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Home My WebLink About0111 BRIARWOOD AVENUE - Health 111 Briarwood Road,Hyannis 0 0 TOWN OF BARNSTABLE —..L(X ATION iGQf O O SEWAGE # � VR,LAGE /7�� ASSESS S MAP& LOTQZV,Go —P 17VSo�Q M%*A��NAME&PHONE NO. SEPTIC TANK CAPACITY " :DC LEACHING FACILITY: (type (Size) NO. OF BEDRO BUILDER ORI OWNER I PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: �/9 f 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 3 t of lac .n ac' ). /v � Feet Furnished bQg� A3 ale 4� O t . n � le" o a cl, � Z r� � w s C- /Gs e-,--r r � f t i ro � 0 VV � a � •K i"-a,,','..a8"?e��='�'�g^, �f c i�£- �4 cap r a BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop Ica M ? . Date of Inspec}7 7 7 S map Z `� Parcel pOZ Owner / ) PART A — 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 AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE 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. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. HE 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. v THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR �MAINTENANCE APPROXIMATED BY NON—INTRUSIVE METHODS. L�- THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER OF SSDS. PART B — SYSTEM INFORMATION RESIDENTIAL FLOW CONDITIONS . No of Bedrooms � V1 No of Current Residents a Garbage Grinder /`4. S Laundry Connected to System Season e NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: GALLONS Pumping Records and Source of Information: r SYSTEM PUMPED AS PART OF INSPECTION? t) IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF S EM: Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system(if yes,attach previous inspection records,,if any) Other(explain) Ap r xl—age of all:components. Date installed,If known. Source of information. CtD SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM J PART B - SYSTEM INFORMATION (Continued). E TI A K: Depth below grade: Dlmenslonsex Material of construction: ___L,,�Concrete Metal FRP Other} Sludge Depth �j Distance from top o�f sJu9pe to bottom of outlet tee or baffle Scum Thk:kness 6 l/ Distance from Top of.Scyp to top of outlet tee or baffle Distance from botb6m of Scum to bottom of outlet tee or baffle Comments: f /P� bz �eDISTRI o n e.� BUTI N X: DEPTH OF LIQUID Comments: LEVEL A VE OUTLET INVERT Comments: n MBER. Pum s in workin order? RPTI N S(STEM SA IF NOT PRESENT,EXPLAIN: / TYPE: — �1G0'` ,L Comments: � ,, //l_�CtC�j %Z/O All oet 7Y7,P op CESSPOOLS:: Number and configuration Depth—top of liquid to inlet Invert Depth of solids layer Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater Inflow(cesspool must be pumped) Comments: PRIVY: Materials of constructkm Dimenakms Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' D� 0 a$' DEPTH TO GROUNDWATER: DEPrH To GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: 1 r 02 A- / SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA (Indicate Y—yes N—no ND—not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? Required pumping 4 times or more in the last year?, Number of times pumped IV Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration? tank failure imminent? Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? Within 50 feet of a surface water? Within 1.00 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? A/ Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION . INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD,MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508)771-9399 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE$ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION 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: V I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS STATED,IN THE.`FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINEDTHAT THE SYSTEM FAILS.TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 1.5.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE:. ORIGINAL TO SYSTEM OWNER_COPIES:. UYER(If applicable),APPROVING AUTHORITY r La . CAT10N ��,�� SEWAGE PERMIT WO. VALAGE I N S 7 A LL It" R S NAME ADDRESS I UILDER OR OWNER I c./ey/1' s / v✓y� S _. GATE PERMIT ISSUE? - 6GATE 'Cflkl, PLIANCE IS ! t9ED_ � :� cs �a � �n�_ a � � .`� � �� 1 ��- \ .. No... Fus...... �....................... � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ...............................O F................................-------------------......----------.............--------- Appliratiou for 11itipuiiFal Workii Tongtrurtinrt runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - L ati n-A re s' g or Lot. ,4 �1 � �!�C ...........e.L.A .. O ner Address ................. . --------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......... __. -_-..._--..-Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building _..._._.... No. of persons............................ Showers �4 YP g P ( ) — Cafeteria ( ) Q, Other fixtures .......... .... W Design Flow........................................ ..gallons per person per day. Total daily flow...... .......................................gallons. W Septic Tank—Liquid capacityiI,0--gallons Length................ Width................ Diameter--------------- . Depth---------------- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...., ,;;�.-sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date.......................... a Test Pit No. 1 minutes per inch Depth of Test Pit.................... Depth to ground water-•- Gi, Test Pit No. 2 ._-__-_--minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............................... Description of Soil f ..�....�.. .._....--------------- I txj ----------------------------------------------------- ------------------------------ -------------------------------------------------------------------- •---------------------------------------•--•---- W U Nature of Repairs or Alterations—Answer when applicable................................................................................................ •---------------------------------------------------------------------------------------•--------•-......-••-•----------------------------------------------.......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in oper tion ti a Cer •fica Com 'ance has been iss ed by the board It Signed a Applica`tio pproved ---------- - ---•--. ----•- ........... ............................... ate Application Disapproved for the ollowing reasons--------------------------------------------------------•--------------------•-----------------------.........-- ................•--•.._.......--•-••----......__....-----------...•.•---.....----------•••--•--•----------------•--••--•----•----------------------------- ........................................... Date Permit No..... 5 3.0 --------------------- Issued.................. ..................... D aw T �J No,25�e:.a FizB Z)Jh A.... .......- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF............. ........ ............ Appliratioul. for. Disposal Works Tonstrurtion Permit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .....e461�... ............ .................... Location 4Mress or Lot No./ ----------- 41 100 Own er Address-2 . _;a.;le........... _21 Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_____________ ..........................Expansion Attic Garbage Grinder ..........A�� P4 Other—Type of Building ............................ No. of persons___.___.__________.____.____ Showers Cafeteria P4 . Other fixtures ........................................................................ ................................. t(l W"....0----------*--------------------- WDesign Flow............................................gallons per person per day. Total daily flow.....--'-I .. .......................gallons. 9 Septic Tank—Liquid capacity/01---gallons Length________________ Width__.___._.__._.__ Diameter-_______________ Depth................ Disposal Trench—No_.................... Width_._._._._.________._ Total Length..____...._.___._.__ Total.leaching area--A15,;1-_sq. ft. Seepage Pit No_____________________ Diameter.__.....____.____._. Depth below inlet____..__.___________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results- Performed by____________________________________________________________________•-•--• Date._________________-_________.._.....,_-. Test Pit NO. 14��. 02�-minutes per inch Depth of Test Pit.................... Depth to ground water.... Test Pit No. 2#4A minutes per inch Depth of:Test Pit____________________ Depth to ground water........................ ................................ . ..... ---�? ---------------------------------------------------*-------------------- --------------------------- ------- 0Soil..-------- 6- ............................................................ Description of . a) ---------- U ...................................................................................................................................................................................�1................... W ....................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .....................................!1�......................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code.—The undersigned further agrees not to place the system in operation until a Certift to f Com iance has been iss, ed by the bDoard_,oLLiealt1j, I igned......... -- ----- ..... . ...... .... ............ ............ A1i ................. ppt coC A4W ................................................................... ... ..................... Application Disappro e for the following reasons:............................................................................ .... ......................... ....................................................................................................................................................................................................... Date Permit No. .............. Issued-......I -.-195------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntifirate of THIS IS by TO CERTIFY, That the Individual Sewage Disposal Syste;h constructed/K,- or Repaired ................ 0 ...................................................................... Installer at............. ............ ........ ................................................................................................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Coe as in the application for Disposal Works Construction Permit No___________________________............. dated-_ ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CC' STRUED AS A G AR �TEE THAT THE ... ........TRUED , SYSTEM WILL UN ION SATISFACTORY. DATE....----.... ....6)..25....................................... Inspector..—.— SETT ............... THE COMMONWEALTH OF MASSAC SETTS BOARD OF HEALTH ...............................................................................................................................OF' NOQJ... FEE- ...... �i��n��al nrk�".�.�n/��a�rr#U^a,,n�_rrntit _ Permission is hereby granted....... to Construct or�Repair i In ividual Sewa aDis osal System atNo.......... f-----Dl--;�............ . .................................................................................................... Street as shown on the application for Disposal Works Construction Permit --- Dated- -- I ---------------- ....................7: .-air........ ............................/.......................... T, Board of Health DATE...................(,1.. ..........................L... FORM 1255 A. M. SULKIN, INC BOSTON i - Lo 24 N 39' so ' l "C U 2 q� In Zo6E2T eIA4 L260SPr) � Cy MULH. . N K x,o IA,*" � 0� t r o%1 ry. ^ � or 10 b ° y q S i 1 00 C � � Lo-r. 2 2 � �y g� �� T tQ COGY� SF I''LN. n� loo': MLv �ID7-H Js� PHIL�1Jj o� ROBERT a BRUCE 2D /O IO ET�SACICS I� WEI G s, ELOREDG A .3366 AL aD su��' € LEGEND EXISTING SPOT ELEVATION 0140 EXI:gTl�flb . CONTOUR --- 0 — m— CERTIFIED PLOT PLAN R114.1'SMED , SPOT ELEVATION ( i P'I4 ISN.ED CONTOUR L�r 23�,,, _POkT ; Nffi .`The location of any existing underground sewerage, webs, or other utilities shown on, this plan is approx- IN <imat�'only. as determined from records and/or .verbal �, A k1 S VA.9 p�o A ASS* ` information. The .contractor is responsible for the �� cation, of the:existing locations in the field. SCALE+ /" = C9 DATE FE3 Zn' .SS k :DREDOE ENGINEER/A16 WIN CLIENIT I CERTIFY THAT THE PROPOSED EGISTERE rsIURVEYOR 419TERED JOB NO. Q BUILDING SHOWN ON THIS P'L AN f . x `CIV1�'' LAND CONFPRMS TO THE ZONING LAWS DR.BY� OF ARNSTA13LE., MASS. k 0 EE ti �, T!2 MAI N STREET. C61, p4. Y e. fi HYANNI % MAM gHEET..t... OP - A E REG. LAND SURVEYOR f a O 14 : Oo , �C� J 0 HO H w04 ZA PQ Of �:. 411 U : V �• aae; .. oo •� e .i� h � b J2�� Q V' ` ♦ 44 46 �► 0 00 1. Ziu Q Jk Ci . • w ' � oe'• Q 41 ft .: .14 to VQI . hk4w w 44In -� 41 k k k.. 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