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HomeMy WebLinkAbout0062 PINE RIDGE ROAD - Health 62 PINE RIDGE ROAD, COTUIT - A 018 058 I� DATE:_8/21:95 PROPERTY ADDRESS:U Pinerid,ge Cotuit , u11ECEIV2.® Mass. 02635 AUG: •1995 HEALTH G`'PT. TOWN OF BARNSTABLE On the above date, I Inspected the septic system at the ab areas.. This system consists of the. following: 1 . 1-1500 gallon tank. 2. 1-distribution box. 3 . 1-6 '.x10'. leaching pit . Based on my Insertion, U, certify the following conditions: 1 . This is a title five septic system ( 78' Code ) , ' 2. .The septic system .is in proper working order at the present time'. 3. Septic tank should be pumped. ( has n.eve.r. pumped 'it, _ ) 4. Leach pit operating 'at two thirds. its capacity.- = 4. Cover' on' leaching pit should, be raised. . SIONATURr: 149 Name:_J P.Mac'omber. +Jr+.--=-- Company:_`�.P_Maco�gjber__&_Son!-Inc Address: _ Cente'rvill;e .Mass__02632? �. Phone:__, -7-5a3338 ---_' f�) THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY s . JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped .i Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 .775-3338 775-6412 CE SEWAGE DISPOSAL SYSTEM i1 S'n A4dress Of Proper.t , 62 Pineridge Road Cotuit ,Mass . Owner ' s name Rodney Dawson Date of Inspection 8/2/95 PART A C1tF;CKLIST Check if the following have been done: ---TZ 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 volumes of water have not been introduced into the ystem recently or as part of this inspection. As built plans have been. obtained and examined. Note if they are :not available with NIA. V he facility or dwelling was inspected for signs of sewage back—up. P The site was inspected for signs of breakout. 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 n existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance '.of SSDS.- SUBS.-r;FACE SEWAGE DISPOSAL SYSTEM INSPECTION rORM PART B SYSTEM INFORMATION FLAW CONDITIONS If residential number of bedrooms __ number of current residents -garbage grinder, yes or no laundry connected to system, yes or no seasonal use, yes or no If nonresidential ,` calculated flow: Water meter readirigs, if available: 1993 149, 000• =GPD=408.22 1994=123 , 000=GPD=336 . 99 Last date of occupancy GENERAL INFORMATION Pumping records and source of information: hk4Iego- all dN _A16 System pumped, as part of inspection, yes or no if yes, volume pumped Reason for pumping: T_yppe of system l �S Septic tank/distribution box/soil -absorption system Single cesspool Overflow cesspool W11 Privy _AD Shared system (yes or no) (if yes, attach previous inspection records, if any) A Other (explain) Approximate age of.: all components. Date installed, if known. Source of informat ' n: 0 Sewage odors detected when arriving at the site,. yes or no Eo;Gb 3Z .... `� , 7 • � �` •�` +_• p - b A Alt U, .44Z tow- ►� , . , �,,��, ,,>,,, t . 1 V • j 14 IN I • sow ' � , -. :rr � � ' � _ • • 3 4g ';.�� R i m,,•0�.., wT TdWN OF BARNSTABLE Ll?-13 LOCATION::`, 'i �Y t;L� SEWAGE # VILLAGE ('q ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO - ,t, 1 c .cC�, h yx?,`.2 p 11 73 SEPTIC TANK CAPACITY LEACHING FACILITY:(type)/t't 0 C. •P, l�X�a (size) �k/ NO: OF BEDROOMS FR OR PUBLIC WATER BuiE#t OR OWNER 4jatf, DATB.PERMIT ISSUED: — � DATE` COLIPLIANCE ISSUED: , VARIANCE GRANTED: Yes No • 4 P Q i W• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: 1-1500 (locate on site .plan) depth below grade: material of construction: XXX_concrete metal FRP other(explain) dimensions: W=5 ' 8" H=517" : Af. sludge depth 23" distance from top of sludge to bottom of outlet tee or baffle 1911 scum thickness Firan distance from top of scum to top of outlet tee or baffle 21" helnwdistance 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, recommendations for repairs, etc . ) - e tic tank should be' um ed once every three. ears . Septic tank is structurally sound and has no evidence of leakage . All water levels are fine , repairs needed . I DISTRIBUTION BOX: XXX (locate on site plan) .. NO 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, recommendation for repairs, etc. ) Distribution box is level :No carry over of solids ; -No evidence of leakage in or out of the distribution box. No repairs needed at this time _ PUMP CHAMBER: NONE (locate on site plan) NONE pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, • recommendations for maintenance or repairs, etc. ) NONE SUBSURFACE SEWAGE DISPOSAL. BYBTZX INSP PART B ECTION TOR?i SYSTEM IN70R?tATION continued SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not: requi.red, but 'may •be - approximated by non-intrusive- methods) If not determined to be present, explain: Type leaching pits and number i leaching chambers and number r leaching galleries and number leaching trenches, `number, length leaching fields, number, dimensions overflow cesspool , . number Comments: (note condition of soil, signs of hydraulic failure, level of ponding., conditiQn of vegetation, recommendations for ain enance or repairs etc. iF}tICU Y 0 91 l/ C{ j F i CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert 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)' (�+ ------------------ j Comments: (note condition of soil, signs of hydraulic failure, level 'of ponding, condition of vegetation 0, recommendations for maintenance or repairs etc.). PRIVY: (locate on site plan;)..,._ ._._ - ------ -- - ------------..._.._-..._.---.-._....__..:....._.:.._._.__._... materials of construction �tDN dimensions depth of solids Comments: (note condition of s.oil, ' signs of hydraulic failure, -level of.ponding, condition of vegetation, recommendations for maintenance or repairs,r- 71 .SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION' „FORM PART B SYSTEM INFORMATION continued i SKETCH OF SEWAGE L'_'SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 1008 r 00j DEPTH' TO GROUND WATER depth to groundwater method "of determination or approximation: f .... fir....._,...., _, . ._..;... .......��� • 12 SUBSURFACE 'SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART C 1 FAILURE CRITERIA . Indicate yes, no, or not determined (Y, N, or ND) . - Describe basis of determination in all instances. If "not determined", explain why not) ►© Backup of sewage into facility? �vv Discharge or ponding of effluent to the surface. of the ground or surface waters? KID Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available' volume< 1 .2 day Y i Required pumping 4 times or more .in the last year? number of times pumped 'pie. t 1V© Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? r'1 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? i within 50 feet of a' bordering vegetated wetland or salt marsh— (cesspools and .privies only, not the SAS) ? _[jam within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water P quality analysis? If the well has been analyzed to be acceptable, attach. copy of well water anal, for coliform bacteri 4, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. •rrsvascreerrisr.Z':rr.��ram.ter.=:�ssucarast:s.•�•r�T rr—^jr--ess+cmcae... rati;.:�er.._—.... I TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION �ii5'Cf:C�PTL�iTZTit>ttt':TiQ C4.'LG'ttf:'4TIIt1«.�iRT �t'LR7f..�3C3TfiaQ' .. y������ I �it�lJiR►ittTID TL•:'RRr•�:,r -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDFf. S 61 Pineridge _Road Cotuit ,Mass . ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME Rodney Dawson .. PART D - CERTIFICATION NAME OF INSPECTOR J P Macomber Jr COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville Mass . 02632-0066 Street ; Town or City State ZIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa-I system at this address and that the :information reported is true, accurate, and complete as of the time ofinspection . The inspection was performed and any recommendations 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: XXXX System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* j The inspection which I; have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and.. as specifically noted on PART C - FAILURE CRITERIA of this inspection form. � Y Inspector Signature Date 8/2795 One copy of this ertification must be provided to the OWNER, the BUYER ( where applicable) and the. BOARD OF HEALTH. * If the inspection FAILED, ,the owner or operator shall upgrade within one year of the date of the inspection, unless allowed ort required he m otherwise as provided in 310 CMR 15 . 305 . partd.doo I I C:.mmcnwea^n c, Masscc^.aers ExecuTive Ol111ce c, EnvironmenTc, Department of Environmentai Protection ' E P Water Pollution Control Tecnnccl Assrstence and Training Sections rv►W=F.w.+d Trudy Cozs Swary,EOEA Thomas IL Powws 06/12/95 ATTN: Joseph P. Macomber, Jr. Joseph Macomber and San PO Box 66 Centerville, MA 02632 Dear Joseph P. Macomber, Jr. , _ I am pleased to inform you that• you have attended training, met the experience qualifications,, and have passed the Title 5 System Inspector exam, pursuant toY310 CMR 15. 340. The passing grade for the exam was 39/52 or 75W. This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15.340. You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at .the following address: Kimball Simpson D.E.P. Training Center 50 Route 20 Millbury, MA 01527 Thank you very much for yoar time and consideration in this matter. Sincerely, I Kimball T. Simrson, I DEP Training -er Director (2 4 0 5) Fuuu 20 Millbury, MA . FAX 508-75S-4253 • T•'�, _n• 508-756-72, • U:'•"' Water ` Conservation SAVE Tips ME. CHECK FOR LEAKS Water Loss in Gallons Due•to Leaks Leak this Loss Per Day Loss Per Month .. Size 120 3,600 360 10,800 • 693 20,790 �. 1,200 36,000 • 1,920 57,600 ® �3,096 92,880 ® 4,296 128,980 ® 6,640 .199,200. -.6,984 200,520 8,424 252,720 9,888 296,640 11,324 339,720 121720 381,600 14,952 . 446,560 . t TOWN OF BARNSTABLE `1 LOCATION �` SEWAGE # VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER.OR OWNER PERMITDATE: 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 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) Feei Furnished by5��. �" �+� w Y fr w //I .� '\ / �� � 4r \ \�� / S�/ ` . r ���� � / � � � ��� � �-�. � � 0 �: _ � � �- �j ,v•e ��� G � �� � � . OF BARNSTABLE LOCATION °Z 3 4Z'tt SEWAGE # VILLAGE , ASSESSOR'S MAP & LOT() ( /9OX10 I? INSTALLER'S NAME & PHONE NO ,: -C ? SEPTIC TANK CAPACITY I-VO LEACHING FACILITY:(type)/Q60 4. -t; (size) 6)C/ NO. OF BEDROOMS 3 ""'r =w-cE OR PUBLIC WATER OR OWNER jL V DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 73 VARIANCE GRANTED: Yes No �y . � � \ D - _ � �, `> ,. {s `I� 6 "� [' p � � �,. r�"® �� : � - o.» .... Fps. ....5 THE COMMONWEALTH OF MASSACHUSETTS A BOARD OF HEALTH LQ. ..............OF.....� r�l^ IS"T!�l >�� ..... Appl rati.orn for Dispnittl Works Towitrurtiun rami# pp iCatio ere by made for a Permit to Construct (,X) or Repair ( ) an Individual Sewage Disposal System at• i � • Location-Address or Lot No. ...... »»»»»...� ........ ......................................... .............................•------•--.........-•-----------•--••................................ i W caner ddres M Installer Address Q7i ype Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............... ___................... Attic ( ) Garbage Grinder ( ) Ga4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------•••-----------------------------.-----------•----.------••--•-------------------.....---------•----.......------._........................--•--.. W Design Flow............... ...................gallons per person per day. Total daily flow.......33C� :'...._....Depth.....5.............gallons. WSeptic Tank—Liquid capacityl9?@.gallons Length.....8....... Width..._`.._._.. m D i ....... x Disposal Trench—No..................... Width.....................Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........]........... Diameter....d......... Depth below inlet......a,........ Total leaching area..���e8:: . Z Other Distribution box ( Dosing tank ( ) '-' Percolation Test Results Performed by....... ? ... ______________ Date.!.__!li. f............ __. S._.. -- 1.4 1.4 Test Pit No. 1. ___minutes per inch Depth of Test Pit..��o S....._..__ Depth to ground`water.A1.8.....1��1OF)e- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-....................... P: ............-- -•---•••••••••••-••--••------•--•••--------------••--•••--•-•-••----------..._...-----------•-••-•--•-.....••............--•....-- O Description of Soil...... C..... laY\.....--•-•----------------------------•-•--------------------------------•••- U ............................................................---•---•--------•••••--••-------------••------••••--.._..•-•----•--•-•........•-----••---•-----•-----•----...------••-•---•..._......------. W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ..... ----•••--•••-•-----••-•------•-•-•-•---------•-•--•- --------------------- ..................... Agreement: I , /I 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 agr es n place the system in operation until a Certificate of Compliance has bee issued by Zoard of health. /, -, Date / Application Approved BY. ----•----•-•. �,- DatX e Application Disapproved for the follow n reasons:-----•---------•----•---••----••...............-•---•---------...._..---------------....._......-----•......---- -•........................•---•••----.............--------•-•-••-•-------•------••••-•-••---•--•--.-•-----------------•-----------•------------------------------------------------•-•----•----•---•--- Permit No..............P..U. .7.7: » Issued_...........................................Date........... Date No.. �........ q - Fps.. .....5. .... l "e THE COMMONWEALTH OF MASSACHUSETTS •• BOARD OF HEALTH .................................... - , l rttt n for t #dMI WeR`, Tonotrnrtion ramit Application�is-.her-eby,made.for-:a)Permit,to Construct ) or Repair ( ) an Individual Sewage Disposal Sykem at: p.. ... �5 ..P.. .>� ..n__., J Ter'' . f � LoJs 23il_-4 7.5 ... .. .._... _ - -- - Location•Address or Lot No. ��._ �----__- J ---'-`!............................................................. ......................................... --•--•---------- _ ...--................... Owner M / Installer Address "Q7i ffyp\f Building � Size Lot-----.......................Sq. feet ar Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons--------------____.._------- Showers ( ) — Cafeteria ( ) Otherfixtures -----•------------------------------•-----------------------•--------•---------•----......------------•...__....---------------•--•----..........._.. W Design Flow.............. ...................gallons per person per day. Total daily flow-------3 .......................gallons WSeptic Tank—Liquid capacitvf .gallons Length.....6....... Width._..'f+`_.___. Diameter................ Depth...... x Disposal Trench—No..................... Width.................... Total Length................... Total leaching area....................sq. ft � Seepage Pit No..........t........... Diameter....1n__........ Depth below inlet.....(....._._... Total leaching area.. .: -.&, t� Z Other Distribution box (� Dosing tank ( ) �? --�a. Percolation Test Results Performed by....... __ {_a_._.__ ............... Date.Ma.u-._ -�...���5.... � Test Pit No. 1_G r_...minutes per inch Depth of Test Pit jtot.......... Depth to ground water.Xi A....U}� L=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ................................. ...........••--------------•••-----•....-----......---.......-----......................................................... ODescription of Soil.....' P..... iq� .-•-•--•---------------------•---------•------------------------•-------------•------ W UNature 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 TIT1Z- 5 of the State Sanitary Code— The undersigned further age es n place the system in operation until a Certificate of Compliance has been issued by th . oard of health. igned- •_ �. /�...4__._... �a�s.l 3 = -------- Z j Application Approved By-----]--•------------- --- ------•. .. �gc,,, Date Application Disapproved for the follow n reasons:.................................................'...................................-................•......... , ..---••--•--••-•----••...........................•-----------•---•-----•---------.•......-----------...---••---•-----•-•-----•-•--••--•--••-----•--...•--•----••••-----•--•••--•-••------•--•-....------ Date PermitNo.............! --J-....-•--••---•-•....._.. Issued-..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of Tantphatta THIS W TO CERTIFY, That Indiyoual Sewage Ispos 1 System constructed K) or Repaired ( ) Installer at................•••-----•••--••--------••--.......--•---------•---•----•--••------------------ has been installed in accordance with the provisions of TITIEF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated----------.....................................0. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............••................... n-------••---. Inspector.....---.....0.................. _ ......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .OF...............•---•-•--........_. c2' No..... .... 15.....�._7 FEE ........-•-•--...... Dispnoul Works TWonstrnrtmi n "Vrrmit Permission is hereby granted............ >' ....•...$ �' I !C,:�� -------------------•-------------------....------......---••••............,...: L.. to Construct (P or Repair ( ) an Individual Sewage Disposal System at'No....................... Pt_5.....__2 ..........PE_ x .l .l.rl6}-� C O?u /-1- stredt as shown on the application for Disposal Works Construction Permit No._g6.71�. Dated---------j/ 7. ��•••--....... ?�. DATE.............-... --•- -------------•-------...------------•------------- ------- F.. p.. A. , �p y toir t 40t j71_ _ _ .__�._ __ __°._ t S AA,00 e x ; ,c;f-Inq = 1`)FF�/VHOL e COVERS TO SCAL.E I !U' _ p _ 4 a--� -- /�•`aFcose'c& t�rc�unc Prot l _ Cr- N ECJuf�L S PT. 0 ;rnvrn per �cao-a� ) „ o r S X _ k 0-ic -3 4 -lf2 c.�ashed stone AoIt. o c o0 '.e j � • ,� \ �,! 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