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HomeMy WebLinkAbout0099 HILLTOP DRIVE - Health i 99 HILLTOP DRIVE,MARSTONS MILLS PF A=077 014 I 1/i TOWN OF BARNSTABLE V7 LQ;'.ATION % 111Z,1-1D,'0 Cad! SEWAGE # 9,170 VILLAGE 1`7WS9Qv� ASSESSOR'S MAP & LOT L�C INSTALLER'S NAME&PHONE NO. 4v11.644 y SEPTIC TANK CAPACITY lam' 6114 LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 3 SbM-DEROROWNER /7X a- ,t tY J>t04S 19Z -41 PERMITDATE: 0" COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ��b'3� 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) j Feet Furnished by t � Q r 4 ��q�. SfQ63 �(1 ��. llej 03 w b� pb SvurH�v �s.9>C6JCs1' LOC&TIOKI : SEW&C-IE PERMIT MO. VILLAGE 06L 11�1STQLLERS 1J�►NlE � ADDRESS - ,e/ - - - - - - - - -- bUI D ER S/ % AF- A/DDRE SS D1►TE PE-RMIT 155UED — — — — — — DATE COMPLI &DICE ISSUED : - — �O � ��/� ��,,� �s�� a �. r 9l/ POrc �Gl/mac `�. ���� ,+ ��//T,� ��' :�... i CERTIFIED SEPTIC SYSTEM REPORT LOCATION 99 HILLTOP DRIVE MARSTONS MILLS, MA 02648 MAP 077 PARCEL 014 LOT 6 PREPARED FOR SELLER MR. & MRS . JAMES C . BEDOW 99 HILLTOP DRIVE MARSTONS MILLS, MA 02648 BUYER Oil MR. & MRS. TIMOTHY GREEN ' 24 LARCH LANE Q CENTERVILLE, MA 02632 RfcEI�dEO SEP 1 ,1 1995 w e PREPARED BY HILLIARD HILLER, JR. P .O . BOX 250 CENTERVILLE, MA 02632 508-778-1472 3 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property q9 owner's name 114 t V_79 BS e �C3ea�w % Date of Inspection PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. c/None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. v 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. The site was inspected for signs of .breakout. L/ All system components, eluding the SAS, 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. The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. L/ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. RFC o Ay-7,=,vim 19 T/o.Is 4 T-7 400 t H SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential .3, number of bedrooms number of current residents -,AZV- garbage grinder, yes or no YkS laundry connected to system, yes or no /l/a seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: 1,71 y 73,, Mi S41-1T1-y Last date of occupancy GENERAL INFORMATION Pumping records and source of information: 2ZAy91 '9 PAX r, //,�-7 System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system c/ Septic tank/ /soil absorption system .Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: a o y u sic'=i ciV isY VO Sewage odors detected when arriving at .the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) depth below grade: /8N material of construction: I-"concrete metal FRP other(explain) dimensions: FHB" X �� <o�> YB% o•; y„ sludge depth distance from top of sludge to bottom of outlet tee or baffle 3" scum thickness -7' distance from top of scum to top of outlet tee or baffle /VjIi`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, recommendations for repairs, etc. ) . Titer l G��S A G.Po,��-S,�GT,d.�.e L ,�3�/12,�/! . i9,vy T it.£ /,�L•�T T�.� c�/�s A2 lzl w u4 gam/ &-V 1fz'4'-z5T i<fA9 TIle 7f�,�` ,f�,�' •�.o,� Gv py DISTRIBUTION BOX:��G (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, 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, recommendations for maintenance or repairs,etc. ) r 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEMINFORMATION 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 present, explain: Type leaching pits and number leaching. chambers and. number leaching galleries and 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, recommendations for maintenance or repairs, etc. ) /5�°/,xa,X i-,fT,C/_y .67 90 of= 7-/fA /02T wvZ5 /'f`GG /1f�Go�i�r o Tl�isr WE 7,;141K /A-V T 8,->i h1 9,6 /-,`i•o.Eo CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert OAP 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, recommendations for maintenance or repairs,etc. ) G�SS�ootr /5 R/6117- 4,4c% %a !H� /�O/�Gf1 /3115.���.�. TNZ 7;'IZ LPSs �l 41 /9 a Loe_-ext , H-X,, 7�ye t,A::a? x x-O Tirf DLit-T .%15 Ir dxi fr TC4 y '' rloy4C /=44;v/1 TEf�' PRIVY: locate on site plan) lf�ea-7 ( P ) %HQ G�ZSSIdc�G /3y �/GL,�1J /.�/ /a,�o T/�L" f/�� /,v Th'� /90�• materials of construction :d R ^0eo, dimensions depth of solids Comments: ,(note condition of soil, signs of hydraulic failure,- level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL' SYSTEM: 9> include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' \ -7 y` 1 - 11. • poRc ti �� � - i afiG� � Qvt kN&StD Gf�l�lU,� DEPTH TO GROUNDWATER depth to groundwater method of determination or approximation: G/1RUS T79�3L G/S ShaZis %/r� QL�U/9T/o•�J QL �!/7Te11 Ti9/jL,C J U�� /�9e2 06?fl�yryG 6f>vu✓S T�� G,Fc�,vo ��n'.� T� �.�' /9T jl t,��A r��w !� 7 ifs i°rT rS 8 B7; ?�L vs�5 e- -X e6 7-1c r S .3� 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) A,k�l Backup of sewage into facility? ,VT2 Discharge or ponding of effluent to the surface of the ground or surface waters? N/4 - Static liquid level in the distribution box above outlet invert? box //V A/o Liquid depth in cesspool <6" below .invert or available volume< 1/2 day flow? _ 4A? Required pumping 4 times or more in the last year? number of times pumped 11,V Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is -any portion of the SAS, cesspool or privy: W below the high groundwater elevation? , V within 50 feet of a surface water? A10 within. 100 feet of a surface water supply or tributary to a surface water supply? _ -V within a Zone I of a public well? itV within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? IL-V within 50 feet of a private water supply well? 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 analysi for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. . �----------__-_----_.�_.------TOWN OF BOARD OF HEALTH ------------------ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS �1 ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAMES a�'Y/�_ �T�9�1lS G• .� �� PART D - CERTIFICATION NAME OF INSPECTOR COMPANY NAME — COMPANY ADDRESS /042> /�X o?SZ> 1r/1 C3.2 Street Town or City State EIP COMPANY TELEPHONE ( •Sof ) 77,F - >V72- FAX CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at. 11 this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : System PASSED The inspection which I have conducted has' not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form. Inspector Signature WZ�4v Date f1 One copy of this certification must be provided to the OWNER, the BUYER (where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doc SUN f _,�— --ADDITION 'ROOM `� l 1i {� 1 KITCHEN_ IBATH;( BEDROOM ;'it pELi I t ALL if 9A_RAG E i L I' _[NG U] SE DRUOI"! j ! I I FOYER! �1 EXISTING FIRST FLOOR FLAN - SCALE: 1I8" - i'-0'' PH II( t�111 (I. I �41 ���1i11�1j 1 PALL E BEDROOM ; BEDROOMit -- ( 10 it ' , j lI : EXISTINECON D FLOOR FLAN SCALE: 1l8" it-n" afljtll:,,( , �-- �� I I r ----r it I . CCLQ.S�ET - S E IJRC�Of'M ,t n Fl - - REf"IOIDELELD 99COND FLOOR PLAN SCALE: 1/8' 1'-0" 10'--0" i RB 2571-4 LFFR j 100 1/2"x 74" P-C 265PI-2 1 50 3/4"x59 3/4" -ADDITION j z EXISTING V_ FIRST FLOOR PLAN SCALE: 114" = 1'-0" PCC 255q-2 50 3/4°x5q 3/4" j {� 4 KNEE WALL z. i PCC 255W-2 50 3/44"x.5q 3i4" 'I jl �; Ijjij,! � Jill :111! , r EX 1ST I NCB► :> SECOND FLOOR PLAN SCALE: 1/4 11�011 Wxl(R" VENT j LY C} -A Q f.Y - B"xt(v" VENT CRAWL SPACE 1 tL 2" CONC. DUST GAP : I { C3_ i I 000 EXISTING A2 0244 FOUNDATION PLAN .roe: DRAwN aY� KI^� SCALE: 1/4". G 11- 011 DATE.