The URL can be used to link to this page

Home My WebLink About0036 MASTHEAD LANE - Health 36 Masthead Lane, Centerville f A= 193 -067 �J�aE�vciEo�oy� llll NoC 3 Co HASTINGS. MN TOWN OF BARNSTABLE LOCATION 2(,_[M(,� {-jNr j L(�� SEWAGE# VILLAGE S t1 ASSSESSOc.cR.'S MAP&PARCEL Xct 3 1Otc7 INSTALLER'S NAME&PHONE NO. 5(fit` hc`G✓� S"T) o��1�{ �6 S SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDROOMS aw xti bi'�n 0 r38� OWNERac��.� v, I�CIn O �bx PERMIT DATE:/07 f)a, �/e 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 .-� �. ,�� 9 � ". � � '� � 3 ; � l� � � = �� ` �-. . � No. � � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLAtlon for Disposal *pstrm Const ution Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System [individual Components Location Address or Lot No. 3(, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ' O�' C j ``t v` oxv_- a 6 Installer's Name,Address,and Tel.No. tM?-9A,,.k 6O to 5 Designer's Name,Address,and Tel.No. c-\ � 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(min.required) tl tr gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �(p t`lbyt� (�7G WO 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 place the system in operation until a Certificate of Compliance has been issued by this Board o lth. Sign _ Date / Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued 2 G t No. �)V CJ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑Complete System G dividual Components Location Address or Lot No. 3(o Owner's Name,Address,and Tel.No. Assessor's Map/Parcel t 9 3 & C V; `C V t okc { b Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. J U. J 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(min.required) (1� gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. i . Description of Soil V Nature of Repairs or Alterations(Answer when applicable) b(�S:Y r. l �S► 4 �� t�' \s?� Date last inspected: r 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 place the system in operation until a Certificate of ,. Compliance has been issued by this Board of Health. Signed Date t :2 / /a I j k Application Approved by Date / Application Disapproved by Date for the following reasons Permit No. ;2 U(0 — 3c� a Date Issued ------------------------------------------------------------------------------------------------------U------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate Of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V/ Upgraded( ) Abandoned( )by _ at ?L , Gts� �� r .N has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. c./ 3�1 dated 2 (� Installer jErx,,�k_, Designer #bedrooms Approved design flow and The issuance of this permit shall not be construed as a guarantee that the system will function as,desli'gned. Date /'`�2 / �; Inspector --------------------------------------------------------------------------------------------------------------------------------------- No. G n Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstE Construction Permit Permission is hereby granted to Construct( ) Repair 0/ ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date ' ' 1? Approved by 4 � 4/0 BORTOLOTTI CONSTRUCTION, INC. 'Q 765 WAKEBY ROAD,MARS7'ONS MILLS, MA 02648 508-771-9399 508-428-8926 FAX: 508-428-9399 `J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A S / CERTIFICATION Property Address: 1 �q� l�J,`l Date of Inspection: — — lnsp�� is Name:_ �, ,f p --� w er's Name and Add ess C _ �Ly / 112.74 CERTIFICATION TAT M NT• I certify that I have personally inspected the sewage disposal system at this address and that the informa= tion reported below is true,accurate and complete as of the time of inspection. 'file inspection was per- formed based oil my training and experieuce in the proper liuiction and maintenance of ou-site sewage disposal stems. The System: Passes Conditionally Passes Needs Further Ev ation By to Local AProviug Authority Fails Inspector's Signature: _ Dale:__ ((o The System Inspector shall subnut py of this inspection report to the Approving authority within thir- ty(30)days of completing thus 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 Environipental Protectiou. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY-. A)SYST PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes, nor,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,cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is inunineut. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructedpipe(s)or due to a broken settled ctt ed or uneven strt i 'd button box. The system will pass inspection if(with approval of The Board of Health): - 1 - 9 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART'A CERTIFICATION (continued) Broken pipe(s)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 TILE BOARD OF HEALTH: Conditions exist which require further evaluation by'fhe 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 HEAL'Cli (ANU PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT TILE SYSTEM 1S FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and 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 the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: 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. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year X01 due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART A CERTIFICATION (conliniied) 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 l of a public ivell.. Any 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliforin bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FALLS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safely and the environment because one or more of the following conditions exist: 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 II of a public water supply well. The owner or operator of any such system shall bring the systeu►and facility into full compliance with the groundwater treatment program require►rents of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: !"Pumping information was requested of the owner,occupant, and Board of Health. None of the system components have been puu►pcd for atleast 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. �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. _ _LGThe 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 site. "Y_ ,/The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees, material of construction,dimensions,depth of liquid, - depth of sludge,depth of scum. _&Zrhe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(conlinuc(l) �!I�iccility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION / FLOW CONDITIONS RESIDENTIAL: Design Flow: 3 3r gallons Number of Bedrooms: Number of Current Residents: Garbage G,rinder;,( Laundry Connected To Systcm:_ Seasonal Use: XJO Water Meter Readings, if ailable: _ Last Date of Occupancy[ /1�e/Y ��— COMMERCIAL/INDUSTRIAL: //V Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no).__ Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings, If Available: _ Last Date of Occupancy: OTHER: Describe) — Last Date of Occupancy: _ GENERAL INFORMATION PUMPING RECORDS and source of information: 'C7j 64I7/e(,y� System Pumped as part of inspection:)0 If yes,vo tnc pumped: gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy hared System s,attach previous inspection records, if any) Other(explain) , � aid� � APPROXIMATE AGE of all c m rents,dale� � /installed(if known)and source of information: ,'- ,90�7 • �� 04 Sewage odors detected when arriving at the site:_ _ -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART G GENEItA1, INFORMATION (continued) SEPTIC TANK: _ Depth below grade: /f Material of Construction: crete metal. FRP Other (explain) -- - Dimisions: S/ Sludge Depth: Scum Thickness: Distance from top of sl dge to bottom of outlet tee or baffle: W Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidenc of lea age,etc.)-/5 Q-lbop_<" �Qr�, GREASE TRAP: Depth Below Grade: Material of Construcl.iou: concrete metal FRP Other (explain) —- -- — — Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: 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.)_ TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:_—concrete metal. FRP Oilier(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and Float switches,c(c.)_ DISTRIBUTION BOX: Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER:: - — Pump is in working order`: Comments: (note condition of pump chamber, condition of pumps and appurtenances,etc.)_ -5- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (coulinued) SOIL ABSORPTION SYSTEM(SAS):, (Locate on site plan, if possible;excavation not required, bait ma-y be approximated by non-intrusive methods) If not determined to be present, explain:_____ .Type: Leaching pits, number: Leaching chambers, number: Leaching galleries,number: Leaching trenches, number,length: _ Leaching fields, number,dimensions: . _ Overflow cesspool, number: Comments: (note condition of soil signs of hydraulic Whire level of ondiug, condi 'on of vegetation, etc 5 S2 � - i CESSPOOLS: ----------- Number and configuration: Deptli-lop of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool Materials of construction: _ Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, Icvel of pondiug, condition of vegetation, etc.) PRIVY: ------------- Materials of construction: Dimensions: Depth of Solids: — Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) -6 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA IIT C SYSTEM IN.IiOIIMAT1ON (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. eeor ` o It It DEPTH TO GROUNDWATER: , Depth to groundwater: /151 _Feet Method of Determination oy Approximation: Af .,I'CXive*,l 1_41 .41,3. -7- LOCATION SEWAGE PERMIT NO. VILLAGE f N S T A L & A D D R E S S7An,ES DOLLA UAY . CONTRACTOR 3012 1 t IG;'� Ulu ubaga Twaia � u, , Cen�eaville; Niacs. 02UP B U 11 D E R OR OWN ER DATE PERMIT ISSUED ` l-7 DATE COMPLIANCE ISSUED &-,3- 77 �� _ � � - � 1 � 1 � I a` ��......s.e� �`; ......�r.�........_J ._ �..._._....,_,�_.��...._,._._._....._�.___.._- , TOWN OF BAR NSTABLE \` LOCATION SEWAGE # VILLAGE �� ASSESS R'S MAP &LOT r b P,.7S e—e 70 NAME&PHONE N // SEPTIC TANK CAPACITY A200 / LEACHING FACIUM (type) D` L/ J (size) P NO.OF BEDROOMR BUILDER R O R PERMITDATE: 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 feet of leaching facility) Feet Furnished by ��- D`� �� - � . 1 'Ic o �, ,� `'� ,� �� THE COMMONWEALTH OF MASSACHUSETTS Application is hereby made for a Permit to Construct el_�) or Repair an Individual Sewage Disposal ..... ;A......................... ......................... . . . ........ .... .......................................... er Address- Instafl'e'r Address of Building Size Lot_ feet Disposal Trench—No.....................Oh. .................Xotal Length..............oo�.. Jpffl leaching area....................sq. f t.I ...................................................................................................................................................................................................... ` ^ g ^^~e~^' ' The undersigned agrees to install the aforedescribed Individual-Sewage System inaccordance with THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL,,TKe Z ..........OF,49.��....... ...... .............................. Tntifiratr of Tourpliatta THLS IS TO CERTIF hat Individu wage Disposal System constructed 4e-`��®rRepaired by....... .... .... .............. ............. ..... ....... InsA .......... ....... ............1�.....�.. ------------ ... .............:;;_-.*_0-------------- at........ .. .......... --------------------- . ............................. has been installed in accordance with the provisions of TIT LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--*.................................... dated---------------------------4...............*---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.- DATF..................................................................b!............. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HE L ............ ....,at.00dep" OF..X. %A. . ......................................... No......................... FEE' ........................ Bispos Vorkg Tons ton Permission,is hereby granted......... ....... .......................... .. .. .......... . .............------- ............... to Construct r Repair Ind4i Di n 609al SeAAl* ispQW System at No...... ....li�v.... ...................... ........... ............... Street as shown on the application for Disposal Works Construction Permi ........... Dated .......... ---------------------- A----- in nwi 4a Sem -;tr U 4ct .................................................. .................z--------7�_--- Board of Health ................Z.................................... .4 "FORM i-I INC.. PUBLISHERS WARREN 0 „,r�� {5 g �' 1 uY.� I ✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD F H EA - 14� ...------..OF... .... ApPratinn for Dispoii al Worka, Towitxnr#'inn ramit r. Application is hereby made for a Permit to Construct Repair (, ) an Individual Sewage Disposal a� Ast�( r �_ .... .... . �.'.- .. ........ • .... R ................................... Lo n Address { or Lot No e 1. — ....... ...................... -•------ ....................................... .. i ner Address ....................... ------ ------- ---- ............. ------------------- -- _.._...:. .. .......................................... �staller �/� Address Q Type of Building Size1. Lot__ �e►" __ '_ Sq. feet a Dwelling—No. of Bedrooms---- .__ Expansion Attic ( ) Gbage Grinder ( ) --••---- aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) PAOther fixtures __� --------------_--•-------•-----------------------------•------------------------_____-----------•----------------------------- W Design Flow............ . ....................gallons per person per day. Total daily flow________ C_d...................gallons. WSeptic Tank—Liquid capacit _.-.:_. __. al ons Length................ Width................ Diameter ____ ___ Depth............... x Disposal Trench No Xth otal Length ___ 1 leaching area....................sq. it. Seepage Pit No__lr�” pw ..... . ....:...: tal leaching area_: !, ...sq. ft. Z Other Distribution box ( Dosing tank ) .•^ Jcw A ,(»7 y '—' Percolation Test Results Performed b .. 4 ..... � Y �--- � •-- �.. .... ............... Date...#�'�_,�.G`.7/�__.............. Test Pit No. I.................minutes per inch Depth of Test Pit____________________ Depth to ground water________:_.:________,__. Test Pit No. 2................minutes per inch Depth:of Test Pit.................... Depth to ground water........................ t� .............................. Description of Soil__________Q."_i ____._ f.14ft � x V .................................................................................................. 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 i1Tl�E 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 oard o health. -� --- Signs .. ---- -- --- --. ....... -: ......... Date ApplicationApproved By.................................................................................................... Date Application Disapproved for the following reasons:__...-•-------------------...................................................................................... ..............•-----••------.._...._._..--•-••--•-•------•-•--•------•------•---•--------•-•-----•--•-•-----------..•--..-----------..-.---------•----------------------------------------------------- Date PermitNo.......................................................... Issued_------•---•----•--•---------------••------••-----•-•--- Date s c-, rA a< c- 7t L V-rlll�- 4D f;.,A,,-IT A ICU' Tar rwo lc>c>.,,- Lv L:9 4 A + 4 4. lkiv. 0. 7-A W- INV. Isiv. GAL. cf4. LaAaH -41ovr WASWED Ao C-V:-:-Z T F-1.a 41- SCAL��i �jl A/6 UIA71;V = 46 -rlotll -5LA.0-14(jQ a kli c C-- Ct3-VT( P-1 rOlINDIS Ii T= LOT 4-o V-IJ O-rT Vi L.L.A 4, t.-)LAI-! I,-' LIOT /—\ i-1 &<ASe,,, J,.j