✓ I iG. L /O L�-►-�a.f tJ er- e✓ 4- G,i, DISTRIBUTION BOX: V (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 leakag e into or out of box, recommendation for repairs, etc.-- . _ ) o _ X � N � � a w s � � � .b� f.emu l G PUMP CHAMBER: IVIt� (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) I F SUBSURFACE SEEPAGE DISPOSAL SYSTEX INSP ECTION PORK PART B SYSTEX ZNFORXATION Continued SOIL ABSORPTION SYSTEM (SAS) :_V (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits and number Oil i leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs etc. ) O f V r J c.0 K w A Ya c, O O u CESSPOOLS (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 pondin condition of vegetation, recommendations for maintenance or repairs etc. PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments : (note condition of soil , signs of hydraulic failure, level of pondingr, condition of vegetation, recommendations for maintenance or repairs,etc. ) . 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE E'_SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Fro v,4- a'bit DEPTH TO GROUNDWATER �Le.164- depth to groundwater method of determination or approximation: `J {.� • e V Iti. to �— .� 01� v a c -� h L lit U rh G Q c.J !n L v 4z is BQBSQRFACE SEWAGE DISPOSAL SYSTEK INSPECTION FORK PART C / FAILURE CRITERIA l Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Backup of sewage into facility? Discharge or ponding of effluent to the surface of the round o surface waters? g r Static liquid level in t el � he distribution box above outlet invert? Liquid depth in cesspool <6" below .invert or available voluiae< flow? 1/2 dad Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration ? substantial exfiltrat � ion. tank failure imminent? Is any portion of the SAS, cesspool or privy .. below the high groundwater elevation? within 50 feet of a surface water? . /V_ within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? -LLA— within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water supplywell with no acceptable ceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well .water analx . for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector y 1 I j u S Company Name �^ / Company Address 7 4 / U �d 13a s s v� 4�,1 X4 dMtification 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 rdin upgrade,9 g Pg , maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Ch`e�c one: 1 have not found any information which indicates that t he system to adequately protect public health or the environment as defined ins 310 CMR 15.303 . Any failure criteria not evaluated are As stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303 . . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector' s Signature Date Original to system owner Copies to: T Buyer (if applicable) Approving authority 3_ -4 y Lam, r 6z, ' ' TOP on � 80•MIN. Z� PeR$r�u , POV�tD. l0 MtN. ' SEPTIC TANK r' Ot�j;B07C. LEACHING �'MM1 FA►CU.Il Y 5b,r7� : IObO r�.�, 57. ?I 577 6' 0 I SECTION. � � SEWAGE '1 , ld -q7.5` /qr Ij WRSHED & 1 OWU 7,Esr1401,E LO,65 0E516A1 3 B�pROO TEST ay: f� �R� EWG _'—� � FOR I)N EL-NIG r"t OATF: 2 5 6 PERC.RATE 4 2 H1Al./IN. WJtN�Sg: tJ. F MWEFP, FLONRArE11pGA4 joAr :33Q GPp �=bl 1 O SEPTIC TkNK 330 as) Cps 41gEPTIC TANK ICAO M- Coats '� RING ACIL/7' Ir'" SUS 510FWALL 10 6 2A — 51.s' _ 80 OM iz 7 s, S `q71.O _ CLFa N (1.0)z 710TA4 9J+ s 5� W/ Us r=Fl L sAcHnvr, PIT' f 4' BANDS Err. or- ,AM D I. DATu/y(MSc)t•TAKEN FtoM f� 2.Muw1CIPAl 15 4V�10R1♦NCLs KAl Iqq"— �IATER I$ AMAILAt6L1a 8' DBgIGN L01lpM1G I°OR ALL PRECAsr omir5;M6K0:= U01 WRT. 4.plPp VOINrS SKALL 811HAbE '`' C�NSrRticT/ON DETAlCS AUATEM T/GNT. 70 ISE IAJ ACCOKDAP/C9 I'1M.OF MAsS. SFIITE ENv,,roAme"rA.L ce N/rH 6. r" PI-AA' PoolPROPd d6 7C /3L�"Ev"R PROOE 5�d LIORK 4NGY�)ND dAt'0U'.0 NOr RT'r' CAI. OTAK/N4, AA Of 44 ARNE H. iI NE �yG s OJAIA -r H j OJALA ,� (yowl q� a Q/ a t 9 E c vl a �. l lrNGl►.��I'RT � AI ..r t� �`;� ljRh LAND SURVEYORS �� 92o Malty St.�rynbut$,F. . JOQ NO. APPROVED: board of heq/lh - Q ,MA TOWN OF$WQSTAel lEA55E550R51r1And254 LOT 6(b ZONING: CLUSTER 75 7.S IS SETBACKS: FRONT s 3O 5raEg o f 5 fMAR IS a 7t�,ICARI / ' ct�;Lora i N Ile IQ' LP p towi. Ao L p N E �30,Op w I t k 1. - 35, <Bo.0pA , oNraveS lexryr) Locus : LoT 7, G�A!~IP.S� ��( L .11� RE�Ef�EKCE: '[�C� ,�l MOLE El CB PREPAREo �ST MOLE .. scac.=: . 30 oaTE: 9125y86 HOMEOWNER RECORDS SEPTIC TANK MAINTENANCE �a o ' (-� ~7 Sketch house, septic tank, leaching facility and O show distances from septic tank cover to nearest ' _ I �., I house corners. I C ,"\•d e z �L " � o TANK SERVICE RECORD Approximately 90% of Cape Cod's population Do" conayem. sry+p P+Yf°^+►'d " disposes of its wastewater through individual on-site sewage disposal systems. If properly operated and maintained, an on-site system can provide many ycais of trouble free servire. If neglected, however, the system is likely to fail, creating public health hazards and expensive repairs for the homeowner. This pamphlet describes the principles of septic system operation and explains the maintenance pro- cedures necessary to insure long life for the system. A homeowner's maintenance record is v provided on the back. .� Prepared by: /-' Cape Cod Planning&Economic Deveiopment Commission 1st District Court House If you have problems, contact your local board of Barnstable.MA 02630 health or health agent. Tel.362.2511 Ext,477 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH fSatfirate d. faamOtana L THIS ISJ�T0 RTIFY That the Individual Sew.-We Disposal System constructed (� or Repaired ( ) Ur.L.«.r•r.............�., .....In.UIIK I.—-.— ._...«................��....�...............................�......... at_.......O.... ......... 5 ..................... hits been installed to accordance^ ith the provisions of TCI� 17 pf„T he State SanitaryCode as describjd in tite TOWN OF BARNSTABLE LOCATION �7 cy Lo vie. SEW GBG p VILLAGE � � ` ASSESSOR'S MAP & LOT J INSTALLER'S_ NAME PHONE NO. _'�3- 0 6-d t l 77/`3 &17 SEPTIC TANK CAPACITY h O d 0 LEACHING FACILITY:(tppe) (�2rnG�► i _(size) '�r, jgd ) `i I Ll6(A f NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �j �/S, bQ,Id,j,4 Co. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ;� t ' ������-- i � . ��;� � r 4 � + � � �� � ��� --E, ��-�- � � � �� 6 �.� 9 /1 f f. J _ ; No.. ..... . ... FEs..............».............. THE COMMONWEALTH OF MASSACHUSETTS. g ' Y07 BOARD OF HEALTH ...!:O.!'v. ................OF........ 1v ..................................................... Appliration for Diipusal Varks Tonstrurtion trrmi# Application is hereby made for a Permit to Construct (i/) or Repair ( ) an Individual Sewage Disposal system at:, ... ... .. .........Locatioi r ............................ ........�`-j� ..� .... Lot o........•................................ - �1 .. .._ .--_.. .... ....lr- :........................ ddress..- ............- - ---- A a ........... Installer a Address Type of Building Size Lot............................Sq. feet U a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 044 Other—Type of Building ............................. No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fi` s ..:........... :..... ......... ....---•--.............._.....--••••......' Design Flow..................:.........................gallons per perso per day. Total daily ow............aan.... ......._.._$_ alon WSeptic Tank—Liquid capacity.t� gallons Length .. __.... Width: .` . . Diameter:............... Depth.`..«s x Disposal Trench—No..._"................. Width....:.. .........._ Total Length.................... Total leaching area.......:............sq. ft. 3 Seepage Pit No..........1........... Diaineter.........1.0.... Depth below inlet........e..... Total leaching areal;;? ....sq. ft. Z Other Distribution box (v� Dosing tank ( ) 0.4 Percolation Test Results Performed by................................................... Date.......................................: 0.4 Test Pit No..1...'�. .minutes per inch Depth of Test Pit..��� .._. Depth to ground water....�... ... f� Test Pit No. 2....... per inch Depth of Test Pit......:............. Depth to ground water........................ OG ..............11 - R O Description of Soil.....Q_`. .•--�f-•_ > Sl) Q l�...t •---• - ...... ................ ... '24 W U Nature of Repairs or Alterations—Answer when applicable.................... .......................... .. ... ..........•-.......---.......-•.-_...._......_.....----•-••--•-......----------....----•......------------................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITL: 5 of the ate Sanitary Code— The undersigned further agrees not'to place the system in operation u it a ificaty of C liance has been issue by the board of health. Signed..... •\ • ......................................................... � r ^_ .. Date ° Application Approved By............. ........................................................ ......jd..:.��. r ; Date Application Disapproved for the following 'reasons:.............. ....................................•-----•-----•-..........................---....--•---..........................-••---................-•-•---•--..............................---•--................._ Date Permit No.... . _ + I - ......................................... . . ... Date ' Issued b' — 1/0 7 �+ A - No................ , tea.. FEs.........�........ _ r THE COMMONWEALTH OF MASSACHUSETTS gg_ °� � BOARD OF HEALTH Appliratioll flan 'Di-spnlittl nrkii Tonstrurtiun Permit Application,is hereby made for a Permit to Construct pp y (V) or Repair ( ) an Individual Sewage Disposal System at: ................1-, .......... :.......... .....: .................�... 7 Location=,A Tddress ,h \.C»..... .. ......or�Lot No...» :........«.«.».»..._. r ��c�1C i ..`.. Owner .....—Add s ��J {��(�,/� a � ............................ .. -•---•-••-•......................."......-----Address g-.... ��`i_.. �s�` t.. .. Installer Address Type of Building Size Lot............................Sq. feet U Is ., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a` Other—T e of Buildin 4 yp g ............................ No. of persons---.......-----..---...----- Showers ( ) — Cafeteria ( ) - < Other fixtures ......----•-........---••....................... ...........-•-•--------......----•-------....................---.................._................. Design Flow..................t.10............._....gallons per person perlday. Total daily flow............ _.._... gallons. Septic Tank—Liquid capacity OMgallons Length?:.ll... Width_.. (..... Diameter.................. Depth!!� Disposal Trench—No..................... Width....... Total Length........... Total leaching area__.. '__.........sq.`ft. 3 Seepage Pit No.......... .......... Diameter.........!n..... Depth below inlet.......;:;T..... Total leaching area b ? .._sq. ft. Z Other Distribution box O Dosing tank ( ) a Percolation Test Result Performed.by f..... Date........................................ •--..... Test Pit No. I................minutes per inch Depth of Test Pit--�!q ....... Depth to ground water..._N.4 . . 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Y 94 - ........................ ............... ...... O Description of Soil..... ��--�•� - Q ! " �1 �t�.� .........-- -- --....... ................ 1 4 I1 C�a�.... c uJ �•U ...............................•••--•--...•... •-••---•-••- ........ •-••-•••.....---...-•••-•--•••-••-•--••----. -- ............... .....----••......---•••.. . w ................•---•--•-••-•-••••-•._....•-•••••...•••••-••---•------•--••-•••--•-••••-. x ...-•••-•••----......-•-•-•-•--••......•••••--•---••••••--•••-•••-•---•-•--•••-•-••--•--------•......_......--- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .....----•-.......----•-....--•------------------------------------------............................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 5 of the State Sanitary Code— The undersigned further agrees not to place the system in { operation until a Certificate of Compliance has been issue, by the board of health. .�� r� ...� Application Approved By..'. ......... - - ;t.A T/i...... Date � .............. Date Application Disapproved for the following reasons:............................................................................................................. ................................................................................................................... ............. ..................................... n:.............- . .. ............................ .............Date...... . Permit No..... ....... ------ ---------------» Issued. :. .. Vo 7 te THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH 7.04161.........OF....... ........... .. ............................................ Trrtif iratr of Tomplianr 1 THIS IS TO_CERTIFY at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b \J.....::Z::.........r.:'?':SC<< /� /�;/�.may� / ,,7 -- ----- �1� ( �\�IN/ /`f % `4'AA Installer �Y a ----•••---•_.... ...•-•--- -------- ---•-••-••••--••-••--•------....................................._... .has been installed in accordance with the provisions of TITLEE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.,Vt.: �............... dated....... Q`%1-�,. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 0%- 1/6 7 `'N DATE................... .. ...........�...................................... Inspector.........-----....•--- O. ......'•....----------.....---................ •� G � ���� I ,�THE COMMONWEALTH OF MASSAC.HUSETT546 l� BOARD OF HEALTH ,� _ yr ..........................................OF.......... . � ................................. -��- No. ..................... FEE........................ Rspsal i0arks Tuntrurtiurt Permit Permission is hereby granted.....` :_ . �G I "............. to Construct or Repair ( ) an Individual Sewa a ><sposal System �� at No.....A.UT....... .......i�..._C8.0!�!� C/�'!%�.X..... ...I'' .........._..-----•-----• -... J?' . --...... ..... L r Street �/ -t 1 6 as shown on the application for Disposal Works Construction Permit No...:'................ Dated...I U.....3u , .........--•.--•-..--.... .................•-•-....._............._.._.. ....----...... (71 f 15� � ....................... Board of Ilealth DATE.-------------�------------------..... . ----------- TOIJAI OFBFRQSTABL-E A55F55OR5 MAP23 LOT 6C� 6Z,� ' 2oMlnl. 2,! PERSr01,l E + O 75 7 ZNING: CLUSTER 5 75 r ou:OF l0'M�N. - _ � 5ET8ACKS: FROM-r z 30'510E5.v 15 REAR= IS - SEPTIC TANK FIST. BOX. LeACIJINC FACILI?Y - 55,37 � 57,$7 57.G' _ 5f 1000 GAL. 57.77' S7 5, po b, f. 1051�f \ SECTION- SENAG� qD WRSHED STONE '" � q7.5 - L_E TEST HOLE L065 DESIGN FOR BE°ROOM JAD Dh!ELL I K1C ; o- TEST eY: Z1OW1�1E7JG-�. PERC.RATE4 2 MIN./IN. 15EQCHMRR K DATE : �� 6a�a FLOW RATE 110 6AL:/0AY 'S30 GPD BRB 35) � �' ✓ �IITNE55� Q. �E ITNER SEPTIC TANK 330 (I.S) -195 CgL EL, 9Es.gq' �=rot 10 -REQ'D. SEPTIC TANK ' ICJ© GAL. -I-� 4 I F� 59.5 LEACHING FACILITY 'I S10EWA►L(- IO 6 = IqI$"q (2,5)=g71,0G/D `-" 1 r'' f'� /✓ � ti COGt�t - BOTTOM/ Tr ' /2) = 7E,5 (f Q )= .'78,SG/D 3s' ,f G 2�1'f SUBSC� 51.5' - TOTAL 26&-7 5F, =GA9,5G/D _ CLEA�.1 - 6A2SE - U5E 1 L FACHING ' 1 T ICJ EFF DI A. , G' ; SAtiD EF'F DEPTi-� i Z � - BA D5 o NOTES ' I Y N D - 1. DATUM(MSL)t TAKEN FROM H`�R tJ►.I I S QI/ADRANGLE MAP !. !© ' �'p D. i. — — 2. MUN1CIPAL WATER IS AVAILA13LE S. DESIGN LOAD/N!, FOR ALL PRECAST UIJIT5:AASk -R-1�44 4.PIPE JO/NTS SHALL BE MADE WATER T/GHT, / � f� ��'! � T •5. CON5TRUGTION DETAILS TO SE INACEORDANCE.WITH COMM.OF MA5S. 5TATE ENVIRONMENTAL Goof TITLE 3C 1` J 6. TH15 PLAN FOR PROPOSED AMRIK ONLY AND SNOVI-0 NOT z SE USED FOR PROPERTY. L14. STAKING. C R P1 KI BERRY, ( !� '� 1,��-�tI✓ (o � N-.20--44 � , 0F � sq �, o aRly� SITE__A�1[C7:_:$EIJAGE E. PLAID' OALA o H. -� o�o%L/h ca e eh �%Ieerir� I cE�ENo_: Locus : LOT CIVIL icy OJALA -I � /" � 9 9 - CONTOUes (Ex15T.).----=---- - ' Pao. s r82 0 #26348 �a f CIVIL ENGIt4EERS �. REFERENCE l / II PROP, -b--¢--- PREPARED FOR 'I� (D� �J C)cJr 4� _ a _—.��s °£G��tE ��,�`' _ LAND SURVEYORS CONC.@OUND ) ® Cg EPaRE l�i� 1.4I .Olt PAT E �Ab? { � JALA, 9m Man St.Yormouth/Ma TEsr yore f elth SCa : 5board o - .`36 ' U08 NO. 1'5' `o - APPROVED DATE.: I3a21�[��7�P}l . ,MA