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HomeMy WebLinkAbout0014 HAMSTEAD LANE - Health 14 Haimstead Lane Barnstable F/R A = 349 093 n i v � a y o TOWN OF BARNSTABLE LOCATION AIy ��-,�-,-SZ-1r'A D SEWAGE #.SOD —06 el VILLAGE .Alms�io�r� ASSESSOR'S MAP & LOT 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING.FACILITY: (type) C . (size) 0// NO. OF BEDROOMS /. BUILDER OR OWNER ill I ! L PERMIT DATE: 2 'a® t. COMPLIANCE DATE: Separation Distance Between 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 Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by o 3o.o 0 0 k �56 No. �� �: Fee S70 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for �Digooaf bpgtem Construction Permit Application for a Permit to Construct( )Repair(�( )Upgrade( )Abandon( ) O Complete System El Individual Components Location.Address or Lot No. if M S e A N i Owner's Name,Address and Tel.No. I D �/,tT e5 �Z1N 5�1(rbZ.� 1 Assessor's Map/Parcel �� Q rinr;Vsssan¢, 1v No. -T� Des'g�'s Name,A ss and Tel.No. C/D,vS�r v U 01A Type of Building: &26'($ Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures S Design Flow 3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ®�® 5F Type of S.A.S. - �� e 40 Description of Soil he�Qc k I Sj ch Nature of Repairs or Alterations(Answer when applicable) Date last inspected: DESIGNING ENGINEER MUST SUPERVISE Agreement: INSTALLATION AND CERTIFY IN WRITING The undersigned agrees to ensure th nstruction d maint ce of the afore d j MS191wihliti- cate t`eem TPJCT in accordance with the provisio Title 5.of o de and not to place the sys of Compliance has ee d Si ne Date Application Approved by Date Application Disapproved for the following reasons 4 i Permit No. '-d(p 4 Date Issued No. J�14 + Fee - . _w ...ire..—.. ...�...- ' V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes F PUBLIC HEALTH DIVISION -TOWN OBARNSTABLE,, MASSACHUSETTS j %. f ZIpprication for Disposes *p.5temc Construction Permit Application for a Permit to Construct( . )Repair(k)Upgrade( )Abandon( ) O Complete System 0 Individual Components Location Address or Lot No., j �dhf$(L A tit r Owner's Name,Address and Tel.No. gAILN 5 n1 f31..L't. 7 Assessor's Map/Parcel O IInnstall r's ,Name,Atdqress,andjel:No. Designer's Name,Address and Tel.No. auS r e 0 ,oar L n..)C— 4-�c. e ),0.4.s o.� , 915 77 Type of Building: f Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �`',�t� gallons per day. Calculated daily flower gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /DOGS q �, Type of S.A.S. - SDO -Jo Description of Soil el►c C.k A r•►�far�S Nature of Repairs,or Alterations(Answer when applicable) e A C �,, K)C Date last inspected: Agreement: The undersigned agrees to ensure the construction d maintenance of the afore described on-site sewage disposal system in accordance with the provisions-of Title 5 of ��fy o },to ode and,not to place the system in operation until a Certifi- cate of Compliance has een i s _b_yd . al V Signe Date of Application Approved by---- Date Application Disapproved for the following reasons Permit No. ? C2 i-06n 4 Date Issued 9 P0 017( THE COMMONWEALTH OF MASSACHUSETTS BAMSTABLE, MASSACHUSETTS Certificate.of Compliance THIS IS TO CERTIFY�„tta t the4 On-site Sewage Disposal System Constructed( )Repaired�`(�)�Upgraded( ) Abandon ( )by at a has been constructed in accordance with the pry yisic s of Title 5 and the for Disposal System Construction Permit No. (-U-at t-/ dated A l/ Installer �� c�; Q,` %ti C Designer cc The issuance of tPis permit shall not be construed as a guarantee that the sytem will nction asId signed. Date .Au '/0 L/ " -I fspeetor - !` / /1✓. C No. no L/ - Fee S THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpooar *p!6tem Con! trurtion Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at j A N S�e A ►.1 , and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this 1pe7mit. Date 1�o' Y Approved by TOWN OF BARNSTABLE LOCATION SXcA.D 4/t/ SEWAGE #-aOo —p6 VILLAGE Q ASSESSOR'S.MAP & LOT INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY_ Zow LEACHING FACILITY: (ty : ,0/, C . (size) NO. OF BEDROOMS 3. \ BUILDER OR OWNER / L= PERMITDATE: a® COMPLIANCE DATE: :2,� L Separation Distance Between 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 Edge of Wetland and Leaching Facility(If any wetlands-exist within 300 feet of leaching facility) Feet i Furnished by - E I A-e 3a.o ° ° O F0 c 3Rs— p o , r3-� �y.; t3 v�o•v o Pc FRut°1 F R'; hd0. p�,, a. '�c 200. O_:54PN P 1 MCI 01 03: 09p David and Colleen Mason 500--633 P. 1 Town of Barnstable yugulatory Services A QOmp. F,Cxeik 3 Director Pub it Kealth DIViSiOn 209 'yx�f�in{e�as�1V�$gelCay�m.,m1;13�MeA�u0ry" ' �YY.: 56sR•7�6357� (),141cx: 5G 8-Sb2-a4�c F tally a M8�4T -ado f l ��o r j �vl Ustaller: --- "Jesigmer: ... ....._._ weq issucci it pdtrilt Cry iztstali I rn/t+S Puffy b"o.d O'A'st,dIsiZA d:,Xwb by sep�i�r•syg'l+om� ---�/�c'Irc's5) _ __..,�, r�Ct treed-above ws$ 'installed subsMnalY girding to . lr. 1 that the aopre syirYtem OW!d cliaages stackr as latcrul relocs�atitan of ufie threfs dffiigA,why"'l+ may in�clusla iaun0jr. ° , . eUtlsb�ti�m box w;AUQa seode tank• j Qg*that the � rffi'Wl seE€a-ersCtxi i�x�re w� imsta�lieRf eMrit#t ajar elt�a�(m *,an14' datcxal Yeloclam of,W SAS�any veorh^I1 re"'U' play W nprevi5i c a as of the sole gFt-M)bnt in atcca=day c with Stet 1 �! =dfl eed as b-alt by d,,.Vff to fc,IIOW- 1 a : es�gr s Stgastu �� S "tic 'l'lE DR (};FiCleli�'SC 1$ 6r�4ititl �'�F:111 .. r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA S DEPARTMENT OF ENVIRONMENTAL PROTECTI N u w � . m ' d ; MAP 3 4 PARCEL LOT 2 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 10l CERTIFICATION Property Address: 14 HAMSTEAD LANE CUMMAQUID,MA 02637 L2 dVV4 Owner's Name: NAOMI"HAYNES Owner's Address: 14 HAMSTEAD LANE YARMOUTHPORT,MA 02675 {� Date of Inspection: 11/14/03 ®EC 0 2pp3 Name of Inspector: (please print) JOHN GRACI,INC. TO Company Name: SEPTIC INSPECTIONS WHEAL H DSpT. Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 'HEALTH�F1'T. E Telephone Number: 508-564-6813 FAX 508-564-7270 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes X Condition Passes _ Needs Fu Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 11/14/03 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspect n.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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. PIPE FROM D-BOX TO LEACH PIT IS BROKEN AND NEEDS TO BE REPLACED. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Titles 5 Tncna.rtinn Fnrm Fi/15/?nnn 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 HAMSTEAD LANE CUMMAQUID MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.PIPE FROM D-BOX TO LEACH PIT IS BROKEN AND NEEDS TO BE REPLACED. B. System Conditionally Passes: X 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. Answer yes,no or not determined Y N ND in the for the following ( ) o owing statements. If not determined".please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is.leveled or replaced ND explain: n/a n/a The system required pumping more than 4 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 ND explain: n/a f Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 HAMSTEAD LANE CUMMAQUID,MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 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 public health,safety or 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 public health,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 any)determines that the system is functioning in a manner that protects the public health,safety and 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 SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a r "This system passes if the well water analysis,performed at a DEP certified laboratory,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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 HAMSTEAD LANE CUMMAQUID,MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to 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''/z 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 nLa. X Any portion of the SAS, cesspool or privy is below high ground water elevation. X Any portion of 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 1 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. [This system passes if the well water analysis,performed at a DEP certified laboratory,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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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) 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 in a nitrogen sensitive area(Interim Wellhead Protection'Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 14 HAMSTEAD LANE CUMMAQUID,MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 Check if the following have been done.You must indicate"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 Were any of the system components pumped out in the previous two weeks? - I _ X Has the system received normal flows in the previous two week period _ X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined? the If ( y were not available note as N/A X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and of scum? depth. X _ Was the facility owner(and occupants if different from owner)provided with information on,the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. "I X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] . 5 . Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 14 HAMSTEAD LANE CUMMAQUID,MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): w ©3 _ U Sump pump(yes or no): NO koo Last date of occupancy: n/a Cj2 COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no):NO Industrial waste holding tank present(yes or no): NO i Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as.part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a 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) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components, date installed(if known)and source of information: 1983 PER PERMIT 83-634 Were sewage odors detected when arriving at the site(yes or no): NO f Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 HAM STEAD LANE CUMMAQUID,MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 BUILDING SEWER(locate on site plan) Depth below grade: 9" Materials of construction:_cast iron =40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a . Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade:3" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 1011" Sludge depth: 1" Distance from top d of sludge to bottom of outlet tee or baffle: 33" g ffl Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet'and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a" e 7 f Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 HAMSTEAD LANE CUMMAQUID,MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no):NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): PIPE FROM D-BOX TO PIT IS BROKEN PER VIDEO AND NEEDS TO BE REPLACED.D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): n/a R Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 HAMSTEAD LANE CUMMAQUID,MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: - n/a Type 1000 GAL 6'X 6' leaching pits, number: n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: Na n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil condition of vegetation,etc.): DID NOT EXPOSE LEACH PIT,APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a r Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a ' Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a 4 Page 10 of 11 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1 Property Address: 14 HAMSTEAD LANE CUMMAQUID,MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. a f 56A EACL - ® q AA 3 A6 93 in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 HAMSTEAD LANE CUMMAQUID,MA 02637 L2 Owner: NAOMI HAYNES Date of Inspection: 11/14/03 SITE EXAM + _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. 4 tt C���./ `/ 9 NO C Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Migonl *ymem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. S ^, Owner's Name,Address and Tel.No. fya ,i A,(,- Assessor's Map/Parcel r Ins is N e Address and Tel.N . Designer's Name,Address and Tel.No. �p�YJ��(✓G 1 OtU �NJCr 76 Type of Building: Dwelling No.of Bedrooms_ Lot Size _sq.ft. Garbage Grinder( ) Other Type of Building No.of Pe ons Showers( ) Cafeteria( ) Other Fixtures Design Flow gall per d Ali daily flow g llo s. Plan Date Numb of sktpent isi Djj Title JTV Size of Septic Tank e of S.A.S. il, t Description of Soil too Nature of Re airs or Alterations(Answer when applicable) Aro Pi e tj4 e Date last inspected: V 1�4: Agreement: The undersigned agrees to ensure the cons tio and�ntea nte ceofthe afore described on-site sewage disposal system in accordance with the provisi 6f Tile 5o i on ode Certifi- cate not to place the system in operation until a Cer - cate of Compliance has b n ued by- 's ar e 77 Sig AA Date — - Application Approved by Date Application Disapproved for the following reason a3 on q 4= Permit No. Date Issued /19 -- ------------------------------ ---- ---- No. (G"✓V ... - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:- Yes t PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS s 'ZIPPrication for nigozar *pgtim Con!5truction Permit Application for a Permit to Construct( )Repair( )Upgrade(° )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �, A,m7 S 6 Fri ev AV Owner's Name,Address and Tel.No. �d!�i A'Y"-S Cu,�•m , G rJ r - Assessor's Map/Parcel U Installer's,LN�am .Add and Tel.J.r( Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow gallons. ! Plan Date Number of sheets Revision Date Title 'k Size of Septic Tank Type of S.A.S. Description of Soil t Nature of R,pairs or Alterations(Answer when applicable) 43 r o IC o r b e tj4 4.w ,g e Date last inspected: Agreement: The undersigned agrees to ensure the constructio and maintei dfice of the afore described on=site sewage disposal system in accordance with the provisions o Title 5 of�tl E iron nta ode and not to place the system in operation until a Certifi- cate of Compliance has bedfi"iss.ued.b�-th BS o�azd He f' f Signed�� _ 'xG¢-�c► Atli Date /02.— Application Approved by %/ ; 'i`fr��,,/ 3 . 7�. Date Application Disapproved for the following reason ,n Permit No. "� Date Issued ------------------------- ---j--------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS C�rtif Kate of �CoIiY.�lriaTYCe THIS IS TO CERTIFY, hat the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandonpd( )by sf y r r 6 r 1 �r�c at �`a u Al has been constructed in accordance with the provisio s Title 5 an ,the for -isposal System Construction Permit No. Z� - dated /Z ,_-O j Installer---� a '-§ roti S7-r v C-i'ow �"C Designer The issuance^of this pe shall not be construed as a guarantee rmit e that the system wil_I functions as designed. Date i ., ��J 3 Inspector " No. � � �' ' 1 ——————————————————————— l Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogar *pgtem (Con.5truction Permit Permission is hereby granter to Construct ' )Re par( Upgrade( )Abandon( )n System located at fI/�ri c�'A arm �f u and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. I Provided:Construction must be completed within three years of the date of this,pe'�rnu'vt. � fj� --/'T Date: I Z. - 5 -D`� Approved by 0_ r 1 LO A T ION SEWAGE PERMIT NO. r/ �� ass D Ll L o VILLAGE 1 INSTA LLER'S NAME & ADDRESS B U I L D E R OR OWNER ' DATE PERMIT ISSUED 4, "<-DAT E COMPLIANCE ISSUED 3 1 ��� �� 1 ± ; , __ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appilration for Dispoiial Vorkii Tomitrurtion rantit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at .......1 .! 6T.E .......L A. ............... .....................•---......-.. .............. ,,L� R cp�ion-Address or Lot•No. ....--......''4` .... --...... 17_.f� . 3:::::.:: . ...... ..... ........•--"•---"----•--•----------••-•--- --•-------... -•--•------............-----.. W /tlwn�ty/,, /J /�� �J Address // / ,-] -"------•-----••--------•.....(................( /... (�...P �1(l%'nr Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............�........................Expansion Attic ( ) Garbage Grinder (lyo Other—T e of Building No. of persons............................ Showers a YP g ---------------------------• P ( )--- Cafeteria ) Otherfixtures .......................... -"-""---......---•-•-"---------•--•---•--•-•--•-•--- .............. Design Flow-••••--•-•• •- w gn � �. ....................gallons per per.day. Total daily flow.............. WSeptic Tank—Liquid capacityJ42OQallons . Length. .—.(O.''Width.1..�Id."Diameter________-__-_- Depth!..'.- x Disposal Trench—N ..................... Width"--0........__...... Total Length.._...___..__ Total leaching area........_._..__._ __sq. ft. Seepage Pit No._._._.__�___._.... Diameter...... . '..__. Depth below inlet....... ...._... Total leaching area.,;?. ft. Z Other Distribution box ( <,,Y Dosingtank �] ! W- --_-_- ......"--"- Date--"- Percolation Test Results Performed by....___ �.._ . ..._._ •... ... _ // _,� Test Pit No. 1_.......__ !minutes per inch Depth of Test Pit.....' ..... Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............:......... ... -- O " Description of Soil... 5 - �., a :l{: �N (xj 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 TITLE 5 of the State Sanitary Code—The undersigned f ther grees not to place the system in operation until a Certifi t C pliance has been i d by the and of efilt . l Signed....... --- - ----- �--- ----------------------------•----•---"- ----- ......... ...._........_ D e Application A ro d B ••....--- _---- .....---••----•------••----•-••--••••-- -•-•-•. PP PP Y iy ' at Application Disapproved for the following reasons:...................................................................................................... ........-"•"---"--"-"---"--"-•-"-"---------"•"""....----""-"---•-------------------"-------.....----"-------•-••••-•--••-•-......•--•-•-•••-•••-•------•••••---••----•--•••••-••----•-•••.... Date PermitNo................................:...........•-------..... Issued_....................................... Dater No...8 `l, ,- F�$.....1.�................ THE COMMONWEALTH OF MASSACHUSETTS C { )BOARD OF HEALTH Appliratiaan for Disposal Warkii Tonstrurtinn Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: .......�:/;q �:T = ===� ....•--....-• .......................................Z. .......--------------------..........•••-- /�- '' !''tion.�✓ 3 Add or Lot No. W 0_t / Address / / a Z. .................. ... ..........!......... ,1 �/ P.. !! P!r...,rd��!slL�d ....... �,�.f'�lll. Installer A ress Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............. '"........................Expansion Attic ( ) Garbage Grinder (� O aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ) P I Other fixtures .................................... ••--• - W Design Flow............L .�2....................gallons per:e sarr per day. Total daily flow............... 7�&2............gallons. WSeptic Tank—Liquid capacity)20LIallons Length`5..... c%._ Diameter________________ Depth`_.-..'.... x Disposal Trench—No..................... Width.................... Total Length................... Total leaching area....................so. ft. Seepage Pit No.......... ---------- Diameter.._...j.f...... Depth below inlet....... ......... Total leaching area.. :5...sq. ft. Z Other Distribution box Dosin tank L J t u E. '-' Percolation Test Result Performed by-......_ `"'- ` l' __�_.1..-' '`-------••••_. Date % - t� .. f Test Pit No. 1..........I GPminutes per inch Depth of Test Pit.....t. ____.. Depth to ground water..... _______________ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------•-......--••--•---•• ••••••••••••••----•-•••••••••••.....•-•-•---•--•--••••-•-••----•••-•---••....-----••---------•--•••••......-••--------------- 0 Description of Soil...!... = _ .rtCm --f U .... ---`= J {fV - r%� >r .-•-•--.` .....-�-�----- GJ Tf - ... i"= °- ) --.---••-.1--•- = - ------ W UNature 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 TITIS 5 of the State Sanitary Code— The undersigned f rtlier grees not to place the system in operation until a Certifi t .Compliance has been ' ed by the oard of It Signed----- �;e1""-e� .... ••••... .....� P^ to Application Appro ed By........ r ................................ ---•---• -d------ Application Disapproved for the following reasons:................................................................................................................ ....................•-•--------------=---......_....-•-•-------------------------------...------....-•---•••--•----•--•---------•----•-----••---•--•-•••••••••-......•••-•------•-------•••••••--•...... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH is ..........................................OF..................................................................................... (Irrtif iratr of Taautlifianrr THIS IS TO CE TIFY, hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------Ct....._.•.... ---••-••--•.....--•----•••••.... • -------•--••---....---•--...--•---•----•-•---•----•-------••-•••-•-._.......--- . Insta at ..... '......••••-•••--••-• ....... ....... �= .............................................................. has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.....0.. _-:.�3., ........ d-ated............................................•... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WIL FU 'CTION SATISFACTORY. DATE.. .: ... ...........................•-••--------•-••-...._. Inspector...... --• --•-•-......-•-•-•-••--•••••........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 3 G 3 ....................OF...........---.................... / No...................... FEE.... ............. Rapaasat nrktet� dun trurtilan rrutit Permission iss ereby granted............c•-'•........ • .• ----••-------•-•--------------------------------•--..........••---•........•-•-•- to Constru �) or Re, ai ( ) an Individual Sewage Disposal System Z at No..... . ....-• --••.. ................. ---------------------------------------------•---•------•-.............................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... -......................................................... DATE. r Board of Health FORM 1255 A. M. SULKIN, INC', BOSTON WfL: TEST INVERT" ELEVATIONS NOTES: . DATE. OF SOIL. TEST � 83 INVERT AT BUILDI.NA � - D.FT ALL_ WORKMANSHIP AND MATERIALS WITNESSED: B�Y s,l 04Lsl Jf%CDS8 C. INLET SEPTIC. TANK FT SHALL CONFORM TO D.E.Q.E. TITLE 5 PERCOLATION RATE MIN./INCH OUTLET SEPTIC TANK .9,2,5 FT AND THE TOWN GMAS-t4ni '60LLAULES INLET DIS,TRIBUTIO.N, BOX. 9�• 2 F T AND REGULATIONS FOR SUBSURFACE 08SERVATION{ HOLE' I OBSERVATION HOLE 2 OUTLET DISTRIBUTION, BOX. � o FT DISPOSAL OF SANITARY SEWAGE ELEVATION 1 01'. Q ELEVATION= 0'd LO14m`b 50 $60t L INLET LEACHING PIT -0 FT. w/FINDS BOTTOM LEACHING PIT 80. 0, FT. . DESIGN CALCULATIONS { NUMBER OF FINE- S1°IrND GARBAGE DISPOSAL UNIT... . . . . . . . . . . . . . . . . . . . . . . . . . . I..t/-Tip-r4C,r✓S, o� TOTAL ESTIMATED FLOW (J1.QGAL./BR./DAY x� 8R.)... _�_ GAL./DAY �s + REQUIRED SEPTIC TANK CAPACITY. ... . . . . . . GAL. ACTUAL SIZE OF SEPTIC TANK TO BE INSTALLED... . 10 0 0 GAL. LEACHING AREA REQUIREMENTS _ SIDE WALL AREAL-GAL./S.F. BOTTOM AREA ell GAL./S.F. LEACHING CAPACITY ( BOTTOM SIDEWALL ).. .... . . . . . . 0', Z GAL. nl O hli4'i"�� �3, 1 sF x 1 x X y7 {::+ 3, t�'' X )`fx ` RESERVE LEACHING CAPACITY. . . . . . . . . . . . . . . . . . . . . . . . O GAL. TOP OF .• o� FOUND. ELEV.= 105,0 . CONCRETE 4" SCH. 40 � CLEAN SAND COVERS PVC PIPE MIN, PITCH CONCRETE > 1/8 IPER. FT. COVER f!�• b 12 MAX. 2% MIN. PITCH A�SH OF,N � ��tHOF,yF Z 2�� LAYER OF I/8�= 1/2 �� RICHARD. FLOW LINE N �� �AMes N' � RJAMES WASHED STONE o'HeARrt o y i m �.Q Z 17 i 1 0 ' o. ' i ` ;, Ma 27871 ~ v E 94N Q 4 CAST IRON 0 3/4- 1 1/2 F F � � v c, � PIPE - MIN. PITCH o a w a WASHED STONE ti . 1/4" PER FT. DIS1. o E-- PRECAST LEACHING BOX �p 0w p a BASIN OR EQUIV. n 117, 1000 GAL n w SEPTIC _ TANK � e � 1� , tf- � R. J. .f�•.HEARN, INC., RLS, RS -.1348 ROUTE 134 'EAS•r DENNIS, MASS. PROFILE OF GROUND WATER TABLE � JOB N0. �� CLIENT. �S't'�-'�j 0 SEWAGE DISPOSAL SYSTEM FzEvIs�D NOT TO SCALE I o—( 9 — 63 DATE }g' �� $'3 SHEET Z OF. Z- ASSESSORS MAP : TEST HOLE LOGS PARCEL: �'T' _0 _ v'3 SOIL EVALUATOR:- AN/1 ' MA�OL 5C _ FLOOD ZONE: _ ' L3�!, _ NOTES: REFERENCE: ^��'-� ���• �. WITNESS : 1a�/t �-�•.-�Tb ___---- -` B I} C,� G�Z,7 DATE: k f2 ff PERCOLATION RATE: 1) The installation shall comply with Title V and Town of Barnstable Board of Vt� 'L- lw W Health Regulations. TH- 1 TH-2 2), The installer shall verify the location of utilities, sewer inverts and septic components prior to installation. 3) All septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. S) All septic components must meet Title V specifications. LOCATION MAP .I►�7, (/� __A��IG_ 6) Parking shall not be constructed over H10 septic components. _ 7) The property is bounded by property corners and property lines as depicted. 8) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. Receipt of payment for the fl, plan and installation based on the plan shall be deemed approval of the number of bedrooms. 9) The existing leaching pits shall be pumped and backfilled per Title V {.` Abandonment Procedures. 0 L1� W 10)Proposed leaching is to be within 36 inches of grade or provide venting or cut grade as permitted by the Board of Health. S E P T I'C SYSTEM DESIGN 11)System components to be 10 feet from water line. FLOW ESTIMATE / / Z BEDROOMS AT IID GAL/DAY/BEDROOM GAL/DAY 'EPT I C TANK GAL/DAY x 2 DAYS GAL o�--� USE )D00 GALLON SEPTIC TANK �K.1ST11.�1 oa/ p � \ o 9111L ABSORPTION SYSTEM 1 —I-- ,..- _ A l , •d SIDE AREA: Z u- �Z �t �� D I I�� � , -''��i'-' t O ` € OTTOM AREA: c Z� f.U✓ e ' y' +... 10 SEPT I SYSTEM SECT ION LL��t ) •.w or 03WUL' t � • R t '• ' ( �f IS, a ��OC.�GAL "l b�b JL'1r - �- SEPT I C TANKQV -t� _ __ 3 ,_ 1� (�,q,��'�P.►� SITE AND SEWAGE PLAN I ~ ' LOCATION : PREPARED FOR : "Tu►�� �C)Oe,1 "� 66e-v w —---- ,C� (� _ 1,�o�j - " SCALE iZTZE) 0� o DAVID B . mAsONIR5 DATE: DBC ENVIRONMENTAL DESIGNS Z ,: --- -----3� .. .;,.r'•a,...-3r c. a..__.. .. ..�-'c;�.iar..� = -::'X— yt+r"�-�^.w':.rr :, .. -• •^' EAST SANDWICH . MA Z DATE HEALTH AGENT L508 ) 833- 2177 Z ,41 >T• 1� 4, T f 3 tn v 4 Yid aJ :1 % /r `: •,/ i ,t1 ! - \ /U•r ,�{{ 4 \�\` v s1a yry L�, ' Oil t�e� 3 44, 1 ' _ ; 4' ..�^„`Kr�fh � ... t•tlf 4r•�'�i� �^ T'-,.� "T"' "T'� f , 4*'(/. T^�i�'tT � wr'�"M X� i''.. 1,` ` „y�il+ t7 L? w+ll•'k y A tqlo� Val 4 7: ��4�rr`f �,Q�/,r��'r ` j) j ,!}���} `•.+1��' �u �'�/h� �rl�'� n. i Z. 00, 40 17 V > F L • ., y[ 1 H