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Home My WebLink About0596 FLINT STREET - Health 596 FLINT STREET, MARSTONS MILLS A 'x'OWN OF BARNSTABLE LOCA,no.N . ' XlmlZ- �l _ SEWAGE # VILLAGE ASSESSOR'S MAP & LOT ® s INSTALLER'S NAME&PHONE NO. i h"4 C-e.410 ��.06 P f SEPTIC TANK CAPACITY /J a 0 LEACHING FACILITY: (ty ) /4/ 170W AWS (size) 24- NO.OF BEDROOMS BUILDER OR O rllqq PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Tible 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) Feet Furnished by C rr9� N � �33 : TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT D INSTALLER'S NAME&PHONE NO. ,b C a4)f? Se-: Z7 lj� SEPTIC TANK CAPACITY X s o 0 LEACHING FACILITY: (ty ) Jav 70LIS (size) NO. OF BEDROOMS BUILDER OR O 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) Feet Furnished by I V n No. ` ., Fee �I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Miop0-gat *p$tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) [ Eomplete System ❑Individual Components Location Address or Lot No. %AX /_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel A` dv��s Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms _3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -3 3y gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. _t�A C ' Description of Soil S/�vko Nature of Repairs or Alterations(Answer when licable) Sej2 r) 77)t S�� - _)Li 0 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 C not to place the system in operation until a Certifi- cate of Compliance has b o eal ` Q Signed Date i t—�� ` l Application Approved by - Date /- Application Disapproved for the following reasons Permit No. _77 y Date Issued /-'/7" No. At Fees / THE COMMONWETH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS,. Z I plication for Migo5al 6pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Df6omplete System El Individual Components Location Address or Lot No. IA/7 K I(� Owner's Name,Address and Tel.No. Assessor's Map/Parcel t Q` _O S�Ill. 4.) -S Install_er.'s,Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) t Other Fixtures Design Flow �C� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title 4 ` Size of Septic Tank 1.- Type of S.A.S. \� �.. Description of Soil VKQ Z y Nature of Repairs or Alterations(Answer when a plicable) a7l/,, �T 12-) G y h F / A f 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 Cod not to place the system in operation until a Certifi- cate of Compliance has bee o ea t q Signed Date l t—n '� 1 Application Approved by Date Application Disapproved for the following reasons Permit No. ?I —77y Date Issued /7' 9 9 THE COMMONWEALTH OF MASSACHUSETTS b 2 ✓v S BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(V-10, Abandoned( )by — r= C1 at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 9— 7 7 4 dated //—/7_ 99 Installer Designer -1 r The issuance of s ermit hall not be construed as a guarantee that the stems wrl fu�ncti n a's✓desi n`ed: Date q g Inspector y 1 i / --------------------------------------- No. /9— 17 y Fee—SDI ~•_ THE COMMONWEALTH OF MASSACHUSETTS 2�0 57 _Z_ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mis pogar *p5tem Congtructton Permit Permission is hereby granted to Construct( )Repair( )Upgrade(" Abandon( ) System located at 5: !� ( r' , i <- �R 11 �A. 14`, ((C 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 conditions. Provided:Construction must be completed within three years of the date of - e t. Date: / /7 Approved by C - __J 1: t. 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I � I, c✓ CJ f hereby certify that the application for disposal works construction permit signed by me dated - concerning the property located at meets all of the following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. -/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system " There is no increase in flow and/or change in use proposed There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the ma.�dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor /method when applicable] .—,.-If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the ma dmum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) FA 7 B) G.W. Elevation 16 +the MAX. High G.W. Adjustment .�__ YF17 DIFFERENCE BETWEEN A and B T SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder.cen s �essfo- f r LL"( S��v� e commonwealth-of Mossochusetts Executive Office of Environmental Affairs John Grad -J _ D.E.P. Title V Septic Inspector Department of- - P.O. Box 2119 Environmental Protection Teaticket, MA 02536 rt ii" F.weld - (508) 564-6813 Gooema -. Trudy Coxs - _ -- 8oent.,Y,EOEA David B.Struhs - - - Oomminioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A b®N r 1 CERTIFICATION �pc Property Address: 59�0 l04- S_r M, > (,_ L `n Mi1�SAddress of Owner: ✓IJ4 Date of Inspection: (If.different) - Name of Inspector: 9,96. Co Company Name, Address and Telephone Number: CERTIFICATION STATEMENT` _ I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is=true accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: L-�Passes Conditionally Passes Needs FYrther,Evaluation By the Local Approving Authority Fails / Inspector's Signature: �fy; Date: `7 q b The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 ov,ner and cop,e� serf to tilt bu�cr, if applicable and the approving au:horiry. INSPECTION SUMMARY: Chec A,' , C, or D: Al SY TE$ M USES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. Bl SYSTEM CONDITIONALLY PASSES: + One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, 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 imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One VAnter Street a Boston,Massachusetts 02108 a FAX(617)SW1049 a Telephone(617)292-WW 110 Primed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - = --- _ PART A CERTIFICATION (continued) Property Address: - - - - — -- Owner: \ Date of Inspection BJ SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed _ pipe(s) or due to a broken, settled or-uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are 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 CJ 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 HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRON iE\T: InP �ksten) nd> d >eUtK lanK anu )u,; d6borption sy',iCn, and is w;ihiiS 1.00 fEe, iG a iul'acc v atc, SUNN!, iC surface water supply. The s\�!Pn- ha, a septic tank and soil absorption system and is within a Zone I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. DJ 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 effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - _ CERTIFICATION.(continued) Property Address: - Owner: - Date of.Inspection-5,11" - _ DJ SYSTEM FAILS (continued): - Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. - _ Liquid depth in cesspool is less than 6" below invert or-available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped 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 than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. 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. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design floe,, of 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's 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. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B - _ _- CHECKLIST -Property Address: Owner:��__ Date of InspecTio . �1 VO4 Check if the following have been done: Wiping information was requested of the owner, occupant,_and Board of Health. - _Ltone 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. jAs built plans have been obtained and examined. Note if they are not available with N/A. _L-he facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow site was inspected for signs of breakout. _L,A-H system components, excluding the Soil Absorption System, have been located on the site. �TJae 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. Ye size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _ The e,. if d,ffarPm irnm ownP,' were orovided voth information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM- _ PART C SYSTEM INFORMATION Property Address: �- ��o Owner:-- Date of Inspe idn: �n -- FLOW CONDITIONS - -- RESIDENTIAL: .„�. Design flow:.--- -- Qallons Number of bedrooms: - - Number of current residents: Garbage grinder (yes or no).LZ - Laundry connected to system (yes or no):��Q)Seasonal-use (yes or no): Z� Water meter readings, if available: Last date of occupancy: COMMERCIAL/INDUSTRIAL• D� Type of establishment: Design flow:_ allons/day Grease trap present: (yes or no)_ industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy! OTHER: (Describe) Last date of occupant}: GENERAL INFORMATION PUMPING RECORDS andsource of information: System pumped as part of inspection: (yes or no)�t1� If yes, volume pLImped gallon Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system i, 'Single cesspool Lven`low 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) and source of information: t �� Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) S -.. = SUBSURFACE.S.EWAGE DISPOSAL SYSTEM INSPECTION-FORM _ PART C _ SYSTEM INFORMATION (continued) - Property Address: - Owner: - - Date of Inspection: •\ SEPTIC TANK:_ (locate on site plan) _ Depth below grade: — Material of construction: _concrete _metal _FRP other(explain) Dimensions.- Sludge depth: ' Distance from top of sludge_ to bottom of outlet tee or baffle: _ Scum thickness: - Distance from top of scum to top of outlet tee or baffle: 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.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Scum tnickne». Distance from top of scum to too of outlet tee or baffle: nictanre from bottom of «,gym rn bottom of outle! 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.) (revised 8/!5/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C - __ SYSTEM INFORMATION (continued) — - - Property Address: Owner: 1`1 - Date of-Inspection: -- -- - TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) - Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: mote if level and distnDutiui, eyu4 e,iclCncc of so;id� ca;r?u.er, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART t - SYSTEM INFORMATION (continued) Property Address: C{ nT Owner: � Date of Inspection:' 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. _. Teaching 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 ponding, condition of vegetation,etc.) CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: e—i s, .t r, Depth of solids layer. i Depth of scum layer: Dimensions of cesspool. UAI Materials of construction: V .�l indication of grour.&-a:c-. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ^�Jr�r.\ C-�� c�:,�.\ C?�;`r 1•.� :w1� �; ;� S�L�-��.i c,\L� SC�.�l F: : <�i��C'y;� tc J PRIVY: (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, etc.) (revised 8/15/95) 8 i r .. .� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION (continued) Property Address: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least-two permanent references landmarks or benchmarks locate all wells within 100' - DEPTH TO GROUNDWATER Depth to groundwater: �c� feet \ method of determination or approximation: �S �S�Ct,i�C L (�C:i (revised 8/15/95) 9