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HomeMy WebLinkAbout0078 SEAN'S CIRCLE - Health (2) 78 SEAN'S CIRCLE, CENTERVILLE A= 170 057.003 d �pEcvnE° .Inea UPC 12543 No. HASTIMOS,WN OWN OF BARNSTABLE LOCATION SEWAGE# n VILLAGE lJ L0dT1frd,'Z/e, ASSESS 'S MAP&LO / U RiS-MAE RURs 7�J�d7�r NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ( (size) GYM NO.OF BEDRO 2 BUILDER R OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility r 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 300fzet of leaching facili 1 Feet Furnished by r'IV >V, IN s s ii yai o 3�� a� T` Won DEC 1995 BORTOLOTTI CONSTRUCTION,INC. 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508-428-8926' FAX: 508428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A }} CERTIFICATION Property Address: Date of Inspection: //� Inspector's Name: i- er's Name and Address: o99,1 CERTIFICATION STATEMENT! r 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.The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The System: Passes Conditionally Passes Needs Further Ev ation By the Local Aproving Authority Fails _ Inspector's Signature: Datel,� The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 subinit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTIONS MMARY• A)SYSTJM 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 detennination 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 imnunent. 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 obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - ,i 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 THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. ;> j 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER r SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS 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 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool 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 coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: 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 safety 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 I1 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. r 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 pumped 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. _,GAs-built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. _/The system does not receive non-sanitary or industrial waste flow. ./The site was inspected for signs of breakout. V All system components,excluding the Soil Absorption System,have been located on site. 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. The 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(continued) The facility 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: t/ Design Flow:_ij gallons Number of Bedrooms: Number of Current Residents: y04:4 � o�C��J-` Garbage Grmder:� Laundry Connected To System: , SS- Seasonal Use: Water Meter Readings, if available: Last Date of Occupancy: CK/2! [,c1/- V zzprvS gi�� COMMERC LIIl\DUST rAr.'�6 Type of Establishment: Design Flow: Qallons/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 inform at}}'oWAkon- System Pumped as part of inspection:A If yes,volume pumped: gallons Reason for pumping: TYPE,,Of SYSTEM: Ll 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 AG. of all cgmponen ,date installed(if known)and source of information: m mac/ 7 - Sewage odors detected when arriving at the site: 0 -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK:_ Depth below grader' Material of Construction: �concrete—metal—FRP—Other (explain) Dimisions: .S' Y 'y Sludge Depth: '/ Scum Thickness: /9 Distance from top of sludge to bottom,of outlet tee or baffle: 'Z'17 Distance from bottom of scum to bottom of outlet tee or baffle: 19 ' 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 le age,etc.)�f s Q A660 5U��•+�1 GREASE TRAP: / Depth Below Grade: Material of Construction:—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:.A�2 Depth Below Grade: Material of Construction:—concrete—metal—FRP Other(explain) Dimensions: Capacity: Qallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert: s /(3CJ luor xi/j /U e Comments: (note if I el and distribution is equal,evidence of solids carryo'er,evidence of leakage into or out 2x,etc.) S�l� AV, YI PUMP CHAMBER:4 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 (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: ' Leaching pits, number:j 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 failure level of ponding,condition of vegetation, 160,9 ea1A 4 OL CESSPOOLS: Number and configuration: Depth-top 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, level of ponding,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- f SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL.SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. -/1 d �1 DEPTH TO GROUNDWATER: Depth to groundwater:_ j Feet Method of Determination or Approximation: lryl G�r� -7- L 1, C A T ION SEWAGE PERMIT NO. td VILLAGE I N S T A LLER'S NAME i ADDRESS ti G� BUILDER OR OWNER wl DATE PERMIT ISSUED DATE COMPLIANCE ISSUED y:�� _ r ,�>1 >� �0� I�i ��� ��� �I .. - � � o. 7 ....... F�s....30.. �...... THE COMMONWE�ALTWdF MASSACHUSETTS BOAR® OF HEALTH Town Barnstable .......................OF.......................................------------.....---...........................---- Appliraation for Uigpntial Workfi Tuntiirurtion Vamit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: Sean•'.s Circle: Centerville Lot - -• j ......................... .•-- - S�11TiQ Address Barns' I� ie -James K. n a o a Vetorino Brotg tiers Barns- Aft Installer Address 16 61t, Type of Building Size Lot..........�................Sq. feet U Dwelling—No. of Bedrooms.............3......_.........._...._.....Expansion Attic ( ) Garbage Grinder (no) 0`4 Other—Type, of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------------------••--•••----•••------•-•---•-•----...-•-••-•-•-•................................................ W Design Flow........55------------ y1 000 gallons per persorL$elfday. Total daisy flow.....................330.............Mlons. WSeptic Tank—Liquid capacit .-..._.._._.gallons Length..tt_55-......_....-. Width....4...1. biameter---------------- Deptl .-�k....... x Disposal Trench—No..................... Width................--. Total Length.....___......__. Total leaching area.._-___._ _-_.._...sq. ft. Seepage Pit No..1................ Diameter.......10....... Depth below inlet................... Total leaching area....2b7......sq. ft. Z Other Distribution box ( X) Dos i g tank _- Goa e 6od Surve Consultant $/29�79 Percolation Test Results Performed by...._.p........................................ .. spate....._...._........_.................. 2 12 f----------------- - - none Test Pit No. 1................minutes per inch Depth of Test Pit-_-.--....._........ Depth to ground water..-.:.---_....-.......-. G Test Pit No. 2................minutes per inch Depth of Test Pit..--................ Depth to ground water--_-_-----.--_---. ---. ...................••••----•••......-•--• -•---••-•••.......................---•----------------------------•----•-......................-- Descri Description of Soil....0,0-0_,$__wood•loa s _0.$-2.0 subsoil-,-..2 0- .0 gravel P 4.�.--7 0 med. coarse...Yellow .sand=---7=.0 12-.0 med.J. . fl.... . f white sand. Q.-•_ W .................................... • • ---------------------.......---------- ---•--------------- � REN�d�CaC ,x U Nature of Repairs or Alterations—Answer when applicable.-_----------- ---------C_ -- _. _.............. Z. . R.......--. ------------------------- -----------•..... -----•......--•---........•----••- v CHAPMAN y . ...................... -------- Agreement:* i 7 � No. 27654 Q.- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in S T the provisions of ilTY-E 5 of the State Sanitary Cod — The u dersigned further agrees not to place r operation until a Certificate of Compliance has be i ue of health. Sie i ..! .•• . ------•-------------•-..................... •-•••---•••- •----•--------- Date Application Approved By------.7" l�fdlh- `.. 14 Date Application Disapproved for the following reasons:----•-------------------------------•--------------------------------•------------------------ ---•-------- ------------------------•.....--------.....--•--.....•-•-•-•-----•----••-....---•----.----•--••---------. ---------------------- ---- -- -- - Date Permit No..................... d l Issued.== ................................ Date R � � Fu$.............................. THE COMMONWEALTH"6F MASSACHUSETTS BOARD OF- HEALTH r. Town Barnstable OF:r.................................... AVVIl rajion for Utopoii al Workii Tonwnrtion ramit. Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewagg Disposal System at: ... ..Sean's Circle, .Centerville Legit - yy.��... .. .............. -----•--•---------•-----•••--•--•---•--................_ James X. smitII, Address Barn tail; tr --.._._...--p-......,.{,--�..................•--•-•----........----•--•-•... ...-•----••--•---._......_._..._...---.......---•-•.....--•-•-•----•--••-----•------•----•----.... Addr W ......................�/a iaC� © LIC+4i1. 'a .sab e Installer Address 16 Type of Building Size Lot___------x________________Sq. feet U Dwelling—No. of Bedrooms.............3______-_._.__.__ Expansion Attic ( ) Garbage Grinder (n©) ------•. PL4Other—T e of Building No. of persons---------------_------------ Showers — Cafeteria QIOt fixtures -------------------------------------------------------------•-•••••---•-•--------•-----------------•-•----•---••----••---•._....__._..._._....__.. d Design Flow............................. gallons per perso D day. Total da-1 pw..._._._____._______3 Q____.___..____gallons. W o �t�� 1...��' � 4 If W Disposal Trench�No. ._P_______________ Widt _ __ g_ Total Length � Diameter________.______. llepth______.__.___... p .�____.____ g Total leaching area__________________sq. ft. x Septic Tank—Li and ca acit .._.__._____gallons ss Length Width.�� �� Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..._____.�__._..sq. ft. Z Other Distribution box (X`) Dos tank ) . j a C�d Suave Consultants 29 ?9 � Percolation Test Result Performed by _.p_______________________________ ____t _.._.__._ 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.................... Depth to ground water........................ O Description of Soil_..0 6 8 womd loam, 6. »�. subsoil, 2.0 l .C1 �' ' ( OF x 4.Q»?.0 med. e©�rqe...l!e�3.��r ��z3d, � f}-�.�.� med a c� TiEIVWICK•'" G white sand. N U Nature of Repairs or Alterations—Answer when applicable______ __________ _____ ____ ____________ ____ c-. --••-•--••-••••- -••--•--•...................•-••--•---•••----••-•-•-•--••--••••-•-•---••-•--••--•-•-•-•- --- ............... Agreement: CGNFlo/A_S P2T7m E6A5�4N`�The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in FS 96A G\ h the provisions of TITLE 5 of the State Sanitary Co e—The undersigned further agrees not to place t em in operation until a Certificate of Compliance has b n ' su t d of health. Sie --- --+ .........-------------------------•••._...••• ................................ Date �t Application Approved By-••__ •••. ..... : .:_ ....�.......................... --- Date Application Disapproved for the following reasons:----•-------------------------------------------------•---------------------------------------••-•-•-•-•_-_..._ ••-----------------------•------------•--...----......-----....--•-----•--------------------------._....-••---•......•-••--•--------------------------------------------.............................. . Date PermitNo..............................`.............:............. Issued.................................................------ Date �y r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........Town....................OF.......... n Stable.......................................... ( ntifiratr of Toutplianrr TH4,j jS�TD pCEZ T EK,,e heat the Individual Sewage Disposal System constructed (X ) or Repaired ( ) ts�©© by________________________•----•----•--•--•-•- •---•••- •-- __.._..__ --------------------------------LOt #3� Sean.�s �l.rcle�, G`en�eti�,'1.@� �:: at.-••--•••---....-•--•---••-••--•--•-•••••-••••••--••-••---- --•-•-•. •-••--•_.• -• •-- ----- has been installed in accordance with the provisions of T Lod State Sanitary Code as de c/%ibe in the application for Disposal Works Construction Permit No. _________________________._.____. dated-__.-___jQ_"_..._..-_...__. ________. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE -•--- DATE__________________ ____1___� ..........................._.... Inspector:_.. SYSTEM WILL P CTION SATISFACTORY. THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF . HEALTH (7) 7 a 3 ......... E wn.....................OF..........-----..�$'pia.�7.Ie.................................... No......................... FEE.... ............ Ropooaal Works Tonotnution erntit Vetor no Brothers Permissionis hereby granted............................................................................................................................................... to Constr tt or Repair ( l n I •vld 1 Sewage Disposal System o S�a s �C1�-•-•-------------•-------.......'-8Tf'� .`:V............ ................................................... at No...•••••---•••• ••-•-- .. Street as shown on the application for Disposal Works Construction Pegmt N ,._•_ ___�_____ Dated._:__l._.."__s. ✓_'.__fn.... ..................................Board of He�tty DATE--• ,,1 - ........................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ' ' SOIL LOG waor�,.,�4,.. - T lFEASTONE •LOAM !1 FILL• •' !12•MA%10 fo 1C.I. DIST !, � I°'.:•: ° • 1 b1$ e t 1000 BOX I;:'o•:0 1000 GAL. ° e e i P ,�rc .w✓E 94,9 _ to°MIN. GAL. Via: PRECAST OR ,e o F- 24" ,• 9 . SEPTIC I •• . •• • BLOCK ° • MIN ' • TANK •.. g' 1%::�'�• . • e �I r 1, SEEPAGE PIT o l L¢ 20" . MIN. • •.d � I ?l� .�► / • 'FOUNDATION I n I_ 1 /2 WASHED STONE'' I N dt/ At. y ELEVATION SKETCH 1 Io' 'i PERC. RATE=, �Z -y SCALE i •1°= 4' TEST BY : A7-4A' 1"6ed d, ' -y TOWN INSPECTOR: P�t/t. A -1144 . BACKHOE OPERATOR . • _TEST MADE ON.,: $ 94 T tiro i i� / r J % { f; 10 Ile t 7819 757 ly'76 /'S:' 3,3 ,w --� oi � oz -: / - _ _ � - - /,,Y L 4��:.r it��'�'�'.r+� �.'y.�`.._�.����'wl r'!'/ �i:�✓✓�F .l o v , vc7—aj ° 2` • /��`ST/I77ATg,� LEA/.G f f f'L ObY .r7`.f�"�_S �ti.�Xi�b�1�I ???� Tsb/� 3 �3�p •�oc�a?s (No��,��',�� re� 1��,�x l�cs•�•R�/�„�1 =.3.�0�.�►ra, '�o�v/.w� s�i�'r-,sue �E �,��M��,s 2)MAX, 4.cuxv�,6,LF_ OA,14Y FLOl� � Z*/$ 5'0_V7&11 PL 4-r AJIA'./.C:1464 {`^ at:rapt ! 14 GIs i 9�3 0Q " JI ELEVATION SCHEDULE _ I' PROPOSED SITE PLAN 9-t, rc 8 I. INV. AT FOUNDATION t = F 2. INV. INTO SEPTIC TANK SEWAGE SYSTEM .,DESIGN' IN ' 3. INV 0 U T OF SEPTIC TANK - �1s$ ,+e f:/.S TABG IE C'C•sr�lE 4. INV. INTO' DISTRIBUTION BOX . q ' t SCALE: 1 =�'©� ,�, t 197.,/ s 5. INV. OUT OF DI§TRIBUTION BOX = ;9Gr54 T C -.�94J�/ �2Ev 1a1.41?j 6. INV. INTO SEEPAGE PIT _ '94,' CAPE COD SURVEY CONSULTANTS jfl -ROUTE • 132 7. BOTTOM OF PIT _ 9G" -0 � HYANNIS ;MASS. � , • a kk }