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HomeMy WebLinkAbout0136 CLIFTON LANE - Health 1.36 CLIFTON LANE, CENTERVILLE A= 247 014 UPC 12534 No. 2_153LOR � HASTINGS, MN BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop Date of Inspec Ma arc I Ownero- /e "0 PART A — CHECKLIST E 47 CHECK IF THE FOLLOWING HAVE BEEN DONE: Vo"PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH._ e i !/ NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS kffiN_ RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCEDD I�IJTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP. 'THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. !/ ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. . THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON—INTRUSIVE METHODS. THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL, e� oL_ No of Bedrooms No of Current Residents /V d Garbage Grinder Laundry Connected to System _X KS—Seasonal Use NON RESIDENTIAL: — Calculated flow WATER METER READINGS,IF AVAILABLE: i GALLONS Pumping Records end Source of Information: SYSTEM.PUMPED AS PART OF INSPECTION?/6 IF YES,VOLUME PUMPED = GALS -Reason for Pumping:: . TYPE OF SYSTEM Septic tank/distiibution box/soil absorption system Single;Cessppgl Overflow Cesspool Privy Share&system (if yes,attach previous inspection records, if any) OtherT(explaln)', Appr xlmate age of all components. Date installed,if known. Source of information. g t, °r`� r ir✓*F � kr yt' Uri SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? OUTLET INVERT Comments: e o pISac eso�b77. Oe PUMP,CHAMBERVV 0 Pumps in working order? Comments: IL AB RPTI N Y TEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE Com f rpSnQ CESSPOOLS' '!�' Number and configuration Depth-top of liquid to Inlet invert Depth of solids layer Depth of scum layer Dimension of.cesspooF. Materials of construction Indication of groundwaterinfiow(cesspool must be pumped) Comments: .. .' PRIVY: Materials construction Dimensions Depth of solids Comments .'f THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IM ^ � DATA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: Dimensions: S Material of.constructlon: Concrete Metal FRP Other} Sludge Depth y Distance from top of slud�e to bottom of outlet tee or baffle a 3 Scum Thickness- , `�e Distance from Top of Scum to top of outlet tee or baffle /l/U Q Distance from bottom of Scum to bottom of outlet tee or baffle omments: obi �e� oG O /00 )(o f , . Q $ } e , DEPTH�T 1 11 .. I DWA R "5 DEPTH TO GROUNDWATER METHOD OFD AI�IATIO�I;ORi4PPFfOXiMATION: is{.• 11'{�� �:fy� �W,^ii*4 .' - - - r � {. kx pt w.' �� �'F`f+r. �a 2��``I•yt ��Fpl yr .. -• r 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM A . fi . .PART B — SYSTEM INFORMATION (Continued) SKETCH OFLSEWAQEIDISPOSAL SYSTEM: ,7n1 INCLUDE' TO AT<LEAST:TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL.'WELLS;W: ITHIN.100' Within,50 feet of a surtace water? ✓ 'Within 100 feet of a surface water supply or tributary to a surface water supply? Within alone l of a public well? Al Withim, feet of a private water supply well? Within=50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Less-than100 feet but greater than 50 feet from a private water supply well with no acceptable water qualityanalysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for co6form;bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION r INSPECTOR ROBERT J:'BORTOLOTTI ADDRESS: 765 WAKEBY ROAD,MARSTONS MILLS COMPANY; k �BOR,TOLOTTI'CONSTRUCTION INC. MA 02648 (508)771-9399 CERTIFICATION STATEMENT 1 CERTIFYTHAT I`HAVE=PERSONALLY.INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION ' -:REPORTEDIS;'TRUE ACCURATE`AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATIONREGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THEkPRsJER FU�NCkTIs�N AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. CHECK.ONE�. 'V ;`I HAVE':NOT FOUND ANY INFORMATION WHIC H INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC :.HEALTHxOH:THE.EWIRONMENTAS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS STATE DIN THE;y`FAILURE CRITERIA".SECTION OF THIS FORM. .I HAVE'-DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 0MR16,303 THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS c� i.. r s,> INSPECTOR 3 SIGNATURE'. DATE, ORIGINAL;TO SYSTEMyOWNER,COPIE$'BUYER(H applicable),APPROVING AUTHORITY r. - J $UB.SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Sty. V d..t,a..+. PART C — FAILURE CRITERIA ^'(Indic sde Y-yea N—no ND—not determined.Describe basis of determination.If"not determined",explain why not.) / Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid,level in the districution box above outlet invert? Liquid°depth'in cesspool, 6"below invert or available volume, 1/2 day flow? Al Required pumping 4 times or more in the last year? Number of times pumped Septic.tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiftration? yt tank-failure imminent? V Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? 316- TOWN OF BARNSTABLE LOCATION-X2—��146Q SEWAGE # VILLAGE ASSESSO ' MAP&LOT o/C/- 00b2 .z7VS�ct,���s NAME&PHONE N . Ar C) n// -'/ SEPTIC TANK CAPACITY V�, LEACHING FACILITY: (type) ,GrOz2C A P'Z (size) IL900 cq ,, NO.OF BEDROOMS. z/ BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 t of jeachinn lfac' ' ) Feet Furnished b ✓�h� ,� . , ��� 6� �a��" o �a,��� � may, �,- ft� �� � r 1 Fss....... .... .D.b..... DTHE COMMONWEALTH OF MASSACHUSETTS n a - BOA LTH L,-------------_--....OTF. a.$LU_ ............I......................... , ppliratiun for Disposal orks' Tonstrurtiun ratnit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 1'i•-.-�:t 1+�... s �-.... .....-. ......................................... 5. .. of No. Lac ddres or Lot No. Y cm 0. _ Addicts& n W ........... A. . --• ....... ►-a Installer Address QType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms__________________________ ---•---- Expansion Attic ( ) Garbage Grinder Other—Type of Building ............................ No. of persons.........----------------- Showers — Cafeteria ( ) G" 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 ( ) Dosing to"iPit . O Percolation Test Results Performed by.... -.•-----_...... -•- Date.. •.................................. minutes er inch Depth ...'_`�u_._____. De th to round water........................ Test Pit No. 1`Z...... p p g Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------------_...... O s: Descriptionof Soil-------�-------.--------------------------------------•-------•----------------------------------------------------------------------------------------------------- x U 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 iITL L 5 of the State Sanitary Code—The de signed further agrees not to place the system in operation until a Certificate of ComplianYhasnued by e b and of health. Z/45 Si =---- -•-• --------------- --•------------•---•--••-•-•--...... ------•-------•----- •---.-- Application Approved By--------------•-••- -• .... Date Application Disapproved for the following reasons---------------------------------------------------------------•------------------------------- ----------------- ...........-•------------•-----------•-••••-•--•------------••--------••---------------------•---------...-•----------------•----••••-------------------------•------•-------•-----••--------•--......_.. Date PermitNo....................................................... Issued-....................................................... Date r n • . k No.....46_3=15_6;> Flms.......�t.Q.s .. ..vim THE COMMONWEALTH OF MASSACHUSETTS + BOAR F LTH - ------------------oF........ .�...AJ �.-: t Appliration for DhipmFal lVork.5 Tonarnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ...... -••-- .......................................................... address r or Lot No. t tjJ fs `(X OVF Addr W ._. ....:.................................... .................................I _ �., Installer Address dType of Building ? Size Lot__� �.......Sq. feet U Dwelling—No. of Bedrooms________________________________ Expansion ttic ( ) Garbage Grinder pa, Other—Type of Building ____________________________ No. of persons.........rl-ti ........ Showers ( — Cafeteria ( ) Q' 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 ( ) Dosing tank ( ) '-' Percolation Test Results- Performed by. 2_. ___....____ J" ____.. Date___ Test Pit No. 1___.•-______minutes per inch De th of TPit________•----------- De th to ground water........................ P P P Gx, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -7............................. ........................•----•-----•-----•-•-••••-•-------•..._........................................................... O Description of Soil....... --. ..................................................... x U 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 TITIZ, 5 of the State Sanitary,Co e— The de signed further agrees not to place the system in operation until a Certificate of Compliance has 'en, • sued by e b and of health. Signed_. r Application Approved By................... ' �. i . Date Application Disapproved for the following reasons______________________________ -----------•-----------------•---•-•-----•-•------•----------- -----------•-- ---•-----••----------•-----------------------------•-----._...-------------------._..........-------_•--_.. Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ---^� BOA �OF .TE LT ."` ,era-•...............OF... ... .l....... .................._.........._....... v CIrr#ifirFatr laf utpliFanrr THIS IS TO C FYI That thrdividua Sewa Disposal System constructed ) or Repaired ( ) ... ......4 r ---• ---------------••---•-•._.._....---••••-------••------•-•---•--_••--•- at -•- � /r/Jli taller r �,.. has been installed in accordance with the provisions of TI i r > f The Stflte Sanitary Code as described in the application for Disposal Works Construction Permit No.___._ ___".____tpvl.......... dated-............................................... THE ISSIJANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEM V!I F TION SATISFACTORY. DATE. - ------•• ................................................ Inspector------ -- --- •--•-•-----•••••---.._..--•--._......-••-••-------._.....----_----- THE COMMONWEALTH OF MASSACHUSETTS BOAT OF EV� 3 6� ...............OF......P ,..� .�...._..±........._....._... .._......_......_. No.... .............. ... FEE....... ............... Ekop i Workii T tptrur#ion amit Permission is by granted.--------- -•-Y `�=�' •/fit-Grti to Construc ) o Repai f,awn`'!! ividual ,��evt*.wage DisposalDisposal ystetn reet as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Q �f -•--•-•----• --•----- ----------------------•--•=-- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS • 'N ff-~ 3IA r 33 4A �q N 7/ . 2,D So &XP..AlNs row - Icy. KtST ��' Q1 � MIN I`', •1' 9s. //}7 �1. to�w IV IEhCH . .p . 3 PIT17, . Lo7- 3 OT .30 °q o: FI2m ,�c g . 8'' 124.T -- 4' iao.o �. IsrrR. EL= 100.0 F3QFj — i /9o.Q4 7Crql� ° Z:i I S i w a�a D�AI� v ei- PLA-4 0 Dvc./Qg boa 8R11 .p tla 29874 ,0y l o' SUR��'y ,w A �unneG PRccncxl UNDER AQ�. 1ZC,�-cCT LEGEND EXISTING SPOT ELEVATION 0x0 : ��' oFi���ss CERTIFIED PLOT PLAN EXISTING CONTOUR ---- p -- o�� �e Lo T 3 zA cL��o� ��,►��. FINISHED SPOT ELEVATION , ` �a WEsT- HY�+ �✓�''-�.' �. T FINISHED CONTOUR 0 QRSE Z; NO.i0sso a. IN 1 APPROVED BOARD OF HEALTH 90 c,STE ` �) a ,_� -�..tt .• r �FSS1ONAl.E�C-/ �.;l h.J f A .� ,.' J iIJ A:5 GATE AGENT Al SCALES ;��30� OATEN �� / LOREDGE ENGINEERING CQt iN .; $v0Wo A _ CLIINT_._._. I CERTIFY THAT THE PROPOSED . EGISTERE REGISTERED JQB N0. 9`w..�_ BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING -LAWS DR. .A A-, AS9. ��PT EN�OINE R <.l tz. OF BARNSTASL ' jj . 712. MAIN STREET CH. BY;,. HYANNIS., MASS. SHEET./. OF ? GATE E.O. LAND SURVEYOR - t � 1-4 lN V Q (n:�, 0 � �'. -1 ��. �.� K � K..,.....�..�.�..1 •a�1 r ••1,F1s. m a COSto by y � � h 0 Zi 1 � o ;a oM:9m o)I Li N �c^G .p ... m •ate, O Rt. e 0 '� .,;1 �� O: ♦ n S113s� 441 V y` •i O, ^ t ML r 1 AAA -47 CD 1" � G • �o• • ifs J r • •: r b � hm00 Oh o � � ►q w � � � 2 � o � � � y y . goo ..`, as �A � � � � �� � Aj y �r Vo�` r"n ru �� A � N b1py � `L0a°AT (ON 13G SEWAGE PERMIT NO. ze2 1-4 V I L GE z-^-�. INST L It NA i ADDRESS BUILDER OR OWN DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� �_ �. , - , �- 1� �� -� - . . � � , CENTERVILLE PINE STREET } O PARCEL 247/019D �pG�P R�900 O LOCUS �� Drn NG < PARCEL ID: �P _ 247/020 ROAD CRAIGV�LLE ROAD 0o N SHED OS�Q F LOCUS MAP pP ��1 N PP�\C NC ' LOCUS INFORMATION SEPTIC / `�� ES� � PLAN REF: 118/123 LOCATION (V8 , TITLE REF: 9997/154 PER TIE CARD o0' 201 PARCEL ID: MAP 247 LOT 014/002 PARCEL ID: ZONING: "RB" SETBACKS: 20'F-10'S-10'R " 0% 247/014001 FLOOD ZONE: C" COMMUNITY PANEL: 250001-81) DATED:07/02/92 i 0% S\A CERTIFIED PLOT PLAN O rn �: O LOCATED AT: #136 ,;; r 136 CLIFTON LANE -�-WATER CENTERVILLE, MA. PARCEL ID: 247/013 �p �p$' \\ NZ \ PREPARED FOR GCI BUILDERS O_ \ o \ HYANNIS, MA. I PARCEL ID: \ \ C/O PAUL MAZZOLA 247/014002 \ to AREA=7,500f \ AND OWNER: MAURA E. CAIN ,y - N�1° y SCALE: 1"=20' A NOVEMBER 9, 2009 UPOLE OGE OF P s P � THOFs E. A. S. EDWAR °yam SURVEY, INC. A. 141 ROUTE 6A GRAPHIC SCALE *�� STON D SALT POND BUILDING IN28 0 P.O. BOX 1729 20 0 �0 20 ao eo Po '�F c� T 10 SANDWICH, MA. 02563 LJW ss oN J� qw ( IN FEET BUS:(508)888-3619 FAX:(508)888-2496 1 inch = 20 ft. SHEET 1 OF 1 J 1206 t TOWN OF BARIN STABLE 11-97 NOV 13 AM 9: 13 DI'VIS ION jR � � �ND j � i II1 �;,'jIlI Ill�liilrlj ;l;�jl, �HEADER HE -111" Ln 51-00 V-8 1/20 Lo lid lt�ON- -4 U) r > At u u 0 1/3 O 1/3 1 Z !L o it'll il 'it to to z Z hit �ii III 1!;tj co wmN ;Q-. Sit? A -4>X 14Q �� Q � � -4 al l 1,15 — r I$. M, )R -, 8 r rr lj (IIII I iliiliill .I l�iijl�I THE CAIN RESIDENCE 15(o CLIFTON STREET FINE LINEAPGHI-FECTURALDESTi-k/-'j'N z 13) CENTERVILLE, MA 8WF-5T BAY ROAD 03 TF_RVILLE, "A 02055 ELEVATION 4 SECTION PHONE: 508-420-1230 UD r - lllljl,i.:i;!IiII�;��illl,l,�ill IIIIII Iwl IN! it t lij !fill If I'Iit it H n i ill ' I II HE GAIN RESIDENCE 15(o CLIFTON STREET F INE LINE APCHI-FEC,-7UPALDES-1-GN CENTERVILLE, MA -1A ST BAY ROAD 05TERVILLE, I 02655 8 WE ELEVATION PHONE: 508-420-12-90 16'-a' 41_bn 7i_0" 4i_6u o I a A r^ 1 N S TW 2842 0 34 I/Bn X 53 1/4n 7C (2) 2x8 HEADER 60n GASSED OPENING — `� O — s y IXISTING WALL n —{ N TW 2842 i Ll �11 m D 54 11W X 63 Von 111 � ( z I ❑ ® n ® 1 S A > Di 1 ❑ ° m TW 2842 ------ 34 1/8n X 63 1/4n a B IX4 MAH NY STEP Z W-6" 1 0 THE CAIN RESIDENCE X 136 CLI FTON STREET Z CENTERVILLE, MA m PROPOSED FLOOR PLAN 3'-0° I3'-0" Qp, A O 0 (2) 11 7/8° LVL RIM JOIST ®1 ® s w_ BDF�, N — A Z o \ � O B I1 7/8° I-JOISTS o z dp s B ® 0 (2) 11 7/81 LVL RIM JOIST Z I 1 D D A z s i O C tJ r P to A DN t11 ®� r d Cl r m 0 N z M O q B B 0 ® 1 1 u ^i ®� ,/ THE CAIN RESIDENCE -+ LINE /,��%PCHI-TF—C,-TUPALDESIGNm 13(o CLIFTON STREET FIN Z CENTERVILLE, MA to > 8 WEST BAY ROAD OSTERVILLE, MA 02055 o ► FRAMING / FOUNDATION PLAN PHONE: 508-420-12.-9J6 10-o" 71 W r71 -TI 2XIF RIDGE C3 IIjlltilfllll'ill -u z M i it x jJli zi ! 1 'II IiI 1 Ohl II R i '' iI�!�'iI!'I Ilij� �IiIII THE LAIN RESIDENCE TE INN 136 CLIFTON STREET FWE �I � ARCHI CENTERVILLE, MA DES 8 WF-57 BAY ROAD 05TERVILLE, r'1A 02055 STRUCTURAL PHONE: 508-420-123(3