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HomeMy WebLinkAbout0078 DORY CIRCLE - Health 78 DORY CIRCLE,MARSTONS MILLS 4 I i i DATE:_413L95 _--- PROPERTY ADDRESS:—_78 Dory Circle Marstons Mills ------------------------ Mass . 02648 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: A, 1 -1000 gallon septic tank. B. 1 -distribution box. C. 1 -1000 gallon leach pit. Based on my inspection, I certify the following conditions: A. This is a title five septic system. B. The septic system is in proper working order at the present time. C. The present septic system is not large enough for a bedroom home. Does not meet Board Of Health requirements. SIGNATURE- Name: J`P�Macomb� ���,_______ Company:—J_P_Macomber &_Son Inc. A • Box 66 Centerville,Mass_-02632 AHR 1995 j —_ ' �'OWiV OF Phone: 508 775 3338 AB(E THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 04/04!1995 12:46 508-428-3508 C. -.O.MM. WATER DEPT PAGE 02 KEY NUMBER <10469 > NAME <BURBANK, DANIEL > B-C 1 B-C 2 B-C 3 B--C 4 STREET 78 DORY CIRCLE i REF 2 CITY 14ARSTONS MILLS ST MA ZIP 02648-1848 REF ) �- REF 3 REF 4 PHONE ( METER NO.< 10151> DATE READING P131 STREET <DORY CIR NO. 7B> 12/31/94 514 CITY MM M L54 ST LOC 06/30/94 383 41 PHONE ( ) - 12/31/93 342 143 06/30/93 199 57 ROUTE NUMBER 02 '12/31/92 142 142 -SERVICE DATE 10/22/91 06/3 /92 0 0 METER DATE 10/29/91 0 0 CAPACITY 7 STYLE T10 SIZE 1 RATE SCHEDULE KEY PIT PLASTIC X NOTE RR LEFT SIDE ADDITIONAL CONS 0 ALTERNATE MIN 0 I i 0_1lon� 1 r draft 1113195 SUBSURFACE SENVAGE DISPOSAL SYSTEM rNSPECTION FORM Address of property -] 6 D LILy Ct r-d e- AVh-gTk1$ 10'u, Owner's name (and/or resident) f Zo5A t y N !7 vY /}►v �L Date of Inspection PART A CHECKLIST .S 6 t q 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 30 days 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. 01G As built plans have been obtained. �1 See. J, P, M /y ���►✓I . /4uI L;7 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 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 on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner were provided— Y P ) p ded with information on the proper maintenance of SSDS. draft 1113195 9 SUBSURFACE SE"'AGE DISPOSAL SYSTEIII INSPECTION FORNi PART B SYSTEM INFORIIIATION FLOW CONDITIONS If residential number of bedrooms number of current residents garbage grinder, yes or no laundry connected to system, yes or no NG seasonal use, yes or no If nonresidential, calculated floe: �3 - ,S 7 voo Water meter readings, if available: iZ/31 3 pda 613°<9¢ —lt/ obd _ Last date of occupancy lq3119� i31 ooa --�— GENERAL INFORMATION . -,nping records and source of information: �o7L �C' Y N° System pumped as pan of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: r� L Sewage odors detected when arriving at the site, yes or no draft 1113195 SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: ,�/too90-� (locate on site plan) depth below grade: / " Z �,, ; /3q,r-{ material of construction: Zoncrete imetal _FRP _other(explain) dimensions: 3 %z X4 ol / 0 y 64-c. C eN G 1/ sludge depth 3' `/distance from top of sludge to bottom of outlet tee or baffle _af scum thickness 8�1 distance from top of scum to top of outlet tee or baffle ii 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, recommendations for repairs, etc.) DISTRIBUTION BOX: (locate on site plan) #0 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.) draft 1113195 11 PUMP CHAMBER: ate on site plan) i pumps in working orde , yes or no Comments: (note condition of pump cham)er, condition of pumps and appurtenances, recommendations for maintenance or i repairs,etc.) 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 and number / 6"X A ' Pi�- r'r-e(iI_r 7`- leaching chambers and number 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, condition of vegetation, recommendations for maintenance or repairs,etc.) n draft 1113195 low1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued CESSPOOLS: viv (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 pt rt of inspection) Comments: (note condition of soil, signs of hydraulic fail re, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) PRIVY: 17 G,ti v (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure level of ponding, condition of vegetation, recommendations maintenance or repairs,etc.) • draft 1113195 13 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORA'IATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I C ti �r 1 � DEPTH TO GROUNDWATER ? depth to groundwater do t � �r.0 ���,,, — C o G Us Cv 4.57— - iu,�- r y q z method of determination or approximation: SP.Q. f�jvu P • draft 1113195 1 • 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) M, Backup of sewage into facility? 0. Discharge or ponding of effluent to the surface of the ground or surface waters? NL) Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Pumped 4 times or more in the last year? number of times pumped b BUD Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure-imminent? Is any portion of the SAS, cesspool or privy: Nb below the high groundwater elevation? within 50 feet of a surface water? N3 within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? N� within 50 feet of a bordering vegetated wetland or salt marsh? /U 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 quality Y analysts? 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. i draft 1113195 15 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector ROA)141,0 "�' CAVIUA-C.) l e1 Q J Inspector Number $ /U 60 Company Name &W+(V J. C-4df/,i, pa )S - Company Address &4 2 �v 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. Chec one: Y ! I have 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. _ I have determined that the system fails to.protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature 0 --) - --- Date Original to system owner S441I ?d/41912� Copies to: Buyer (if applicable) proving authority '7ff � T N OF BARNSTABLE LOCATION Lpi r La F.SJ G/A, /,e, SEWAGE # VILLAGE ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. Ai A-AA 110 SEPTIC TANK CAPACITY 02)o LEACHING FACILITY:(type)l4A�� NO. OF BEDROOMS v PRIVATE WELL OWPUBWATaER BUILDER OR OWNER ' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: Iq. VARIANCE GRANTED: Yes No TOWN OF BARNSTABLE LOCATION- SEWAGE # VILLAGE a �i �►' ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 000 LEACHING FACILITYAtype) �-�" (size) /O O NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes tq 0 �Nd S/f0 ' Gd $ 6 6� 7 F off yc «'. No_ -- AFps..../.00-=- P ....-� t p THE COMMONWEALTH OF MASSACHUSETTS$blu C r D V E D BOARD OF HEAL °nservatjOn CormzSS1°� � - ..... ......OF......�A0145-°�� fined Alip irFation for MipusFal Works oa�str tiou lermit °ate oolApplication is hereby made for a Permit to Construct (&01 or Repair ( ) an Individual Sewage Disposal System at: ................_... ... G.«Gi1 __...._....:. -- ---_�_. _..._ cation-Ad�re or Lot No. - Q AJS� 6 �� 2 (,� .... -. ................ .,... � � �. -.---L�� � ....... •...................•••..__........_____. Own Address Installer Address UType of Building Size Lot_____ __-�"',�__!n Sq. feet Dwelling—No. of Bedrooms._.____.____ _________________________Expansion Attic ( ) Garbage Grinder pa-, Other—Type of Building ______________________{___. No. of persons............................ Showers ( ) — Cafeteria ( } Otherfixtures-------------------------------------------------=----------------------------------- -...__... W Desi Flow___________________ _ gallons per person per day. Total daily flow_.._..__.__.___._.________ ___._gallons. >m �------ --•-- g P P P Y• Y WSeptic Tank—Liquid capacity... gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area_____ _____ _-__sq. ft. Seepage Pit No--------------I---ei'ameter._._.s:__.. .. Depth below inlet...... Total leaching area.... _ _�_sq. ft. Other Distribution box ( Dosingtank ( ) %�ii Z Percolation Test Results Performed by Aa (�L___ _.__. _ __IM___I __..__. Date........ Test Pit No. 1----_7�...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........................ --------•--------------------------------------------------------------------•••••••--------•--•-•-----•-••-•-....._.........-••............................. 0 Description of Soil............................................. --------• -••• -- --•--- 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hken issued by thee board o health. - - _ Signed --/ (A .CSC .............. .... ApplicationApproved BY ..... . . ................. . ......... . �! . ...... ......... ........................ ----.. e Application Disapproved for the following reaso s ................................................................................. .. .. . . Permit No. -q-------------3...0 Issued --- .- ................................ Date Dace 3 No... 5 Fiz$..... 00- THE COMMONWEALTH OF MASSACHUSETTS -- BOARD OF HEALTH ............... 1 �Nt............OF......... ------------------------------------ a Applira#iun for 11iupuuttl lVarks nn,sirnrtinn Vamit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ......................... 1:?' #iz�'Le:.=......1.�.!l�M ......................................�._1''�...._ . ....-----•------•---•••••....----- cation-Address or Lot No. .................................................................................................. ....................._.......................•................................................_.. Owner Address W Installer Address - d Type of Building Size Lot...._.. y�` 'Sq. feet .......... V Dwelling—No. of Bedrooms........................•__-___--__-_--.__-•Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Q' Other fixtures„ Q --------------------- W Design Flow....................55....._..........gallons per person per day. Total daily flow.......................... —%°.....gallons. WSeptic Tank—Liquid capacity.� allons Length................ Width........,....... Diameter................ Depth................ x Disposal Trench—No.................... Width.--.._ __.......... Total Length.................... Total leaching area.... ..._.......sq. ft. Seepage Pit No.............. ...... Iameter.__......___�_�____- Depth below inlet...... Total leaching area..... 1 _sq. ft. Z Other Distribution box ( Dosing tank ( ) I E R Percolation Test Results Performed by.__^ f _._ _.... t�.t::�.... *._..... Date___-•_ __"�......._._��'........ 1 I a Test Pit No. 1...... '-!'"`---minutes per inch Depth of Test Pit------- .... �?..y_ Depth to ground water----- Test Pit No. 2................minutes per inch Depth of Te$t Pit.................... Depth to ground water----------------........ R+' ----•------------------•--•---------•-•••••.....-•-.................•••-••--•-••......-•-------••-•.......................................................... ODescription of Soil-•--•--•----••---•-•-•••• --------------- ------•--•......................................................................................................... W --••-----------------------------------••---••-••••----•--•------------••---•---•---•-•••••••••---••-------------•------------------......--•.......................................................... VNature 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 TITLE 5 of the State Environmental Cod —The undersigned further agrees not to place the system in operation until a Certificate of Compliance a ben issu by the board 9f health. 7 �. Signed ........e�,ZP ......-- .A lication A roved B ��!---.:>-....-- �' � .... PP PP Y Application Disapproved for the following reason ---------------------- --------------------------------------- ----..................-----------....--- ................................... 13 .....................-------- ............................ - ---------------------- -- � -- Dace Permit No. ............. Issued ...U . .. ,- ------------- Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---........._-. ------------ OF ...... ........................... Tertifirate of Contylittnre b THIS, YETIF ha Individual Sewage Disposal System constructed ( or RepairedY -��' ......� ... .. Q------_----------------------ins----------------- ....... � /�at .. �-- C. }}---- .© 1-1 .. has been installed in accordance with the provisions of TIAEf o The- ate ironmental Cqd s scri ed in the application for Disposal Works Construction Permit No. ....... '�-_, 5.�.... .. dated -_0j-. ... -- _- - - THE ISSUANCE OF THIS C RTIFICATE SHALL NOT E CONSTRU S A GUARA TN T THE SYSTEM WILL FUNCTION SAT10FACVORY. DATE--------------------------------- ...... Inspector ----------- -------- --- --- -- - --=�� p - . .... ............... ------ ................. „6 THE COMMONWEALTH OF MASSACHUSETTS r- BOARD PF HEALTH /� OF ",�............................ 1 .................0 ............. .........., No.__ FEE./Y............... iu�ruu1 /u� u its tun unfit Permission' hereb ranted..._ b1. _... ___ 1--- ...........•. Yg to Constr c or pit ( ) 'dual S , ge Disposal S / `-� - � . l at No. } -_ b.... l.!C.a / Street / as shown on the application for Disposal Works Construction Perini o.. Dated__ �.1................ G fir.�'- .. ............... ........... DATE...........9 ............................... Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS i � 44 If Sf/A,J Cati'Si• I ' i en G^ o I13,3 99 L o. 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