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HomeMy WebLinkAbout0072 OAK STREET (CENT./W.BARN) - Health 72 Oak Street / -- Marstons Mills / A-173-010 :l TOWN OF BARNSTABLE �f LOCATION 7a oot 5T. SEWAGE # 14 VILLAGE S- hlM ASSESSOR'S MAP & LOT ?3�o INSTALLER'S NAME & PHONE NO. (5 wti►f_f 4 SEPTIC TANK CAPACITY IDGd , TEACHING FACILITY:(type)� , (size) /000 :' NO. OF BEDROOMS 3 PRIVATE WELL OR(PUBS L W TA ER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: fYes No O �� t � � �e4`'�'. 1,` �� �� -_ .. M� . is S' .� f �..� �� E �� � s �,o�,��` / TOWN OF BARNSTABLE LOCATION `I� 0-94, S-k SEWAGE # (®� VILLAGE Id 4�41le ASSESSOR'S MAP&LOT 173"0l6 INSTALLER'S NAME&PHONE NO. Cow ,%3 q- 194 SEPTIC TANK CAPACITY /too0 G,C LEACHING FACILITY: (type) 5v tcl (size) NO.OF BEDROOMS BUILDER OR OWNER rA-y&-41Anr PERMITDATE: 3I�s ��' 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 Feet- on site or within 200 feet of leaching facility) Feet Ede of Wetland and Leaching h'Facili If an wetlands exist g ( Y within 300 feet of leaching facility) Feet Furnished by -7�2 y.3 J I 30' 1999 999 BORTOLOTTI CONSTRUCTION, INC. 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508-428-8926 FAX: 508-428-9399 ~ E Z SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: GAR Date of Inspection: aJJ 7 9 Inspector'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 tems. The System: Passes _ Conditionally Passes Needs Further uatio y t (cal Aproving Authority Fails ' Q hy Inspector's Signature: Date: /!, The System Inspector shall submit a 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 SUMMARY: A)SYS TI PASSES: V 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. 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 mall 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 ThOBoard 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 - .5�a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 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): 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 HEALTHJAND PUBLIC WATER SUPPLIER,IF APPROPRIATE)-DETERMINES THAT THE:SYSTEM IS FUNCTION- VG IWA MANNE&THAT PROTECT THE PUBL'ICREALTH AND SAFETY AND THE -J ENVIRONMENT:' The system has'a septic'tank.and soil absorption system andJs 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 Zode 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'oveiloaded or clog- . ged SAS or:cesspool..., 'Liquid depth-in cesspoofis less than G"Below'mvert-'a'vailable'volume is less than 1/2 day flow. Y 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'1NSPECTION 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 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 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.mater supply,,.. ;s The system'iswithid200 Feet:of-a'tibutary:tc,a;surface,drinlung.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-ssupply 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 CiI ECKLIST Check if the following have been done: _/Pumping information was requested of the owner,occupant,and Board of Health. Jf�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. jZ*-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 system does not receive non-sanitary or.industrial waste flow. The site was inspected for signs of breakout.. _ ti = A11 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 ofconstruction,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 noIn-intrusive methods. -3-' ��.�.,' �s.�r-sus •,% .�;A � ,t`� �x{� SUBSURFACE SEWAGE DISPOSAL'SYSTkt4I INSPECTIQN FORM PART B CHECKLIST(continued) 1/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:.3 ZDb allons Number of Bedrooms:. 3 Nunibcr of Current Residents: 3 Garbage Grinder: A'Q Laundry Connected To System: Seasonal Use: A)46 Water Meter Readings,if 'fable: , Last Date of Occupancy: _&thh fAt1-(JP,QA.1 0 �QO 9Y-e� 67 COMMERCLAIJiNDUSTRiAi �Type'ofEstablishmerit Deslgn.Flow:_ gallons/day Grease Trap Present: (yeso'rno) r. . Industrial Waste Holding Tank Present:..-:.. . . .. Non-Sanitary.Waste Discharged To The.Title X.System:. Water Meter Readings,If Available:--. Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: h'' System Pumped-as�as art of inspection:, CZif yes,vo e pum ped: gallons y , Reason for pumping: i } TYPE 9F SYSTEM: } Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) - Other(explain): APPi ROXIMA AGE of all components,date installed(if known an so` ce;of`'information: w..._._...._ ... ;w. - - - Sew* a odois det ted when`arclving`at tfie site`. ` . ' ` I i ?•,.SUBSURFACE SEWAGE,DISPOSAL SYSTEM;INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: v Depth below grade: O ^' Material of Constnrction: `concrete metal FRP Other (explain) - Ditttisions:_ */& ,X S' Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: 3:511 Distance from bottom of scum to bottom of outlet tee or baffle: '7 Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to clef invert, structural integrity,evidence of le kage, etc.) ' GREASE TRAP: Depth Below Grade: Material of Constnrction: concrete metal FRP Other (explain) — — — — Dimensions: Scum Thickness:' Distance from top of scum to top of outlet tee or baffle: r Comments (recommendation for pumping, condition of inlet and outlet tees or ballles depth.of,liquid level rn relation to outlet tnveft, st.nictural rntebnty;eyrdence of l'iA, e;etc.) TIGHT OR HOLDING TANK: A_)b Depth Below Grade: Material of Construction:—concrete—metal—FRP_Other(explain) Dimensions: Capacity; gallons Design Flo«: gallons/day Alarm Level: _ Comments: (condition of inlet tee, comclition of alarm and float swilches, etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert: &� r Comments: (note if 1 el and distribution is equal, evide ce of solids carryover, evidence o leakage into or out qf box,etc.) PUMP,CHAMBERA�d _. - `Pump"Witi—Wd king order Comments: (note`condition"of pi mp`charnber,CoiidIUon of pumps and appurtenances,"etc:) • _S r SUBSURFACUSEWAGE DISPOSAL SYSTEM`INSPECTION FORM PART C 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: Leaching chambers,number: Leaching galleries,number: Leaching trenches, number,length: Leaching fields, number,dimensions: A 30 'L Overflow cesspool, number: Comments: (note condition of soil, si ns of hydra lic failure vel of ponding,condition of vegetation, et .) �W.X lob CESSPOOLS:/00 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) i 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 i s. ;.SU.BSURFACE'.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to adeast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. DEPTH TO GROUNDWATER: Depth to groundwater._ /s" Feet Method of Determination or Approximation: i -7- 173 --0 No. `� Fee l � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppficatiou for Mi5po5a[ *pOtem Con5tructiou permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Inst ler's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Pwr11)10 1�li eer1141r414&e s Type of Building: Dwelling No.of Bedrooms Garbage Grinder(/'cr07 Other Type of Building IAeXlef e.1;l:Z`No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //R gallons per day. Calculated daily flow a gallons. Plan Date /Z Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applica e) ,4 400 09—940' q e,7� A i,' Date last inspected: Agreement: The undersigned agrees to ensure the construction of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi ea Signed Date �� Application Approved by Application Disapproved for the following reasons Permit No. Date Issued i � 1 173 -Flo No. �' Fee THE COMMONWEALTH OF MASSACHUSETTS �I pPUB��LIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS s � 2pplication for Miopogar *p!ftem (Construction Permit f Application is hereby made for a Permit to Construct( )or Repair(k<an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 72 4lril Sr k/, O®1N_VX41A1e WC'St' isle w4/4- 7z. O�iY��` y z 1' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder(-W Other Type of Building /;?Ps1,0et°.v4 No. of Persons Showers( ) Cafeteria( ) Other Fixtures �. Design Flow PIP gallons per day. Calculated daily flow D gallons. Plan Date /Z 3`-f—% Number of sheets / Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicab e) .400 0",6O 4a01/ kv L 0efZWc wi 400 Date last inspected: Agreement: The undersigned agrees to ensure the construction aC06A3kUR=ww of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this- TdLof Fealty-. r / Signed %�Y�i' / Date .rZ-5 45� pz Application Approved by Application Disapproved for the following reasons Permit No. ""°°� / Date Issued THE COMMONWEALTH OF MASSACHUSETTS / 73 47O PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the,On-site Sewage Disposal System installed( )or repaired/replaced( on by i`fOrf44�471�/ for 7`lsek/"MAr as has been constructed in accor klce with the provisions of Title 5 and the for Disposal System Construction Permit No. .° dated Use of this system is conditioned on compliance with the provisions set fo hK elow: f99 i No. 173 3 Fee � M THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migo!6al *p$tem Con5truction Permit Permission is hereby granted to g©I" to construct( )repair( ✓' an On-site Se age System located at 7 6�' Zo$- G' Y 4 /dI4Y5 J'�OA'S �.5 j 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. All construction must be completed within two years of the date below. Date: Approve <by ° CE1111FICA7'I014 OF SKETCH AN U APPLICATION FOR A DISPOSAL 1VUKKS CONSTHUCI7UN I'I;IN111'(1V1'CIIUU'I' llGSIGNEU PLANS) hereby certify that the application for disposal works construction permit signed by me dated -7)?5- 9 , concerning the property located at �7 s,71- zxi, k meets all of the following criteria: `✓ There are no wetlands within 300 feet or the proposed septic system /Thcrenre no private wells within I5o feet or the proposed septic system /The observed groundnvater table is 14 rector greater below the bottom orlhe leaching facility /There is no increase in flow and/or change in use proposed /There are no variances requested or needed. SIGNED:— r _ DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also irthe licensed installer posesses n certified plot plan, this plan should be submitted). J /S 77-