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Home My WebLink About0094 WAKEBY ROAD - Health 94 WAKERY ROAD,MARSTONS MILLS A= 043A17 }-- - - - - TOWN OF BAMSTABLE LCvr1TIt�'1N "`� SEWAGE # VILLAGE ASSESSO 'S MAP & LOT G tn►sPEZvR NAME&PHONE NO. -� SEPTIC TANK CAPACITY _LD&) LEACHING FACILITY: (type) . A t �� (size) NO.OF BEDROOMS `3 BUILDER R OWNE 4�.✓2uG� - PERMTTDATE: 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 ` 37 - 5 Val G 3 f BORTOLOTTI CONSTRUCTION, IN.,.;, lie! v 765 WAKEBY ROAD,MARSTONS MILLS,MA 8 o - -508-771-9399 508428-8926 FAX: 5081428-93 1 7, r `' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT PART A S CERTIFICATION Property Address: Date of Inspection: 6-16-19rr Ins tor's Name: Owner's Name and Address: CERTIFICATION STATEMENT, - 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 stems. The System: Passes Conditionally Passe Needs Further E tioi By ie Local Aproving Authority •Fails Inspector's Signature: Date: The System Inspector shall sub a copy of this inspection report to the Ap;_+raving authority within thir- ty days of completing this inspection. If the system is a shared system or has a design flow of 10,000 tY( ) Y P g Pce 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 bt:sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: A)SYSTII PASSES: 111/// 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 zi aluated are indica ed 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 detertnit=ation 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 Wslution if the existing sep- tic tank is replaced with a conforming septic tank as app ror ed 4y ,he Hoard 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 us a-rcn distribution box. The system will pass inspection if(with approval of The Board of Health): - I - d 44 r, #"�- w r F,SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM t g PART A ` w ' CERTIFICATION (continued) a 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): Broken 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. � , =i� t• r° - 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING 1N A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: € Cesspool or privy is witlun 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 FUNCTION- ING IN A MANNER'THAT:PROTECT.THE"PUBLIC HEALTH ANDSAFETY-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 colifonn 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 def ned in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health s 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. Staticiliquid level in the distribution box above outlet•invert due to an overloaded or clog- ged;SAS.or cesspool:° Liquid,depth in cesspool is less than 6"below,invervor 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(sj.: Number of times pumped -2- c• 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 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 SG Feet from a private water supply well with no acceptable water quality analysis. lf.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 FAU S: 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: The system is within 400.Feet of a surface drinking water supply Tlie system-rs within 200 Feet of a tributary to a surface dripkirag water.supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (1WPA)or a mapped Zone I1 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 merit• ro ram requirements ments of 314 CMR 5.00 and 6.00. Please consult the local r treat ,groundwater p g eq regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if,the following have been done: t/ 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. "-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. , _jZ-The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All„system'components,'excluding the Soil Absorption System;have been located on site. '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, depth of sludge,depth of scum. - ' he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by-non-intrusive methods., A -3- p ik '.j W. ask rY kx 1 1 �RFACE SEWAGE'DISPOSAGSYSTEM.INSPECTION FORM' SUBSU PART B CHECKLIST(continued) V 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 RESIDENTIAL! " Design Flow: lion Number of Bedrooms: �_ Number of Current Residents: Garbage Grinder: Laundry Connected To System; Seasonal Use: AM Water Meter',Readin ;if Table: Last Date of Occupancy: .RCLAI JINDM IAI.• _ Type of Establishment:` ..; - _ ._.. .,_.. ._.v. .... Design Flo*": ' ,` `"gallonstday `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 PUMPING RECORDS and source of information: �p System Pumped as part of inspection: If yes,volume pumped. p oons Reason for pumping: TYPEi F SYSTEM:' 1/ Sepdc Tank/Distribution Box/Soil Absorption System Single,Cesspool Overflow Cesspool Privy ; Shared System(If yes,attach previous inspection records,if any) Other(explain): ROXIMATE`AGE of all components,date installed(if known)and source of information: Sew a odors detected when rriving at the site: 4 � ,. 's«$".�..r - '. . . . . . . .. ., .. .. ._ ... _... a .... ' SUBSURFACE SEWAGE DISPOSAL SYSTEIM-IRSPECTION FORM PART C GENERAL INFORMATION (conlinued) SEPTIC TANK: Depth below grade: Material of Construction: concrete metal FRP_Other (explain) Dhnisions: G' -/ Sludge Depth: / Scum Thickness:,,5* Distance from top of sludge to bottom 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„de th of liquid level in tion too l et invert,structural inte rity,evide a of leakage,etc. 62 ' O iiad ZZA i� AX, Q�� ,(�lRC CLl/Jz�/JGCt/X,�.O cg , GREASE TRAP: A)d Depth Below Grade: Material of Construction:—concrete—.-metal FRP_Other (explain) e Dimensions: Scum Thickness: " .y 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,of.liquid level in relation to outlet invert,'structuial.integrity,evidence of leakage,,etc. _ TIGHT OR HOLDING TANK: 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: V - Depth of liquid level above outlet invert: Comments:(note if 1 el and distribution is al,evide ce of solids carryover,eviden a of leakage into of,put of_box,etc.) /Vi �Jf �iYi �yL� �L/f �ll(ll L'e 10 PUMP CHAMBER:: Pump is in working order: Comments:(note condition of pump chamber,condition of puinps'asid`.appurtenances,etc.) r , '0; Sys •oaa ....:' 1 - .. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 4 ' SYSTEM INFORMATION (continued) 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,'number: !I� 'Leaching chambers,-nuinber:" Leaching galleries,number: ' Leaching trenches,number,length: 'Leaching fields,number,dimensions: Overflow cesspool,number: Comments: (note condition of soil,signs of hyd aulic failure level of pondin ,condi 'on of vegeta 'on, etc.) — 71 At i� CESSPOOLS: ` N ,. 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 pondint,condition of vegetation, etc.) 'R 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- • i 1' 5r y �tl'c tom- .4� '�. _ - _ f• ' SUBSURFZiaACE SEWAGE DISPOSAL SYSTEM INSPE.CI'ION FORM I iA' 'R'f C SYSTEM INFORMATION (conliumed SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to adeast two permanent references, landmarks or Micl►marks. Locate all wells within 100 Feet. , r DEPTH TO GROUNDWATER: Depth to groundwater: $ Feet Method_of Determination or A proxi lion: �d ® -7- r � ASSESSOR'S MAP NO. PARCEL :.,.0 C-A T ION S E W A G E PERMIT NO. Lor VILLAGE INS �A LLER�j'S MAA i ADDRESS i. Z�-Qa- ,X /?-W) d UILDER OR OWN ER DATE PERMIT ` SSUED � � � � DATE COMPLIANCE ISSUED � ti r ilk" � u �1 I s ASSESSORS MIAP NO: 4 PARCEL NO.- No..... . __ Fx _............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...... .... ........................OF.........................-----.....__.--------------.....------------------....._---•---- Applira#iou for Uigpnaal Vorkg Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: a �1_•Z-YA,r� � -.�..h', ------------------------------------------ . Location-6Adress r I.ot N w _ Owner Address a ----------------------------------- = Installer Address ` Type of Building Size Lot____-- ,_�il /Sq. feet' Dwelling—No. of Bedrooms_______.�1...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures . ------------ -- -------- W Design Flow...............1 _____._______________gallons per person per day. Total daily flow..........33...........................gallons. WSeptic Tank—Liquid capacityl.TO__gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 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-.-_____________.�- ____ ------------ - - - - - ---------------- - O Description of Soil------ ---•-•------•--- x U --••-------•-----••----•--•--•----•--•--•••---------•---------------•------------•----------••-----•---._...--------•-••-------....----•------•-----•----- ----- ------•------ W -•-------------=--------------------------------------------------------------------••--•-•----••---------•. - ...........-••------------•--- t j Nature of Repairs or to tions—Answer w e licable----- / .. - ._ --il!M Q I ----•• r- l---------------------------------------------------------------------------------------------•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT E y g g p y of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the bard f him JL ignepns: __mil s ....� `3� t --••-- �D e Appli ion Approved y-----•------------------• ------------- - Date Application Disapproved for the following re -•--------------------------------•----------------------•-----------------•-----------•--------- --------------------•-----••-•---------...._.__.....-------•----------------------------..._..-------...._.....---------------------------------...-----•-•-•--••--••-----....------Dau-•••-•-•-.._. a'. ,, Permit No......................................................... Issued..................................................... � i/I "_ V - - THE COMMONWEALTH oFxxAssAoeuSsTTa ` BOARD OF HEALTH | ' / ��F� -----------'- ---------'-- � firatiou for' - � DisposalTonstrurtionramit - ' Application is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ' /V/ Xw,ess . Installer Address Type cfBuilding Size Lot. feet Dwelling—No. of Bedrooms............... Expansion Attic ( ) GarVage Grinder / ) Other—Type of Building --'A_;64ft_iU........ No. o[ persons............................ Sbm~cro ( ) -- Cafeteria ( ) ^� Other fixtures ---_---_--.-.-_.------.-------.---_---.'----_-' Des' ��n�----1'l.L�----_-----'-��ulouoycr �crouuy�zduv. Total daily gallons. Septic Tank—Liquid C>....gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench--No..................... Width.................... Total Length.................... Total leaching area.--___--og f t. � Seepage Pit No------- Diaozetec----.--' Depth below iolc�--------- Iutu leaching ..................ml. �. �� 0thorD�xb�bo600bu� ( ) Dosing tuo� ( ) ~~ Percolation Test Results Performed by.................................................... Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------- �-4 44 Test Pit No 3................minutes per inch Depth of Test Pit.................... Depth toground water.--_----.--- ," � .--. --.--_-.__--_'__-_---------_---'_'--'-_-----'-----'--'-----_---- `' DescriptionofSoil- _-----------'--'----------'---.---_------.--'--------------------'--_ U Nature of Repairs or Alterations—Ans er when aall ble--- ------02C7:1AeL_ � --------- Agreement: The undersigned agrees no install the uforedcyccibcd Individual. Sewage Disposal System in accordance with � the provisions� ofTIT LE, -5 oi' the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certincate of Compliance has pbeenis ued�by thn Nard of,heaNl /:a/, »ate PermitNo.......................................................... Issued....................................................... Date . ` ' THE COMMONWEALTH OF MAssAoHussrTS. ` BOARD OF HEALTH --''------ ......... ......................................_'-'___''---'.---_. Tntifiratr of Toutpliatta THIS IS TO CERTIFY, That the Individuahs(Tge Ejisposal Spte conj!4ucted or Repaired has been instilled in accordance with the provisions of TILTIE Xi-The-State--Sanitary Cod -----de-scribed--in--the- application for Disposal Works Construction Permit No------Z 1 L n_16111 1. .......... dated--------)cl THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR ��EE THAT YHE WIL�L SYSTEM SATISFACTORY.[6�][IL-----'--8.- 1��-'�-' - ------------' Inspector.......-r.-'\! [�_�--��_----'-----'-_'--_---_' � THE oowwomwsALr* or mAsewo*uscrrs ^ | ^ BOARD OF HEALTH ---'_-_----��F---.---_-______________-- � ' E E.to Construct or �p an Individual Sewa e isposal System as shown on the application for Disposal Works Construction Permit No�� ....... � ard of Health 12-55