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HomeMy WebLinkAbout0086 SKATING RINK ROAD - Health 86 SKATING RINK ROAD, HYANNIS A=291-173 i TOWN OF BARNSTABLE LOCATION515' SEWAGE # VILLAGE ASSESSOR'S MAP & LOT _ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY --ncp � 0 ? 1 LEACHING FACILITY: (type) A Sall.t is e,Ergta(—L4size-) NO.OF BEDROOMS BUILDER OR OWNER g-+ --1 QN-0A&Z PERMUDATE: s-- 1�2 -9S COMPLIANCE DATE: L� I`•9�l Separation Distance,Between the: Maximum-Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private.WateFSupply 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 d i 4 F I 1Al i P* No. / d Fee sv, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for nigpoml *p$tem Cow6truction permit Application fora Permit to Construct( )Repair QX)Upgrade(. )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (Q, � K,��� Owner's Name,Address and Tel.No. Assessor's Map/Parcel a NaV Abv Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �10--C.bpe-c—e Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3.30 gallons per day. Calculated daily flow 1/5 7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ::F-rc� 5Cy \UllU C.�,YsX ©V`- Type of S.A.S. 144 Cti 061%!: .Xt- r1\,TVe._1oY9 Description of Soil SA_ Nature of Repairs or Alterations(Answer when applicable) :�V�-s C Y��\ N� l7`Q 0� /� Y�CG ►% i�Tv---VMS 4r- 1 �` 5Tuy-e- p,v S'� S t 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 Environmen C and not to place the system in operation until a Certifi- cate of Compliance has been issued b this lth. Signed Date Application Approved by Date S --7-9 T Application Disapproved for the following reasons Permit No.�' 2°l Date Issued _7^g •t +en,,, No. / �' '7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes .q PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migpogal *pgtim Con.5truction Permit t E Application for a Permit to Construct( )Repair QX)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.g(Q 5�• Ln ��,��P„� Owner's Name,Address and Tel.No. Assessor's Map/Parcel P S a N�V ViN -1 4 - r 3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. (Vni 0-cwAPC- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design,Flow .�3o gallons per day. Calculated daily flow V5 gallons. Plan Date` Number of sheets Revision Date Title `<• Size of Septic Tank Type of S.A.S. tA a C -Description of Soil &-e tQ SW� Nature of Repairs or Alterations(Answer when applicable) _-:y'w5'C Ye\� S 6'aSTuv-� y,n. S���S 1 /Y`� ✓1, 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 Environmen C and not to place the system in operation until a Certifi- cate of Compliance has been issued b thi alth. , tgned i Date Application Approved by _ Date.- -7-g Application Disapproved for the following reasons Permit No. 5Er- -Z a Date Issued 7- - ———---—————— ----- ----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS � Certificate of Compliance ��V a. THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(X) Abandoned( )by 1� -0-r-`A 7 E 5 C-(Tv,(_ at o Q",,'<- QX -lv^w-15 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system ill function as designed. Date I l� Inspector Fee THE COMMONWEALTH OF MASSACHUSETTS i PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'ligpogal *pgtem Construction Permit Permission is hereby granted to Construct( )Repair.( )Upgrade( )Abandon( ) System located at '! 710 ti N. tv- 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 permit. �^ \ Date: ��7-9� Approved by 4& 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(WITHOUT ' ENGINEERED PLANS) pie hereby certify that the application for disposal works I i consttw1on permit signed by rile dated concerning the meets an of the ' S��\ cam,, � • I f. Pro" ideated at ; . fo1 ng edtma: • That M no wetlands boated wittihl 100 f let of the roposed loathing bite ty are no privets wells withle 130 teat of the propoxd aeptit +t There le no h+ame in flow m War change in we proposed There are ne rrianees to p"W or needed. WIN prrsposed lesthbtg 1ko ty will be located within 230 feet of any wetlands.the bottom of the ; ptifposod leaching fikiiny will am be located less than routteen(14)feet above the maximum adjusted - groundwatertableeteration. Meatra complete the h1le mom LO A)Top of Crowd Llevallon(MtOdIng to the Lngi-eertng Divtaloe O.I.S.map) I.. B)Obw"d Groundwater Noble Blevatton(according to Health Division well map) f+ t DA71L ..x " t = LICENSED Same ` ALLER IN IM TOWN OR BARNSTABLE NUMBER (AttaeA ii cMeA AIM or#*p op�ew spotA,Atis Irdn ik.M.e town.►de....u.e.�eltt.d otet pt.a. tbls plan doold be anbmit"o 3 am sl # ty • � - C9 i sV 6 f Q f 4 TOWN OF BARNSTABLE LOCATION SEWAGE#_/V C VILLAGE �-�Lc.. y�-y`-! l ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)JLI gbh 64 i;�9�L(size) f NO:OF BEDROOMS BUILDER OR OWNER�p uv a,0 A-INJ PERMITDATE: -T- 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 ocl`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 o O j 0 j j O , e BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop ��`Y` !%Z3 �/<c`j �L _— Date of Inspec} Map Parcel 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. i THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. l�/ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. _v__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 SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR //APPROXIMATED BY NON-INTRUSIVE METHODS. v THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL No of Bedrooms _ -No of Current Residents _Garbage Grinder ur Laundry Connected to System _ � ✓U Seasonal Use NON RESIDENTIAL: (Calculated flow) _ _ _ WATER ME TER READINGS,IF AVAILABLE: GALLONS 0umpin_MBecords and Source of Information: CC'6�7fj�/' SYSTEM PUMPED AS PART OF INSPECTION? d IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF SYSTEM: Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system if yes, attach previous inspection records, if an / -Other(explain*4V -��� ,�� YL Approximate�agof all components. Date installed)'f known. Source of information. SC�IslI;q'� SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? u SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B-- SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: � Dimensions: Material of construction: oncrete Metal FRP Other} Sludge Depth ^ Distance from top of Iudge to bottom of outlet tee or baffle Scum Thickness 6 Distance from Top of Scum to top of outlet tee or baffle Distance from bottom of Scum to bottom of outlet tee or baffle Comment -� /air mad 2// s e �61,A DISTRIBUTION BOX: 1 DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: PUMP_CHAMBER: Pumps in working order? Comments: SOIL ABSORPTION SYSTEM SAS : IF NOT PRESENT,EXPLAIN: TYPE: - G'D� �Un Clef.(- Comments: fS a / � i, e Flo'" �Glk CESSPOOLS: 6 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 construction Dimensions Depth of solids Comments: l 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' uji O DEPTH TO GROUNDWATER: Z DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: 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? r¢ 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 Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration? / tank failure imminent? /Y Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? Within 50 feet of a surface water? Within 100 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? 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: 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 DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE: ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY I �! O 3 1