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HomeMy WebLinkAbout0097 WEST WIND CIRCLE - Health 9 7..,Westwi n d Circle ' n 121 011 .035' . Ostervi((e II- P a =. M . a n y o 0 : o , 0 TOWN OF BARNSTABLE LOCATION 6—�-S SEWAGE# VILLAGE ^mil AS70S R'S MAP & LOTD// b35—T1ST �'NAME&PHONE NO. DJ SEPTIC TANK CAPACITY /COd G'/j I.' C9c�r 'C; .S LEACHING FACILITY: (type)Q 7L L/-/ (size) 16 C)Q Cg-fS NO.OF BEDROOMS BUILDER R OWNER G 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 et o leaching f lity) Feet Furnished by rh�0 � .��lCtc�'/b� 2i1lC. /,vo/w 3`�' BOR'1'011,01"1'l CONSTRUCTION, INC. 765 WAKEBY ROAD, MARSTONS MILLS, MA 02648 508-771-9399 508-428-8926 FAX: 508-428-9399 �`f t SUBSURFACE SEWAGE llISPOSAL.SYS'1'EM.INSPECTION FORM PART A CER'H CATION Property Address: ��7 i7 C2i' / 777,� �5 t Date of Inspection:/dS--9,�, Inspector's Name: _6F, i, o,k- Owner's Name and Address; V. CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the informa lion 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 maintenance of on-site sewage disposal systems. The System: ,/ Passes Conditionally Passes Needs Further Evaluation By the Local Aproving Authority Fails Inspector's Signature: Date: 2�( 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)SYST"PASSES: V I have not found any information which indicatcs Ihat Ilie system violates lily of the failurc 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 heed to be replaced or repaired. The system, upon comple- lion 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 exfiltration, or tank failure is imuuinemt. The systems 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 Icvel observed in the distribution box is due to broken or obstructed pipe(s)or dice to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - l - I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced 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 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 IIEALTII (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT 1'HE 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 l 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 colifornt 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)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted 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. 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 U2 day(low. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- _5 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM. n PART A CERTIFICATION (con(inue(l) 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 I hall 100 Feel but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. if the well has been analyzed lobe 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 (IWPA)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: ji Pumping information was requested of the owner,occupant,and Board of Health. 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. ✓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. _,-The site was inspected for signs of breakout. ,jAll system components, excluding the Soil Absorption System, have been located on site. 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, depth of sludge,depth of scum. .-Tile 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- e. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CIIECKLIST(continued) v"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 PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL: Design Flow:_S 3,12 gallons Number of Bedr000►s:_3_ Numbcr of Current Residents:. Garbage Grinder_ Laundry Connected'ro System: yS Seasonal Use: Water Meter Readings, if available: Last Date of Occupancy: 3 M&OV S n-cj0 v COMMERCIALAN D U STRIAL: 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 Dale of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of III Flo rmal'on_��� ,/ /c. - �/ 'Daa System Pumped as part of inspection: If yes, voile pumped: gallons 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): APPROXIMATE AGE of al components,date installed (if known)and source of information: Sewage odors detected when arriving at the site: -4- 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: S,,5'X(9 ' X S Sludge Depth: `," _Scum Th ickness: Distance from top of sludge to bottom of outlet lee or batfle: 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.)f,46 Q E' [lash ale GREASE TRAP: Depth Below Grade: Material of Construction: concrete metal FRP 'Other (explain) — — — . Dimensions: Scum Thickness: -- -- Distance front 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: /V/6 Depth Below Grade: Material of Construction: concrete metal - FRP—Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet lee,conditiou of alarm and float switches,etc.) DISTRIBUTION BOX: V, Depth of liquid level above outlet invert:, /OS/- Comments: (note ' vet and distribution is�q ,evidence of solids carryoyer,evidence of leakage into or out of box,etc. 4 PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART•C SYSTEM INFORMATION.(couthmed) 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 pondIFIR,condition of vegetation, Q4/0 Ce�' GJud-r—Q OYl o,r m e CESSPOOLS: 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) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) --—----- -G - SUBSURFACE SEWAGE DISPOSAL SYS'CEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM:. Include ties to atleast two permanent references, landinarks or benchmarks. Locate all wells within 100 Feet.' Cc � 4.3 DEPTH TO GROUNDWATER: i Depth to groundwater: 7i z Feet Method of Detern(nation or Approximation: " 'lrx /Z/, - ZV _7_ i.: mvceK Q LQCAI ION SEWAGE PERMIT NO. l..o'�30 Wf*lf GUjti�da l S y-- .�-a / VILLAGE ©,57'e-`w1le INSTA LLER'S NAME ADDRESS Q, 0 U I L D E R OR OWNER 36. t DATE PERMIT ISSUED ��— DAT E COMPLIANCE ISSUED �� O �� �. � d�1 �J 0 O t�l � � W � �� Z � �3 � � � ct� 2 � Sys ,s THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ° 3�J ti .... oF..... .,.:� .: ApplirFation for Disposal Works Tonstrurtinn Frrutit Application is hereby made for a Permit to Construct ( or Re air,,( ) an Individual Sewage Disposal System at: - r cation-Address -- ------d.-_ ------- O Address Installer Address �� Type of Building Size Lot,,4;.F✓ ----Sq. feet V Dwelling—No. of Bedrooms_______ Expansion Attic ( ) Garbage Grinder ( )a Other—Type of Building _ _t o. of persons........ _ _ Showers — Cafeteria Otherfixtures . -- -_---_-__---------_------------------------------•------------•-- ..................................... Desi n Flow________________ __ _ ________________gallons per person pell d y. Total daily flow____._._.___ __ . W g / 3- ga�lonsf i WSeptic Tank—Liquid capacity/0 gallons Length-_.��.�'-_____ Width.__- _-_-- Diameter................ Depth.- ----` _-- x Disposal Trench—No_____________________ Width_._._._.t----------_ Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..........I........ Diameter_________ _______ Depth below inlet......... ......... Total leaching area__/. sq. ft. z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by..... �'__/✓Y�. � � ,1 / ___. Date.......... __ .....�.' Test Pit No. ................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 waterz _r.o?*,.#r6,(�" a ............................................................ -••---......................................................... O Description of Soil__...----._<: .. EE.D.1.1/. ------ A'/4 D------------------------------------------------- x 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 iITI.SJ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by the board of health. Signed-- � Dat Application Approved By................... e GP �--------- .----•• , ��ate Application Disapproved for the following reasons-------------------------------••----•------------------•---•----------------•--••--------------------------•---- ..-•-•••-------•-•--•--•-----.._..-•--•..............•-•-----.....__._..--•;--••-----•---•...••------••--'--•--•-•----•-•----•---------------•---••..................................................... Date PermitNo......................................................... Issued....................................................... ---- -- --- - ------� _ Date o i No................_..... ;y Flcs.... ................ THE COMMONWEALTH OF MASSACHUSETTS lr BOARD OF HEA TH ,"� �.�.'.- , ppliratiou for Disposal Works Tonstrur#iuu Errant Application is hereby made for a Permit to Construct V-) or Repair ( ) an Individual Sewage Disposal System at ...... .... .. ......: .::....... . ........ neat on•Address r t No. .os✓ll.:i _ die'!.G�+�=,A•-, J- r :✓n` ---•--------------•---. ....7 ==�'�-E==�G�a. V........ Qwper Address 4.w - -,� �' .... Installer j Address U Type of Building Size Lo .....Sq. feet Dwelling—No. of Bedrooms.......... ...............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building D t/j! No. of persons......:-----•.---_--__- Showers ) — Cafeteria ( ) AqOther fixtures ----------------------•-•-••• . ••----•------•-...-------------•--------•-•------------•----••-••-•-----------------....-•------....._..--•----- w Design Flow................ ...............gallons per person pet��y. Total daily flow....._......�.0.. ......_.....g4llon�.� WSeptic Tank—Liquid capacity�{ •gallons Length. .._..__ Width._,._._. Diameter----_........... Depth. .... .__: x Disposal Trench—No..................... Width...... ............ Total Length.............._ Total leaching area....................sq. ft. Seepage Pit No---------1.--__.__-• Diameter......... Depth below inlet...... .......... Total leaching area. ..!9.�:/..sq. ft. z Other Distribution box ( ) Dosing tank ) `' Percolation Test Results Performed b .__. '..�1 '�+ -`` a y ,G. •f/1:�'/�J.rl-�--•-- Date-------f---------••- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.................... (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water -------------------•••••• ---.- .. .....----.----.... D Description of Soil-•-------- _..4!t .1.. .f�1-----` � -•-•-- x - 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the board of health. Signed...A. - i _ yj __.._ ----------_------- Da ....'......................•-Application Approved BY ar? ! ate Application Disapproved for the following reasons:-----•---•---••--------------------------------------•-------••----------•---------•-•........................ .......-•-•---•------•--------------•--•--------....---------•-•----------...-•-•------......•------•...-'---------•---...--•---.-•-------------•------•---•------•-------•--••--------•.........••----. Date PermitNo........................................................- Issued...................................................... Date THE COMMONWEALTH--OF MASSACHUSETTS BOARD OF HEALTH ......OF...f; - �•r'" "" c'�ydh":�••••• Tntif irFatr of TuutpfiFaurr THIS IS TO CER IFY, That the Indiyidpial Sewag Disposal S yPlom constructed 'or Repaired ( ) by...................................... �a -----.----/0 Installer .. at ... '/#/ '" !� ._+ " .._�"' .. � -°.w." 1.. ----------- has been installed in accordance with the provisions of TIT F 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-___--: '__ L_ ........... dated-....------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM VlIIL.. FU!�IPN S TISSr-ACTORY. �' DATE ..� ....-- Inspector •--•-•................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��• S'E, !D/e ......O F..: . ._.P f' .,,..�. ._. ,,X. ..�'G.�, ....... d FEE........................ Disposal oustr�Wit uti Permission is hereby granted::. `�". ----------- ----• -•-•-- 2. ...........,... ..._ to Construct q ) or\Repair ( ) an Individual Sew ge Disposal Sys Street as shown on the application for Disposal Works Construction Permit.No..................... Dated.......................................... ............. d L :..__.:. 1.F Board of Health DATE.............................................. FORM 1255 A. M. SULKIN, INC., BOSTON C�Ea lE2AL- NOTES ,�-7- -� A2F 1...6ld1E 1... M IU IM Urej of 1/b'•/FCx�lT Zi9EG�1ED- 1! / ------ -- � i►1j- PIPIES To, AA1D 14I THE SYS;IEM S `� r AE CAST IZO" Cie- 15C. EOUL-E AO P�/ A�.L�Lr..�S+�E16P T Kp�TAIJKs, A/-ID SHALL �:E DESIs,ti1ED ��� o J O N - 2.0 ! N _ �JtZEt�OEQT E1/ATl 1S OF L EVC1�i, IE��EiS�t��C A 2na0S of 1 U A.Jo Q�,Lr_F=+La_ ,Tu CLl+y T mT I I it I lJ O c) '' C1 t� A+JO Peto� To ecaGF+�lua f ZO _1Z"� IC• L O `I V V \`J/ �J 7(� — 1�+�t-ES OTNEQ�I+SE PioTE Q, ALa_ "YSTFr . rr-- ` v c = TEcr.^L,� � -�• O C� 0 O �� ^ --SE � C44CCf`I�P2�DNJAi.,1J�E S4#O.L-I-- 8�TE L..E_I _� o_f=c Tt]l-►EIw JS T ATE -f\/PICAL DIST2lE5U-Fl0 bo1C. � - --_ � C� 0 O Ci �O `3 � � or�iTXa�'y CC�UE Atilo tart { Lf�CtaL '�L>tES ►,1 c>T TO §C A L.E 1J crTE S7iST21t�l1T�cs.� 13rs+� l�.w►� li c�c�._ T1(P IC^ 7L 0_6T+41_ EPT IC. TAJ ki ,ill 1_4,9, _P►f 08-5E�t VAT/DAl P/T5 ¢�E►.iFoecEa Se-rrlc rr--�,K ny AM e+C�► c�eFu.sr ,wT m s�,�E ea xa`E Off'- ��UAL TIV.LKS R.Fu.aFcicC.EP T�ou4HCa"I' ,,e.Col-A r/o N AA7 �. /env., /.•�,c iJ ! ' _- _ 4JIn� Elbc:r�+G wELpED w+¢C wlT'1.1 7r f/' j:' r '2A _AIL•, EMBEODED STUEL- eaz�S ra) SC�TIC T1►.J+C A LF^-r-W( 6,, �t4g O�B3�•CY•IT/o�15 ay: P r r�a/4-ra!R!F a0,1t t0 OF fit�,4 L TH �R 6o-r c,,,j. 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