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Home My WebLink About0016 WAKEBY ROAD - Health 16 WAKEBY RD., MARSTON MILLS A = 060 016 i i �" v CLVc l TOWN OF BARNSTABLE L ; r N ` ' F.WAGE #qy VILLAGE �� k ASSESSOR'S MAP & LOT NO INSTALLER'S NAME & PHONE NO.c6,�,t�tv,7 'etetd SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) l000 4 c� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �� DATE PERMIT ISSUED: q a ( I i DATE COMPLIANCE ISSUED: I q VARIANCE GRANTED: Yes No Q1 1 coo �� No. f`� p��!`C�1 tt f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iration for Di_rvnotti 19orkii Tontrnr#inn Fermi# Application is hereby made for a Permit to Construct ( ) or Repair r ) an Individual Sewage Disposal System a o .................................................. ........................... N --•- L oo � s . . 0. Owner � � Addres t_ `mil cti r..- �__.._ ` . ,-I Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '14 Other—Type of Building No. of persons---------------------------- Showers — Cafeteria a' Other fixtures ............................... . . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity...---......gallons Length---------------- Width................ Diameter................ Depth---------------- x Disposal Trench—No. .................... Width-------------------- Total Length_................. Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................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....................... V .....-•-•------•-•......•---••---•••---••-•----•-•••----------- ------------------ -----------•-----------•-•-•-------•----------------------••..._••-••-•...•-•......--•••--- W .......................... -------------------------------------------------------------------------------------------- ---------------- ........................................................ U Nature of Repairs or Alterations—Answer when pl cable................. ... �.. �.._ .��: .______._._.-. -`- --- ----- -- ............................................. •-----•-----•- .._.•-- - . .....•------------- �`r.C_,.lc�. �5 O............. 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 Corn is has been issued by t e board of health. �C a Signed ...... - ... - .... - ..�... -- Date Application Approved B - ........ - .............. -.. .. ........--- ------------- .1...._�.'".a` _.^.`�... Dace Application Disapproved for the following reasons: .............. -----._.....................--------------------------------._....-------- ..... ................................ ............. ...-- . . ..... ---------. . Dace Permit No. '� q � �� Issued �'..°� .' ..14..-- .... ............ - Dace MP P 4 6 b THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE -_ Applirtt#iun for Di iau ttl urlt Cnun�#riir#iun rruti# Application is hereby made for a Permit to Construct ( ) or Repair � an Individual Sewage Disposal System at, I .....•••-•••=` -••----......................k --h-�......... ................ ..............................................._............................. ss or K0.......-r ---- ............................ Loca \ddre .. •----------••-•-.....-••------•---•...... ......•--•�----••......-•-••--••-•.....•• ............................... 0 I ,O^wner Adres c Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................ -----------------.____Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. G: Septic Tank—Liquid capacity...____....gallons Length________________ Width................ Diameter................ Depth.............. W Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. I_---------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ rT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---••-•-••-•---...._....•----•••--......••••-••-•...---•••-••••••••••-••-•••-•..........-••-•-......-----••-•••-•------------------------- ---------------- 0 Description of Soil.......................S WI'!;r -'_..---------------------------------------------------•-----------------------------------------------------------•----- V ...•---•-••••---•---•--•-•--•••----•-•----•-•--•---...-•-•-•---•••-•••••--•- - ---------------------------------------------------------------•--------------------------...........•.._...... ------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------•--- l U Nature of Repairs or Alt ations—Answer when p •cable._.__._.__._.c-�-y .. �.`.__ .___._...1/��.e-. ................f 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 Cornt y has been issued by the board of health. Signed ------�-- a------ ----............. ... J Y Dace Application Approved B . �------- ---- ---------------— ...... ...._. ........ a.. ^.I �( ........ Date Application Disapproved for the following reafonr- ---------- ----- ---------- ------= .......................................................... ............. ..... ..................... ------------------ .................................._....-----------------------------......--------------------------------------.......------------------- - a 7 � . Date Permit No. f'.. ... .................. Issued ! PI I^�1 y ................................................ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifi ate Df Tompliance T/RJS IS TO CERTIFY, T at the Individual Sewage Disposal System constructed ( ) or Repaired--------------------------------------- (V) ,tnuet w - �rV1 ... S.--------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental'�2de as described in the application for Disposal Works Construction Permit No. � dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF/A�CTORY. DATE.... -----..: ---------------- I p ctor- . - - . ns e - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.._.. .... Dispoll urkii Tung#ratio%Famit Permission is hereby granted..... :..__.....�e _ .N.. �^ ..._� _w � --�� ' to Construct ( ) o,rr Repair (�n Individual Se A Dispos System atNo......................Pt°----------_-�`�� ............................(c-�---'-------------------� = 1(1!�1----- ............� : S[reet q " as shown on the application for Disposal Works Construction Perrni d �45 D ted._�.r'.C�_-l-'�9. � 4 - s- Board of ealth DATE........j._r_-.03t5."q^---•-- .......................---••-••--• V FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS a g t 9� 6 BORTOLOTTI CONSTRUCTION, INC. 765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 508-771-9399 508-428-8926 FAX: 508428-9399 ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: QO Date of Inspection: y/.kj/Q9 I pec[or's Name: er's Name and Address: CERTIFICATION TAT . ENT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion 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 ems. The System: Passes Conditionally P es Needs F r•, aluatr By the Local Aproving Authority Fails Inspector's Signa Date The System Inspector hall sub 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 S IMMARY• A)SYS I'vl PASSES: V I have not found any information which indicates Utat the system violates anY of the failure 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 need to be replaced or repaired. The system,upon comple- tion 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 imminent. The system 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.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): - 1 - V. SUBSURFACE SEWAGE.DISPOSAL:SYSTEM,INSP.ECTION FORM Al •., 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): Brolcen.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.INA 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;s salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND.PUBLIC WATER SUPPLIER,IF APPROPRIATE`)DETERMINES.THAT THE 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 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 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 less than 6",below'inveit 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 { -2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 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 pricy is within a-Zone I'cf 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 FALLS: 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: 4 Tlie system'is within 400`Feet of a surface drinking water,supply The system is within 200 Feet of a tributary tog surface drinking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone II 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: _k-1 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. 'fhe system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. , I.. . . - I - .All system components,excluding,the Soil Absorption System,have been located on site. _IL_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, /Thedepth of sludge,depth of scum.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- 3 " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) 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 Design Flow: lions Number of Bedrooms: 3 Number of Current Residents: Garbage Grinder: Nv Laundry Connected To System:. Seasonal Use:,w . Water.Meter Readings;if gmp'I bie: - 1__ Last.Date of Occupancy: 07 ....CO ".MF.R AIJIND 14T IAI ,X,t-) Type ofEstablishment: Design Flow: aallons/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 Date of Occupancy: GENERAL INFORMATION Y"- PUMPING RECORDS and'source of information: System Pumped as part of inspection: If yes,volume pumped: _� Gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If es,attach previous inspection records,if any) Other(explain): _ qir,.2 d" (�-cam✓ . _ PROXIMA AGE of all components;date installed(if known)and sour of information: ,age.odors,detected when arriving at the site: 4 SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C~ GENERAL.INFORMATION (continued) SEPTIC TANK: Depth below grader Material of Construction: l-toncrete metal FRP Other (explain) Dimisiotts:$.S�X(o 'ar` Sludge Depth: '' Scum Thickness: Distance from top of sludge bottom of outlet tee or baffle: - 3 q Distance from ttom of scum to bottom of outlet tee or baffle:_ ye/1 6 Comments:(recommendation for pumping,condition of inlet and outlet tees or baBles,depth of liquid level in relation to udet invert, structural integrity,ev' ence of.leaka etc. ' REASE TR AP: De pth p Below Grade: Materia l of Construction:_concrete_metal=FRP,._Other- (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth ofliquid level in relation to outlet invert,structural integrity, evidence of leakage. etc.) TIGHT OR HOLDING TANK:-A.YJ Depth Below Grade: Material of Constriction:_concrete_metal_FRP_Other(explain) Dimensions: Capacity: gallons Design Flow: galIons/day Alarm Level: Comments: (condition of inlef tee.condition of alarm and float swi(ches. etc.) DISTRIBUTION BOX:_ZJb Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal;evidence of solids carr)-over, evidence of leakage into or out of box,etc.) PUMP CaAMBER:�� Pump is in working order: Comments: (note condition of pump clamber,condition of pumps-and appurtenances,etc.) w I SUBSURFACE;.SEWAGE DISPOSAL SYSTE*INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): V" (Locate on site plan,if possible;excavation not required,but may be approximated.by non-intrusive methods) If not determined to be resent lain: P 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 failurA level of ponding,condition of vegetation, de.) /000 CESSPOOLS: U q '* 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.) -6 SUBSURFACE,SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF`SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locale all wells within 100 Feet. 1 DEPTH TO GROUNDWATER: Depth to groundwater: 315' Feet �+ Method of Determination or Appr ximation: �i►'I�Q T lee e,r 7__ t _�_( _ _ 5EW&C;E PERMIT UO._ i _ BU-1LDER_5 . Q &VAF- ADDRESS DINE_ PERMIT ISSUED D ATE _ COMPLI WA CE ISSUED : - - �OT� � i t�°�'% �� i J