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HomeMy WebLinkAbout0135 WHEELER ROAD - Health 135 WHEELER R1®cx d A = 082025q - -- TOWN OF BARNSTABLE LOC9TION 0 35—0)h'Fr E1 SEWAGE# VILLAGE keeirwS Ma-5 ASSESSOR'S MAP & LOT YR d25- i INSTALLER'S NAME&PHONE NO. UAl le-4txIJA1 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) y ES (size) NO.OF BEDROOMS BUILDER OR OWNER 1 086e7 Nu-S Ktads 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 C ����� ; . _, �� �! , � .; E3/� � � C ila�-�cli �. TOWN OF BARNSTABLE LOCATION /3 S" Xo SEWAGE # VILLAGE Z, 2-; . r %GG� ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. 04,0':' Vic`: G C TANK CAPACITY � SEPTIC 1d LEACHING FACILITY: (type) 6 s5d`�� (size) G eC NO.OF BEDROOMS 5� $bM;BER-OR OWNER A,9 %s?L S %C dLsTei;d 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 � s `• � \ ,r, 7 � J� � �� WOr✓51_' �_ �_ la//1 Z(, Fee----- --- ---- BOARD OF HEALTH TOWN OF BARNSTABLE Application forlVell Con5trutt ion Permit Application is hereby made for a permit to Construct ( ), Alter 0*,), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel J(—Wner Address ---------- -- --- -------------------------- - Installer — Driller Address Type of Building Dwellingv!'� Other - Type of Building---------------- No. of Persons------------------------------------- Type of Well — -------- — Capacity---— - ---———— - --— Purpose of Well--- Agreement: S'A"vZ Lo& The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. d.tof Application Appro date Application Disapproved for the following reasons:----------— - ——--—-- ------- --------- --- ---------- date -ev' •) a ®l ---— Issued--- - =©—�-- -- — Permit No. --�L1 date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by -- -_� �!�L � -- r^r -- ------- - -- - ------ ----- -- '�I�nstal 0!' `�------- - -- -------- -------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----------------Dated-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- --- —- -- Inspector----—-- - ---- —------- i ——-—------- � F ---- -------- - 1 BOARD OF HEALTH TOWN OF BARNSTABLE ZppCicat ion ArWell Con5tructiodPrrmit Application',is hereby made fora permit to Construct ( ), Alter (ri), or Repair ( )an individual Well at: .�/ C3<Xek o 1p--5 Location — Address Assessors Map and Parcel — Owner — ---_---------------Add — -----_f f , f ress - A -----`v---- --- -__-__- - - - ------ Installer - — ---- — Driller Address Type of Building tr Dwelling " Other - Type of Building No. of Persons-------------------------- w Type of Well �1�,.,� �, -t Capacity-------------- -- Purpose of Well--- -�— Agreement: I a"ry Z low"' ' -' The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to j place the well in operation until a Certificate of Compliance has been issued by the Board of Health. 4 SignedLcr------- - d -- .3 Q Application Appro d$ — —--------— o- date i Application Disapproved for the following reasons:--------— --- — ---- ----- ---- ---— -- — -----— f O ---- date Permit No. ~�! ---- Issued---—--- ----- - � r date �---------- �, . I - �.. ., - - —;�--4..-.�.-.c�-�-'v--'�--c--d�-..v....-.--...,..-c_ -r.-:��. x..�_.._a-.u�....-..ems.-,a_..a-..e:l-r,_.� .--•s._s+...,,a..aw.-:s�--;.�:..-c.....�...�,,.-.....__._.. �..,<.._. I ' d BOARD OF HEALTH TOWN OF BARNSTABLE �r Certificate Of Compliance i THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) I by---— Installer-------------------- t ---------- ---------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------------Dated------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. !, DATE--------- ---------_ — -_ I Inspector-- - ------------------------——-------- f , BOARD OF HEALTH TOWN OF BARNSTABLE K Veil Con5truction3permit -orsLl 5 -- I No. - � Fee- i Permission is hereby granted -- ------ to Construct �,_Alter ( ), or Repair ( dividual Wen at: j -- 3 5 G�-�/V�'e t�? r- Gc�--F-- ! -No. , Street as shown on the application for a Well Construction Permit No.— ----- Date Board of Health t.. DATE —_�— CERTIFIED SEPTIC SYSTEM REPORT ► gEE'VE�j )DEC NOftFfta l 1 19,95LOCATION 135 WHEELER RD . MARSTONS MILLS, MA MAP 082 PARCEL 025 LOT 2B PREPARED FOR SELLER MR. & MRS. CARL C. SYLVESTER 17 SWING DR. BERKELEY, MA 02780 BUYER MR. & MRS. ROBERT HUSRINS 129 DRIFTWOOD LANE S. YARMOUTH, MA 02664 PREPARED BY HILLIARD HILLER P .O. BOX 250 CENTERVILLE, MA 02632 508-778-1472 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld ooMrtior Trudy Co:e s.a.+uy,EOEA Oavldd B. �hs SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 13S 4-",rZ-4M OeO• -*/**Address of Owner: ArA rIl.CS. C^e& c. SYGvts�u► Date of Inspection: //1,tv-/1VVf' Of different 7.. Name of Inspector: ff/GG Company Name, Address and Telephone Number: ISO 6ax a,tb IF�'�K��Y G�,{�TL.Cv/tG.e< may oaC3� 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: _LRasses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails -.Inspector's Signature: /,� Date: 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[hvironmental Protection. The original should be sent to the system owner and copies sent to the buye(, if applicable and the approving authority. INSPECTION SUMMARY: Check B,C, or D: A] SYSTEM PASSES: 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. 81 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. trevised 8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)06-1049 a TeMPhone(617)2>i2-SS00 40 Printed on Rwycled PVw Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /3dr- G✓&ACXc-11R -44.a Owner: e-41W4 4 sy4owstE-f Date of Inspection: 81 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 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 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 ENVIRONMENT: The.svctem has a septic tank and Soil absorption system and is within 100 feel to a Surface water Supp;y or tributary to a surface water supply. The system has 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 dogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool. (revised 8/15/95) 2 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1.75 !.✓11111"I-llu aG Ay�J�Qs�,vf irj/G�• Owner: "'I/AP 44W d 4. 5 yL,t/,Cf rC 4 Date of Inspection: //�/O D]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 dogged 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 flow 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) 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 U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: /-KS 4vA&,C4,r_,4 iQD �si1S25Tays �iiLcS ' Owner: . Ghat'/- c SYLvL,sr,C�l , Date of Inspection: j///v Check if the following have been done: L.-Pumping information was requested of the owner, occupant, and Board of Health. _f-�N one 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 a5 part of this inspection. 4L4As built plans have been obtained and examined. Note if they are not available with WA. ,/The facility or dwelling was inspected for signs of sewage back-up. ✓The system does not receive non-sanitary or industrial waste flow --The site was inspected for signs of breakout. _All system components,eluding the Soil Absorption System, have been located on the site. &/The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. t/The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by norr-intrusive methods. t/fhe facility o%%nei (and occupants, if different frog: owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. trevised 61151911 4 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: S Owner: /y��y t,/ft L. G, SYGS �t Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: gallons Number of bedrooms: Number of current residents: O Garbage grinder(yes or no):,yg,� Laundry connected to system(yes or no):yQS Seasonal use(yes or no):_yj&5 Water meter readings, if available: Lri.�LL Last date of occupancy: SyM.�st2 55 vtGA'io.��P� w �'�'OS COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/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 occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: IIati System pumped as pan of inspection: (yes or no)_ If yes, volume pumped eallons Reason for pumping: TYPE OF SYSTEM t/ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) Other(explain) a APPROXIMATE AGE of all components, date installed (if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)_p (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: /3S Gddf.a0e-" 4Q0 is�h?s/�� ices Owner: �I.y G_4�Ct G. 6YLv*C5r" Date of Inspection: j//oo SEPTIC TANK:�/ (locate on site plan) Depth below grade: I'V Material of construction: `Concrete_metal_FRP other(explain) Dimensions: d' X 47,J"r L00 8 h QED Sludge depth: /V" z Distance from top of sludge to bottom of outlet tee or baffle:020/-Z Scum thickness: o 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.) T6fl �-✓�S G�PuSs-Si�v�� /li1.C.�i �� � IA., t.Cr %F� 4---OS /'i/SS/�•-G Ado c is L 13.Qar�2 �L1L ,c3��C!/.t.0 �.cm 74- L Axe` GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of SrUm to bottom of outlet tee or oaiiie: 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 8/15/95) 6 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 13.5 ✓� '� /Q'o• M S/d vS los/6 LS Owner: Ni/rj �/tQ[- C. SyldlLSre/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: Rallons Design flow: Rallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ ,A,~ "{locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution cqua!, evidence of so!id! carl,over, 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 6/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) �z . Property Address. /,3.� Gr/�>*z,rCG�fC/I �t9 T1�us lGG.S Owner: G.Oft L G 5YL 4-W-S" •f Date of Inspection: Il//o SOIL ABSORPTION SYSTEM(SAS): !r (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:_ 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.) G GfSes�caL h [. c a;� oie ST1iti.E o /fL o /lL'Of�SiP�,O S�ivrLL /¢�Z�t /Al T/ts' CESSPOOLS: _ (locate on site plan) 'Number and configuration: : Depth-top of liquid to inlet invert: Depth of solids layer: . Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater. inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 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 9/15/95) 8 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /3.S whV-444 t .� •S�Y'srrass �4/GGs Owner. •t�A, G-AeZ- G. 5YG4-V-W2:A Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' . s 13 R E/I.4 fiifi� /�v�SE h F' c c :.DEPTH TO GROUNDWATER E; _Depth to groundwater: a� 't' feet method of determination or approximation: TEE d6s2ti�o t..�irl�t 1?9�SL.F JcarirF /'-3`3.Z C7i?At..�,� w.or.0 r rwu Ggollry c c d ono v ✓s 4 sow-o?,53 7,a' y�Z -1/1/ -7,v f:G7 z 32-33' (revised a/15/95) 9