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HomeMy WebLinkAbout0095 THISTLE DRIVE - Health 95 THISTLE DRIVE, CENTERVILLE A A= -148 018 No. 42101/3 ORA ESSELTE 10%U& 0 0 © o No. i Fee 5 0.0 0- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es Application for Mtgoar *potem Conotruction Verrait Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 95 Thistle Drive Owner's Name,Address and Tel.No. 1 —9 41 —3 5 5—41 7 2 Centerville,Mass. 02632 Richard Macnamara Assessor'sMap/Parcel ` 6939 W. Country Club Drive North Installer's Name,Address,and Tel.No.5 0 8—7 7 5-3 3 3 8 esig a sgla►► ,A N — J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass.02632 Type of Building: Dwelling XXXIo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Loamy sand to medium fine sand Nature of Repairs or Alterations(Answer when applicable) Ex i sting 1000 tank Omitting cesspool. Installincl two SOO c[Allnn leacbing cbarabers --Zd �ti� F`ly packed in 4 ' of 11" stone. 25 'X13 'X2 ' & 1 —Di. trihutinn hnx 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 oRvwe lth. SignedDate 2/2 7/01 Application Approved by Date � ��� � Application Disapproved f the following reasons Permit No. Date Issued ` TOWN OF BARNSTABLE L!_A�ATION / cam_ SEWAGE # ILLAG-GZ,if�S Fh, /l ASSESSO MAP & LOT NAME&PHONE NO KI-047d SEPTIC TANK CAPACITY aim. LEACHING FACILITY: (size) ( D NO.OF BEDROOMS-,? BUILDER R OWNER r PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 17.E 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 any wetlands exist within 300 t of leaching f :,lip) ' ^ Feet Furnished by lG '72 -�nl _ TOWN OF BARNSTABLE L36TION 395' a l 5rLe VP. SEWAGE #A001 - I7g VII1AGE C eAlfe&V-111 ASSESSOR'S MAP & LOT Iy g f� INSTALLER'S NAME&PHONE NO. f,4 A C ® A 15e f S 0 Al' SEPTIC TANK CAPACITY / D 0 D LEACHING FACILITY: (type)— C W-4, 612 RS (size) S-0 a NO.OF BEDROOMS � A/ BUILDER OR OWNER AC V / aA^11-aAC— PERMITDATE: 7- 13 —7-14,I COMPLIANCE DATE: 3/ Z'�Z'Zow 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 ``-`�. � � i � �. i � ' \�� �� b � � � �, ;�� '�6 1 y..� TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. L L-2,12 14 C 0. /'16 1 5 0 Al SEPTIC TANK CAPACITY LEACHING FACILITY: (type)A__j__,Z (size) NO. OFBEDROOM BUILDER OR OWNER 3 COMPLIANCE DATE:. PERMIT DATE: 'Separation,Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Supply Well and Leaching Facility .(If any wells exist Private Water Supp Feet on site or within 200 feet of leaching facility):. cility(If any wetlands exist Edge of Wetland and Leaching Fa Feet. within 300 feet of leaching facility) Furnished by ------------- ii 1 'fib `30 ' No. /4D/'"' `!�'9 - Fee 50.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ✓� 2pplication for �Diopaar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 95 Thistle Drive Owner's Name,Address and Tel.No. 1 —9 41—3 5 5—41 7 2 Centerville,Mass. 02632 Richard Macnamara Assessor'sMap/Parcel O /9 6939 W. Country Club Drive North -344 Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Des�gner�'s ame,Ad rests randd `�.No. C U 1 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerbtile,Mass.02632 Type of Building: ` Dwelling XX*To.of Bedrooms 3 Lot Size Sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Loamy sand to medium fine sand. Nature of Repairs or Alterations(Answer when applicable) E x i s ti ng 1000 tank / Omitting cesspool. Installing two 5900gallon leaching packed in 4 '1'of ' 1 j"-• stone. 25 'X1 3 'X2' ,&. 1 -TDistribution boxx 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 issue by this �oaz�)of a lth. Signed i�G Date 2 2 7 01 Application Approved by Date �G Application Disapproved f4 the following reasons Permit No. Date Issued ' ��� THE COMMONWEALTH OF MASSACHUSETTS a BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded... X) Abandoned( )by J.P.Macomber & Son Inc. at 95 Thistle DRive Centerville,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Noll /-/7 f dated V J 0� Installer J.P.Macomber & Son Inc, Designer J.P.Maco,tuber & Son Inc. The issuance of this erim shall not be construed as a guarantee that the s sot,�1�i cF�cd esigded Date �� a Inspector r50.00 , --------------------------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 30igpogaf 6pgtem Congtructton i9ermtt Permission is hereby anted to Construct( )Repair( )Upgrade-�,X )Abandon( ) Systemlocatedat A Thistle DRive Centerville,Mass. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this a t. Date: �/` �� —Approved 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only, CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (W=OUT DESIGNED PLANS) Joseph P.Macomber Jr..., hereby certify that the application for disposal works construction permit signed by me dated 2/2 7/01 concerning the property located at 95 Thistle Drive Centerville,Mass. meets all of the following criteria: The failed stem is connected t ry o a residential dwelling Y m only. There are no commercial or business uses associated with the dwelling. +/ The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. /There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system /There is no increase in Dow and/or change in use proposed There are no variances requested or needed. iy The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable) Af the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the ma-cimum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation ' -�— +the MAX. High G.W. Adjustment. 6 • DIFFERENCE BETWEEN A and B f SIGNED : r �' DATE: 2/27/01 (Sketch , posed plan of system on back). q:health(older.cen �r . e "1 44 6 M. BORTOLOTTt CONSTRUCTION,INC. -1-99 765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 508-771-9399 508-428-8926 FAX: 508-428-9399 tie � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART A CERTIFICATION Property Address: i r f� Date of Inspection: ;.2 = Inspector's Name: ner's Name and Address: ,� � ea 6104 CERTIFICATION STATEMENT• 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. The inspection was per- formed based on my*training and experience in the proper function and maintenance of on-site sewage disposal tems. The System: Passes Conditionally Passes Needs Further Ev luation By the ocal Aproving Authority Fails Inspector's Signature: Date: 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 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. INSPECTION SUMMARY- A)SYSTWPASSES: V 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 imminent. The system will pass inspectionlif 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 'q•: .. 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 �Aheisystem,is failing,to protect the•public health, safety and the environment. %s 1)SYSTEM WILL PASS.UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM.IS NO.T>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 HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIQ_N.- 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 Ito a surfacer 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 buf50 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 poilutionfrom the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 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. I Static liquiddlevel,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 at day,fiow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- 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 watef,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 iignificant 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 Il of a public water supply well -..a.,:.t 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: VPumping 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'sysiem hasa k' been receiving normal flow rates during that period. Large volumes of water"liave'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. -i/The system does not receive non-sanitary or industrial waste flow. ✓The site was inspected for signs ofbreakout. _ All system components,excluding the Soil Absorption System,have been located on site P-M6 septic tank'inanholes werelu'ncovered,opened,and the interior of the sdptic tank'wasktn}`+ spected for condition of baflles`or tees,material of construction,dimensions,depth!of iquid,, 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- t a y{ sty 4.. a� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CIIECKLIST(continued) Tacility owner(and occupants, if dilTerent 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: i n Flow: allons Nu mber of Bedrooms: '� Num er of Current Residents: Des g g —� y Garbage Grinder: it O Laundry Connected`L'o Syslenr:_ &S Seasonal Use: AZT Water Meter Readings, if a • able: Last Date of Occupancy: c�'i✓' COMMERCIAL./LNDUSTRIAL• 4/ 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:_ GENERA NFORM.ATION PUMPING RECORDS and source of irifOrma System Pumped as part of inspection:/Y u if yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool P r hared System(If yes, attach previous inspection records, if any) Other(explain)( P OXLMATE GE of all components,date installed(if kno n)and source of information: Sewage odors detected when arrivin6 at the site/ -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: I/ Depth below'grade: /' Material of Construction: concrete metal ' FRP Other (explain) Dimisions: . "-' Sludge Depth: Scum Thickness: On Distance from top of sludge to bottom of outlet tee or baffle: 3 y�� 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 t utlet invert tsstructural inte rity,evidence of l ag ,etc.)cZ�I 5 CL"/ �,, . . . GREASE TRAP: �1/ ` �y' • 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:/V y Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other(explain) Dimensions: Capacity: gallons 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: 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_ - t t: 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: Leaching chambers,number: Leaching galleries,number:, . Leaching trenches, number,length: Leaching,fields,number,dimensions: Overflow'cesspool, Comments: (note condition of soil, signs of by raulic,fai u e le el o nding,condition of vegetation, etc r� CESSPOOLS: Number,and.co figuration: Depth-top of liquid to inlet invert: F. 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- 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. ,t°ohTi G F �s qr � a 59 3y , 0 DEPTH TO GROUNDWATER: Depth to groundwater: / 7' Feet Metho of Determination or Approximation: r' y' -7-