HomeMy WebLinkAbout0046 COLLINS AVENUE - Health 46 Collins Avenue
Centerville F/R
A = 210 007
I
I
�11/l �REcvago
m0 �J gym
UPC 12543
No. 53LOR. °o�.coNS°"`�
HASTINGS.hiN
.. No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes_J__/
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for �Diopo!ml *potem Cong;truction Permit
P
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) 1:1 Complete System ❑Individual Components
Location Address or Lot No. 6 r NS de Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer e A�dd ss,an_¢Tel No/ Designer's Name,Address and Tel.No.
�(77
Type of Building:
Dwelling No.of Bedrooms L5 Lot Size sq.ft. Garbage Grinder( A)o
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
Size of Septic Tank %_500 Type of S.A.S. 0 rjj 4C4CA;y!;,; SL4,-ii
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 'jd2 C rase 4v���/'i
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 provis' 5 nvironme tal ode and not to place the system in operation until a7Celrtifi�c
ate of Compliance has b n ' sued by d of th
Sign (711V Date
Application Approved by Date
Application Disapproved for the following reaso
7
Permit No. r Date Issued
at o.
No: - f�� r Fee
THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer:
Yes`
PUBLIC HEALTH DIVISION -TOWN 6F BAARNSTABLE., MASSACHUSETTJ 1
t
?� ZIpprfcation for Mtgpoqar bpftem Congtruction Permit
Application for a Permit to Construct( ),Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot N�o. ` 6 , NS J 2 Owner's I�am�A ess and Tel.No. j f
Assessor's Map/Parcel 2-5,— 0
7 y r
lnstaHq.re:s,Y7rne Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms _5 Lot Size sq.ft. Garbage Grinder 0
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow �Lj gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank �5�� Type of S.A.S. �00 Sf4 1,,C4C
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) v4e ►^a�e ` o �12 / ./��/
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 provis' Gf`PiHS 41 nvironme a ode and not to place the system in operation until Certif-
cate of Compliance has b n i ued b b a d of k3ealth,
Sign 4e Date f
Application Approved by t l 4 Date
Application Disapproved for the following reason L.
Permit No. �X r Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO C$BTY,(that the On-site age Disposal System Con ructed O Repaired ( )Upgraded( )
Abandoned( )by "b ► r y c``( G ► S -
at constructe ,in(acc•rdance
with the provisions of Title 5 aj d the f isposalcSstem Construction Permit No. dated s I 1
Installer l ,6 S Tr y C U s o Designer vo a e s(t A 1
The issuance o s i shall not be construed as a guarantee that the sy tem will,f 0.ction as d igta d.
Date a 6 Inspector A— p
v
1— ———————————————————— ———
i
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
71M.5po5al 6p.5te`m Construction Pgmit
Permission is hereby granted to Conso u�J�O Repair(J�)Upgrad � lo�( y/
System located at / "a _
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: Construc ' t ,e co[i�l-eted within three years of the date of t ' �e t:
Date: / O / Approved by J
u
TOWN OF BARNSTABLE �C
LOCATION �� Cn��.��s /�r/� SEWAGE # 074,44—�s 3
VILLAGE G��it. =2 !/���.CE ASSESSOR'S MAP & LOT /�
INSTALLER'S NAME&PHONE NO. yZl rszu—y
SEPTIC TANK CAPACITY /I!r-
LEACHING FACILITY: (type)==� (size) a2—SZXJ
NO. OF BEDROOMS -3
BUILDER OR OWNER
PERMIT DATE: COMPLIANCE DATE: 71
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
r:
Edge of Wetland and Leaching Facility(If any wetlands exist j
within 300 feet of leaching facility) Feet
Furnished by N
u2,0
'� o � 9•0
- F3/• O
oe
o,= •o �r� 1
I
May 25 04 09: 23a p, l.
..I
-ro n bf Barnstable
Regulatory Services
`owas F C c r,'DiMMr
L
SMAIL
Pabfic Hadtk Divbi*D
i0 '£borms 1 dCk2n" urec4or
200lVJigS Street;"mis,MA 02601
Office: 508.862-4644
)inst r c� Deer�erfficatiion Fortin.
ate.
u (� A i,A v of..L►llJe.
1�esigner: �. i� � Installer* � K.��,.,._��_...��
Address: � -
�
Qa was issued a,permit to iassatl a
(inst9 kr)
septic system at 1.QIl��9b :1_. �cssT�E. 11c. based c��a dcsigo dxe,�by
I p A --7(a fess
w Y�11�w t dated
--- .
to
I ctxtify that the septic system m erenced abovewas n a as lateral rctoc4.o of the
she demgo,ww1mch may iaa�cltWk-ssx' r aP� chwg
di5tr-Lbuh<w box and ar s+ept kc UMIL
I cectiff that d,10 septic system refer above w*s installed with awaic r e ges (i.e.
fir, UX Shan lop laffieral relocation of the SAS or ate+vr3lic2l relation of amp►mnponmlt
of the sceptic sue)but in acmrdaice wiilft S to&Local RegalAtiona- plan w4ision or
catifed as4mit by d to fou ww.
µ
ex'$Siutc r_.
DesignCr's Stamp 11=5
PARR TO L
CIE E l
ARE REI
n�x sT y »> sa
U.
Q: Cettiticaton Form
TOWN OF BARNSTABLE
LOCATION CO /Oyr-- SEWAGE # aoo4-•L2JS 3
VILLAGE C)FiVY'75, ASSESSOR'S MAP & LOT all
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY J.S OQ
LEACHING FACILITY: (type) ' l• (size)
NO. OF BEDROOMS -�
BUILDER OR OWNER V
PERMITDATE: S - 0!1 COMPLIANCE DATE: a( U
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
L3 -'
• D 3 �7' O
F3i. 0
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o � �a•O
1 Alo, (o
oi•'' •0 �rl �
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e
tt,3
FAILED INSPECTION 1
DATE: 1 1 /8/01
PROPERTY ADDRESS: 46_Collins Ave
Centerville,Mass. n %
------------------------
02632
------------------------
On the above date, I inspected the septic system at the above address.
This system consists of the following:
1 . 1 -6 'X8 ' Block cesspool.
2. 1 -LP-1000 Packed in stone. 61X8 ' 3
Based on my inspection, I certify the following conditions:.
.3 . This is not a title five septic system.
4 . The sewage system is in hydraulic failure.
5. A new title five septic system needs to be installed.
6. Pumped complete system at time of inspection.
7. Waste water was above all of the invert pipes.
SIG NATURE..s' _
Name:_J_F_ Macomber Jr_______
Company: JoseTh_P. Macomber_& Son , Inc . RECIE J -6
Address:- Box 66
------------------ DEC 0 7 t IJ u l
Centerville , Ma . 02632-0066. TOWN OFBAR..NSrABLE
HEALTH DEPT.
Phone:— 508-775-3338
--------------------
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tan ks-Cesspools-Leachfields
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775-3338 775-6412
•
i
COMMONWEALTH OF MASSACHUSETTS
t EXECUTIVE OFFICE OF ENVIRONMENTAL, AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:46 Collins Ave
Centerville,Mass.
Owner's Name: George Wetmore
Owner's Address: Same
Date of Inspection: 8 01
Name of Inspector: (please print) J.P. Macomber Jr.
Company Name:Joseph P. Macomber & Son Inc
Mailing Address: P.0_ Box 66
ran1-arvi 1 1 c 14a 02632
Telephone Number: 508-775-3338
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. 1 am a DEP
approved system Inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
_ Passes
_ Conditionally Passes
Needs Funher Evaluation by the Local Approving Authority
iF Fails r
Inspector's Signature: Date:
The system inspector sha bmit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 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
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and CommentsIr ,
""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.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 46 Collins Ave
Centerville,Mass.
Owner: George Wetmore
Date of Inspection: 11 8 01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:40
Al I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 C R15.304 exist. Any ailure criteria not evaluated are indicated below.
Comments:
The cesspool and leaching pit are in hydraulic failure.
A new septic system needs to be insta e
B. System Conditionally Passes:
_,d)o_ 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 statements. If"not determined"please
explain.
4,;=The eptic tank s 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:
t'IIL° Observation of sewage backup or break out or high static water level in th istribution bo 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:
AThe 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:
2
r
Page 3 of 1 1 ,.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 46 Collins Ave
en ervi e, ass.
Owner: George Wetmore
Date of inspection: 11 8 01
C. Further Evaluation is Required by the Board of Health:
.d�� Conditions exist which require f inher 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:
416 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.
'0 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
,Ud The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
�(IQ The system has a septic cant and SAS and the SAS is less than 190 feet b 50 feet or more from a
private water supple well". Method used to determine distance
"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
The sewage system consists of. 1 -6 X8 bloc cesspoo )
1 -1000 gallon t,recast leaching pit 6 ' X8 ' ( 19 82 ) The
pit acts as the overflow.
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 46 Collins Ave
Centerville,Mass.
Owner: George Wetmore
Date of Inspection: 1 1 /8/01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yew No
✓ Backup of sewage into facility or system componentFdue to 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
4/d41e— Static liquid level in th distribu_ tion box bove 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 1/2day flow
7
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
oft
imes pumped I.
Any portion ofthe SAS,cesspool or privy is below high ground water elevation.
2Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
/water supply.
41A, y portion of a cesspool or privy is within a Zone 1 of a public well.
tiny portion of a cesspool or 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 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.)
(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�
ththe system is within 400 feet of a surface drinking water supply
v system is within 200 feet of a tributary to a surface drinking water supply
he system is located to 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 I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 46 Collins Ave
Cen ervi e, ass.
Owner: George Wetmore
Date of Inspection: 1 1 /8/01
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes Noll,
Pumping information was provided by the owner, occupant, or Board of Health
Zwere any of the system components pumped out in the previous two weeks?
2— Has the system received normal flows in the previous two week period ?
Have large volumes of water been introduced to the system recently or as pan of this inspection ?
_ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
z_ Was the facility or dwelling inspected for signs of sewage back up?
_ Was the site inspected for signs of break out ?
_ Were all system components,041uding the SAS, located on site?
Were thq septic anholes 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 depth of scum ?
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
/_ Existing information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance
is unacceptable) (310 CMR 15.302(3)(b))
5
� Page 6ofII
•
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 46 Collins Ave
Centervi e,Mass.
Owner:George Wetmore
Date of Inspection: 11 /8/01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): .
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):-;YQg=3 10�
Number of current residents: 02 _
Does residence have a garbage grinder(yes or no):46 r GI
Is laundry on a separate sewage system (yes or no): 4-6 [if yes separate inspectiog-rGqu�yed�j
Laundry system inspected(yes or no): S
Seasonal use: es or no
Water meter readings, if available(last 2 (gP ))usage ears d : 1 ` ✓C� CZ CJ S ��
Y g
Sump pump(yes or no): ,C.pO
Last date of occupancy:OPA
COMMERCIAL/INDUSTRIAL
Type of establishment: /yl�
Design flow(based on 310 CMR 15.203): ,V, gpd
Basis of design flow(seats/persons/sgft,etc.): 4
Grease trap present(yes or no): A14
Industrial waste holding tank present(yes or no):All
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use: A1�4
OTHER(describe): 4//¢
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no): ,
If yes, volume pumped gallons-- How was quantity,pumped determined?Lly �l/
Reason for pumping: o �j
r
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
T Single cesspool
Overflowresspce} k;/d?) .6 X 1d
Privy
Shared system(yes or no)(if yes,attach previous inspection records, if any)
V Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
4:11)Tight tank 0 Attach a copy of the DEP approval
,V6)Other(describe): _ XJ/
App ximate as f al �ponent , date ' stalled 'f kn own)and source of information:
Were sewage odors detected when arriving at the site(yes or no):,,0
6
0 Page 7 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 46 Collins Ave
Centerville,Mas
Owner: George Wetmore
Date of Inspection: 1 1 /R/o 1
BUILDING SEWER(locate on site plan)
�7 qd
Depth below grade: /l
Materials of construction: _cast iron 40 PVC .,,/&ther(explain): A/90
Distance from private water supply well or suction line: is',*-
Comments(on condition of joints, venting, evidence of leakage, etc.):
Joints apnaar t; qhi No Ai»denca of leakage. The systefft-
is vented through the house vents.
SEPTIC TANK6&&(locate on site plan)
Depth below grade:
Material of construction:4kconcrete,d4 meta Lc 4 fiberglass.opolyethylene
Nyother(explain)
If tank is metal list age:" Is age confirmed by a Certificate of Compliance(yes or no):A.)A (attach a copy of
certificate)
Dimensions: 4ZA
Sludge depth: AM
Distance from top of sludge to bottom of outlet tee or baffle: ��
Scum thickness: A)A
Distance from top of scum to top of outlet tee or baffle: QUA
Distance from bottom of scum to bottom of outlet tee or baffle: V4
How were dimensions determined: Az,Q
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 is not present
L
GREASE TRAP�.(locate on site plan)
Depth below grade:
Material of construction:444 concretet/2 meta L4�Lfiberglass4J polyethylenuO other
(explain): 42.4
Dimensions: 11/X
Scum thickness: 'VX
Distance from top of scum to top of outlet tee or baffle: i!/A
Distance from bottom of scum to bottom of outlet tee or baffle: ,e*
Date of last pumping: r(J4
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
Grease trap ; -, nnt_prasent
7
Page 8 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 46 Collins Ave
Centervil e,Mass.
Owner: George Wetmore
Date of Inspection: 11 /8/01
TIGHT or HOLDING TANK (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: 41?
Material of construction: t),4 concrete metal W fiberglass A&Ipolyethylene lZLother(explain):
AJA
Dimensions: Affl --
Capacity: AM _gallons
Design Flow: AIW gallons/day
Alarm present (yes or no):_A[A_
Alarm level: —AS Alarm in working order(yes or no):A
Date of last pumping: A)A
Comments (condition of alarm and float switches, etc.):
Tight or holding tans are not present.
DISTRIBUTION BOX (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 11119
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.):
Distribution box is not present.
PUMP CHAMBEW A)e_ (locate on site plan)
Pumps in working order(yes or no):4
Alarms in working order(yes or no):dA
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber is not presen .
8
Page 9 of 11
a
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 46 Collins Ave
Centerville,Mass.
Owner: George Wetmore
Date of Inspection: 1 1 /8/01
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
1 -6 'X8 ' block cesspool and 1 -1000 gallon precast leaching
pit packed in stone. 6 'X8 '
If SAS not located explain why:
Located see page 10
Type
leaching pits, number:
111.Q leaching chambers,number:0
gyp_leaching galleries,number: 6
A/C7 leaching trenches,number, length: D
410 leaching fields,number, dimensions:
,4/d overflow cesspool, number: 6
,�)6 innovative/alternative system Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,
etc.):
Loamy sand medium fine sand.The leaching it and the cesspool
are in hydraulic failure.Waste water is above the invert pipes.
Pumped system at time of inspection.
No signs of water intrusion.
CESSPOOLS(: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: /
Depth—top of liquid to inlet/rnvert:
Depth of solids layer: �
Depth of scum layer:
Dimensions of cesspool:
Materials of construction: Lld'rzelnon
Indication of groundwater inflow(yes or no):_:!f&
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
Same as above
PRIVY&A. e(locate on site plan)
Materials of construction: 14
Dimensions: /9
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
Privy is not present.
f
9
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t, Page 10 of I I 1 ,
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 46 Collins Ave
Cen ervi e,Mass.
Owner: George Wetmore
Date of Inspection: 1 1 8 01
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.
Ale-
10
.Page I I of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 46 Collons Ave
Centerville,Mass.
Owner: George Wetmore
Date of Inspection: 1 1 /8/01
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water Ai feet
Please indicate (check)all methods used to detennine the high ground yvater elevation:
. i
Obtained from system design plans on record-If checked,date of design plan revjewed:
Observed site(abutting property/observation hole:within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation) i
Accessed USGS database-explain:
You must descnbAgR8H Itablished the high ground water elevation:,e
s waterabove sea level
USGS 92-000-1 Plate #2
USGS 92- Oh-,i-rv,�ti_on well data -
Leaching
Pit '. :eet
Groundwatere"1 Feet Below Bottom of pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the bottom
of the leaching pit and the adjusted groundwater table is ":'
feet.
11
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1 TOWN OF Barnstable WARD OF HEALTH
SUIISURFACE SEWAGE DISPOSAL .SYSTEM INSPECTION FORM PART D •- CENTIFICATION II
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-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 46 Collins Ave Centerville,Mass. '
ASSESSORS MAP , BLOCK AND PARCEL # 210-007
OWNER' s NAME George Wetmore
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P. Macomber Jr.
COMPANY NAME Joseph P. Macomber & So•n Inc
COMPANY ADDRESS P.O. Box 66 Centerville Ma 02632
Street Town or City State LIP
COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 1 790 - 1 578
R
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposaj system at
this address and that uie information reported is true , accurate , and
omplete as of the time of -inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems ,
Check one :
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or, the environment as defined in 31-0 CMR 15 . 303 , Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
.Lv System FAILED*
The inspection which I have con acted has found that the system fails to
Protect the j)tlblic health and the environment in accordance with Title
6 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signatu a Date
ecopy of this ertification must be provided to the OWNER, the BUYER
On
Where applicable ) and the 130ARD OF HEALTJI.
* If the inspection FAILED, the owner or operatorshall upgrade
within one year of the date of the inspection, unless allowedort required
he m
otherwise as provided in 3.10 C�IR 16 . 305 .
partd .doc
0--r TOWN OF BARNSTABLE
;. LOCATION SEWAGE #
VILLAGE ASSESSOR'S MAP & LOTJJf Od
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY O �/
LEACHING FACILITY: (type)��i��I�d or (size)
NO. OF BEDROOMS��'_
BUILDER OR OWNER GlB�?:e- �U���D/'�
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 Le hing Facility(If we ands exist
within 300 feet ���hi ty) Feet
Furnished b
s � �
, y �07T-j !6
O,C li'T i S E W A�o E PERMIT NO.
VILLA E - 1
1
I N S T A LLER'S NAME i ADDRESS
d UILD OR O jN R
DA T E PERMIT ISSUED D
DATE COMPLIANCE ISSUED �%
t "_
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FEB
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® ,
........... .........OF....... .........................
ApVfiration for Dhivviial Works Towitrurtion rantit
Application is hereby made for a Permit to Construct or Repair Individual Sewage Disposal
Systein -
00
21�----------------------------- -------------71,'V------..........------------------ ---------*-------- ...................
Location- d e s r
Owner
!9�. ... ............. ........ ....... --------------------------------------
. . .. . . . . .............. .
"stall-er --� Address
......*-----------*----------*---------Address
Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
a
PLI Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfixtures ......................................................................................................................................................
Design Flow.............................................gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter-------------.-- Depth......r...*"i"
Disposal Trench—No..................... Width.................... Total Length---................. Total leaching area------_-----------sq. f t.
Seepage Pit No--------------------- Diameter............---..--. Depth below inlet.................... Total le aching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.--.--.............. Depth to ground water.------.-.------_._..--.
44 Test Pit No. 2................minutes per inch Depth of Test Pit...---.........._... Depth to ground water........................
9 j............. I
------------------ 1-11f- --------------------------------------------------------------------------------------
0 Description of Soil....................�_
W
U ........................................................................................................................................................................................................
.................. ---------------------------------------------------------------------------------------------------- --------............... ................. . .........................
U Nature of Repairs or Alterations—Answer when applicable------------Z:7/42�------ /----- ..............................
.4r
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T I T TIE 5 of the State Sanitary Code— The undersigned further agrees of to place the system in
n:further agrees ol t,
operation until a Certificate of Compliance has been sued by the bo,rd health.
eed . .. .. .. .... . ....... .....
d... ...... .
at
Application Approved By------ ........ .... ..... ..................................................................... ----------
...... ................
ate
f 11owjng r ons. ..................
Application Disapproved the ollowing reasons:........................................................................................................ .....
........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
d
............. .....OF...... .:................................
Appliration for Bispvii al Workii Toni#rnrtion 11grmit
Application is hereby made for a Permit to Construct ( ) or Repair (4+an Individual Sewage Disposal
System af�t• Wa -
........: Jib2 !�f o✓Sr a " -r.............................................. ........... ... ............•--.....-- ------...--------•------------•.....•-----
a f Location Address y _ or Lot No.
... ............
i� s Owner _ /�pr�f r Address
a ...........................- / 1 r�.,rf�� '"r a!r'�fY��` _� ` ``� �r / { :? ,�jc � : �
--- .... .....................................
Installer Address
QType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
a' Other fixtures ......................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
W Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •---•-•--•--•---•-------•-•-•--...-•.............••-
O Description of Soil-------------•----- ......":.-'�1'�'tf, / fi ,� << r ".
....-•--•------------•---...-••-----•-•--•-•-•-•-••--•----•••••••---•-••••••-•-••-•--•-•••••-•••--••-•--•-----
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 Code— The undersigned further agreespnot to place the system in
operation until a Certificate of Compliance has been issued by the board of health V
f
ate
Application Approved By....
= = f� / ` z_.
-•-• --
Date••--•••....
Application Disapproved f r'�the ollowing reasons______________________ __
-•------•-•----------•----------------------•-------•--------------------•-----------------•-----•--------------------------------------------------------------------- .....................
Date
PermitNo......................................................... Issued_......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF" HEALTH
pt.`. ✓... OF .. .........' ......................................... .... ..J . . !....... . t .. / ' w1A
(9rdifiratr of f91impfionrr
THIS IS TO.CERTIFY, That the I,ndividual Sewage Disposal System constructed ( ) or Repaired ( �)
f A - .._---_..+w
Installer ,
at...............................
- ------ �. __..---• ---••---------------- ----- - ---------•----------•-------------------------------- -----------------------
has been installed in accordance with the provisions of TITLE, `' ofr�The State Sanitary Codeg s� de./rib d in the
application for Disposal Works Construction Permit No.__.del -' a/__________________ dated_...;/p K% __ ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU ® AS A GUARANTEE THAT THE
SYSTEM WI L NCTION SATISFACTORY.
DATE.._>/a I d__�•-�-----------------------------•--...---•••------------ Inspector--f
...............................................................
THE COMMONWEALTH OF MASSACHUSETTS
- - BOARD ®F' HEALTH f
?I (�G�% ' .f r���Ao �. OF.. �.... r y .. /-r r ` .........................
d 4�
No......................... FEE.
' , . �i��ar��f arrk� �ono#ruan rrmi�
' Permission is hereby granted........ _
to Constuct�( ) or Repair ( �'an Individual Sewg� Disposal System _
at No.•••-_,_✓..w'i__• {1 f ` 1 < �/....'.. . 1� t / !� Z.
Street
as shown on the application for Disposal Works Construction Permit r -___ �"`�Y Dated....
................ ---•--•------ ----------------------------------------------------------
-
Board of Health
DATE............................................--•-------------------------
FORM 1255 HOBBS & WARREN; INC.. PUBLISHERS
J —
ASSESSORS PAP
TEST HOLE LOGS_ �
4
PARCEL :
L FLOOD ZONE-: SOIL EV,ALUA,Tok : ' ( 4 Y t' ,M4
� WITNESS :REFERENCE: , � / t^-��%�' v�,'��-,\f�,ya��'1,:�
�J ��`/ elf DATE: i`��4,� 1-� ! 7..C;� •�
0
Ct l• � -,.� �' PERCOLATION RATE: .� Z ��,.
�,,�-r'�� !`L�t,. D� Lit-�l/� d�j 0 �071 /'44fE f �`� ��- 1) The installation shall comply with Title V and Town of Barnstable Board of
b�v _ Health Regulations.
2 The installer shall verify the location of utilities, sewer inverts and septic
"cJ `�� ' � o�= ,C�k./ 5=�2F-�✓ 2 TH- 1 TH-2 ) Y
a 5�W I components prior to installation.
`�''DEL f' `"`/ � �� 'C.` ' .__._ 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot.
5 40 Lo y- 1. 1200 4) This plan is not to be utilized for property line determination nor any other
- purpose other than the proposed system installation.
110 �- --.._ 5) All septic components must meet Title V specifications.
LOCAT I ON MAP (�-17,6)
6) Parking shall not be constructed over H10 septic components.
7 The property is bounded b property corners and property lines as depicted.
p p �' � YP p Y p P Y P
.-a ` i 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
1 plan and installation based on the plan shall be deemed approval of the
d
number of bedrooms.
9) The existing; cesspcooUsegtic components shall be pumped and backfilled per
Title V Abandonment Procedures.
_ . y 10)Proposed leaching is to be within 36 inches of grade or provide venting or cut
` . grade as permitted by the Board of Health.
SI I)System components to be 10 feet from water line.
L- I I SYS 1 E DES ION
FLOW E°�T I$SAT
PEDROO ;S AT G LADAY/uEDRt?Ch3 - GAL/DAY
SEPTIC TANS
L; - j'-j C �LIu�, DAYS. GAl
�'' / U E 1.� GALLON] SEPT IC TANK
'taC� ,, _ yr Lit +r�, �--1.f_._. �`�.-, c-75
�<7 P SO L ASSGRPTIOfiYSTIr� -
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GAL 181 � � --
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SEPT 1 C TANK
EWWI
i
h S 1 TE AND SEWAGE PLAN
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� CAT Iv : t-415 AVE,
PREPARED FOR : C I elc) 6 1-M
a SCALE:
AV I D B . MASaN,V! DATE: 7
L./BC ENVIRONMENTAL DESIGNS
J
w DATE
_TST SANDWICH . MA
w , Al TH A NT O ) S a3- 2177
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