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Home My WebLink About0007 CAPTAIN BELLAMY LANE - Health 7 CAPTAIN BELLAMY ROAD Centerville A = 230 — 174 UPC 12534 ' No.2 5_R HASTINGS,MN r BORTOLOTTI CONSTRUCTION, INC. i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop CA"i1j 'Buc qPV 'z Ne Date of Inspec} 7/ Ma arcel Owner.--�ors �,3d PART A — CHECKLIST — -- CHECK IF THE FOLLOWING HAVE BEEN DONE: ✓PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. C/NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS . EN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN,,INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. SAS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WIT-N,N/A. THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP, a� ✓(f� �`% c� THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. vALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. 19,96 � C"THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC N, WAS INSP CTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID, PTH OF SLU E� DEPTH OF SCUM. V THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON—INTRUSIVE METHODS. L----THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL No of Bedrooms Q.��'No of Current Residents /V(� Garbage Grinder tOs Laundry Connected to System Y&19 Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: Pumping Records and Source of Information: GALLONS - r)t�r SYSTEM PUMPED AS PART OF INSPECTION? /YO IF YES,VOLUME PUMPED= GALS Reason for Pumping: TYPE OF SYSTEM: Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system (if yes,attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed,if known. Source of information. SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? /r 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) S E P T I C TAN : Depth below grade: Dimensions: Q x x -5- i Material of construction: _Concrete Metal FRP o Other} Sludge Depth 1 Distance from top of sludge to bottom of outlet tee or baffle Scum Thickness , / Distance from Top of Scum to top of outlet tee or baffle Distance from bottom of Scum to bottom of outlet tee or baffle om nts: GL /OOd s� o12 (-I-C m v"41` DISTRIBUTION BOX: G/' ✓n DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: �. -PUMPCHAMBER: I Pumps in working order? Comments: SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE: Comments: f CESSPOOLS: Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater Inflow(cesspool must be pumped) Comments: PRIVY: Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' 3` FRO/ 7- � l O 3y VV DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: III SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA / (Indicate Y—yea N—no ND—not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? IVA Liquid depth in cesspool, 6"below invert or available volume„1/2 day flow? Required pumping 4 times or more in the last year? Number of times pumped Al Septic,tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration? tank failure imminent? A/ Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? Within 50 feet of a surface water? 'A Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? _ Within 50 feet of a private water supply well? !_ l� Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. I; I, PART D - CERTIFICATION INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS lCOMPANY. BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 i CERTIFICATION STATEMENT I CERTIFYTHAT 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 I RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MYTRAINING AND EXPERIENCE I IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS. CHECK ON : I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15:303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I 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: I ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY 'POWN/OF B"LE I LOCATION co,o - 2e�//a1;?24/�c -j SEWAGE # VILLAGEa5�v moo,/�e ASSESSOR'S MAP&LOT 5 s AME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)'?, �� (size) /00 NO.OF BEDROOMS _ BUILDER*O R, PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility a Feet Private Water Supply Well and Leaching Facility (If any wells exist IV IX site or within 200 feet of leaching facility) /Y/ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fac ) / / /V .� Feet Furnished bt�46 7�C c,i 6Aof), -7,)C• I l S ° � � ��S"' I ��' �� S► I�` 3> O ,�)U _ �Y" �� v VN rt 4 UEc � d \v 1 kor LT CY C p ®a THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH &w./ ..................OF....... .................................. Appliration for Disposal Works Tonstrnrtiun frrutit Application is hereby made for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal System at: ................... ... may..._.. s ................................................ Location-Address or Lot No. ��.�7 C-jI� 7 ._... 4_.t........................ �' - ��--�.K.. .�o t s!«c. r�! ss- Owner � Address 1Z\SC�o . ��' .......................................... ...... ........ --......-•-----... .....-----•-••----.---•-•-^-••----------- Installer Address dType of Building Size.Lot_ .y�.2.._..Sq. feet Dwelling—No. of Bedrooms..3....................................Expansion Attic (11(0) Garbage Grinder (MO) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures ...................................................... W Design Flow............ ......................gallons per person per day. Total daily flow----------- ....._............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 Diameter.............._..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ,/) Dosing tank ( ) �' Percolation Test Results Performed by............................................. •----------------•------- Date........................................ a Test Pit No. 1_..._ ._. -..minutes per inch -Depth of Test Pit....... _._ __. Depth to ground water.__.. f= Test Pit No. 2_..} .minutes per inch Depth of Test Pit__._ir. .. Depth to ground water..� ��... 1 --------------------------------------------------------------•-'`•-----•;-------•.--•-•-........................................................ O Description of Soil•-Q....................L�4i`x � ( .................- �------�`�= ��`� ---�Ny------•----••--- x — • / ,L - 5� Ri 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 iITLB 5 of the State Sanitary Code—The undersigned further agrees not to place the system'in operation until a Certificate of Compliance has b ued by theof health. Lsr /p�35 Sig d.-- -• ••• �11.�a� .Y.... �_...L-. Dat �,C Application Approved By---•-•. . •---• -_. ._. ....•-•-----•-----•••-•-•••-•-••-•---•• ...........V __9__ I Dai Application Disapproved for th following reasons---------------•-------------------------......---------------------------------------........................ .................•-•••-•••--..._..----------•------•-----••-•...•••••-•••-----••---•-----•--•--------------•••------•---•--•••----••---------•---------•--•--------•---•--•-------------•---•--•-•-•-•-- c-� Date PermitNo....... .................. Issued..............•-------------------••-------------------. Date a F � No....................... b THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r4s!'. OF...... r',4'-_", :., .............................. Appliration for Biiiposal Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: :a ------------------------------------------------- - - -• . � Location-Address or Lot No. ....-•--- bn. J'?+ .......................... .......... • -,Owner Address ...................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._; :....................................Expansion Attic (A(f) Garbage Grinder (,Vr) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a4 Other fixtures .--•-••......•. •--•---•-------•--••--••--••••... . W Design Flow........... �......................gallons per person per day. Total daily flow--------- : ..................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 (Z Dosing tank ( ) aPercolation Test Results- Performed bY----•-•--•••-•-•------•---•---•----••-•-•-•---•-•-•-•......••••..........-• Date........................................ Test Pit No. 1.... ..........minutes per inch Depth of Test Pit....._. ..._... .. Depth,to;ground water.____.__________ ._-. GL, Test Pit No. 2---"ram---_40..minutes per inch Depth of Test Pit.__.. .. Depth to,ground water_:!-------------------- I ' .......-- .-•-----------•---•--••---••••-•••••----••..............••-••--•-•-----•--••...........-----....-i•-----...-•---•.......................------...-- O Description of Soil L .:___?w�`.......: r.-.x= "`'...e.......- .M1.._ .� , til x -- -- 1.6«:'j Vic.�----------------------- r � 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 TIT1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. r1 g g �at Application Approved B Da Application Disapproved for th follow' ing reasons:-----•---------------------•--------•-----------------••-----•--------------•----•--•.......................... ----------------------------------------------------------------•---------------•---------•-•-•-•---•-.............--••••-••-••-•-----•--•----••------•-------••-••---•••----•-•-•--••--------•--..... Date PermitNo.----- _.'_ .. .: ................. Issued....................................................... Date ' THE COMMONWEALTH-OF MASSACHUSETTS BOARD OF HEALTH f^✓�!r!...... ..............0F..._/7 A R A45.r!'5 ............................... (Intifiratr of TnntpHanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) r� F ........... Installer _ at ---- ---• ----- .c', � _ -'l .. 4^4- '------ 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............................. ---_._---- dated___.._____._________-_______._____---_-_.------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUE® GUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE . - ----- -- --..... Inspector P t THE COMMONWEALTH OF MASSAC ETTS BOARD OF HEALTH .. �t+ 1..................OF....6 "Aem --- ---...-----............... • �... No...- ��-•�� FEE... ..... Disposal Vorkv T-141n#rnr#inn rrntit Permission hereby. granted.....-•:. ------• ....--•--•............................................. to .Construct (4 or•Repair ( ) an Individual Sewage Disposaj4ystem at No... _7 --, -a..,... s .0 �f ........ -► Street + •. as shown on the application for Disposal Works Construction Permit No.1)..J?__ ated.._..... _.�j ._...... --------------------------- of h . > --:.. trd Healt ,. DATE......... ." g' --•--------------------------------------- FORM 1255 A. M. SULKIN, INC., BOSTON C r• �` J t1 r r �> ..013 � r L�14r F p ,;' ' �' 7� I " Alp VJ r Q� d D T 1 �- 0 7 3 -- Z 5, 4 7i2 S,F SU � / AR ¢y k Ol � 4 a L4�z'rl457` l50 Fi"� r N f f r t 4 A `� } SA L-UT � � S�l�sT o > • � � 5` IZ�fir. '� �• tJ r L07- 9 'A C.R C - SC-.TZ3 it c/<S. \ / NOTE ; A5-5cJ i ✓ M` pRoTECT'i0nl SECTI IJL G:E. Tv .✓N f3 y�..� v✓s / �1H OF c, R®BERT AL.3kl2"f\ , j C B. ' ELDRE:'DGE y No. 19367 o rho.1G951n. L 1' v'� IST C� r. LEGEND `= EXISTING SPOT ELEVATION Ox0 CERTIFIED PLOT PLAN ` EXISTING CONTOUR --- 0 - - Lo T 3 C47 /*j,- Li4A/E ' iFINISHED SPOT ELEVATION FtNtSHED CONTOUR 0 C z,5—.-A TE-f< L/, �.�. IN � �APPROVED BOARD OF HEALTH 9 A I;kl 8 fA 9 L A A ASS* SS+ DATE AGENT SCALE: / = 'O"DATE t G aErLDREDGE ENGINEERING CO. 'NOCLIENT I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED �3 9 BUILDING SHOWN ON THIS PLAN JOB NO. _ CIVIL LAND DR.BY= A �•�'I CONFORMS TO THE ZONING LAW t r ENGINEER SURVEYOR OF. BARNSTABLE , MASS. S-- 712 MAIN STREET CH. By: CBS H YA N N I S, MASS. SHEET OF DA E REG. tLAWb SURVEYOR �....c,. ^-Y: y e ._...�._ r _ �,. -��._..r ..ter. ... ., r.c,.. �-: .:- _. .r�,�,,_ l"-v'.. �., ♦ ..'' k. ?F). a ;9AA'a .. Y.\' •F 'J .d:: r ,:7''f�'�4y.1..^�.. .i+'. ...�^ .S'S.. #�- ,.w. .s. .' XS' ; .: ...+»y Yk. 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Cel S7-/RO/y G�✓ER:3'HA L L"BE //SEA P.TGN . /F:%N GR/VEy✓AY} ' L S o o CDI�ERS -� 'p v._• a .4aE . . co rfR f1 EAA' SAA/-.0 Ai• _ BACXF/LL I L •a LQUIO L Ei/EL •TrT-.�, {-=°r r,-r� . ..``.:� -^- I� �. PIA. 2 LAYER sCH ED Uum P/PE /UOD s . /yASHF S ,, is-yi I�lIIV.O/Tc/v GAL. ► • .� . • , . . � ,. . OT" E r'T SFpTIC TANK D/ST. • •'• I , � . . ,. . . BOX • • • � $ • • • • • � • _ '^ * 4 - / r? :�;, • • • loop r • • • • • WASNED STOVE 37 7 .� • • • • •• • • a p. . pREC,gST SEEA4GE � • • t • • • • • � ,•i . P/7OR EVVI� /l1(YC/t"r CL f Y.4T/ON J FiT CA�''�c rr 490 G A L�t7�'y s •. • • • •' • • • • • /NYERT A7' QL//LD//VG `�q,-O.= 3SEE na�/L A rlON> /NL ET .�iEP'r.*C TANK /2 � O/�4l►� LC � OU74&T SEPTIC Ti�tNK 43.3 fT. !INLET O/STR/D//T/ON BOX `/ FT SECT/ON OF' GROLNO MG9TE/� TitQLE OvTLETD/STR/BYT/ON BAX 4z.(� �. , /INLET LEACN/NG PIT `/Z�'fT. SEWAGE O/SPOSA L SYSTEM IrAaVLA ON # . LEACH/NG o/T o/MENs/oAf A � FT. i JCALE : %4 s /=0' f'T, DESIGN CR/TERIA 'OlAfA Vs1o/V a � UNDER OF. QEDRoOMS � D/ME1VS/ON G LA f T. �'^� . a4RdAGEO/SPOS,AL C//V/T I✓��+iE SOIL LOG S0/1. TEST TOTAL E,?T/A'fA-rED FLOWS/3'3 G4L.�DAY SOIL TEST ,*/ SOIL TLcST*2 �S VUMSER aoc 4fACNI/VG P/73 f^E[C✓. �S] f`-ElEY. OATS OF JO/L TEST S// (' S/DE 10PCH/NG PER.P/• - I1/ SQ FT. 1 RESULTS PVIr"ESSED or PM ��LD�✓ , p -Z z �/ -�-N�9i- ✓/yJN. I NCH OCTTOM4.z4CH/NGpERP/r 3S4• AL -V P-A7 y �OTi!L LEACHtn'G AREA Z6y S� r7 su/35C7/ )W.VCOLAT/ON DATE�2 Zoo Q LEACNI/16 AREA z'�`t SC. f T 2- z g s��Tys�+.✓� 5v/�L -77---s7- ice — ¢� 3 �7— s� UT 3 Frz3E[LAMy .�st.✓� S;. Nu 66a`!c'� A,L®c.4T '\�_',<: PJrJ—hiT G' B. d S.ii7:S� Al �!` f7 L Ar- '� 5A-,� ELDREDGEE/1ArlN.EWa R/ s c �.crvic_ s'R 4" /9 MA-� �,• a 712 MAIN ST.� HYANN 1 G' \`v,! n - a NOGRO[!ND YY�4TER ENG'OCINTERER 3.7 eZJEA0'7-' BkiC T _ �� GA:OIl/VO kVATE,P AT ELBY! 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T..T.uJ.-y-r C►ZouCaN) �0 � '� DUcR a S i D r=5 4Il 5 H r,JG UEf 3O -.S 7-rid,r- ry v�� o V r:2 // 1 GD X., PLC, /X,5 fzDS 3 „ l�V�� ST• X a-..oZX.y Ta.(�_._ N-ew a r ' ►23a ' T x� NAIr- -- a axe/ ei�"cY. a-Ax417` P P CONC. �DUa U Q' ' h y � Ix8�A CIA a L a q GON7T/ L'-y/-o� _b Ix85 FF/T 4i� obi N D000r- +Z 211�y �1 q'MI,J. ,S�Loid 6124-.vT Jx8�LZI�� ` o % 1a7-@ 9"tit/a AA)C.Ho 2 --O Gq-" PEP uJl DEn1-7:Ec j, DA71AP 10Qo0 NP U Zs �uD,�b ---- -- EscsTaxs G/b"oC- eZ�4 D I 1, LOG)L _ L ANGttOc2 &OLI-r - __.f-P2_.coop _zv... Dooms .. ... _ . . /, S 8-ELoW G/t N -a-E 2 /LO. /o' 9- "/lp. " „�. 9,V-7 Ora. boo 2 F - p 3px68 9�T �D! o�y5!(p chi]N7�A-T70N PL..4-nJ r 1 _ t BRA NS F/E,-D