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HomeMy WebLinkAbout0069 WARWICK WAY - Health 59 WARWICK WAY, CENTERVILLE A= � t -� A , OCT �E�V fg COMMONWEALTH OF WEASSACHUSETTS ©R POOO EXECUTIVE OFFICE OF ENVIRONMENTAL, AF'FAI� �'D& z DEPARThmNT OF ENV1RONm:ENTAL PRoTEc TON . , ONE WINTER STREET, DOBTCN MA 02109 (617)292.6600 '[RtR1'.!COXE sic"tary AIRGEO PAUL CELLUCCI D kVII)S.3rRUIi3 G�tlAot' SUBSURFACE SEWAGE DWOSAL SYSTE♦ilt■ FWTIOM FOIWI ,^,ammiesianar PART A CatYWCAT►oM Pvopmy Addy...: 6S War uJt`{L W Mama at Own se R0100- Ce ni et'd i j 410I'n Sj, Addiren of Owner: Do* ti D *of Ibtap*eti, t D 0 o o Mesa*of reap*stae:!Flaw*Mrry,� c.�1.a,dr l am*DEP syssatt scare►purwmtt to 16.3 40(st TNW 6 0110 CM 16.0001 CaaRm"Mann: A &rk ✓t rn a. n s pecA-tc.&%4 IBalbo Address: o w T46 P, I Mmaew: 9'S'-177,6 QB i c*Mfy that I have parsonall.y inspects!the sewage disposal system at this address and that the information reported below 11111 ae,im anito and complete as of die time of inspects m, The inspection was performed based on my training and experience in the prow funu.don and mdnNmence of on-site sawage dispose I systems. The system: K ra..ee CondiMonsBy Presses _._. Needs Furth►11vsiustion By the local Approving Authority Falls Yapects►'a Slignmews= _,,C� Z L. �� I:.di!` Dens• �CX1 . ' f The System Inspector shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)wIthtr i0jh,:f(301 Arfs of completing this inspection. If the systsin is a shared system or has a design Mow of 10,000 04 or greater,the inspector and the eyetarn enNner shall)submit the report to the appropriate regional office of the Department of Environmental Protection. The original shousel be si it to lien systivr►owner and copies sent to the buyer, if applicable,and the approving authority. MOTHS AND COMMENTS rev:.sed 9/2/98 PO4PIOf11 ' oases an R«, w ispr SUBSURFACE SEWAGE 010*AL SYSTRA MSFECTIOM(FORM PART A CEiIT1FICA?ION lasrrlMared) 111impeatyAddrees: 6q "rtJ,k poster: Z4n1 h Ov of : Ltd t'S(00 =,PwCTfION SLMMMRY: Check A, C, of D A. SYSTM PASSES: Az I have not found any information which Indicates that any of the failure conditions described In 310 CMR 15.203 wdw.. Any teilire criteria not evelusted are ind Wed below. COWEN I S. SYSTM CONDITIONALLY 11►ASSIM One or more system components as desedbed In the"Conditional pXthesystem to be replaced or repaired. T1ne ystim,ui;ion compl*dan of the rspiacement or repair,as approved by the Board o . indicate yes, no, or not determined IY, M. or H101. Describe basis of deteer•.oin :s. If'not detar:S;Ir.:ct",eapli iro vny no:. The septle tank Is rnstal, unless the owner or operator hastem Inspector with s copy of a(: raficaaip Ma Compliance Istischsd)indicating that"tank was Ins en within twenty(20)wears prior to the date cif the nspectlorr or the septic tank,whether or not math,Is ereekad, aurally unsound,shows substantial Infiltration or sx11N.stion, CN Iank failure Is imminent. The system will pass Inspe if the existing septic tank is replaced with a compiling i optic tirik an approved by firs Board of Health. Sewage backup or xaakout or hi static water level obsoeved in the distribution box Is due to broken ar*birr►e+ted p�tl:�eis) or duo to a broken, settled or u van disMbution box. Th io system will pass inspection If(with approval of tl:r Bcwnl of Health). �irrok (s)are replaced r on is removed .1 butlon box is 6 we ad or ropleced '. The system requ rI pumping more then four times a year-due to broken or obstructed pipe(s), the syslwn%i,1N pest inspection if( sPp►oval of the Board of Heath): I;Ncksn pipa(s) We repiaosd 1:6struct)on Is removed revised 9/2/98 pop aof111 1 StMURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART A CMIT7►iC/1TI0e1 IasttlMiaadA •*oewt�►Addraae: b Q Owttar: `$ nor, D.b cif 1,0\31.�0 C. FURTHM EVALUATION M M UIFIED BY THE BOARD OF HEALTH. Conditions exist which roWnr further evaluation by-the Board of Health in order tXd,*t*r ,, f the system is failing to i:rote:t 11M public hee th, safety and the onvironment. .11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMPM M ACCO WITH 310 CMR 15.2031111b1I TFL#,I'ME JIVIITM a NOT FUN M CTIONG N A MANNER WHICH WK.L PROTECT THE PUBLIC TH AND SAFETY AND THE MVIMhIU;Mr: Cesspool or privy is NltAin 80 foal of surface water Cesspool or privy Is NKNn 60 feet of a bordering veget t wetland at a ash marsh. SYSTEM WILL FAR.UNLESS Ill RD OF HEALTH IMi1D PUBLIC WATER SUPPLAM V ANY}DETERIllMM TWIA'1'1:IE I yS'flflgl M F11NCT MWG N A MAMA PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE gNV�IMEDIFT: The system has a w c tank and$oil absorption system MAP and the SAS is within 100 test of a our.le,1%finer sul:ply or tributary to a au a water supply. TM system hoe septic tank and call absorption system and the SAS is within a Zone I of a public wstg1r gilopl;ly well. The system a st:ptio tank and tog absorption system end the SAS Is within 50 feet of a private wetor tuup;;ly mrsg. The syatam a ecotic tank end sell ebsoM don system and the SAS is leas than 100 feet but 60 fact 4:r n�+o t MOM:e private w supply wall,unless a web water analysis for cogform bacteria and volatile organic cornpousldn in:ileatms dolt the wall is h a from poilirilon from tAet facility and the Presenes of MW orda nitrogen end nitrate nitrogen ill et*iin to or,iass; than B pm. Msthogt used to determine distence ($gSroakrrslion sot�dl. 3i! OTHER revised 9/2/98 For 3ofit a 4 SUBSURFACE SEWAGE DUUMIt LAL sr'STM NS►tiCTION F0tI1M PART A CE R I PWATIM fcaenMraaedi Pmeety"POSS: 4P 9f wow f w tic(� Osrnar: 0y r or Daaga agl �: t O t3 160 O. srst o PALS: You ewst indicate anther"Yee" or"No" to each of the following: I haw determined that one or more of the following failure conditions exist as described in 310 R 15.303. Thu himli for thlii glawminatlon is identified below. The Board of Health should be contect*d to determine w will ba necessary to cart act Via 11si ura. Yes No Backup of**wage into facility or system component due to an overt d or clogged SAS or cesspool. Discharge or pending of effluent to the surface of the ground o urface waters due to an overloaded or seboljjp d SAS op Cgaped. Static liquid level In th edistribution box above outiat' rt duo to an overloaded or clogged SAS or casspooL Liquid depth In cess than 5"below 1 or availebie volume is less than 112 day flow. _ Required pumping rn times In set yea►JW glue to clogged or obstructed pips(a). Number of times pw Any portion of tits Stio ystcm. Csaspeel a privy is below tho high proundwatw a#evation. Any portion of a cssvy la within 100 fact of a surfsco water supply or tributary to a surface vaster ,uppfy. Any portion Gf a o*siory is within a Zon•#of•pu,bbc well. Any portion of a o rpooi or privy is within 50 feet at a pri+.aate water supply well. o Any portion of•10 gas►pool or privy is lass-than 100 feet but greater than 60 fast from a prlvst*water sul,ply v.all vditfi ra.;a acceptable water quality analysis. If th*well has been andlyted to be acceptable.attach copy of wall wntrar ri+aly.xis Fiaa conform b,ct*ria,voletilt orgenio compounds,ammonis n1vogon and nitrate nitrogen. E. LANK SYSTt'sM FAU; You irnust Indicate either "Yoe" or"No" to each of the following.- The following criteria apply to large systems in addition to the criteria above: The system serves a facility w Ith a design flow of 10,000 gpd qtgrgratar(Large System) end the system is a sign0icant :hreat t;a laubiic health end safety and the anvti,onment because one or the following conditions exist: Yet he the system is within 400 a surface drinking water stapply fire System is within fact of a tributary to a surface drinking water supply the system is I spa in a nitrogen sensitive was(Interim Wellhead Protection Area:iWPA)or a mapped Zons if of a puld#C wabr supply am ly efl) The owner or operator "aR h systa shall upgrade the system In accordance with 310 0MR 15.304(2). Please consult tine Goal regional afiloie of the D*pawbnent further hnfoimsdan. reprised 9/2/98 PAP 4orit I UBSNNfACE StwADE DOPOSAI SYSiTUA NnPSCTWN FOfW PARTS CNECIUST AtOaOWMarll► ^R (t)r f u.J Dam of=ft��l. LolSlOo Chock if the following have been done:You tnuot Indicate either "Yes" or "No" as to each of the following: Y No �. Bumping information Lves provided by the owner,occupant,or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receivbrsp rorrrud Bar rases during that period. large volumes of water have not bean introduced into the system recently or au part of this Inspection. .._ As busk plans have burn obtained and examined. Note If they are not available with NIA. v The facility or dwelling was inspected for signs of aswago Mock-up. The system dove not receive non"sankvey or Industrial wasai flow. The eke was Impacted for signs of breakout. r Ail system components.excluding the Soil Absorption System, have been located on the site. v The septic tank manholes were uncovered, opened,and the interior of the septic tank was Inspected for condit m of bietfles at toes. material of ornstructon.dimensions,depth of Yquid, 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. Por example,Plan at S.O.N. _ Determined In the Ael9 lit any of the failure criteds related to Part C is at issue,approximation of distance Is uev ccelrta3fol i/S.302ljl(b)l The fecillty owner tend occupants,If different from owner) vrare provided with Information an the proper msintiamce o1` Subsurface Disposal liysterns. revised 9/2/99 hip sot it 'SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTtON FORM PART C - STEW MIP+ORM/GTION PmgaAy Addrses: 6 q t1.� Owner cw Osola a4 � Ct� I�(OO FLOW CONDfnotlx Oasiion flow: . Q .p.d./bedr Number of oorma( ) N;oR►ber of bedrooms laetusll Tool DESIGN Saw_ Number of swreat reNd@rtb Garbage WNW"ly@e or ns}: Laundry(wosrsta eyetent) (yes or no):,Aw it yea,separate inspection required \� 1 aw'dry system Uspeated or no) Ssssonsl use Nee or no}: Q G Wsp►r maftr readings,if ev s(last 1 rro year's usage(9pd): �� 7 Sump Pump(yes or no}' ? Lost dots of occupancy:�„��'/i�, � M lam Type of establishment-* Oeelign flaw: mod.(Based on t 6.2pE1 Besia of design flow areas@ trap pro$*":(yes or no)` Mdugdoel Waste Holding Tarns present, as or no)_ Non•sanitery waste diseh@tged to -Ile 6 system:)yes or no)_ Watfrr meter madinge.If oval Lost deft of occupancy: OTMIi#1:(Ooecr(bol r +.ast date of coca y:� OfiflERAI tiIM�ORIIEATXIN G PNMPMA IIECOROeR d arc•oP intrw nr+�on^,r�� �`� / 57 l System pu as part of in p tl:(yes or nol.&D If yes.vokane pumped: .—gallons Ross"far pumpktg: TVPI"pp SYSIM Sorge tw Wdie WAlon box/soli absorption system _ Single cesspool Overflow cesspool Privy ._.s Shared system(yes or nol (if ,,ea,attach previous inspection recede,if any} I/A Technology ate.Attach col;y of up to data operation and wWntarnwrea contract Tight Tank Copy of O EP Approval MOO APNIOXNATE AGE of all components. !Jet&installed(if known)and source of information: Sa op sdere detected when arriving at the site.)yes or no) revised 9/2/98 i 4UWWALE UWAGE DlEPOSAL SWITEii MPECTWU1 FORM PART C SYSIM NPORMATIOM leendnmsd) Prapttity Qo,� oatstesr. * N K o.e s>f k. UM.lMO sENM: (loeaa on.he pan) �l 0004 below grads:1, Mau4al of aenmuetion: oast:ron.A!r40 PVC,,,_ether(explain) Diatonic from private water supply well er suction line Diemeter-- Comtients:Ioondidw of joints, venting.evidence of leakage,ate.) iEP1IC TAN111:4 ltoear*an she pan) Del"N below rob. Material of oonstmction:,-concrets_rnatal_,,,,Fiberglass _Polyethylene­other(explain) If twill is metal,list age_ Is age confirmed by Certificate of Compliance (de /No) ohnensiens: o 61l VhAP death: d Distance from top dNdge to bottom 0outlet tea or baffle. `U :ieun,thiel:ness: �r �r Distawe Pram top of scum to cap of oW at toe or belle: dr Dista:%ce hmn bottrwn of scum to botton,of outlet tee or baffle: 1 `'low dimensions were detwonk -.22Z QDu—y z Comrrta"s: Ireco:mmendation for pumping,can of inlet and out t teas or befMles,depth of id iwel in eiedo to tie Invsrt, ear �r:a;nt4gt;ty evtdenae o4 y kpa,etc.! K ,�..�1� .��..�� 4WAAM TRAP- ""me on ehe plan) Depth below grads:____ IMOW'W of construction:seone►ats_1010"I rglass _•Poi)nthyNne—,otlher{e�p;n) DiffmWons• -- Soum thickness Distance from top of seam to top of it tee or belle: Distance from bottom of scum to e outlet te ns of e or baffle: Dab M lost pt+rtipirtg: Comm"; frecornmendedon fer pu condition of inlet and outlet teas or belles,depth of liquid level In retedon to ougat invert.autrctiwh ingrgrl,hr. evideve of leakage,ate. rewteed 9/2/98 Pap 7of11 $USSUMACE SEWAGE DISPOSAL SYSTtMn MIMCTiON FORM PART C STST>M NPORMATION JOWAR SO PWOMW Ar IMM: bct UAvw kC V Wol owe«►: trove Data of l o(31z TIOWT ON MOIOMO TANK: (Tank must be pumped prior to, or at time of,inspection) lime"on eke plan) Depth h ol-M graM:� Ma/edd of construction:_ooncret,-_m*W,_Piborglass olyethvleno _othw(explainl Dimensions: - - Capsafty.. too" Design flow: gailonsldev Alan"present Atom level:_Alarrn In w 041 order;Yes_ No_ ds Da of previous p urnping: Conwesnts: te itondkion of inlet a,to on of slang,and float switches,*to.) DIi411®t vm sox-1 Voters,on sots plan). --'-.Dwih of liquid level @bow outlet invwt;.-f Comments: (neto If level and dstr)ht on is• ud,evidanw of solids earey/owe(�,outdone took ge into or t of box, ) __ _ PUMP CH�: potato on sit plan) Pumps in working order:(Y or No)_._ Akins In working order as er No)�,,,,. Canraents: inat Condition of chamber,condition of pumps end appurtenances,atc,li revised 9/2/98 Per I of 11 SUBSURFACE SIEWAOE DISPOSAL SY1iTWA WSPEC I FORM PAI1T C 9VSTM INIK MAT10M IloadrMraoadl) •wMRlr AdYaad# �,T �arw�. Dow agents,i w to l3 tc� I m- AfilsollMll o-YSM1 1-4 2J (locate on sits plan,if possible:exeavede'll not rsdllrired,location may be approximstod by non-intrusive methods) Of net located,ouplaln: Type. - iaoolft pits,mmnber:/ 1 --Mrp dwft ra,number:-- IeeeNnO 9~9*.number leeelding vent; 9.number,hmlr:h: Isaeft fields,number,Amerelons: overflow map",number:_. Aitarnodw system: . Name of TochinolegY;. CenrduerMs: (note condition of sell sigr+s of hydraulic lall re,level of pondift, damp soi,coo 4uon o vegetati qq aNa+was: - (locaol on efts plan) Number and confirmation. Dy '"'lpth-top of lmy to idtlet Invert:o pU of eelide or'. Oapth of seen+Wyatt Dhow'Idene of ceeepool* Mew-i We of construction: brdiaatlon of groundwater: inflow(cesspool at be pumped es part of inspection) Cemn�ants: (naw iron Mjen soli,sign of hydraulic I'@Our*,level of ponding,condition of vwrietation, etc.) PINIIfT:_ (locapr an sits plan) MsteAitls of dterN orlon Qidr�eseoas Depth of seeds: Comrseft (new uenMW of soil,signs of hydrauie i'aflute, level of pending,cool an of wrgetatlen,eta.) revised 9/2/98 h rfsfIt 81 JBSURFACE SEWAGE WSPOSAL SYSTVA M BPECTM FORM PART C SYSTM NFOOOMTM troadbasaatl aop«'r A %cSL Ow It. Mae Ra e4 Ea� �h r� t3loo SKMM OF SeMfAOE OMOSAL SYSTUI: Mlduds tl"to at least two perrranent reference landmarks or benchmarks locate all wells within 100' (Lee ste where public water supply earn**hito house) � r J? �3 revised 9/2/98 Palle toofit sussuar-ACE sswAes oWFOGAt aver M imspEcTwu FORM PART C SYST16M NFORIAATWM toc■dnMed) Pt pse t,Addgas: (�Ct {1.�0.1'W t( ll�c�..•� Ow W! ra n Dowofi Lc�13h NFICS Report name Sell Typa, _ - 'ryaitcoi depth to groundwetar — --- ---_ USGS Oat*website visited _ Observation Wells checked Groundwater depth. Shopow----- Moderate Deep SITE EXAPA Slope Surface water Chock Cafler Shallow wells Estimatodi Depth to Groundwater-L feet Floss InC91sto all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observer.!Sit*(Abutting property, observation hole,base emsrtt sump etc,i Determined from local conditions _Chocked with local Board of health _ Chocked FEMA Maps Chocked pumping records Chocked local oKcavaters,Installars Used USGS Data Describe how you established the High Groundwater Elevation. (Ifto be completed) HIV SAO a A. L° Q. P s Past of U / l/ revised 9/2/98 /- r I.,OT NO. :Z_�_1DDRE'S.S: WaAAAJ _ OWNERS NAME:— SEWAGE PERMIT NO. :0 ')"NEW: ✓ RCFAIR: DATE ISSUED:I�' ; jDATE INSTALLED: /d � INSTALLERS NAME : INSTALLATION OF : ell WATER TABLE : FINAL INSPECTION BY: DP-AWING OF INSTALLATION ON REVERSE SIDE : r �z �� �� o � � �t �'� l ����� � TOWN 6E BARNSTABLE r LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: 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 TOWN jO. BARNSTABLE .TION �Akricl �-<< �,VE `1 SEWAGE # LAGE �y� -J ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 100 O LEACHING FACILITY: (type) (size) K 7 NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: I . job 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 s 3 l