HomeMy WebLinkAbout0140 HARRIS MEADOW LANE - Health 140 HarrisMeadow-Lane 7
Barnstable P
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LOCAT10N ��®'��%� SEWAGE #GP60-
V gI'.AGEJ�k�r � �%'/>�b/� ASSESSOR'S MAP & LOT29'OV5'
INSTALLER'S NAME&PHONE NO.
^� Cam®
SEPTIC-TANK CAPACITY AIDO
LEACHING FACILITY: (type) /IV41rp (size) ;0,S /X—?4 �X 7 �
NO. OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: 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
d . a
IL eiY Lye
l
s
No. c?U�— Fee �y
• THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpprication for �Diopooar *pztem Con!6trurtion Permit
Application for a Permit to Construct( )Repair("pgre( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No/V6 141cz//-;S C A-k)AU
Ow er's Name,Address land Tel.No.
Assessor'sMap/Parcel
Installer's Name,Addres VIVO UNCO Designer's Name Address and Tel.No.
Jown �4 p2 �✓l
350 Main Street
W. Yarmouth, MA 02673
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 7 S� gallons per day. Calculated daily flow y yU gallons.
Plan Date /"A /9, .2gba. Number of sheets l Revision Date /-,Z/4
Title
Size of Septic Tank /ova Ex,s1��t 9 Type of S.A.S.C.
�S
Description of Soil sr �� �-A IN��C�;_Vt 20-J`X36)
Nature of Repairs or Alterations(Answer when applicable) -C l (A AJ
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 lace the system in operation until a Certifi-
cate P Y P
of Compliance has been issued by this Boaz f H
Signed C Date 1
Application Approved by Q Date
Application Disapproved for the following reasons
Permit No. — '� Date Issued Q
--L
Fee
4
THE COMMANWEALTH OF MASSACHUSETTS' Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
14
01pplication'for Miqaal 6potem Construction Permit
Application for a Permit.to Construct( . )Repair(t.4pgrade( )Abandon( ) El Complete System D Individual Components
Location Address or Lot No./40 Cr/t is/V-Qr, OIL�J 1 A Owner's Name,Address and Tel.No.
k/e&) -T-0 Lj
. Assessor's Map/ParcetD80 . 4�5-6cs(ArLilf
Installer's Name,Address,and Tel.No. Designer's Name Address and Tel.No/
Type of Building:
Dwelling No.of Bedrooms Lr j 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' y y gallons.
Plan Date /71.4 X /9, Jc,,6 A Number of sheets Revision Date "V ZA4
Title —1
Size of Septic Tank /ouo peofS.A.S. V-Z
Description of Soil r 117-2osX
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of thelfore described on-site sewage disposal system
n accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
Cate of Compliance has been issued by this Board •f Hril.
Signed r Date
Application Approved by _�c Date
ng reasons Application Disapproved for the following
Permit No. Date Issued a(L
———————————————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(d)
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired L.-*)Upgraded
Abandoned( )by
at
1416) Ik
,f t , 4 U—,- alit .61 j 14 has been constructed accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No;DLb_'-)-7_KDated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the systeeNwill functio as desi d d.gne
Date Inspector J
—
No. e-K —————————--------------------Fee
------------------Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE MASSACHUSETTS
Miqooal *ggtem Conotruction Permit
me o Grade Abandon Permission is hereby granted d t Co Repair(14rpg
at 4
System located Ar, 1Y 4�00 A.Q.
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 of4hipermit.
Date: C) Approved by_K_Q_
T WN OF BA.RNSTABLE
LOCATION SEWAGE c5'6C-4— "
VILLAGE Q_ ��� �% � ASSESSOR'S MAP & LOT290—OVr
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY �r57
LEACHING FACILITY: (type) (size) & x 36 7
I NO. OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: 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
—r
r N
� , r
I a o � D �. �
I �3 �
TOWN OF BARNSTABLE
C ,
LOCATION /90 114--is /l yitc%✓ La/ S WAGE #,2 ` ylc 3
VILLAGE � ��� r ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. � Co�/s�iccfia✓ �' C
SEPTIC TANK CAPACITY 60K cc,. 1&2 /S-r G/QG hVe-
LEACHING FACILITY: (type) Kd c' (size)
NO. OF BEDROOM _
BUILDER O OWNER
PERMITDATE: 6--a-a2 COMPLIANCE DATE: id wo
2
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5 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 f
within 300 feet of leaching facility) Feet
Furnished by 9, �- r gle
�zG
Li
ss�
OO
� I
QR lrna<,oc s/,o � I
/��/0 c•j't/l�147 I I
$.3'6° '
I
Apt
tel.(508)362-4541
.939 main street rt 6a yarmouth port fax(508)362 9880
mass 02675 down Cape eft
gineerhng
civil engineers& land surveyors
structural design
Arne H.Ojala P.E., P.L.S.
Daniel A.Ojala,P.L.S.
land court Timothy H.Covell,P.L.S.
surveys
November 15, 2002
site planning
Thomas McKean, RS
sewage system Director, Barnstable Health Department
designs 200 Main Street
Hyannis, MA 02601
inspections
Re: 140 Harris Meadows Lane, Barnstable
permits
Dear Tom:
On November 12, 2002, Down Cape Engineering, Inc.
performed a+ soils inspection as required on the approved
plan at the above-referenced location.
This is to certify that the soils removal was completed
satisfactorily.
If you have any questions, please do not hesitate to call }
me.
Yours truly,
Arne H. Ojala, PE, PLS
Down Cape Engineering, .-Inc.
cc: Ken Fowler Y•
TROY WILLIAMS-
SEPTIC INSPECTIONS
Get-tified by MA Department of Environmental Protection ~� yFq°yo��Tr�e` g8 (508_) 385-1300
19 Hummel Drive A F
South Dennis, MA 02660
COMMONWEALTH OF MASSACHUSETTS 6
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS COPYDEPARTMENT OF ENVIRONMEN
ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON, MA 02108 617-292.5500
WILLIAM F.HELD TRUDY CORE
Govcrnor
Secrctan
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr
PART A
CERTIFICATION
Property Address: /yO rr f M ewd.o,, Lh, i3<..-.,s{�.b 1� Address of Owner:
Date of Inspection: Q�
spe 6 /�/ "W (If different)
Name of Inspector. T r0y W i 1 1 i ams
I am a DEP approved system inspector pursuant to Section 1S.340 of Title 5 (310 CMR 15.000)
Company Name: Troy .W i l l i a m s Septic Inspections Qra N k /�/i1 /0 7U
Mailing Address: _19 Hummel Drivp - SDuth lennis , MA 02660
Telephone Number: (508) 385_1300
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:
,Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature _ Date:
The System Inspector shall submit a copy 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:
VI have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 1 S.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
61 SYSTEM CONDITIONALLY PASSES: A//19
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.
The septic tank is metal,unless the owner or operator has provided the system inspector wiih 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 exfiltration, or tank
failure is.imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
1 r•�r••d 0�/2 SJ 971� P•q• 1 or 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A.
CERTIFICATION (continued) t
140 Harris Meadow Lane,Barnstable,MA
Property Address: Tom &Helen Welling
Owner: June 2, 1998
Date of Inspection:
B] SYSTEM CONDITIONALLY PASSES (continued) A//1�
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). Describe observations:
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
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IT APPROPRIATE) 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 l00 feet to 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 (approximation not valid).
3) OTHER
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 140 Harris Meadow Lane,Barnstable,MA
Owner: Tom &Helen Welling
Date of Inspection: June 2, 1998
D) SYSTEM FAILS: A1119
You must indicate ei;-.er "Yes" or "No" as to each of the following:
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.
Yes No
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 less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
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 ar 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 wRh no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS: Al/l
You must indicate either "Yes" or "No" as 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
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'll 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.
(r•v1••d 04i2;i 5'I D•o• 1 n �
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
140 Hams Meadow Lane,Barnstable,MA
Property Address: Tom &Helen Welling
Owner: June 2, 1998
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes, No ,
_ Pumping information was provided by the owner, occupant, or Board of Health. 1
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.
Y _ 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.
_ The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
�/ _ All system components, excluding the Soil Absorption System, have been located on the site.
.1L _ 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,
P q d, depth of sludge, depth of scum.
/ The size and location of the Soil Absorption System on the site has been determined based on:
_✓ _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
_ Existing information. Ex. Plan at B.O.H. '
Determined in the field (if any of the failure criteria related to Part C is at issue,approximation of distance is
unacceptable) (I5.302(3)(b)J
(reviL d 04/25/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 140 Hams Meadow Lane,Barnstable,MA
Owner: Tom &Helen Welling
Date of Inspection: June 2, 1998
FLOW CONDITIONS
RESIDENTIAL:
Design flow: yyo g.p.d./bedroom for S.A.S.
Number of bedrooms:
Number of current residents: CG
Garbage grinder (yes or no):—Y—FS
Laundry connected to system (yes or no): YES
Seasonal use (yes or
Water meter readings, if available (last two (2) year usage (gpd): 6,o u u 4 /� �-s 7/q g = G yw
Sump Pump (yes or no): yt S
Last date of occupancy:
COMMERCIAUINDUSTRIAL: /,/M
Type of establishment:
Design flow: ttallons/day
Grease trap present: (yes or no)_
Industrial Waste(Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title S 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: 7
Ca IJ1
System pumped A pan of inspection: (yes or no)_.A/o
If yes, volume pumped: gallons
Reason for pumping:
TYPE 9F SYSTEM
✓ Septic tank/distribution boz/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. Copy of up to date contractt
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information:— c- Q (, �7 f
Sewage odors detected when arriving at the site: (yes or no) /✓o
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 140 Harris Meadow Lane,Barnstable,MA
Owner: Tom &Helen Welling
Date of Inspection: June 2, 1998
BUILDING SEWER: A//,g
(Locate on site plan)
Depth below grade:
Material of construction: cast iron 40 PVC other (explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:
(locate on site plan)
Depth below grader b
Material of construction: 2concrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions:_ s iX
Sludge depth:_
Distance from top of slud a to bottom of outlet tee or baffle:. ,,y
Scum thickness.-`.r. 4e,✓
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined: P✓b 6 e. .
Comments: =
(recommendation for pumping, condition of inlet and outle tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence� of leakage, etc.) PU c�TQ� - , /� t c-r ck 5R- `Y���t f— - 'r a u .,/
G
t,j e-r- - TU�J r.- , ✓- ��
GREASE TRAP:
(locate on site plan) -
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) .
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
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.)
(-i-d 04/25/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
140 Hams Meadow Lane,Barnstable,MA
Property Address: Tom &Helen Welling
Owner:
Date of Inspection: June 2, 1998
TIGHT OR HOLDING TANK: A1119(Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level: Alarm in working order_Yes; No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: L e-
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) iL
AJ
J 6 w �k
.PUMP CHAMBER: /J/4
(locate on site plan)
Pumps in working order: (Yes or No)
Alamo in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of'pumps and appurtenances, etc.)
(rwlsed 04/25/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 140 Harris Meadow Lane,Barnstable,MA
Owner: Tom &Helen Welling
Date of Inspection: June 2, 1998
SOIL ABSORPTION SYSTEM (SAS):
(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, number:
leaching chambers, number:
leachinggalleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:_-d," --
overflow cesspool, number: '� ,k 1a
Alternative system:
Name of Technology:
Comments: y
(note condition of soil, si ns of hydraulic failure, level of ponding, condition of vegetation, etc.; /
l
CESSPOOLS: A04 ;
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensionsof cesspool:
Materials of construction:
Indication of groundwater: '
inflow(cesspool must be pumped as part of inspection)
e
Comments:
(note condition of soil, signs of hydraulic-failure, level of.ponding, condition of vegetation, etc.)
PRI.VI:
(locate on site plan)
Materials of construction:
Depth of solids: Dimensions:
Comments:
(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
(1—i—d 04/25/97) P.q. a of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 140 Hams Meadow Lane,Barnstable,MA
Owner: Tom &Helen Welling
Date of Inspection: June 2, 1998
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
I (,3l.owor
1
gyp, 5/b
a
�,- .
< r
a Or u e— Lj
Ily
(rwls.d 04/25/97) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 140 Harris Meadow Lane,Barnstable,MA
Owner: Tom &Helen Welling
Date of Inspection: June 2, 1998
Depth to Groundwater 7 k'Feet J adjusted high groundwater level
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the /High Groundwater Elevation. Must be completed)
Uriyi �. u � 4es + ha �2
C�✓C kJ h J� h1 a j c✓I �. T / i IJd f/'+�l a, c -11 Ic e4- c. h S ., c2 /
c, ✓o �«.Ji..j Sc. �<r c^ ✓c y ✓irc� o � ��r,
Z L�. ti y ; S /� l0`L a- -cc/t
cU:,( . �i/raJ�l� rJ4-�<✓ (J j JS t n <n� S ti✓< h/Gc. ✓✓w (—�
-(r—i..d 04/25/91) _ Page 10 of I0
LXOjCATION SEWAGE PERMIT NO.
J
VI`LLAGS
Po oqi�f
I N S T A LLER'S NAME iORESS
�r
U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE I S S
� 7 �a-
n4,
t
-cI Pro
Y � -
t
Fxs... ... ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.................. .. ................OF...�4
Appliration for Bhipoii al Workii Tonstrurfiun -Vann
• i
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal 4
System at: typ l
f �
..Los-i� ................................................. ......:!. ..... ��!p�•..s��9B�P..
Location-Address or ......--
•
v '- ••••••••••-•.............•-••........•-••••••. ••..._..._•---•-•• Slsl<! try ......n!-' .................................................... '
` Owner Address
a .....__sfc.rQ. .... . ......... .. •----•----•--..P- ..�d/K_i...................... ....
Installer Address
UType of Building Size Lot..YZ__9Q.F_......Sq. feet 1 .k
a Dwelling—No. of Bedrooms._T'REE.......................Expansion Attic (.vd� Garbage Grinder
a Other—Type of Building _C' o ............. No. of persons. _��'e........__.. Showers (�) — Cafeteria ( ) '"
Other fixtures
d ----------------------------------------------------------------•------••-----------•..-----•-------•----
W Design Flow•...........................eeQ._......_.gallons per person per day. Total daily flow..........................33Q_.......gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. ;
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by..... ............................................ Date....G� �___._..._.._.
a
Test Pit No. 1------- ....minutes per inch Depth of Test Pit_....!o'........ Depth to ground water... ---------
f14 Test Pit No. 2._ ........minutes per inch Depth of Test Pit......e.-5!.......... Depth to ground water__-1'r........_.
04 •-•----•-••--•-------------------------•--------•--•--•-•--••.....-•----..._......•------------•----.........................................................
0 Description of Soil........ ?f...... �9.✓.�__ C! sa�'c
�:.�.�._ a•-•-------•-•-• --------------•--- ••---••-•---•---------•••• ---- ------------------------
-------------------------------- s _
� ---) . cam.__�_�i_
UNature of Repairs or ns—Answer when applicable � .. /-�- y ------------------------------------•--------------------
--••----•--••---•--••-------•-•-......-••--•••--•--•----•-•----------------••-------........_.-•------•••••-------------------•--•......----•-----------•-----------------------------.....----...------.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI.E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ken issued by th rd of health.
Signed...--
...ID
r
..........................
ate
Application Approved By..... ---- .......0-p ------------------
Date
Application Disapproved for the following reasons:_...................
-----...._.. ......_.....
..---•--------------------------------------••---------------•--------------••--------------------•-----•-----•-••-----•••-•-••---------•------••---•------------••---•--------••-----------•--••-------
Date
PermitNo......................................................... Issued.......................................................
Date
r
x THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..._...... ~ .....................OF....'�' ! ::..:
Applira Lion for .anti#
Application is hereby made for a Permit to Construct (601 or Repair ( ) an Individual Sewage Disposal
System at:
.�......-..`{S ....►a..aAz.. /91t•f .... �e^,...5 s� +w^c9t"C... ................ - ....._..
Location Address ��-•� or Lot No.
....I r fD.cp / Trd.� .... ... t/ef! C o Y......�'1..9.................................................:....
._...---_...........................^_...
Owner Address
.............................................................-
C�
Installer Address
Type of Building Size Lot... Z.2-0..F______Sq. feet
., Dwelling—No. of Bedrooms.__ '"�`J �`______________________Expansion Attic (.01 Garbage Grinder (VI
'4 Other—Type T e of Building �*�� No. of persons 704,9S'A'.__.___._.._ Showers —
f-4 YP g ---•--•-•----=•--•-----.... P - (�) Cafeteria ( )
Q' Other fixtures -----------------------------------
----------•-----------------------•----------------•----•-------------••-•••---_------
W ..
Design Flow___________________________/� _______:_gallons per person per day. Total daily flow____.._._._.__._._._____.._tea 6.......gallons.
WSeptic Tank—Liquid capacity----_.......gallons Length, _____________ Width.._ Diameter_:_____________ Depth................
Disposal Trench—No_ .................... Width.................... Total Length..................... Total leaching area....................sq. ft.
Seepage Pit No---------------------- Diameter.................... Depth below inlet.................... Total leaching area...................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results erformed by � o e--IF__________________________________________.Date._._.s�.'°�'�_` �?___...__..__.
Test Pit No. 1........ `,.m nutes per inch Depth of Test Pit_____!6'___.__. Depth to ground water:._I5,.8_'..._._.._.._.
LL, Test Pit No. 2.._�.....;_nt'nutes per inch Depth of Test Pit______� ......... Depth to ground water.._ ''S_�_._______
Description of Soil......... ..___.._..._..________-
„-... -• -
V Natures e of 1Zepairs o ns 'Answer when applicable._____ ...............................................
Agreement
The undersigned agrees to install the',,aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance ha si een issued by the, s d of health.
,..� Signed----...'>..-•----`-e'" "=.-•---------------------......................... ................................
Application Approved BY----- f �
Date
Application Disapproved for the following reasons:-------••---•--------•----:-----•-•-----••••----••••---••••--••--•----------••••--••------•-••••--------------•-
...................•---------•••••--••--....----••----•-•-•----------•---•-------•-••-•--------•-•--•••••••---------•---•-••-•-- -••••••----••-•-•---------•--•••-•------•-----••-•••••----•••••---
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
•......"J•Gst>�....................OF..: .........._ • °•.F..--...._..........................
Trrtifiratr of TomptiFaurr
THIS IS TO CERTIFY, That the Individual Sewage IDis osal stem cspstructed ( Y') or Repaired ( )
-�
by :.:.............:............ ........................ :...:. - -=--•--... ... ..........................................................
Installer
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described 'in the
application for Disposal Works Construction Permit No---------------------
-------------------- da d................................................
THE ISSUAN E THIS CERTIFICATE SHALL NOT BE S A UARANTEE THAT THE
SYSTElm9 VlIILL N TION SATISFACTORY.
DATE.......«-4.. .... �. ..........••----••.....••-----_.. Inspector. ---- ...................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF Hf�TH
...........................................OF.......,Ci�k�-:_:.......___ .........-....._......_._......._..-.._......... r
No. ................. FEE. ...........
liov at 4kii Can* dirrat rruti#
Permission Is y granted. ��� � == �
to Constru or R. i an,. - 'idual '.wage Disposal System
atNo. Y -----___..�1----�, l� -- . ....------•--.---•--- -----------------------------•. �'= --�- ...................
}�
r }�-s�✓ Street / ! fr
as shown on the application for Disposal Works Construction Permit No..... Date _
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
-
362-4541
92V main street
yarmouth
mass. 02675 down cope engineering
civil engineers& land surveyors
structural design
James H.Bowman P.E.,R.L.S.
Arne H.Ojala P.E.,R.L.S.
land court John W.Jalicki
surveys
site planning
October 14,, 1982
sewage system'
designs
Town of Barnstable .
inspections Board of Health
Town Hall
Hyannis, MA 02601
permits
Dear Members of the Board:
This is to certify that on October 4, 1982 I made an inspection
of 'the sewage system at Lot 11„ Harris- Meadow Lane and found that
the system has -been installed according to the approved plans and
permit.
Sincerely,
�A • ��
Arne H. Ojala, P.E.
AHO/mkh
cc: Barnstable Conservation Commission
David Sauro, Builder
Victor P.itzi
Jr
.. . . .
� �
�,
I
i
• C��i F,
�r
..y. ...I�� ..,�:: r_-: '„ �: v ;. :; a' 17i .. • ,:..t:ai:�±' (:• J!.'��.-• -ai r.�.: t�t:s 1.<:?�: _"a. _,M«a� w,.,s': �.il /`, - s i .---.,s
i
3[7k 0LJ(Tert
r � /
E} 6 Id{ t4 c s x-i-.Sx.Y'xFm
Removat'Car�tra�~+�Tn Carrtami o Assoil
esstn t :
W ME WA rim=
J
'�2nk�ttfarm rattan♦.
I
.:17ts�asai�rrtarrrzat�o ALL,
}x�
.., 'k. 7 .� .:.C.
« RJR.
r
lot 57cu ae Sea& 9;�,,X.,,W
Forth FP 291
RECEIPT OF DISPOSAL OF UNDERGROUND STEEL STORAGE TANK .�
NAME AND ADDRESS OF APPROVED TANK YARDt�� .: 1
YNNI WAIA
APPROVED TANK YARD NO. Tank Yard Ledger 502 CMR 3.03(4)Number:
I certify under penalty of law I have personally examined the underground steel storage tank delivered to this"approved tank yard"by firm,corporation or
partnership and accepted same in conformance.with Massachusetts Fire Prevention Regulation 502
CMR 3.00 Provisions for Approving Underground Steel Storage Tank dismantlin
FDID# CC �r g yards. A valid permit was issued by LOCAL Head of Fire Department.
to transport this tank to this yard.
Name an®fficial till of appr�vyed.tank yard owner or o ers authorized r sentative:
SIGNATURE TITLE
DATE SIGNED
'his signed receipt of disposal must be returned to the local head of the fire department FDID#
:ACH TANK MUST HAVE A RECEIPT OF DISPOSAL -- pursuant to 502 CMR 3.00.
TANK DATA TANK REMOVED FROM
Gallons d 7t�
�`"' ) /77 l"1 P�_ "5� ' � G
(No.and Street)
Previous Contents
Diameter Length
(City or Town)
Date Received f
Fire Department Permit# �✓C�1�
Serial#(if available)
Tank I.D.#(Form FP-290)
Owner/Operator to trail revised copy of Notification Form(FP290,or FP290R) to UST Compliance, `
'� Office of the State Fire Marshal,P.O. Box 1025 State Road,Stow, MA 01775.
NO #arr.13 #We
i
i
y
is 4 ',s,.a= �+•�-�
u u � too"",
uPC i2 34 '
Mp.
bllJifi��i•
SYSTEM PROFILE AssSsoRs MAP 280 PARCEL 45 TEST HOLE LOGS
TOP FNDN. AT EL.
-- ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE)
LOCUS
ACCESS COVER (WATERTIGHT) TO ENGINEER:
AH OJALA, PE
MINIMUM .75' OF COVER OVER PRECAST /` WITHIN 6" OF FIN, GRADE 2% SLOPE REQUIRED OVER SYSTEM WITNESS: P. MURPHY, HEALTH AGENT
RUN PIPE LEVEL 2" DOUBLE WASHED PrASTONE� DATE:
6/27/77 & 3/31/80 I
FOR FIRST 2' PERC. RATE = 5 MIN/INCH
EXISTING 1Q00 H-20 STANDARD 18" MINIMUM COVER
GALLON SEPTIC
13.54 INFILTRATORS` 7' CLASS SOILS P# $ N
TANK (H- 10 ) ;jTGAS 1 7� —L
R E—USE BAFFLE o
+y..
13.28' o z
4' 8 Cr
0.58 12.7' ., ELEV., ,. a
Xj
DEPTH OF FLOW 13.8 0 14.0
TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE LOAM AND ROUTE sA
i INLET DEPTH = 10"
14" LOAM AND SUBSOIL
CLAY 18'r
OUTLET DEPTH LOCATION MAP NTS
LEACHING SUBSOIL ELEV.
FOUNDATION— EXIST SEPTIC TANK 35' D' BOX 11 FACILITY 5' 7_9' SILTY 13.5'
CLAY
LOAM AND
CLAY
ENGINEER TO CERTIFY ® SUBSOIL
SUITABLE SOILS PRIOR TO
INSTALLATION OF SYSTEM HIGHEST OBS. WATER EL. 7.7' 53" 9'5' s 5
(� I COARSE
SAND MS W/LT
BENCHMARK: TOP STONE 84" OBS WATER OXIDE
BOUND = EL 12.7' FINE
72" 8.0' SAND
22S WATER
PAVED/GRAVEL
DRIVE
EDGED WITH 80.()0 EXISTING 84" OBS, WATER 7 0'
LEACH FIELD
5' REMOVAL OF
COBBLESTON ""'�r� APPROX. LOC.
,..�'
UNSUITABLE SOIL MAY -- �� MUST BE REMOVE) IN M5
I BE REQUIRED AROUND ly ITS ENTIRETY ALONG
PERIMETER OF - WITH ALL
LEACHING FACILITY, _ ` a CONTAMINATED SOILS
I DOWN TO SUITABLE 3.7'
SOIL LAYER. REPLACE ~ TTH1 120' 3.8' 124' 1.5
WITH CLEAN MED. OARD 15 2
EDGE OF I SAND. ENGINEER TO WALK I ' / PROP. VENT
WETLAND � � NOTES:
INSPECT AND CERTIFY
.10T s
REMOVAL. SEPTIC GLL,IVN: IUM I(GARBAGE GISFOSER IS i-
.
' EXIST. -
`r<'N ( �) DESIGN FLOW: 4__ REOPOOMS ( 110 GPD) 440 �P7 ti'^!PA' ,�fr,=,�' 1 :C EXIc r !G
D—BOX REMOV ., DESIGN .�. � , iv��)� �.,�� �
USE A 440 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
2ND STORY \ SEPTIC TANK: 440 GPD ( 2 ) = 880 4. DESIGN LOADING FOR ALL UNITS TO BE H.— 20
DECK RE-USE EXIST. SEPTIC USE A 1000 5. PIPE JOINTS TO BE MADE WATERTIGHT.
TANK ____ GALLON SEPTIC TANK (RE—USE EXISTING) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
LEACHING: ENVIRONMENTAL CODE TITLE V.
DECK EXISTING SIDES N/A 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
EDGE OF 1 DWELLING / : TO BE USED FOR ANY OTHER PURPOSE.
WETLAND , TF a 18.17' 20.5' x 30' (.74) = 455
BOTTOM: 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
TOTAL. 615 S.F. 455 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
USE 20.5' x 30' LEACH FIELD WITH 3 ROWS OF 4 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
FROM BOARD OF HEALTH.
�%K Hi 20 STANDARD INFILTRATORS WITH 3' STONE AT 10. PUMP & REMOVE EXISTING LEACHING FACILITY & D'BOX
SIDES AND BETWEEN ROWS AND 2.5' AT ENDS
N REPAIR
00 LEGEND TITLE 5 SITE PLAN
CV
- 100.0 PROPOSED SPOT ELEVATION OF
100x0 EXISTING SPOT ELEVATION 140 HARRIS MEADOWS LANE
IN THE TOWN OF:
EXIST.
100 PROPOSED CONTOUR BARNSTABLE ( VILLAGE)
'
GAR.
LOT 11 100 EXISTING CONTOUR PREPARED FOR: KENNETH FOWLER
47,928 SFf
30 0 30 60 90 Feet
BOARD OF HEALTH
APPI:OVED DATE MA SCALE: 1" = 30' DATE: MAY 19, 2002
off 508-362-4541
VP fox W8 562-9880
1N OF M� t
down cape engineering, Inc. M Of�� ��y �,� '
N. G IRK
� CIVIL ENGINEERS
199.66' O�P LAND SURVEYORS
0
939 main st. yarmouth, ma 02675 ,��
oz-osz
ARN . OJA DATE
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GALE A S S H o 1�/ti/ Loa,ti, ,f' -- / 197,9
s;/�c,� c a, /FED/.s�L- dK FNI/3E2 %S, ,yam:,
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_�"o`-o—o -` Pr'oPosed GontourS ,�/9�E'/11 T/9BC.. E_- � MASS.
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