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Home My WebLink About0027 STONEY CLIFF ROAD - Health 27 STONYCLIFF RD., CENTERVILLE A = 4:Y 2JARECYeffO co, �m UPC 12534 No.2 153LOR HASTINGS. NH rr i y , COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION I � Property Address: 27 STONYCLIFF RD. CENTERVILLE �S w / � i� � Name of Owner DORITHY BIRON /� Address of Owner: 30 POLAND ST.APT B 8 WEBSTER MA.01570 O �GC/' Date of Inspection: 11/24/99 CC CI )y,,�� ,7 Name o/am InspaeDEP approved systctor:(Please em iinspecto JOHN orr pursuant to Sectlon 15.340 of Title 5(310 CMR 15.000) Op 61999 �a Company Name: n/a Mailing Address: n/a 4 Telephone Number: n/a L � 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 inspection.The Inspection was performed based on my training and experience in the proper function and maintenance of on-sfte sewage disposal systems.The system: X Passes The inpectlon is based on criteria defined in Tile V Conditionally Passes Icode 310 CMR 15.303.My findings are of how the system Is _ Needs Further Evaluation By the Local Approving Authority performing at the time of the inspection.My Inspection does , _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:11/27/99 The System Inspector shal submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)wfthin thirty(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 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. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 STONYCLIFF RD.CENTERVILLE Owner: DORITHY BIRON Date of Inspection:11124199 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: n1a 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.If"not determined",explain why not. n1a The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure Is imminent.The system will pass inspection if the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health. nta Sewage backup 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). broken pipe(s)are replaced obstruction is removed _ distribution box is levelled or replaced n& 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 revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 STONYCLIFF RD.CENTERVILLE Owner: DORITHY BIRON Date of Inspection:11/24/99 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 IN ACCORDANCE WITH 310 CMR 15.303(1)(b)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 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 AND SAFETY AND THE ENVIRONMENT: 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. The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS 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,Method used to determine distance ntL(approximation not valid). 3) OTHER nta SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 27 STONYCLIFF RD.CENTERVILLE Owner: DORITHY BIRON Date of Inspection:11124/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least 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. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 27 STONYCLIFF RD.CENTERVILLE Owner: DORITHY BIRON Date of Inspection:11/24/99 FLOW CONDITIONS RES113ENTIAI: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):2 Total DESIGN flow: = Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system Inspected(yes or no):M Seasonal use(yes or no):JSLQ Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NQ Last date of occupancy: n& COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: n&gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):�LQ Industrial Waste Holding Tank present:(yes or no): MQ Non-sanitary waste discharged to the Title 5 system:(yes or no):MQ Water meter readings.if available:nLa Last date of occupancy: n& OTHER: (Describe) nla Last date of occupancy: nta GENERAL INFORMATION PUMPING RECORDS and source of information: DLa System pumped as part of inspection:(yes or no):NO If yes,volume pumped nLa. gallons Reason for pumping: nLa TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nLa APPROXIMATE AGE of all components,date Installed(if known)and source of information: 1996 BY ROBINSON Sewage odors detected when arriving at the site:(yes or no): lYO revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 STONYCLIFF RD.CENTERVILLE Owner: DORITHY BIRON Date of Inspection:11/24/99 BUILDING SEWER: (Locate on site plan) Depth below grade: Z'E Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n& Comments: (condition of joints,venting,evidence of leakage,etc.) Ilia SEPTIC TANK: X (locate on site plan) Depth below grade: Z' Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) 13& If tank Is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): MQ n/A Dimensions: L_10'6"H 6'7"W 6'6" Sludge depth: Z" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 1L How dimensions were determined: MEASUREn 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.) Ct=pTIG TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING EVERY TWO YEARS GREASE REA E TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) n& Dimensions: n/A Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:-n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a 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.) revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 STONYCLIFF RD.CENTERVILLE Owner: DORITHY BIRON Date of Inspection:11/24/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,Inspection) (locate on site plan) Depth below grade: nla Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) Dimensions: n& Capacity: n/a gallons Design flow: n& gallons/day Alarm present: NQ Alarm level:xta_ Alarm in working order:Yes—No—: NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nla DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms In working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n& revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 STONYCLIFF RD.CENTERVILLE Owner: DORITHY BIRON Date of Inspection:11/24/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: D& Type: leaching pits,number: nLa leaching chambers,number: 3-COLTEC CHAMBERS leaching galleries,number: _WA leaching trenches,number,length: n& leaching fields,number,dimensions: n& overflow cesspool,number: n& Alternative system: n& Name of Technology: -n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SAS APPEARS TO BE FUNCTIONING PROPERLY,SOIL IN LEACHING AREAS PROBED DRY. CESSPOOLS: _ (locate on site plan) Number and configuration: n& Depth-top of liquid to inlet invert: n& Depth of solids layer: n/a Depth of scum layer. Dia Dimensions of cesspool: n& Materials of construction: n& Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)nfa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa PRIVY: _ (locate on site plan) Materials of construction:nLa Dimensions:n& Depth of solids: nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa revised 9/2/98 Page 9 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 STONYCLIFF RD.CENTERVILLE Owner: DORITHY BIRON -Date of Inspection:11/24/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a eC 0 0 c h AA t► Qc a� 6c 30 revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 STONYCLIFF RD.CENTERVILLE Owner: DORITHY BIRON Date of Inspection:11/24/99 NRCS Report name: Wa Soil Type: n& Typical depth to groundwater: nta USGS Date website visited: n& Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9098 Page 11 of 11 tiff 9 �0 �= Fee No. 40 .00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS a 01pprication for Digpogal *pgtem Congtruction Vermit 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. 27 Stoney Cliff Rd Dorothy Biron Centerville 30 Poland St Apt B8 Installer's Name,Address,and Tel.No. Des. § 9,rAd an IeP 0 b08— — 1 W.E. Robinson Septic Sery P.O. Box 1089 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 sand Nature of Repairs or Alterations(Answer when applicable) Install a 1 , 500 cal septic tank d—box and Title 5 leach—system. Fill old cesspools 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 no to place the system in operation until a Certifi- cate of Compliance has been issue y this Boa kof h. Signed Date Application Approved by Application Disapproved for the following reaso s Permit No. Date Issued 71 l'�' a. � - ^"f�l-"'4"••`7., n''-R-.:.y-r_x ..I�-� ^+t.r^`'.1""^^ vrr-r'"..--1T-" �. Fes..N' e.avw.-... � � ir,.. ,�Y. ....�K%- , �_ _ � - 1 Fee No. .,t•,: 'mow � y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS, 01ppYtcation for Migpogai pgtem�ongtruction ertuit Application is hereby made for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: Location Address or Lot No. 1 Owner`s Name,Address and Tel.No. 27 Stoney Cl&f f Rd "` -,Dorothy Biron Centerville 30 PolAVd St Apt B8 Installer's Name,Address,and Tel.No., Des, Ar Y3 9,rAd an et. o. bUb— — 1 W.E. Robinson Septic Sery r P.O. Box 1089 - n.. Type of Building: Dwelling No.of Bedrooms 3 "Garbage Grinder Po), 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 r ti Description of Soil sand ifjf» l - I Nature of Repairs or Alterations(Answer when applicable) Install a 1 ,500 gal septic If tank,# d-box and Title 5 leach-system. Fill old cessnools. C ` Date last inspected: t V Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system j in accordance with the provisions of Title 5 of the Environ ental Code and n to place the system in operation until a Certifi- cate of Compliance has been issued y this Bo Of� th. Signed Date�'`°mil •LJ. Application Approved by 4 p= Application Disapproved for the following reaso s t € Permit No. �.. -•• Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH-DIVISION - BARNSTABLE; MASSACHUSETTS Certiftcate of eontprtance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(X )on ,. b W.E. Robinson Septic Sery for Dorothy Biron i as 27 Stoney Cliff Rd Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d�att#ed If Use of this system is conditioned on compliance with the provisions set elo : ro ..- r 40.00 No. I Fee THE COMMONWEALTH OF MASSACHUSETTS Biron PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS li000f *p5tem Construction Vertu Permission is hereby gra to to W.E. Robinson Septic Sery to construct( )repair( an On-site Sewage System located at 527 oney r R en ery e 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. �� •.imdw All construction must cometed within two years of the date below. 0Date: Approved by I CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated t i `'l , concerning the property located at S 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 posed ro septic system P • The observed groundwater tar�i! 14�ft reater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. i SIGNED:— C A DATE: 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]. J 6161 1 1 TOWN OF BARNSTABLE LOCA710N % QA SEWAGE # O La' VIL MLAGE ASSESSORS &9 'LO INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 15 LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIAN ATE: 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 a, DC4 cl � R �l fy 2 6c Y TOWN OF BARNSTABLE LOCATION rif CMG / /= /J SEWAGE# , VILLAGE C E'Al T"E�P Y/6Lf ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. �'!_�� 0 3%/V may -ZZ�� SEPTIC TANK CAPACITY LEACHING FAciLrrY: (type)�_f-�/ / �' (size) ro l— r NO. OF BEDROOMS - 4 BbIMPMt OR OWNER ' C�Q PERMITDATE: 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 lo4chin fj�cility) Feet Furnished by i i r �i /,?O'k - t U Ft - [=T 1 - :C:j:1_I1.1_ L1�a=1J��) l` _L Z L. _ .. Z � / - ----..... .. 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SHINGLES - -- _- MATCH EXISTING FLOOR ELEVATION 6/8" PLY WOOD SU>:3FLOOR P.T. 2xV SPAN BETNEEN. LEDGERS " 4" RIGID D INSULATION^ _ G I -- 15TING CONCRETE PATIO SLAB O E( GOIrIG. "SONO" FOOTING I _ LL DOUBLE UNDER NALL P.T. 2x5 LEDGEF P.T. 2x8 LEDGER BOARD BOARD P.T. 2xb's I("O.0 P.T. 2x8's 1.6"O.C. CGALV. METAL C�ALV. 1°'IETAL JOIST WANGERS - JOIST HANGERS BLOCKING AT CENTER SPAN - - - P.T. BLOCK TO EXISTING, SLAIN UNDER TRIPLE UNDER HALL --__-- ------ 4x4 P.T. POST — -- - - GALV. METAL POST ANC�4OR "SONC7 'TUBE" PIER TYP. F1 -F LOOR ' 'F RA �l i i I N G ' FLAN- SCk-E: 114 V c� I AND. 2�446--1 �� 15� o D1 LITE i i SITTING Nr I --- (2) 7 11411 LVL 1-IEADER FL4J54 1 _ I 1 _ 2 9 LITE � AND. 24310 AND, 24310 LIVING ' N lA'-011