Loading...
HomeMy WebLinkAbout1380 OST.-W.BARN. RD - Health '1380 r OST MARSTONS MILLS l A = 126 006 - - - -- -- - 1 ° CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE, MA 02632 (508) 790-23751FAX#(508) 790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F.A.# j 3- Z► f 6 LOCATION: .M ADDRESS OF RELEASE: O Sf_ J, gelig LS, DATE OF RELEASE: (o Ns-113 PRODUCT RELEASED: '72,t nT51=nottC- Q((„ ESTIMATED QUANTITY: < 2-- &A-I. I CORRECTIVE ACTION TAKEN BY RESPLO.NSIB E PARTY: C NOTIFICATIONS: FIRE DEPARTMENT: YES(✓"'NO( ) DATE: TIME: 0010 NATIONAL RESPONSE CENTER YES( ) NO(')Q DATE: TIME: DEPT. OF ENVIRONMENTAL PROTECTION YES( ) NOV) DATE: TIME: OIL SPILL COORDINATOR: YES( ') NO(yj DATE: TIME: TOWN BOARD OF HEALTH: YES( lp NO( ) DATE: 2 TIME: Del 5_, TOWN HARBORMASTER: YES( ) NOV) DATE: T O OTHER AGENCIES: C_L_ ar2S S c O COMMENTS: an o f ez 2 "" L el e e-- m REPORTED BY: DATE: Ip ZS COPY-FIRE DEPARTMENT COPY-D.E.P. COPY-BOARD OF HEALTH C-O-MfA FORM#58 No. � Fee 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipphration for Otg ogal opmem Congtructton i3ernrit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) )aComplete System ❑Individual Components q Location Address or Lot No. 13 8 0 0 s t.W.13`. � OC�r Owner's Name,Address and Tel.No. �/ Deborah Colton Assessor'sMap/Parcel �• � 00 1380 Ost. W.B. Road M&M Installer's Name,Address,and Tel.No.%)* &&o ###* Designer's Name,Address and Tel.No$ ) 5:Q Q t 7 7§f>7 0 0 J.P.Macomber & Son Inc. Ron Cadillac Box 66 Centerville Mass.02632 P.OBOx 258 West Yarmouth,Mass.02673 Type of Building: Dwelling XX No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 448 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil See Plan Nature of Repairs or Alterations(Answer when applicable) 1 -1500 gallon tank 1 —Distribution box 2-500 gallon leaching chambers packed in 4 ' of 1;" stone. 33 'X12 ' 10"X2 ' 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 the Environmental Qode and not to place the system in operation until a Certifi- Cate of Compliance has been igued by s o of Heal Signe Date 9/9/01 Application Approved by Vy Date owl' �_O Application Disapproved r the following reasons Permit No. s Date Issued N�. ti"�t Z,���/ �� Fee .0 0 i - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 'PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pprication for 33iopozal Opotem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) )Complete System El Individual Components Location Address or Lot No. 13 S 0 O s t.W. O d Owner's Name,Address and Tel.No. . let �f Debprah Colton Assessor's Map/Parcel / �� 13 8 0 -O s t. f'� t�. W.B. Road M&M Installer's Name,Address,and Tel.No.%)* &&`is ###* Designer's Name,Address and Tel.No.%)NOO 7 0 0 J.P.Macomber & Son Inc. Ron Cadillac — :d Box 66 Centerville,Mass.02632 P.OBOx 258 West Ygamouth,Mass.02673 Type of Building: Dwelling XX No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow. 448 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 'Description of Soil See Plan Nature of Repairs or Alterations(Answer when applicable) 1 -1500 gallon tank 1 —Distribution box 2-500 gallon leaching chambers packed in 4 ' of 11," stone. 33 X12 1 0' X2' 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 C6de and not to place the system in operation until a Certifi- cate of Compliance has been i wed by As /7o of Heal 1. Signe; Date 9/9/01 _ - Application Approved by Date 414--- Application Disapproved r the following reasons v ,� Permit No. `J., d0111� Date Issued THE COMMONWEALTH OF MASSACHUSETTS --- --BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded)'(XX) Abandoned( )by J.P.Macomber, & Son Inc. at 1 380 Ost. W.B. Road Marstons MIlls,Mass. has been constructed in,accordance with the provisions of Title 5 and the for Disposal System Construction Permit No j,-A /dated A00� ' 6W, Crl Installer J.P.Macomber & Son Inc. Designer Ronald Cadil ac The issuance of this pifer'it shall not be construed as a guarantee that the system/,will function as desi red. ` Date IC I l Inspector s "� �Q No. e l .���---------------------------Fee $ 50.00 THE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 1wizpooar 6potem Construction Permit Permission is hereby granted to Construct( )Repair(<XgUpgrade( )Abandon( ) Systemlocatedat 1380 Ost. W.B. ROad Marstons Mllls Mass 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 this er�nit. Date: Approved by TOWN OF BARNSTABLE V Lz"; ATION 15,F- dam" � /✓� SEWAGE # VILLAGE �004.4S'�;g /�/�.�iC ' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. a SEPTIC TANK CAPACITY (� LEACHING FACILITY: (type (size) 9 NO.OF BEDROOMS BUILDER OR OWNER l� C PERMITDATE: COMPLIANCE DATE: ° Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private-Water-Supply Well and Leaching Facility (If any wells exist on site nr within 200 feet of leaching facility) Feet . { Edi=of W land and Leachi g Facility(If any wetlands exist !! N -Z,-# Within ` .0 feet of c ;g,!f a i ' ) � Feet Fu tish,- ° lyV61',er -LSO ek o �. i TOWN OF BARNSTABLE 8 ,LOCATION 1-3 S O ® &A&dl. /°0 SEWAGE # � 9,0 ,ILI LAGE jM 0 L=%LA2MASS ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. nnaA, � f. SEPTIC TANK CAPACITY >5bC� LEACHING FACILITY: (type) L: Law dl lna la zi-5 (size) 33 s 10 icY� NO.OF BEDROOMS BUILDER OR OWNER l PERMIT DATE: ' �� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 Ll t DATA 8/22/01-- -- - PROPERTY AooREss :Estae`OfwSylvia_Colton - •For;Debra Colton r Marstons Mills ,Mass____ r02648 -- On tho above dole, I Inapootod the oeptlo ay,3torrh at the above address. ThI1 syilem conslsta of the following: 1 . 2-6 'X8 ' block cesspools. ae3vd on my Inspection., I cerilfy the following oondltlonat 2 . Th_s is not a title five septic system. 3. This is sewage system. 4. The sewage system is root bound. 5. A new title five septic system should be installed. b. The present sewage system is in failure. $1GNATVRE!;,� _ � Company; Jo, !2b_P __N•comb•r—b Son , 2nc , A d d r e a a ;_ B o_x- 6 6_---_w______w __Conc@_rY111aL Ne -_026J2r0066 Phone: 508- 715- 3338 THIS CEATIFICAT10N 001E NOT CONSTITVTC A OVARANTY OR WARRANTY JOSEPH P, MACOMBER & SON, INC, T+nk►•0��►poolit.r+chit+Ida Pumpfd 4 Initillid Town S#wir Connovtloni P,o. 8ox 66 Conl+rYlll+, MA 02637-0060 776.Jm 77$441z , P NOF 0?��EP� k f ,per -\ COMMONWEALTH OF MASSACHUSE'I'TS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1 380 Ost. W.B. Road ars ons Mills,Fiass. Owner's Name: Es ate Of Sylvia Colton Owner's Address:C/O Debra Colton 15 Coleman Rt-rPPt Newton,Mass.02465 Date of Inspection: 8/2 2/01 Name of Inspector: (please print) Joseph P.Maeomber Jr. Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 Centervill_e,Masa_ 02632 Telephone Number:508-775-3338 CERTIFICATION STATEMENT 1 certify that 1 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditional]\Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: If'per/ The system inspector shall su&acopyof this inspection report to the Approving Authority(Board of Health or DEP)within 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 DEP.The original should be sA)t,to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments t _ ****This report only describes conditions at the time of inspection and under the conditions of use at that 'time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 1 Title 5 Inspection Form 6/15/2000 page 1 r Fage 2 of I 1 n OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:1 380 Ost. W.B. Road Marstons ,Milis,Mass. Owner:Estate Of Sylvia Colton CTO bra Colton Date of Inspection: 8 2 2 01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: r. y, I have not found any info_ation which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 (fMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The ipresent sewage system is root bound B. System Conditionally Passes: .t L One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes,no or not determined Y N ND in the « ( ) for the following statements. If not determined"please explain. 41 The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: q,tKJ�Observation of sewage backup or break out or hi_gh static water level in the istribution bo due to broken or obstructed pipe(s)or due to a broken, settled or uneven istrebution ox System will pass inspection if(with approva I of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 0 The system required pumping more than 4 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 ND expla:.n: 2 i I Page 3 of I I r( OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 380 Ost. W.B. Road Mars ons i s, ass. Owoer. Estate Of Sylvia Co ton C 0 Debra Colton Date of Inspection: 8/22/01 C. Further Evaluatico 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 public health, safety or the environment. I. S�•stem will pas: unless Board of Health determines In accordance with 310 CMR I5.303(1)(b) that the system is not functioning in a manner wblch will protect public bealtb, safety and the environment: Cesspool or privy is within s0 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 any)determines that the System is functioning 'n a manner that protects the public health,safety and environment: /(2L The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. 1 d The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supple iU0 The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 f et but 0 feet or more from a private water supple %t•ell". Method used to determine distance � 'This system passes:if the well water analysis, performed at a DEP certified laboratory, 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, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 1 Other: This is asewa e s stem. The system consists of two 6 'X8 ' block cess ools in series. The present sewage systeltl -' is root bount.A new septic system s ou a ins 3 r Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1380 Ost. W.B. Road Marstons Mills,Mass. Owner: Estate Of Sylvia Colton C/O Debra Colton Date of Inspection: 8/2 2/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No / _ ku� acp of sewage into facility or system component due to 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 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or / cesspool r/ Liquid depth in cesspool is less than 6"below invert or available volume is less than h day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped D--. _ -,121 Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of 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 1 of a public well. �y portion of a cesspool or privy is within 50 feet of a private water supply well. y 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. [This system passes if the well water analysis, performed at a DEP certified laboratory, 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, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes ri the system is within 400 feet of a surface drinking water supply Ze ystem is within 200 feet of a tributary to a surface drinking water supply t.�e system is located in a nitrogen sensitive area Interim Wellhead Protection Area-IWPA or a mapped — — Y g (. ) PP Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5ofII �- 1 J OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1380 Ost. W.B. Road Marstons Mills,Mass. Owner: Estate Of Sylvia Colton C/O Debra Colton Date of Inspection: 8/2 2/01 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health /Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period? d Have large volumes of water been introduced to the system recently or as part of this inspection? Z'Were as built plans of the system obtained and examined?(If they were not available note /A) _ Was the facility or dwelling inspected for signs of sewage back up _ Was the site inspected for signs of break out ? _ Were all system components,-Wluding the SAS, located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? /_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes nVExisting information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION Property Address: 1380 Ost. W.B. Road Mars tons Mills,Mass. Owe.er: Estate Of Sylvia Colton C/O Debra Colton Date of Inspection: 8 22 01 FLOW CONDITIONS RESIDENTIAL Numoer of bedrooms(design): Number of bedrooms(actual):— K, DESIGN flow based on 310 C 15.203 (for example: 110 gpd x#of bedrooms): ��' Number of current residents: Does.residence have a garbage grinder(yes or no): Ab Is laundry on a separate sewage system (yes or no):� [if yes separate inspection required] Laundry system inspected(yes or no): § Seasonal use: (yes or no):�e— y��� Water meter readings, if available(last 2 years usage(gpd)): 9 —le ,�,�(/�-- Sump pump(yes or no): A,16 Last date of occupancy:oZfAV,— COMMERCIAL/INDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203):_ &j gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industr-.al waste holding tank present(yes or no): 40 Non-sa-iitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: / OTHER(describe): /9 GENERAL INFORMATION Pumping Records Source of information: Was sys-.em pumped as part of the inspection(yes or no):_ If yes, volume pumped:1llons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system l Sing!e cesspool Overflow cesspool Privy 4M Shared system(yes or no)(if yes,attach previous inspection records, if any) ,UD Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) aTight tank ��Attach a copy of the DEP approval Other(describe): Ayy WA to aa-e of all cojVonents, date installed (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 40 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 380 Ost. W.B. Road Marstons Mills,Mass. Owner: Estate Of S lvia Colton C/O Debra Colton Date of Inspection: 8 22 01 BUILDING SEWER(locate on site plan) Depth below grade: � /l Materials of construction:_cast iron 040 PVC e/otheJ(explain): 1 Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Joints appear tiaht.No evidence of leakaae_System is vented through the house vent. SEPTIC TANW&(locate on site plan) Depth below grade: VA Material of construction;,concrete ,#metal W fiberglassl/f�polyethylene 4A� other(explain)_ ;-,*7#4 If tank is metal list age: _ Is age confirmed by a Certificate of Compliance(yes or no)?i1 (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sluci a to bottom of outlet tee or baffle: AW 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:_ (,4 How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc.): Septic tank is not nrPsent GREASE TRAP(locate on site plan) Depth below grade:44 Material of construction:zOconcreten/�metaW,9 ftberglassV_polyethylene 4Mother (explain): 4A Dimensions: AM Scum thickness: to Distance from top of scum to top of outlet tee or baffle:—� Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: A444 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Grease trap is 'nnt prPCPnt 7 I Paoe 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1380 Ost.W.B. Road Mars tons Mi s,Mass. Owner: Estate Of Sylvia Colton C/O Debra Colton Date of Inspection: 8/2 2/01 TIGHT or HOLDING TANKt,&c (tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: Material of construction:XAconcrete metal vf fiberglass gApolyethylene 414 other(explain): -- VA Dimensions: .44 Capacity: X19 allons Design Flow: gallons/day Alarm present(yes or no): Allt Alam level: 4A Alarm iln working order(yes or no): Date of last pumping: - 4/h Comments(condition of alarm and float switches,etc.): Tight or holding tanks are not present DISTRIBUTION BOXf&j (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): lei ci-ri hnt-inn hnx is nnt- nrPGczni PUMP CHAMBER-AA-Vf(locate on site plan) Pumps in working order(yes or no): Alarms in working�order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump chamber is not present. 8 f Page 9 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1380 Ost. W.B. Road Marstons Mil s,Mass. Owner: Estate Of Sylvia Colton C/O Debra Colton Date of Inspection: 8/2 2/01 SOIL ABSORPTION SYSTEM (SAS):Zlocate on site plan,excavation not required) System consists of two 6 'X8 ' Block cesspools in series. Cesspools are root bound. If SAS not located explain why: Located Type ,d leaching pits, number: O _gQ leaching chambers,number:0 1&leaching galleries,number:_0 _&Q leaching trenches,number, length: D A)P leaching fields, number, dimensions: d overflow cesspool, number: j innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of po ding,damp soil, condition of vegetation, etc.): Loamy Sand to loamy coarse sand:Cess ools are root bound.Soils are dry.Vectetation is normal But is in heavily wooded aarea CESSPOOLS: (cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: T 7 Materials of construction: Indication of groundwater inflow(yes or no):4 Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Same as a ove PRIVY/1, ,(locate on site plan) Materials of construction: A Dimensions OA Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): Privy is not present.. 9 Page 10 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1380 Ost. W.B. Road Marstons Mills,Mass. Owner: Estate Of Sylvia Colton C/O Debra Colton Date of Inspection: 8/2 2/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. / 0 lox /3 8d oST 10 r r .0,Page 11 of 11 R OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1380 Ost. W.B. Road ars ons Mi s,Mass. Owner: Estate Of Sylvia Colton C/O Debra Colton Date of Inspection: 8 22 01 SITE EXAM Slope Surfac.water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-if checked,date of design plan reviewed:� l Observed site(abutting property/observation ho)e within 150 fee of SAS Checked with local Board of Health-explain:(� SPI l e r 1 .7,e�V- l C`tecked with local excavators, installers-(attach documentation) JibA=essed USGS database-explain: .r4 You must describe how you established the high ground water elevation: Dug 'test hole 7/24/01 Observed by the Baord Of Health Witnessed by Glen Harrington, No water encountered at 135" Design Alan by Ronald Cadillac 7/24/01 Q,, /e'� low y Cold d66`' Pa9r�e ,V 6 wr1 11 •nrnrw.—n,T'R�'Tf.rn:+en•ne.+rn�+rt rsnrr..arnr-re.sntrr*ermn nrrni+ne�rrasn�+ �1 TOWN OF Barnstable BOARD OF 11EALT11 SOBSURFACR SEWAGE I)ISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION .•••Tf•1^T••.-::t—T.,If.^.TTI-I Tf T:11.1f.T►IT'fT1RT1flR�RT1:r—•.•7r'IITTR'77RnR1"'TITTSOOt i!►10AR�Tf�7R7rrowrwm JRII .!,...•►^-�. �. -TYPt OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 1380 Ost. W.B. Road Marstons Mills,Mass. ' ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Estate Of Sylvis Colton CIO Debra Colton PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Ineo: ' COMPANY ADDRESS Box 66 Centerville,Mass.02632 Strevt Town or Clty Itat♦ LIP COMPANY TELEPHONE ( 508) 775- 3338 FAX ( 508 790 _ 1 578 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 omplete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consisten t with m training and Y g experience in the proper function and maintenance of on- site sewage disposal systems . Check one: Systeui PASSED ; The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public heR1L11 or the environment as defined in 310 CMR 15 - 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of /his form , System FAILED* The inspection which I have con trcted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date Onecopy of this c ification must be provided to the OWNER, the BUYER where appl ieable ) and the I30ARD OF HHALZ'lI * If the inspection FAILED, the owner or"`operator shall upgrade he aYste within one year of the date of the inspection , unless allowed ortrequiredm otherwise as provided in 3.10 CMR 16 - 305 , partd.doc �xn��;yh} `y ..s �'� e'- ��s''t,Yx t �. �•?'ti�S•J:`ltk�7�.t3,L� rar,. -ur Z"_. 'xx -r ,�x,.�.- , � ri4 i LOCATION `-3 �fAi(/. /° SEWAGE VII LAGE ASSESSOR'S MAP & LOT .� INSTALLER'S NAME&PHONE NO. 4 7-)5-'3 SEPTIC TANK CAPACITY I Sf� LEACHIFF TACII:ITY>(type) Z - P6W �l.Q"h bT (size) l %7" _ NO. OF BEDROOMS : .c'( I. BUILDER OR:OWNER PERMiT�ATE. lam. I� ICE I COMPLIANCE .DATE: IO I -S I0 . .. Sepfaraton Distance'Betwecn.the":,"; a+ +: MmJrhum Adjusted Groundwater Table to:the Boitotn of Leaching Facility - Feet ... .. F Pnvatc -8001y:.Well,an.d LcacYiing Facility,(If any..w•ells exist ' on site or within 200 feet of leaching facility - Feet Edge of Wetland and Leaching Facility(If any wetlands exist. `o within 300.fcet ofeaching.facihty) , Feet. Fumtstied by to i .ya j� yo 19. /10 -'' 5 _ - \ - 1 JOB N D. CAUTION: THIS IS A SITE FLAN - < SURVEY, AND NOT A PROPERTY 1. LOCUS IS A.M. 126, PARCEL 6. LINE SURVEY E Y THIS "FFICE• 2. ELEVATIONS SH{:DWN ARE ASSIGNEE). � 3 LOCUS IS IN FLOOC ZONE C ON FIRM DATED A11G�JS7 1<9, 19ff". � C' LOT LINES SHOWN ARE APPROX- r , C ti , � 'UNLESS 4. ALL F IF ES T E?E 4" ,z�H 4ij, AND F ITCHED AT 1�4° F ER Ft, `T, NLES.: NOTED) z IMATE, AS CiONFLIC f WAS FOUND 5. M INiC1F'AL WATER IS AVAILABLE. LOTS WITHIN 11° ARE ON TOWN WATER. d BETWEEN RE':C;RC1 FC?INTS. 6• COMPONENTS Tu BE AASHTO H-1i:?, I,INLU-.,5 NOTED, • 7. INLET TEE TO F'RCJECT DOWN 13% 10,1.11TLET TEE DOWN 14", c> 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR E-w)UAL FLOW \\ J D-BOX EXIT PIPES 70 BE LEVEL FOR FIRS 7\NO FEET. NOT TO <h DEPTH OF COMF'G'NENTS NOT Ti' EXCEED N, OR VENTING MUST BE PROVIDED c r ALE / BUILD UP` COVERS TO WITHIN 1'' C'F ;;RARE. MORTAR CHIMNEYS IN PLACE. ONE COVER OF TANK TO BE WITHIN 6" OF GRADE. 33.2 1C. STONE TO BE UIDUBLE WASHED 3/'4 'TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA. STONE ON TOP. -_ 11. IF UNSUITABLE SOILS, OR SOILS DFFERING FROM TH-_ SOIL LOG ARE FO.1!ND, LOCATION MAP 1 CONTA;:T THE BOARD f F HEALTH, OCR R.J. CADILLAC. r 12, IF AN OVERDID IS CALLED FOR BELOW, FILL M,4TERIAL FOR 5' AROUND AND I!NDER LEACHING IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310, CMR 15,255113" cT HOLE I / $ 13. F'!_iMP AND FILL ANY EXISTING C SSPOOLS. REMOVE ANY CLOGGED SO E.:;• ED IL, P.L.;CK, AND STONE IN �cy BENCH MARK--INSIDE 'CORNER OF .. LEACH AREA, AND DISPOSE CIF A$ DIRECTED BY HEALTH AGENT. ,,NC. 'WALL = .7,07 At.SI,,GN E[, Cr r O r r REGULATIONS. 35.4 J 3n1 'AT WHITE PAINT; 14, ALL NS'TRLI;71 N TO MEET 'TITLE ...> AND LOCAL RE x �LATI PJS. CEFTH !;trche = EL37.8feet TEST HOLE [;ATE: July 4, 1 w A aye,• ryr / / r 2r�0 11, 4 4 F'ERF %RMED° BY: Ron L`•a_ oc, Sc E �lu,at, so dy �a dill ril v., „;r 11= rr b, m W17NE5`5ED BY: Glen Horrinnton, R"� B layer 25y 6/66 Invert 3&0-.5 E , sandy Zoom sa.t / r BENCH MARK--T ' W(OC STAKE F' Rt RATE: <2-f '' infih 2 Inyer. 30" 36 .. �� 9.37 SET FLL1{H=37 3 ASSIrN Top Foundation SOIL S_RVE'Y!'19'' 3?: Eos ch,::K, Ioorr,y fin sorrel r 1 sa dyan 4 + S I! ,� i e C a�a5 5 3q E[` 3EiLC'G C A `.>tl rJ C a df:pr..' 34" 9 35. + • o W\ A35 a I MAP" n wi hi n c.rain pit, {1Ga rc�ei, �. / nvert 35.06 ` 36.6 \ / Exist. Cask Iron Invert 34,F,f- ! 0. 37. /, 2 DRY WELL` c� layer t.5y 5/d � 1 z .§•',: C��I• /use '3as Baffle Invert :34.00 W/•4' STONE loamy coarse sand 4 30.00 '� x/ •7 LEACH / s 1 Proposed (firm', :;°..... ..... :_3'i;,>�f� 1 34.7=Tap Conc. rnir,, r',,:,rver .',. 37.1 �.7.0 _"'__'� - ;:�_ �� /ft �.._.1 •G„/ft 34.-4=�op P@05tOne 114" course sand 28.3 Ae / C' ( 11r, r r Invert 34315 [31;as4..i! ., - / r';' RED,. E <=RA[,E J\ R _ �� _ 1:35 2 6.6 )r � rE LEACH i,✓ / 32, 3 .8 n l lU ( Pr G � ^o waTer ` AREA, AS SH•..WN. opened 1 ,4t: 3!. � 2G„ Inver,, 34,17 /Invert 3.9,3 31,E ���1 3.s k��\ `J� I tv =+rrre I'H'�^ Cc.+rr E;IC,, Proposed F'roposed g©+tem F� 36.7 (�} 3 (J) 1�_ 37.U32� �, s E H1 / -� C-- `� [�ottorr TH1-26.5 < 4.05 36.8 DESIGN DATA ti 3s.s BEDROOMS: -E-- E,2 x 4 h LEACH AREA sy ` „ GARBAGE GRINDER: N<o, a b:o \ "g' ��� REQUIRED CAPACITY: 440 GF)D 1.1,E 2 DRY WELLS SET 8' APART, / \ t • 3z,t 4D 1 V'y G,r r VJITN 4' ,F STONE ALL .AR !!N[i, = 36.t = 37.7 \ �? o SEF'TIC TANK: 15i; : AL. r % a3s 5.8) � F BRADY BOTTOM LEACHING AREA: 4 23.4 SF FOR A 33' LONG BY 12 -1 ;" WIDE, k'-- il BY 2' C EEF, LEACH AREA. 32:2 3s.5 x 37.6 _SIDE- LEACHING AREA.: 183.3 SF _ __. [2 1.2.83'4 330;• X 2' DEEP ] q [ESI :N CAPACITY: 448 GF'D 423.4 SF + 183.3 SF',< X .74 GF'()/.F] d 131A5 Public Health Division Nl/F 41 '� �� ���-�--�.- Town of Barnstable NICHOLAS PO Box 534 Hyannis,Massachusetts 02601 Fax(508)775-3344 Phone(508)790-6265 I TF" LAN FU0R THI;: FLAN I;; .A VALIC:r :. t: PY ONLY IF IT BEAR` _ AN " RI FINAL RE[' TAME' AND �K NATURE. D _ RAM ��p POLP` N, ji jHOFMgSs9C SHOFMgSs9c 1 .3.8 ST VUE-®W . R J'aTA LE Ru,, MARSTONS MILL0, MA, RO LD yGs � R AL y�J S p�rr-oo 1 ( o` M r' J E ` A i�� � T I ' ��' �A "C L . 1 # 1060 � � #35779 Q � ccG STER1� cESS\0 "AIL TH 1 TE5 T HOLE LOCATKON, NUMBER SANITAR9, SURIJ --w WATER,' LINE MARKINGS � f' l D � O ALD J. CADILLAC, PLS, RS E OVERHEAD ELECTRIC WIRES (IF SHC"WN) ` I 9.5 x $,7 EXISTINGc. PR' F% `::E[:: ELEVATION', i';K' MARk;S PCNNT j PROFESSIONAL LANE) SURVEYOR :3c REGI'STEF'ED SANITARIAN E, EXISTINIG 11-10NT11:'-1.)R P.O. BOX 258 ®�8 PR0-P O'-::EC::. t 1NTC•1_!R WEST °(ARMC!l!TI-I, MA 02673 UTILITY P, LE IF `�H;,th'N ®® ���� � � �® e:308} 775-o9700 X _ FEN;E IF t OWN, NOT ALL H %WN;; HEALTH AGEINT APPROVAL. DATE f1 2O...i-I BY R, l 'CADILLA'C' F'A E 1 ' F 1