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Home My WebLink About0056 SHEAFFER ROAD - Health 56 SHEAFFER ROAD, CENTERVILLE A= 172 033 /1// aEc�c�Fo �J� cns All No.53L0 3 y��°osrcorN°` NASTINGs.&M AWN OF BARNSTABLE LO s'A N y` G ' SEWAGE # O cSr OC TIO ,� VILLAGE Cl��tO�, iP�l�, _ASSESSOR'S MAP & LOT.L-.-^�V-5 INSTALLER'S NAME&PHONE NO._ yl. /PC '3 //V�ToA1-7 7 r= a''774 SEPTIC TANK CAPACITY LEACHING FACIL=: (type) (size) < % NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: C 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 b � 9 � o O j b1 YIN tZ NN "Is o /n , A �f No. / T� 03 `� Fee 40.00 %� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for �Digpogal 6pgtem Congtructiou Permit Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 56 Shaeffer Rd Centerville MR Wharen Assessor's Map/Parcel Ip$t ' N,ynO bAld s , n Tge p t i c S e r V Designer's Name,Address and Tel.No. VP.O. Box 1089 C775-8776 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(no) 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 Description of Soil gravel Na reof Re rs rAlte ptt�'ons(Answer when a 1' ble install d-box and 3 high capcit s onepapc�ce� infiltrators cffP ) 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 Certifi- cate of Compliance has been issued by this B az !lealth. Signed Date G Application Approved by _ Date Application Disapproved for the following reasons Permit No. Date Issued "" % ---- _�. ------------- 033 4000 No. LJ T Fee { € THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYtcation for Otgpoo l 6pgtem t Congtruction Permit Application is hereby made for a Permit to Construct( . )or Repair(X=)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 56 Shaeffer Rd Centerville MR Wharen Assessor's Map/Parcel W.�. oe&dres n Tgept is SerV Designer's Name,Address and Tel.No. P.O. Box 1089 Centerville Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(no) 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 ' Description of Soil gravel { Nature of Re rs rAlte o s(Answer when appli able) install d—box and 3 high capcity st"tonepapc�`cec� inf�alrators 0 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site,sewage disposal system accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- =cate of Compliance has been issued by this B ar f Health. - `-- / y w Signed Date _ j Application Approved by ' Date '* Application Disapproved for the following reasons - \ Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS �Certtfirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( x)on by Installer W.E. Robinson Septic Sevv at 56 Shaeffer Centervillp as bee constructed in accordance with the provisions of Title 5 and the for isposal System Construc Permit No. ' !f dated �� . Date THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT T SYS- TEM WILL FUNCTION SATISFACTORY. ——— ;.---------------------------�4,0.:00 No. !; %. 'Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Dtgpogar Opgtem Congtructton Permit Permission is hereby granted to W.E. Robinson Septic Sery t eoz�i rnr i Y r8air( x)an On-site Sewage System located at No.# bb ae er Rd Street and as described in the above Application for Disposal System Construction Permit. :✓? w No. 5aie The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special'conditions. All construction must be completed within three years of the date below. ' \Date: 4, 0,L.6 Approved by Board of Health CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I Wm Robinson Sr , hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at 56 Shaeffer Rd Centerville meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility I • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. i SIGNED: DATE: 7 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. d @I� f J bGl V DATE 56 Sheaffer Road Centerville , q Mass . septic stem at the above aid- B 199� On the Above date, I Inspected the p y This system Consists of the following: 1 . 1-1000 .gallon septic tank. 2. 1-61x8' block cesspool. L Based on my lnf{.ntctlon, I certlfy the following conditions: 1 . This is a title five septic Sys capacity. Code ) 2. The septic system filled to Water is up and over the inlet and out let inverts of the septic tank and over the invert of the cesspool. 3 . The septic system is in failure. The system must be upgraded to a title five septic system. SIGNATURE: Name :_J__P_.�1ac_omber Jr..^__ __:__ Company: J • P . hlacomber & ion _Inc ., +�SSESS01 N1AP N0:�;, _PARC1 NO: Add ross:_ Centc,rvilleLhia s__._02632 Phone : _5 �C_-:_7.7..5.=-333 IR _ _..__..._ "'rtlS Ccr��"irlC:+ +vr� ours NO"t' ;;ONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tankr, Cos- Poolrleachflelds P�mp*d & Installed Towti Sewer Connections P.O. Box 5ii Centerville, MA 02632-0066 77`5-3338 775-6412 -J- ommonweamr) of mossccnusetIs I A ExecOlive Office of Environmental Affcirs Protection WUllant Trudy Cox@ k94Q David B, Struhs LL SUP:j1.j1t.FACE SEWAGE, DISPOSAL SYSTEM INSPECTION FORM PART i� CEIRTIFICATION -'rop-orty Addro" 56 Sheaffer Road Centerville MA Address of Owner. )ate ofiasp*otioa: 7/5/96 (If different) Name oflaspo*tor- Joseph P. Macomber Jr. ";omp&ny Name,Address and Telephone Number -P.Macomber & Son Inc. Box 66 Centerville,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT -.am at this address and that the information reported below is true,accurate certify that I have personally iaspocti�d the sewage disposal Lad complete as of the time of Lupoctioa. The inspection wai foruicd ba" on my training and experience in the proper function and aa.intenanc,e of on-sit4 &owagv disposal systems. The system: Passes Conditionally Passes Noods Further Evaluation By the La-�d Approving Authority LIS P-0c to r's Si, Date: Cho System shall submit a copy of this inspoctiQz report W the Approving Authority within thirty(30)days of completing this aspoction. 11 the system Is a shared system or has a design flow of 10,000 g-pd or greater, the inspoctor and the system owner shall s7ubr,,,:t the, ,Vport to the appropriate regional cMu of the Department of Environmental Protoction. [,he 0.iZiaal should bQ sent to the system owner and copies sent to the buyer, it applicable and the approving authority. .N3PECTION SUMNULRY: C:-- A, B, C, c; X) SYSTUM PASSES: I have not fo'- , 4-1y i for utiom wl�jch indicu,4:i that the eyawat violates any of the failure criteria as derinod in 310 CbM 15.303, Any Ldluxv not aval-,-..iud are in6;c-atod below. 3] SYSTEM CONDITIONALLY 'A.93L- hsn or more system components w-A to be rtplacc-d or The system, upon completion of the replacement or repair, passes 'ndicnte yos, no, or not dotermiac.l (Y, N, or ND). D"cribo basu of determination in all instances. If"not datarnxiaod%explain why not) The septic U-ak is metal, cracked, structurally unsound, shows substantial Lifiltratioa or ex.Mtration,•or tank failure is • Imminent. The system will pass Lnipoctior, z sting septic tank is replaced with a;onforming septic t"as approved by the B oa,-J i eW t h. .reylse� 11/03/95) One Winter St:oat 0 Boston, Massachusetts 02108 0 FAX(6 17) 5 56-1 D4 9 9 Telephone (617) 292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOP.V PART A CERTIFICATION (oontinued) 56 Sheaffer Road Centerville,Mass . Harry Wharen D«W vP l: • - 7/5/96 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or huh 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): broken pipe(&)are 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 Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH,: AJ b Conditions eaist 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) 8 ibTi;tvt WLLL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER VVAI II WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: or privy is within 50 feet of a surface water *r 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 APPROPRIATE) DE'i'h WAINE:i THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: dLO 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. ij The system has a septic tank and soil absorption system and is within 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 r,-.tem has aseptic 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 9) OTHER' ` (revised 11/03/95) 2 ' CERTIFICATION (oontinued) s heaffer Road Centerville Mass . Pro rt Address. 5 6 S , C� y Harry Wharen Date of Inspeotlon:7/5/9 6 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 fail - y Backup of sewage into facility or system component due to an overloaded or clogged SAS or coupool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the di,otribution box above outlet invert due to au overloaded or clogged SAS or cesspool. &7 Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. dj Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($). Number of times pumped A& 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. 4 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 analy$is. If the well has been analyzed to be acceptable, attach copy of well water aaaly$is for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large jyste:ns in addition to the criteria above: y The system serves a facility with a design flow of 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: :JL[r 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 system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for further information., (revised 11/03/95) S 9UI3SURFACE SI:WAGp DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddroaa: 56 Sheaffer Road Centerville ,Mass . Owner. Harry Wharen Data of Inspootlow 7/5/96 ` Check if Zpi:g have boon done: g information was requested of the owner, occupant, and Board of Health. one of the system components hAve been pumped for at leant 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. /A. built plans have been obtained and exannintd. Note if they are not available with N/A. _ZThe facility or dwelling was inspected for signs of sewage back-up. ,XIThe system does not receive non-sanitary or industrial waste flow -IA-e niW ivm, inarxcted for signs of breakout. All system components,&luding the Soil Absorption System, have been located on the site. ZThe 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. ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods, _44he facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 PART C sYSTEM INFORMATION PropertyAddresa: 56 Sheaffer Road Centerville,Mass . Owner. Harry Wharen Date of Inspaotiol- 7/5/96. FLOW CONDITIONS RESIDENTIAL Design wflo -�&&__Ball,Qnalp¢4-!'�f4� • Number of bedrooms. �• Number of=mat residents: Garbage grinder(yes or no): Laundry connoctod to system.(yes or noQL51 Seasonal use(yes or no): Al 5 a / 9 Water meter readings, if available Last data of occupancy:�...;.9"' COMMERCIAL NDUSTR Type of establis ent: Design flow: ons/day Grease trap present: (yes or no)& Industrial Waste Holding Tank present: (yes or no) /q Non-sanitary waste discharged to the Title 5 system: (yes or no)Q�� Water meter readings, if available: AV Last date of occupancy: OTHER(Describe) Last date of occupancy: Vt GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of pection: (yes or no) If yes,volume pumped ons " Reason for pumping: TYPE O YST =ptic toEM aistr��Soil absorption system Alel single cesspool �1 rd Overflow cesspool Va Privy 0 Shared system(yes,or no) (if yes,attach previous inspection records,if any) Other(explain) AP ROIaMATE AGE of all components,date installed(if known)and source of information: /41Z�1— Sewage odors detected when arriving at the site: (yes or no): • (revised 11/03/95) ti k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. • - - SYSTEM INFORMATION (continued) opertyAddress: 56 Sheaffer Road Centerville,Mass . wner: Harry Wharen ate of Inspection:7/5/9 6 PTIC TANK: l000 cate on site plan) epth below grade:._ _ aterial of construction: concrete _metal _FRP —other(explain) imensions: x "' r " 1 udge depth:,•;,_ OF istance from top ofsl dge to bottom of outlet tee or baffle:,___ um thickness: - 0 istance from top of scum to top of outlet tee or baffle:,_ stance from bottom of scum to bottom of outlet tee or baffle. mments: commendation for pumping, condition of inlet and qutlei tees or baffle• depth of liquid level in relation to outlet invert, structural irity, evidence of leakage, etc.) P im tank Annually• Garbage- -Di osal r2 ent• Inl, _ `and outlet tees are in—lace . �fo si ns or ea age; a tic tank 1-4 u ural sound. EASE TRAP. N,f,�. Cate on site plan) :pth below grade:,•4;14 aterial of constrorli6f7,44oncrete _metal _FRP other(explain) mensions um thickness: stance from top v'i scum to top of outlet tee or baffle:_ALA stance from bottom ni From )- honom of outlet tee or baffle:.VA mments: commendation for pumping, condio-ri of inlet and outlet'tees or baffles, depth of liquid level in relation to outlet invert, structural egrity, evidence of leakage, etc.i,_ �� ✓No�tTT'S vised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontlnued) Property Address: 56 Sheaffer Road Centerville,Mass . Owner. Harry Wharen Date of Inspection:7/5/9 6 TIGHT OR HOLDING TANK:!6Ve, (locate on site plan) s Depth below grade:All Material of constructionAZ#oncrete_metal_FRP_other(explain) - ti Dimensions:_J 114 Capacity: one Design flow: ons/day Alarm level:,, Al Comments: (condition f inlet tee,condition of alarm and float switches, etc.) 6MAYLl _x)T DISTRIBUTION BOX:Ab,k., (locate on site plan) Depth of liquid level above outlet invert: 4JA Comments: (note if level)and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBEJLA, tk e. (locate on site plan) Pumps in working order:(yes or no)_n/ - Comments:° (note condi ' n of pump chamber, condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddre= 56 Sheaffer Road Centerville,Mass. Owner. Harry Whareft Date of Inspeotion: 7/5/9 6 SOIL ABSORPTION SYSTEM (SAS):,,, (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) • If not dtermiaed to be present,explain: Type: leaching pits,number: leaching chambers,number leaching galleries,number. leaching trenches,number,length leaching fields,number,dime io overflow cesspool,number: Commen� (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) CESSPOOI*. (Locate on site plan) Number and configuration: Iq Depth-top of liquid to inlet inv rt• !Ahlerr Depth of solids layer. Depth of scum layer: Dime— ns of cesspool: Materials of construction: Indication of groundwater: Lla1 V inflow(cesspool must be pumped as part of inspection)--A / Comments: (note condition of soil, signs' of hydraulic failure,level of ponding,condition f vegetation, ) Cesspool was filled to capacity. System must �e upgra �ed to a title five sep is system. PPJW: � (locate on site plan) Materials of construction: VA Dimensions:�y� Depth of solids:__ Comments-(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) ` (revised 11/03/95) g 6 V ; I .t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontlnued) ProPertyAddresa: 56 Sheaffer Road Centerville,Mass . Owner. Harry Wharen Date of Inspection: n • 7/5/9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: • r . include ties to at least two permanent mferenou landmarks or benchmarks locate all wells within 100' y Centerville`/Osterville Marstons Mills Water Company 428-6691 � i r i F� p�p R L F 4 h EI'TS TO GROUNDWATER Pth to V0undwaUr.—ZLZ—Zfeet Of determination or approximation: ` evised 11/03/95) 8 ` . E: 3 I W I � to t, r THE COMMONWEALTH OF MASSACRU 1`TTS DEPARTMENT OF ENVIRONMENTAL PROr�=`ECTI . BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfye `` tl: iDepartment's qualifications as required and is hereby authorized to use the title :.-P T FIED TITLE 5 SYSTEM INSPECTOR as provided -,.a 310 CMR 15.340 and Section 13 of Chapter ?1.:4 of tl, General Laws. Issued by The Department of Environmenta} :- �<< °c June 8, 1995 Acting Director of the ion of W4. TOWN OF Barnstable BOARD C'.1' SNAGE DISPOSAL SYSTF;M INSPECTION FORM - PART' ;,.;•;: : ,; -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STIZ17T AFMC-SS 56 Sheaffer Road Centerville,Mass. ASSESSORS MAP , BLOCK AND PARCEL OWNER' s NAME Harry Wharen PART D - CERTIFICATION Y NAME OF INSPECTOR Joseph P. Macomber Jr. . COMPANY NAME J.P.Macomber & So 'no ---------------- COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State LIP COMPANY TELEPHONE ( ) - FAX ( ) - 5.08. 77 3338 _ _508___ 790 1578 9 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the -tithe of .inspection . The inspection was performed and any recom►nendations 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 : Sys tern PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated . are as stated in the FAILURE CRITERIA section of this form , 0 XXXXXXXXXSystem FAILED* The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and 'as specifically noted on PART C - FAILURE CRITERIA of this inspection form ; ,r Inspector Signature Date 7 5%96 One copy of this c rt.ification Inust be Lz ( where aPpl icabl e ) and the I30AIlD of IIRA Provided to the OWNER, the BUYER * If the inspection FAILED, the owtier or"operator shall upgrade ' the eystem within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 ChJR 16 . 305 . Partd.doc