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HomeMy WebLinkAbout0008 WINTERGREEN CIRCLE - Health 8 WINTERGREEN CIR., OSTERVILLE A= 119 040 0 0 a DATE:-_7/.21/95 . . PROPERTY ADDRESS: s Wintergreen.._Circ.le_ Osterville ,Mass . vy( 02655 -- On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 2-6 ' x8 ' block cesspools g® 1-ld d� mft c RfC IV Bailed on my InR:�tion, I certify the following conditions: JUL 2 8 1 . �This is not a title five septic system. 19� � 2 . The second cesspool is not receiving any water Q` from the main cesspool . Line is collapsed and must be � ej replaced . 3. The cover on the main cesspool has to be redone , Cover `� does not fit arch of cesspool . SIGNATURE: !, Name:J P':iMacom'b`er Company: J_.,P_Macpinb_er_&_$on,! )� Address: Bo,x . c, en"te)lrw�.tlh �: 0263�L1�1 ------------L��`—� Phone: S98=775=3.S�18; THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY s _ JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-00)66 775-3338 775-6412 r 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM Address of . property g Wintergreen Circle Osterville ,Mass.. Owner' s name Albert Drukteinis Date of Inspection 7/21/95 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 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 vailable with N/A. . The facility or dwelling was inspected for signs of sewage back=up. The site was inspected for signs of breakout.. All system components, excluding the SAS, have been located on the site. The manholes were uncovered, opened, and the interior of the qepti - tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of ludge, 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. �he facility owner (and occupants, if different from owner) were provided with information on the proper maintenance -.of SSDS.• Recommendations 1 . Cover on main cesspool must be removed and new one set . 2 . Overflow line from the main cesspool to #2 is collapsed and must be . replaced . It is not receiving any water from the main cesspool . t . 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B 1 SYSTEM INFORMATION ) FLOW CONDITIONS If residential number of bedrooms number of current residents S garbage grinder, yes or no' e- laundry connected to system, yes or no e seasonal use, 'yes or no If nonresidential, calculated flow: Water meter readings, if available: 1993=39, 000 gallons=GPD=106. 84 1994=33, 000 Gallons=GPD=90. 41 Presently Last date of occupancy GENERAL INFORMATION Pumping records and source of information: . -No Pumping Records available .' Nn System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: NONE Type of system _ �mh Septic tank/distribution box/soil absorption system YRy, Single cesspool YR4 Overflow cesspool _ n Privy Nn Shared system (yes or no) (if yes, attach previous inspection records, if any) *, Nn Other (explain) Approximate age of all components. Date installed, if known. Source of information: �'�roarc nr n� rear•' Nn Sewage odors detected when arriving at the site, yes or no . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION ­ntinued SEPTIC TANK: NONE (locate on site plan) depth below grade: material of construction: concrete metal FRP other(explain) NONE dimensions: NONE n sludge depth _0 distance from 'top of sludge to bottom of outlet tee or baffle . 0 scum thickness n_ distance from top of scum to top of outlet tee or baffle n_ distance from bottom of scum to bottom of outlet tee or baffle 0 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outle.0 invert, structural integrity, evidence of leakage, recommendations for r: ;::::irs, etc. ) NnNF DISTRZ•BUTION BOX:.NON (locate on site plan) NONE depth of liquid level above o'' '. ' -_t invert Comments: ,(note if level and distribution is equal, c'.; dence of solids carryover, evidence of leakage into •or out of box, rc .•:. :..:;-endation for repairs, etc. ) NONE PUMP CHAMBER: XoNg (locate on site plan) , O _ pumps in working order, yes or no Comments: (note condition of pump chamber, condition cf pumps and appurtenances, . recommendations for maintenance or NONE --._..... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART S 8Y8TEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : YES (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 and number _ NO leaching chambers -and number ° NONE leaching galleries and number _ NONE leaching trenches, number, length N_ONF .. leaching fields, number, dimensions —NnNF overflow cesspool , , number CPcc'nnnl - 2 61x8 ' B1 Comments: (note condition of soil, signs of hydraulic failure, level of pondirig., condition of vegetation, recommendations for maintenance or repairs,etc. NONE CESSPOOLS (locate on site plan) : number and configuration 2-61x8 ' Block cesspools depth-top of liquid to inlet invert 6811 ��--- depth of solids layer 12" depth of scum layer 611 dimensions of cesspool 6 ' x8 ' materials of construction Concrete block indication of groundwater NONE inflow (cesspool must be. pumped as part of inspection) Comments: (note condition of soil, signss of hydraulic failure, level •of ponding, condition GraVelyNoehadraulicefailuresoroponainpaintenance or repairs,etc.) ion norma sound . ver ow lne . co must be rep a new cover set on # l. cesspoo . PRIVY: (locate on site plan-).. : ---- -.......... ... ....._...:.._........ - .....:.._.... .... .._: ...... . ._ _. materials of construction NONE dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, - level of.ponding, condition of vegetation, recommendations for maintenance or repairs,P' a • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION •FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L'_SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells. within 100 ' n Town Water r O DEPTH TO GROUNDWATER 18 '+ depth to groundwater method of. determination or approximation: Test hole no water . 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 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? AM Discharge or ponding of effluent to the surface. of the ground or surface waters? ALL&Static liquid level in the distribution box above outlet invert? 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? Is any portion of the SAS, cesspool or privy: �l below the high groundwater elevation? l VO 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? kO within 50 feet of & bordering vegetated wetland or salt marsh- (cesspools and .privies only,. not the SAS) ? ND within 50 feet of a private water supply well? Na 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. bee analyzed to be acceptable, attach copy of' well water anal- . for coliform bacteria, volatile organic compounds, ammonia nitrogen-` and nitrate nitrogen. �:rarrszrr�v ti.-zar..:m��.:=�a�caarsaasr�rr�rs-�s¢�:-scze:- ��-zara_�:�.-^•ate-r_I TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION �t.�:aa�r:is�-xra^.arsxs-rsa�xn�r¢cs--or�smss�+r�:r�rir- �stsa:�vavr*r:rar+s.�--_r.�-rr_.=arc�arx:ar..z-rscrtsr:rrrr.ry_:rar•n--:J -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRfZS #"Minter Green circle Osterville ,Mass . ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAMEAlbert Drukteinis 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-1 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 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: xXYK 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* The inspection which I. have conducted has found that the system fails to protect the public heatlth 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 . � t Inspector Signature Date 7/2�/96- One copy of this c rtification must be provided to the OWNER, the BUYER (where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or cperator shall upgrade the system within one year of 1-1he date of the inspection, un :ss allowed 5�i, required otherwise as Provided in 310 CMR 15 . 305 . Pa vd .doo Ccmmcnwearr cr Masscc^::seTTs Executive Office cr Envircnmema C: Department of Environmental Protection ' Water Pollution Control Tecnnicel Assisrance and Training Sections ; YARIam F.wow cww.•n. Trudy Cox* seammy.cO Thomas&Powers Acwq Comne.orw 06/12/95 ATTN: Joseph P. Macomber, Jr. Joseph Macomber and Son 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 to 310 CMP. 15 . 340 . The passing grade for the exam was 39/52 or 751. 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 your time and consideration in this matter. Sincerely, Kimball T. Simpson, DEP Training Center Director [2 4 0 5) Route 20 9 Millbury, MA 01527 • FAX 508-755-9253 a Telephone 508-756-7281 C Water .. . 1r Conservation sa�E 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. 0 4,296 .128,980 ® 6,640 199,200. `A � 6,9,84 '. 200,520 8,424 252,720 9,888 296,640 ® 11,324 339,720 12,720 381,600 14,952 . ; 448,560 ,9 "' =IUWN OF nARNSTABLE 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 PERMIT DATE: 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 lea c 'ng facility) Feet Furnished by 7 N f � � Q No. (U / J 7 Fee D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: VY ..PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for Thgpoar *p5tem Construction permit Application for a Permit to Construct( ) Repair(fig Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. h l�Jllr° Owner's Name,Add ess,and Tel.No. rV c ►vs p S��aeXv Assessor's Map/Parcel �', © Z� © ,eXV T InstalLar's Nalne,Address,and Tel.No. Designer's Name,Address and Tel.No. Oh 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Al erations(Answer when applicable) Peptu pp _ 9f)L,?u A',q 4,en / ok 14 Z, 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 Certificate of Compliance has been issued by this of th. IL �. e Date Application Approved Date CJ / Application Disapproved by: Date for the following reasons Permit No.— C � Date Issued _ ,. ;x Fee/ r� f F: THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Vy 0[pprication for Mi5po!gal *V5tem Con.5truction Permit t Application for a Permit to Construct O Repair(AT Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot""cN^^o. �R� �JtJc" Owner's Name,Address,and Tel.No. � � l JT V !�t I J t � -QXl/1.!UL � ' ► "�` Assessor's Map/Parcel c f/ � � .. Ole Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. E T z X l'P cay1fk"tF 0. T 1 l.h'i,: 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(inin.required) gpd Design flow provided and r Plan Date Number of sheets 4� Revision Date Title Size of Septic Tank Type of S.A.S. ' Description of Soil iA Nature of Repairs or Alterations(Answer when applicable) T ep A Lz:y A* '-v) Pbln ; �t Date last inspected: Agreement: 1. 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 Certificate of Compliance has been issued by this Board of Heapth. f �+ Si ne Date �A-2/,0 Application Approved b. Date ��CJ Application Disapproved by: Date for the following.reasons Permit No. �CZ=Z) --7 Date Issued 3 �7 THE COMMONWEALTH OF MASSACHUSETTS rl �� - BARNSTABLE, MASSACHUSETTS c (Certificate of Compliance r THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ,X) Upgraded ( ) Abandoned( )by . ,T , ►i ( pk�ayr w CI i 4 r at A 6 k-r. r2•.,tl n (" %-' �g�, has been constructed in accordance 1 G with the provisions of Title 5 and the for Disposal System Construction Permit No. 9� -1 dated Installer Designer #bedrooms Approv d-design flow gpd The issuance of this permit shall not be co/istrued as a guarantee that the syste will fu ct�on designed. Date c� l(� Inspector ——------------------------------------------ No. 69�6 //_� Fee / l THE COMMONWEALTH OF MASSACHUSETTS fyA at 1 ) 1­4�PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ��e e =igpo�ar � 5ten� Con�truction Permit Permission is hereby granted to Co�struct ( ) Repair (�) . Upgrade ( ) Abandon ( ) System located at e6 UJ k_XZ t�?Ira( r\ 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 conditioris. Provided: Construction ccst be co pleted within three years of the dat of this pe 1$. Date `�j CT I b Approved \ �'�� TOWN OF BARNSTABLE J LOCATION A SEWAGE # ' 4'ti• VILLAGE ASSESSOR'S-MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY . LEACHING FACILITY: (type) z (size) j NO.OF.BEDROOMS 1 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 leac 'ng facility) Feet Furnished by N S' og- r R � I 00