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Home My WebLink About0101 RUDDER ROAD - Health 101 RUDDER ROAD, HYANNIS -- - A= 247182 C i TOWN OF BARNSTABLE Y� LOCATION tX R o6pin" -;Roo d SEWAGE # VILLAGE U/�,4 V i= ��' ASSESS R'S MAP&LOT _TJVS��eIi� E&PHONE NO. �i �,,, SEPTIC TANK CAPACITY 1D000 G��yc��7n , LEACHING FACILITY: (type) �S �� (size) ,QQQ.Q�,,/s, &G NO.OF BEDROOMS �'� BUILDER O OWNER ') � QJ-J PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: s Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /6 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 14Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 eet of lea chi facility J Feet Furnished by / ----�— L p c, ' df _ n 'e- O -� �� i / nf: BORTOLOTTI CONSTRUCTION, INC. • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop d . 7, e4!� • .. fi pL. Date of Inspec) Map 2'l Parc�l Z Owner PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. [/DONE 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 NIA. i-- HE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP. (iTFIE 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. E SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON—INTRUSIVE METHODS. FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION RESIDENTIAL FLOW CONDITIONS . No of Bedrooms X2 No of Current Residents Garbage Grinder Laundry Connected to System Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: Pumping Records and Source of Information: GALLONS y SYSTEM PUMPED AS PART OF INSPECTION? 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 any) Other(explain) App oximate age of all components. Date installed,if known. Source of information. e 1'S as SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: Dimensions: `5, , s Material of construction: Concrete Metal FRP Other} Sludge Depth Distance from top of sludge to bottom of outlet tee or baffle Scum Thickness Die Distance from Top of Scum to top of outlet tee or,baffle Distance from bottom of Scum to bottom of outlet tee or baffle Commer v ' _7 1 -A s - sro , s �r�� o�.r DISTRIBUTION BOX: V DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT CommentsLL: PUMP CHAMBER: Pumps in working order? Comments: SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE: — Cj oW oL 6126/ Comments: - 6C6o,� ,. - Co an 6tj I a !lam one . cv/?0Z ," i _rn 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 6ohstruction Dimensions 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' as D�-nw 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.) /V Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? i Al Static liquid level in the districution box above outlet invert? I Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? it/ Required pumping 4 times or more in the last year? Number of times pumped I 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 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 1 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. I� PART D — CERTIFICATION �!INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 �i 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 1 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. II CHECK ONE: I v I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC l�— HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS i STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. �ii I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN I 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. II it INSPECTOR'S SIGNATURE: a,-, II DATE: II ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(ff applicable),APPROVING AUTHORITY y ,TOWN OF BARN TABLE LOCATION/ ine SEWr1GE # VILLAGE Ci v�,/IiS ASSESSC)Tt.'S M.A.1' Si LOT — _ �. .INSTALLER'S NAME & PHONE NO. F MOCiCLA, _'2'2 SEPTIC TANK CAPACITY /Uav LEACHING FACILITY:(type}; If ]a, J _(size) X 0 GN'l NCB. OFBEDROOMS _PRIVATE WF.I.L OR PUBLIC 14'ATGR �& , BUILDER OR OWNER _ _ DA.'ITE PFR MIT ISSUED- _7/3 9.__ DATE COMPLIANCE ISSUL•I?; VARIANCE GRANTED: Yes --No r V I C l i / N / 1 � re` .. t � ,. A . No.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................I.........OF Appilration for Dispaiial Works Tonxitrurtion rtrait Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ...... ........................................... 01.......W.7---------------------------------------- t.-.1040A ---------- ..... Loc i Add Lot .iticjn. ..........4 -lisp.. ........................... ................*----------------------------------------------------------------- -—----- er Address -------------------------•....... -------------------------------------------- ...................................................... nstMr Address Type of Buildi6g Size Lot............................Sq. feet U Dwelling—No. of Bedrooms._____.___........_12 ..........................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons_______.q................ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. P4 Septic Tank—Liquid'capacity............gallons Length________________ Width-_______________ Diameter--..--_-________ Depth.___._______._.. Disposal Trench—No_ .................... Width___._._.____.__._.._ Total Length_.____._____.___.___ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter......__._..___..._. Depth below inlet___..._____..._.__.. Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 4 Test- Pit No. I................minutes per inch Depth of Test Pit________.____._..__. Depth to ground water.____....._.__.____..,_.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit_____._._____._____. Depth to ground water_.____...._.__.__._.___. I . . ............................................................................................................................................................. 0 Description of Soil....................................................................................................................................................................... WI..................................................................................................................................................I..................................................... U W ------------------------------------------------------------------------------------------------------------------- ..................................................................................... U Nature of Fapairs jor tSterations—Answer when cable________________.....____._.____._______ ---t----------------------------------........................................... ---- ..... ................ ... ........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLIIM 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isWed by the board of health. Signed---! ;r�... ... .................... ..........;? Date Application Approved By----------------- ........... Date Application Disapproved for the following reasons:..................................................................... ....................................... ..................................................................................................................................................................................................... Date PermitNo........ • .....31 ...................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................................O F.......................................--------------------...............-----------•---- AVVfiration for Dispu,iaaf Works Tomitrur#ion amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1 .........................(� ------ ---------•------------------------Lot --.................................... LLo ti n-Add r s1 --•-•....................................... Lot No. �--- Owner a ................................Address- T<. '^ c.........1../.1.�!. G:.✓1................................. ........... ••----..............................•..... Inst�Wer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ....... No. of persons........_�................. Showers — Cafeteria QOther fixtures ---------------•---------•------•. --•---••-•--------------------------------•-----------------------------.....----------•---------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................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........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.._-_...________-___-._. Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •-----------•-----------------•----•------...........-----------•-••-----•------•---••••••................................................................... 0 Description of Soil......................................................................................................................................................................... x V .....--••-------------------•-------------••-------------------•------------------•----------------------------•---•------••-----------•----.......-----------••----•----••--•••--•••-•-----.........--- W -----------------------------------------------------------------------------------------------------------------------------------------------------------•------•--------•------------------•......-- U Nature of Repairs or�jlterations—Answer when(�Jp icable................]__-.-----_--.........._____......--------.--.--_-----------_--_-------..---_-. Agreement: �J 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 Certificate of Compliance has been issued by the board of health. �- Signed r ' ------••------------- -------- ? �i `G S Application Approved B 0-4- / Date A PP PP Y "" a D `J Date Application Disapproved for the following reasons:................................................................................................................ ---------------•--............_•-•••-----•--- ------ -•--•---•---------•--•----------•...-----------••--------------------•----•- ------------------------------------------------------------- ' r, Date PermitNo....... .,(."_..?.-�7........................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........� �Gq............OF............ ... :r................................ (In ifirtttr of T o mptiFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by � �' ----------•-------- 1 Installer has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..__ ,•_..__ _ 4........ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON ASfA GUARANTEE THAT THE SYSTEM WILL FUNCTIO SATI FA TORY. DATE................................ � ...: ................. Inspector................ -•--- ... ... .(_\...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .� . ........OF........ r°s� ,��........... ... .... ............ �i��a��a1 alrk� ��at��ria�tc rr�tit Permission is hereby granted /T?1 2 c ---W.En.'. .------------------------------......-•------•---------..._........_.. to Construct ( ) or Repair an Individual Sewage Disposi ystem at No..............1-C2-1--•-------. ._:C":_... .........-- Street as shown on the application for Disposal Works Construction Permit Nov`... .__ Dated.......................................... -------- ��----------•-----------------•--••---•---•---- oard of Health DATE................................................................................ ` FORM 1255 HOSES & WARREN. INC.. PUBLISHERS LOCQT10-N #C&,Oo , /,� • SEWQG,E PERMIT 1`l0 E_R-S-tJA.l-J_l E-�_A_D D_R EmS S DQ`CE PERN�IT ISSUED '— � — - f ID 4 COMPLI_Qt`lCE ISSUED �' � �- �� - :,; 9 �� .. �r , c,3 --� ,, ,Y �: -. 5 , yY � �p tl` � , �. � .. ..., 2:� .ti w u r1� i'. .. ✓✓. No.-••••I:1-- -• Fla$../..e............... THE COMMONWEALTH OF MASSACHUSETTS \ BOARD O HEALTH �/ �i V � : ... OF........ ..... -............... ...... ..f �—li�' 1 Appliration -for Bi_gpoml Workii Cnowitrurtion Vrrmft Application is hereby made for a Permit to Construct (<.or Repair ( } an Individual Sewage Disposal Syst at: ��/.°�./.��.y,/♦ ---•----•------------------------------------- ----------------- ••----•-•--------•--•--- -•-••••---- ..........•'r-"-'l-'----•---- '------- -Add D------------•------------------ ..0......1 w............ /G /c-D...or Lod:;d"_ ifs' Owner Address a / iC�si!v fyl. ��-----•-••-•--•••----------- ------•---------- --••-------------•----•-••-•••• ---- Installer Address ff Type of Building Size Lot....._... __1_ -d-- q. feet U Dwellings No. of Bedrooms.--______ ____________________________Expansion Attic ( ) Garbage Grinder ( ) p_, Other—Type of Building ----________________---__ No.- of persons---------------------------- Showers ( ) Cafeteria ( ) Q' Other fixtures ---------------- ---•-.-----___ __ W Design Flow.......................... .__.___;gallons per person per day. Total daily flow----- ``-- --_-----.-_-.---gallons. WSeptic Tank Liquid capacity gallons L eter................ Depth-----__---_--... x Disposal Trench—No..................... Wi th____..... ..._ __ tal-'Length.................... Total leaching area--------------------sq. ft. Seepage Pit No_________ _________ Diameter� _ epth belo z Other Distribution box ( ) Dosing tank ( ) /•�L e --------------------- Testa Percolation Test Results Performed by-------------------------- _ ___ __�- ,� Pit No. 1----------------minutes per inch Depth of Test Pit..------------------ Depth to ground water--------.-----.--------- (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__._---------_---_------ ----------------------------- --- --- --------------------------/y 0 Description of Soil_.... ... .._... _ _ ' U ----------------•----•----------------------- ._...........................-------------------------------•----•-•--•-•------------------•----------------------------••---•------------------------ 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 Article NI of the State Sanitary Co e—The and nsig further agrees not to place the system in operation until a Certificate of Compliance has en is ue y th o of th. /7 -7 Si • - -- --- ------ ------ ------------------------------------ ------------------------------- Date Application Approved By-- `` �i/i ............... ......`f� � �� Application Disapproved for the following reasons................................................... -_---"-------•--•--------------•---------•-•----------------- .................••--•••-----------------•-•-•---.....-----•-••-•----•---•--••---•-••-•---•-•---------••-------••-•••----•-•-----•--------------••-•. ......_..........•-•-.. ......................... Date PermitNo......................................................... Issued........................................................ Date 'THE COM`kONWEALTH.OF-MASSACHUSETTS . s. BOARD O HEALTH pp Appliratiaan -flit IN.4paxiittl = as kii Tonfitrurtion Punift Application is hereby made,for a Permit to Construct (<''T or Repair,..( ) an Individual Sewage Disposal Syst at t --- ------------ *----------------------:. Addrpess or Lo No. ' e ,aa......................... i. Ow er a� Address _w.nstall c t Address ��*y► // Q Type of Buildings'g ;:"�t Size Lot-------------- �l k� q. feet U Dwellin No. of Bedrooms__.__ 1.......................__.__Expansion Attic ( ) Garbage Grinder ( ) p-, Other,—.Type of Building- . -_____ _____________ No. of persons__-____-___________________' Showers ( ) — Cafeteria a' 4: Other fixtures ---------�� --- W 1 Design Flow- ______ Mons pe person per day. Total daily flow -_- ___.......................gallons. WSeptic Tank ' Liquid capacity �eogvallons,'/`A&ng�._.___:_ ' h-.__'--7-_-'-Diameter........ ..... Deptli...._____-._..Disposal Trench—No......____.•.________ Wi h_��, ___ tal Length-------------------- Total leaching area-. _._._-.._. -____sq. ft.'. Seepage Pit No----------r/-------- Diameter belo inlet..- _____ ____::_ Tot 'leaching area.. _. sq. ft. z Other Distribution box ( ) Dosing tank ( ) i"tt" "' .i�.+c. /i°� Percolation Test Results Performed' bY._,, .`.""_.:.................. ___� %;e":.._______._:___________: ;{. Test ,Pit No. 1________________minutes per inch Depth of Test Pit--------------- Depth to ground water...=:_:_ •:___.__._: fi Test Pit No. 2________________minutes per inch Depth of Test Pit_______________.___: Depth to ground water............ ,K /l ":... ��_ _ ff - D Description of Soil ('� '• - 5. ...j .-.. _ ' ----- ------ x ---- ------------------------?1-------------- --=-------------------------------------------------------------------------------------- ....................................... Nature of Repairs or Alterations—Answer when applicable.._____________________------------------------------------------____..___.._____._:_._.:_... -------------------------------------------------------------------------------------------------- Agreement: The under,�igned agrees )to install.the aforedescribed Individual-SewageDisposal System .in accordance with the�rovisions,'A Article XI of,the,State Sanitary C e— The and I si fu.rtl e'agrees not to place the system in operation until a Certificate of Compliance has en is ue y th of th. Si e? Date Application Approved By. _-- ---- 1..... r'r""�' 6//_ �1 ='APplication Disapprovedyf or the following reasons-----------------•-•----•••--•••-------•----------------•-------............................................... `.. `', t �_ . . Date Permit No....................................-----=------=------- Issued Date ! THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH r �........ Cy ... l ...................... .... �� _ �rrftfirtt�r .aaf f�aQut�littnre T I' S O CETIF' t the In vidtial Sen� e"Disposal System constructed Repaired ( ) by....... . -------------•-----•---- 'Inst I at :X• G1f/s ---'rtt -------- 7�---•----•--•---------------- 'in_, has been installed accordance with the provisions of Articlehe State Sa ary C s de ribed in the .� n+, yam,. �' -application for DisposalWorks Construction Perrrii< No........... ___________ dated_.f/AIL __ . THE ISSUANCE OF THIS CERTIFICATE, SHALL NOT BE CONSTRUED AS A NTEE FIAT THE SYSTEM WILLIfulurXIONrs ',IS ACfORY. •_.DATE----------•--• -•--------•-------- Inspector-= ---=-- --------------•---• •• ................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD' HEALTH y O `.. NO,--( ` .1.. S trur 'on it Permission i eby granted-•-- = --- ------------- •••---••-----------•------•••-.___.. to Constr ( r or_-gRep idu Se a e isp sal tem a' ) ,div J A __(.. • at NO.- 1 q. 1 -- ' s. e --- ------------- ----- ----•-=--••--•-- as shown on the application for Disposal Works Construction er i '__:__ Dated-:--- ._��__------ _-________ F - , �� /� ��/j ______ _____ ___ _ ____'i'_�__�_T_ .___ _.___.._ ._.__ _____....- oard f Health DATE------------------------------------------------------------------ FORM 1255 HOBBS &-WARREN• INC.. PUBLISHERS x t S l