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HomeMy WebLinkAbout0025 WALTON AVENUE - Health 25 WALTON AVE. , HYANNIS A=310-013 �i I I i 6 i TOWN OF BARNSTABLE LOCATION SEWAGE # 7 VILLAGE h'V4 WIV/5 ASSESSOR'S MAP & LOT ""-1�91.3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITYQli LEACHING FACILITY: (type)fOO Gk C /,Vc4 64-11-) (size) 12d ,cP.! X,2 � NO.OF BEDROOMS 3 BUILDER OR� >�C� PERMTf DATE: "—/4/—,5�7 COMPLIANCE DATE: —JWY/9Z Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility' S f 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 ti co A i f� 1 i M14' No. / Fee y Vs THE COMM NWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Di!gpool *pgtem Conotruction i3ermit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) LPComplete System El Individual Components Location Address or Lot No.. Owner's Name,Address and Tel.No. Assessor's Map/Parcel *>IewflA; "el Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /-9�3 y Type of Building: Dwelling No.of Bedrooms ✓a Lot Size sq. ft. Garbage Grinder(-90 Other Type of Building $ AZzl e No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow f gallons per day. Calculated daily flow _34�10 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank .11 5 Type of S.A.S. /Z,"2=A Z57 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 7-1 2—le 4?7 44, ?� 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 t is oar of He Signe Date Application Approved by Date Application Disapproved for 1he following reasons Permit No. Date Issued No. -- `� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0ppYication for Mie;pozal *pgtem Construction 3permit Application for a Permit to Construct( )Repair,( )Upgrade Abandon( ) LJComplete System ❑Individual Components Location Address or Lot No.7,G'_(Alf/t,'Y17 WP ,s Owner's Name,Address and Tel.No. Assessor's Map/Parcel Idstaller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 771-"q'31,!�I Type of Building:_ Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder('� -�• Other Type of Building P_5% ,-A No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow f D gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title ..-'Size of Septic Tank �O�9�J' Type of S.A.S. Description of Soil t� Nature of Repairs or Alterations(Answer when applicable) 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 i Bo�fe Signe i Date Application Approved by Date Application Disapproved for the following reasons jQ Permit No. Date Issued ------------------------ THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY,that the On;site Sewage Disposal System Constructed( )Repaired (Y )Upgraded( ) Abandoned( )by eo/' Le,*91 at Z-S ei-io n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '". dated Installer Designer , Lie The issuance of this perm/-� �l�a 1 nol e ednstrued as a guarantee that the s ('e wi unction as j��prgn Qd. ,t ' Date V Inspector � `" z� -� -- --- --------------- -- -- 0 d/ -- e i No. 1 Fee f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogaf *p! tem Con!5tr Lion hermit Permission is hereby granted to Construct( )Repair( )U,p�rade(Y)Abandon( ) System located at 23 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 's/he-duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructs in sl c pleted within three years of the date of, e n Date: / Approved by a J J ,r ,r Q C - CERTIFICATION OF SKETCII AND APPLICATION FOR A DISPOSAL WORKS CONS"I'R O]ON PERMIT(WHUOU'I'DESIGNED PLANS) de.-fA If'�/ , hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 'Z JF &I4/f0/I 4m.—O '6y-1 -5 meets all of the following criteria: +� here are no wetlands within 300 feet of the proposed septic stem P Po P system There are no private wells within 150 feet of the proposed septic system /The observed groundwater table is 14 feet or greater below the bottom of the leaching facility Y There is no increase in flow and/or change in use proposed /There are no variances requested or needed. SIGNED:—� �"'`s%��� 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). i1 TOWN OF BARNSTABLE LOCATION Z,5—W;M/o-1 SEWAGE # 77 VILLAGE NY !1d%2 ASSESSOR'S MAP&LOT ©��3 INSTALLER'S NAME&PHONE NO: 711 SEPTIC TANK CAPACITY IreZ) �a L LEACHING FACILITY: (type) f od Ga< <�rc�r ll ��i•� (size). /2,1; T X,2 NO.OF BEDROOMS 3 BUILDER OR IWISO PERMIT DATE::'_/e0—/L/`t4l 7 COMPLIANCE DATE: V . . 4 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility s f 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 1o. goo, 3s' ty O O Ib' THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) m A �C(�J L DATA . 6,- 316 Town of Barnstable R Department of Health, Safety, and Environmental Services i AM Public Health Division t439• � 367 Main Street, Hyannis MA 02601 woe: 308-?90-6465 Thomas A.McKesk Its,CHO FAX: 509-790.6304 Director of Public Health FAX T0: �n N► (� -� `C� } 59, DATE i ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 26 �1`" was wispect d�i"� z9�on by a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: I n' 't X�' You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty, (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to, pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health CORM ) BORTOLOTTI CONSTRUCTION, INC. to 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648508-771-9399 508-428-8926 FAX: 508-428-9399SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F PART A CERTIFICATION Property Address: (.CJ Date of Inspection: Inspector's Name: Owner's ame and Address: Q//A 77 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 mainlenance of on-site sewage disposal systems. The System: Passes Conditionally Passes ��Needs Further E ation th Local Aproving Authority Fails . Inspector's Signature.. /bv Date: � �t~I 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)SYSTEM PASSES: 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 exfrltration,or tank failure is imminent. The system will pass inspection if 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 - SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM c:! PART A f:'°•` CERTIFICATION(continued) `, Broken pipe(s)replaced s ---' 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 r_ 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 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 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 FUNCTION- 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 to a surface 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 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 the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYM FAILS: I haEve determined that the system violates one or more of the following failure criteria as defined in 310 9MR 15.303. The basis for this determination is identified below. The Board of Health shouvbecontacted 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. J Discharge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- v. 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 water 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 significant 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 (1WPA)or a mapped Zone 11 of a public water supply well. 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: _fCPumping information was requested of the owner,occupant,and Board of Health. _Lz-None of the system components have been pumped for atleast 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. t/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 system does.not receive non-sanitary or industrial waste flow. t/The site was inspected for signs of breakout. _/All system components,excluding the Soil Absorption System, have been located on site. _L/The septic tank manholes were uncovered,opened, and the interior of the septic tank was in- spected for condition of baffles or tees, material of construction,dimensions,depth of liquid, fth of sludge,depth of scum. j 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- : l '� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) i/The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a ... _. .PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL: Design Flow: gallons Number of Bedrooms: v� Number of Current Residents: Garbage Grinder:2_ Laundry Connected To System: Seasonal Use:�(� Water Meter Readings,if available: Last Date of Occupancy: COMMER AI,/INDUST IAL:A)d 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: GENERAL INFORMATION PUMPING RECORDS and source of iiilormation: �� - System Pumped as part of inspection:_ If yes, volume umped: gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(lf yes,attach previous inspection records, if any) Other(explain): APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: -4- y t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: Material of Construction: concrete metal FRP_Other (explain) Dimisions: Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: 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 to outlet invert,structural integrity,evidence of leakage,etc.) GREASE TRAP: 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:A 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:Ab 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 CHAMBEROLL Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -5- r 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,number: Comments: (note condition of soil,signs of hydraulic failure level of ponding,condition of vegetation, etc.) CESSPOOLS: Number and configuration: Depth-top of liquid to inlet invert: "� 'CJ Depth of solids layer: Depth of scu layer: Dimensions of Cesspool: V " of Materials of construction: XS �9GYtJnd�cat�on groundwater: Inflow(cesspool must be pumped as part of inspection) Comm nts: (note condition of soilk_, Sig s of h draulic ilure, le of ponding,condition of vegetation, etc. cJ" 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 - fi 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 be ichmarks. Locale all wells within 100 Feet. 3� a� DEPTH TO GROUNDWATER: Depth to groundwater: 1 5— Feet / Metholt of Determination or Ap roxi ation: NJl1 �t" ��m� /.l• 5. • -7-