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Home My WebLink About2305 MAIN ST./RTE 6A(BARN.) - Health 2305 Main Street/Rte 6A (Barn) r Barnstable A = 237 047 TOWN OF BARNSTABLE rn c� LOCATI N Z, tj S <,, —S AEWAGE # O) 701 VILLAGE ASSESSOR'S MAP 6z LOT 'Tmv INSTALLER'S NAME & PHONE NO. �� . �,�j 1• bA� SEPTIC TANK CAPACITY 1 0-0 LEACHING FACILITY:(type) �Gc�S'r` �� (size) 1�2?e NO. OF BEDROOMS q PRIVATE WELL (�O UBLIC WATER BUILDER OR OWNER yKct 6tf-Ga DATE PERMIT ISSUED: DATE COMPLIANCE_ISSUED: ;L7 - 8- VARIANCE GRANTED: Yes No °--� 5 _ Q vl . No._ . .......v Fss....�V�m THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....--_�U...............----.....OF. �.....e ........... ....................... Appliratiun for Disposal Works Tans#rudinn ramit Application is hereby made for a Permit to Construct ( ) .or Repair ( Q--sn Individual Sewage Disposal System at: Location-Address or Lot No. ........L— ti� x5..........t`.Y1.o:gt ....................... ..._.....•--- -�CJ.. �s:ti' '•-- --------------- k�e-�C�• __Y y� .... . ........... Owner Address ...................... •- • .........:-- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.._... .................... .Expansion Attic ( ) Garbage Grinder ( ) �+ Other—T e of Buildili ............................ No. of persons............................ Showers — Cafeteria Otherures ...--••----•-••••---•-•--•---......•--••-•-•---•••--•••••-•-••••-......••-•••-----•...................•••••...............--•-••...................... Design Flow......-: -- ........................gallons per person per day. Total daily flow.........3 2.0.............--..gallons. Septic Tank—Liquid capacity.I6 .gallons Length---l. .j.... Width..6.......... Diameter................ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No......./............ Diameter....�.��-------- Depth below inlet.....6.-......... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground Water......................... a .... ••.......................... -•--- .............................................---•--...... O Description of Soil...........�?�.5-r....... r`' ----5U.U_,-0......<ZUx*te.._.5.!ft.............................................. ..........-•-- ••-------••-•--••-......••.......-•-----••----------•------------•--•--...-•-----•- ----•....--••--•- ----------------------••---•--••......... .--••••-•-._....----.............. U Nature of Repairs or Alterations—Answer when applicable..'....:Q� ::5 .2�._.G 'is�_�1�.LS f.............................. �T't�s.ST.e.G......... ...Ss . rL-. . ..... .......V L. .-�!� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of lTA IS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the ar f-1 Application Approved By-- ... ....................... ..•---.....------.........--------- bate �------ Application Disapproved for the following reasons:...............i..................................................................... ........................................ ---------••-------••.....................................-."•---•-•-•...............•-......................... N - Date.... Permit No---------------------- .............._.... Issued-................................ ..----------- Date No._ 1LT Fzz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 71-0\-l-'V�............OF. ................r....................... ...................... Appliration for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct or Repair ( C),-zCh Individual Sewage Disposal System at: .......................................... .......... Location Address or Lot No. <a ...... ......... Address CV C::n Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........r;a................................Expansion Attic Garbage Grinder 1.4 PL4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Other . . ..ures ...................................................................................................................................................... Design Flow.......5..D...........................gallons per person per day. Total daily flow..........._5.2_0.................gallons. Septic Tank—Liquid'capacity.16RIgallons Length.._/e')_'..._ Width..6Z.-... Diameter................ Depth..--............ Disposal Trench—No..................... Width....-_..__....._._.. Total Length.................... Total leaching area...................sq. ft. Seepage Pit No-------/............ Diameter..../.00......... Depth below inlet.....46........... Total leaching area.................sq. ft. Z Other Distribution box ( t-)— Dosing tank Percolation Test Results Performed by.......................................................................... Date............... ..a '**--------------"-------Test 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.............../7v%cle: ........................................ ................................................................................................................. -------------"----------------*--------------*----------------------------------------"---------------*----------------"-----------------------------I -------------- ........................................................................................................................................................................................................ Nature of Repairs or Alterations—Answer when applicable........Doc 5 M ... .............................. ........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System inja6cordance with the provisi6ns of T I A'IX 5 of the State Sanitary Code— The undersig4ed further agrees not to place the system in -operation until a'Certificate of C.omphance has been issued by I the board_of_health oarJI 4. ..... oApplication Approved y.- -A-- ----- ............ . 0 ...... .11 ... ' Date Applic /a '- ation Disapproved for the following reasons:...................... k . . ............. 41 ....................................... ......... ....... ................................................................ .....................................Da .......... ..Permit No..... ................... Is"sued..................................................... Date ------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........OF..... .................................. (1verfifiratr of Toutpliana THIS IS TO CERTIFY, That the-Individual Sewage Disposal System constructed 'or Repaired by......................... .......... ...................................................................................................... Installer at...................... ...... ........... ............................................. has been installed in accordance with the provisions of TIT Fq 5 o State Sanitary Code as described in the application for Disposal Works Construction Permit No......W----I..... .. ......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS,A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... ..A.........6.. ---------------...... Inspector. . . .................................................. \Z_ ---------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH oa.7- 7 ...... ..........OF.. ... ........................................ N ...... .. F=Ao........ Disposal 11orks-Tonstrudion frrutit Permission is hereby granted..............'R Z,ni X!1=:...... .......................................................... to Construct or Repair %_�.)-,an Individual Sewage DisNposal,System ,at No.:--...... .:4. .......... Tkg ........... ...... ................................... --------------- -/--------- ee Permit Da ed t 7........ Street 0?..as shown on the application for Disposal Works Construction Permit .......Dated..&_ .0_319. ........ ............. ... .........;... .... ........................................................... • ---------- f le t DATE....._.. /0 (:;6 1 * oard of Health -7----------------------- ........ ` V. MAP `z441- ,. � 5n rt r �� PARCEI. �, 441 LOT r .;�.. x _ , £ , .., ro 0 0 BORTOLOTTI. CONSTRUCTION, INC. 45 INDUSTRY ROAD, MARSTONS MILLS, MA 02648 508-7.71-9399 508-428-8926 FAX: 508-428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: , Date Of Inspection // Inspector's Name: O w er's Nam and Address: v . 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 Inspectioin was perform- ed based on my Training and Experience in the.Proper.Function and Maintenance of On-Site Sewage Dis- posal Systems.Tiyc`system ; •Y/ asses'. Conditionally se t.Kr L Needs Furt v a 'o By the Local Approving Authority Failure Inspector's Signature Date: TheSystem Inspector shall submit a copy of this Inspection Report to the Approving Authority with 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 Offie 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) SYSTE"ASSES: V 1 have not found any Information which i ndicates that the System violates any of the fail- ure criteria as defined in 310 CMR 15.303. Any Failure Criteria not evaluated are indi- cated below. B) 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,nor,or not determined(Yj N,OR ND). Describe bases of determination in all instances. If"not determined",explain why not. The Septic Tank is Metal,Cracked,Structurally Unsound,shows Substantial Infiltration or exfil- tration,or Tank Failure is iimminent. The System will Pass Inspection if.Existing Septic Tank is Replaced with a conforming Septic Tank as Approved by the Board Of Health. 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): -1 - . r I SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (conlinucd) 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 FALL UNLESS THE BOARD OF HEALTH (AND PUBLIC-WATER SUPPLIE ,IF APR PRIA:TE DETERMIN ES T ,T.;T. IE, YSTEMIS FUNCTION- ING IN AMANNER THATPROTECT THEPUBLICZEALTH 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 aseptic 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 r than s'ppm D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR45.303. 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 theground'or'surface waters due to an, . overloaded or clogged SAS or cesspool. Static liquid level;rrthe distritiuUon box above outlet divert due to an°overloaded or clog- I.! o. ged SAS'.or cesspool: b_ = Liquid depth in cesspool is less than G"below invert oravailabie'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- rSUBSURFACE`SEWAGE UISPOSAI:SYS I'EM 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 Zones 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,anunonia 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 arid'safety'and the'environmerit,bccause'orie'or more of the following conditions exist •:r,' t x -The'system ns witlun 400'Feet`of a surface drinking water supply The system is within;200 Feet'of a tributary to 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 systein 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 ECKLIS 1 A' Check if the following have been done: ✓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 .`. _ ✓.The system.does not.reveive non-sanitary or,industrial•waste flow.• .; _ The site was inspected for signs ofSbreakouL system components,excluding;WgSoilA�sorptionSystem,leave:beery located onsite. The septic tank manholes were uncovered,opened;andOe.interior of the septic tank was in- � apected.for condition of baffles'of tees,�.tnaterial of construction.-Amensions,,depth of liquid, ` ✓depth of sludge,depth of scum. `.The 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- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continucd) V The facilityowner and occupants,if different from owner were provided with information on ( p ) the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE.DISPOSAL SYSTEM'INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDW.NTIAII Design Flow: —salons Number of Bedrooms: Y Number of Current Residents: Garbage Grinder: ,41 Laundry,Connected To System:( Seasonal Use-mod Water Meter Readings,ifavailable: ` -Last Date of Occupancy: - 3 ) - CO MERCiA Ji U <, . ;, f �+'s'' r;� Type of Establishment. > .`,• -':. , ,,,:, 'Design Flow:__ gallons/day Grease Trap Present: (yes or no) Indttatrial Waste Holding Tank Present: Non,Saailaq 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: y System Pumped as part.of inspection:0 If yes,volume pumped: Aillons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System es,attach ='A.'J1 tion records,if anyj ✓.. Other(explain): .,Q:S PROXIMATE AGE of all components date installed(if known)and"ource,of information: ' ge odors det ed hen arriving ai the site: ,�� -4- SUBSURFACE SEWAGE 1)ISl'OSAL SYSTEM INSPECTION FORM_ a _ TART C r`` �1 GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: 117' Material of Construction: V-C-Oncrete metal FRP_Other (explain) Dimisions: ' 1 Sludge Depth: Scum Thickness: Distanc'e from top of sludge to bottom of outlet tee or baffle: {� Distance from bottom of scwif to bottom of outlet lee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees orb es,depth of liquid level in relation t • uUet invert, structural integrity,evide ce of leakage,et`� i2 q /Q LOA IL r GREASE TRAP:. Depth Below Grade: Material of Construction'.' concrete. metal_FRP Other -(explain)-- Dimensions: £. , Scum 1'hickness.�;..,_ Distance from top of scum to-lop of outlet tee or baffle: Comments: (recommendation for pumping,condition of'nlet"and-outlet tees or`baDlesrdepth of'l/i�quid ... level in relation to,outiet invert,structural integrity;er•.idence.oC..leakage..etc:j 411 TIGHT OR HOLDING TANK Depth Below Grade: Material of Construction: concrete_uietal_FRP .Other(explain) Dimensions: Capacity:_ _gallons Design Floc: gallons/day . Alarm Level: _ Comments: (condition of inlet tee, conditiowolalanil and float swi(ches,etc.) DISTRIBUTION BOXY� Depth of liquid level above outlet invert: Comments: (note if level and distribution is e(ual, evidence of solids carryover,evidence of leakage into or out of box,etc.) - � •.� rr.l S�c�S rt :.:5' Y .x. a az 1., !°.!E i k!""i�•Y�Ap i"7°*�'�. 6 g�t 1�f�_R»I. . . _—Purrijis`tti`wdiking'o der. _..Comments:-(note-condition of.pump chamber;conditionvof,putnpspnd appurtenances,etc.) ` g i a SUBSURFACE=SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (con(inued) 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: Leaching pits,number: Leaching chambers, number: Leaching g alleries number: Leaching trenches,number, length: Leaching fields,number,dimensions: Overflow cesspool, number: Co nts: (note condition of soil,si of hydraulic failure level o )ondh condition of Keg( Uon, et . Q CESSPOOLS: I, fit Number and configuration: Depth-top of liquid to inlet invert:',, i 4tir, J 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: 1 • Material o construction: Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) 4° C -6- 1 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART(' SYSTEM INFORMATION (conlinocd) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atl east two permanent references landmarks ks or benchmarks.ks. Locate all wells within 100 Feet. 1 , 'k �J, j l _ _ �...., ._.._. .__ _.. � ?(?`' e+ ,'• i°�Tr#,TB �,. "rt' iCf. t!jl-; -4, n DEPTH TO GROUNDWATER: Depth to groundwater: $ Feel 7y� Meth )et rminatioq or Appro 'coati �:06 4' -7-