The URL can be used to link to this page

Home My WebLink About0010 AUDUBON CIRCLE - Health 10 Audubon Circle Centerville. P A = 191 176 I 0mrford, NO. 152 1/3 ORA �;�. 10% , DATE: 8/14/02----------- PROPERTY ADDRESS. 10 Audobon Circle Centerville ,Mass . ------------------------ 02632 ------------------------ On the above date, I inspected the septic system at the above addr This system consists of the following: RECEIVED 1 . 1-1000 gallon septic tank . SEP 3 2002 2 . 1-1000 gallon precast leaching pit . 6 ' X9 ' TOWN OF TH BARNSEPTTABLE Based on my inspection, I certify the following conditions: 3 . This is a title five septic system . (.,,78 Code 4 . The septic system is in proper working order at the present time . 5 . Pumped the septic tank at time of inspection . 6 . Waste water is not present in the leaching pit . The stain line shows that it has been 42" from bottom or 30" below the ivert pipe . SIGNATUR N a m e: J . P. -Macomber-Jr. Corripany:Joseph P•�_ Macomber & Son, Inc . S Address:__Box_E_6 ______________ Cen-tgrv_tlle,-bay-Q2632-0066 Phone:--508-775-3338 ------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 r ,per • -\ COMMONWEALTH OF IVIASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 10 Audobon Circle Centerville,Mass . Owner's NameTred Hulme Owner's Address: 59 Pondview Drive Centerville .Mass . Date of Inspection: 8/14/0 2 Name of Inspector: (please print) Joseph P .Macomber Jr . Company Name:J.P.Macomber & Son Inc . Mailing Address:Box 66 Centerville .Mass . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that 1 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 the inspection. The inspection was performed based on my rraining and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: t1/Passes _ Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature21it — Date: eF,,,,W—e'y' The system inspector shall a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ***This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Nee 2 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Audobon Circle Centerville ,Mass . Owner: Fred Hulme Date ofInspection:59 Pondview Drive Centerville , Mass . 8/14/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. S tem Passes• .lIG� have not found anunfom�tatio hich indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The .septic system is in proper working order at the present time . B. System Conditionally Passes: --,t,?Q One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined" please explain. 426 The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existiAg tank is replaced with a complying septic tank as approved by the Board of Health. `A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 12) The system required pumping more than 4 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 ND explain: 2 Page � of I I OFFICIAL, INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propern Address:10 Audobon Circle Centerville ,Mass . Owoer: Fred Hulme Date of lospectioo: 8/14/02 C. Further Evaluation is Required by the Board of Health: VQ_ Conditions exist which require funher evaluation by the Board of Health in order to determine if the system s failing to protect public health, safety or the environment. I. S.stem Mill pass unless Board of Health determines in accordance with 310 CMR 15,303(1)(b) that the system is not functioning in a manner wbich will protect public bealtb, safety and the environment: Ad Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a salt marsh System µill fail unless the Board of Health (and Public Water Supplier, if any) determines that the s.Nstem is functioning in a manner that protects the public health, safety and environment: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. ,W The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply • ,0 The system has a septic tank and SAS and the SAS is less than 100 feet but 0 feet or more from a pnN•aie "ater supply well, Method used to determine distance 'This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facilir) and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are rrigeered. A copy of the analysis must be anached to this form. 3. Other- 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION continued Property Address: 10 Audobon Circle Centerville ,Mass . Owner:Fred Hulme Date of Inspection: 8/14/0 2 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool di Discharge or ponng of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in th istribution box above outlet invert due to an overloaded or clogged SAS or cesspool f��O �.) �Vl _ squid depth in cessge®l 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 clogged or obstructed pipe(s). Number �f times pumped _ y portion of the SAS, cesspool or privy is below high ground water elevation. �y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface /water supply. _ �/�Arty portion of a cesspool or privy is within a Zone 1 of a public well. _ � v 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. [This system passes if the well water analysis, performed at a DEP certified laboratory, 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, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ , the system is within 400 feet of a surface drinking water supply th system is within 200 feet of a tributary to a surface drinking water supply th e system is located to a nitrogen sensitive area(I_ntertm Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properry Address:10 Audobon Circle Centerville .Mass . Owner: Fred Hulme Date of Inspection: 9/1 4/o 2 Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No t/Pumping information was provided by the owner, occupant, or Board of Health ere any of the system components pumped out in the previous two weeks ? ✓ — Has the system received normal flows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for signs of break out ? _ Were all system components,.."ccluding the SAS, located on site ? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? —Z— Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location or the Soil Absorption System (SAS)on the site has been determined based on: Yes no / •� Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:10 Audobon Circle Centerville ,Mass . Owner: Fred Hulme Date of Inspection: 8/14/0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): b Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): 1D- 0 ct�, Number of current residents: �X,eV-11 Does residence have a garbage grinder(yes or no):" Is laundry on a separate sewage system (yes or no):,," [if yes separate inspection required] Laundry system inspected (yes or no): Ke-5 Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): 2000-23 , 000 gallons=63 . 02 GPD Sump pump(yes or no): BUD �1— gallons=41 . 10 GPD Last date of occupancy:_lW.rJi�b� COMM ERCIALMIDUSTRIAL Type of establishment: 4-)i4 Design flow(based on 310 CMR 15.203): 444 gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present (yes or no): ,,? Industrial waste holding tank present (yes or no): f/,4 Non-sanitary waste discharged to the Title 5 system (yes or no):Nib Water meter readings, if available: Last date of occupancy/use: 119�114 OTHER(describe): GENERAL INFORMATION Pumping Records j } Source of information: _0yZ Was system pumped as part of the inspection(yes or no): f If yes, volume pumped: gallons-- How was quantity pumped determined? yyl ,swa/ Reason for pumping: Heavy scum & solids layers were present . TY),E OF SYSTEM Septic tank,dis tiea_box,soil absorption system ,C/A Single cesspool Overflow cesspool �D Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) 44 Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) �L�dTight tank �l}v Attach a copy of the DEP approval Other(describe): ,dot Approximate age of all components, date installed (if known) and source of information: z Were sewage odors detected when arriving at the site(yes or no): e!:' 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Audobon Circle enterville ,Mass . Owner:Fred Hulme Date of Inspection:8 14 02 BUILDING SEWER(locate on site plan) d Depth below grade: Materials of construction: cast iron X/f 40 PVC k cth r(explain)ZA �!_�� O,�G Distance from private water supply well or suction line: 'ey" Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight . No evidenee of leakage .The system is vented throu h the house vents . SEPTIC TANK: locate on site plan) / ham „d Depth below grade: /rly Material of construction: oncrete,/o metaUU fibergl asseLo polyethyIene /VOother(explain) A4 If tank is metal list age:.IA9 is age confirmed by a Certificate of Compliance (yes or no):W,* (attach a copy of certificate) Dimensions: .�� Sludge depth: 00 Distance from top of sludge to bottom of outlet tee or baffle:0 Scum thickness. c2) Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_efli How were dimensions determined: Pumped tank at time of inspection . Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of.leakage, etc.): Pump the septic tank every 2-3 years . Inlet & outlet tees -are in place .The tank is strurturn11y cnnnd and shr)ws no evidence of leakage . Pump tank at time of inspection . Heavy scum & sol ' ds layers were present . GREASE TRAA (locate on site plan) Depth below grader Material of construction;{y concrete4,2dmetaW4 fiberglass•IIlPpolyethylene fOother (explain): ltw Dimensions: A�y Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: .fN — Date of last pumping: e,�W Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap is not present 7 Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert) Address: 10 Audoban Circle Centerville .Mass . Owner: Fred Hulme Date of Iaspection: 8/14/02 TIGHT or HOLDING TANKA LPL(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: A),4 Material of construction: J,�o concretet/,* metal 4 fiberglass,&�4 Polyethylene&o_other(explain): 4 Dimensions 116W Capacity: gallons Desien FloA gallons/day Alarm present (yes or no): _42± Alarm level: t�4_ Alarm in working order(yes or no): Date of last pumping: 4,4 Comments (condition of alarm and float switches, etc.): Tight or o ing tanks are not present . DISTRIBUTION BOX �/�if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: �� Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box is not present . PUMP CHAMBER(locate on site plan) Pumps in working order(yes or no): -114 Alarms in working order(yes or no): _,&y Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present . b 8 Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: IOAudobon Circle Centerville ,Mass . Owner:Fred Hulme Date of Inspection: 8/14/02 SOIL ABSORPTION SYSTEM (SAS): XXX(locate on site plan, excavation not required) 1-1000_gallon precast leaching pit . (6 ' X9 ' ) If SAS not located explain why: Located seepage 10 Ty�leaching pits. number: leaching chambers, number: Z) -t'V leaching galleries, number: 6) leaching trenches, number, length: a leaching fields, number, dimensions: overflow cesspool, number: 0— innovative/alternative system Type/name of technology:;7" I%de C�Yy Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Loamy sand to medium fine sand . No signs of hydraulic failure or ponding , Soils are dry , Vegetation is normal Waste water is not present . Pit is presently dry . Stain line 30" below the invert pipe . CESSPOOL cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: (, Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): i Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools are not present . PRIVYf", (locate on site plan) Materials of construction: Dimensions: Depth of solids: 61 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present _ 9 Pav )0 0( II OFFICLA.L INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACEL,SEWAGE DISPOSA SYSTEM INSPECTION FORM PART C SYSTEM TNFOR/rLATION (continvcd) p'09crT7 .;0ofe,,: 10 Audoban Circle C.12 ryille ass . Owocr: Fred Hulme Ottc of Inigmi0o: �L1_ 4_/02 SKETCH OF SEWACE DISPOSAL SYSTEM P70•ioc t tknch of the tcwttc 4iipoiil tyttem inclvd(ng tic, to 11 Ices, two permincn, rcrcrcncc Ia,nGnUk) o• o<ncnmvki to<i c iu w<(tt wilh,n 100 (cet. Loccic what pvblic watcr supply cnicrt the bviloinj. • n Io Page 1 1 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Audobon Circle Centerville ,Mass Owner: Fred Hulme Date of Inspection: 8/14/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: U=:k��bservation s on record - If checked, date of design plan reviewed: ,V4 hole within 150 feet of SAS) Checked with local Board of Health-explain: 40- Checked with local excavators, installers- (attach documentation) ES Accessed USGS database-explain: hrrp : //town . barnstable .ma . us . You must describe how you established the high ground water elevation: Used ; Gahrety & Miller Model . 12/16/94 Ground water elevations . above sea level . Used ; USGS ; Observation well data . June 1992 Used : USGS : Technical bulletin 92-000-2 Plate #2 January . Annual I up Of uround ranges of ground water elevations . Leaching ^ / Pit -eet Sy,Ud Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. II ' r•r T—.-m -r.—ar..•nmrnr�+r.rerr.rrr.:-.•sr*e+vrr:mr-rrrrr-m�t+na-rrer.rn+ .�TT_�_..-. ,_... 'TOWN OF Barnstable BOARD OF HEALTH I SUBSURFACF SEWAGE DI NSAL SYSTEM INSPECTION FORM - PART D — CEHTIFICATION I{ tsi'�mars+rnrs rstn n'mrr-Rrtrrrrrrm.•.—r rr r•-. ._../ -TYPE OR PRINT CI,EARLY- PROPERTY INSPECTED STREET ADDRES$10 Audobon Circle Centerville .Mass . ASSESSORS MAP , BLOCK AND PARCEL # OWNER ' s NAME Fred Hulme- PART D - CERTIFICATION C NAME OF INSPECTOR Joseph P _ MnrnmhPr._r - . COMPANY NAME J. P .Macomber & Son Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State ilP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 ) 790 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at ®rlecominendaLions his address and that the information reported is true , accurate , and omplete as of the time ofiinspection - The inspection was performed and any regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Che,ckk one : System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public he-RILh 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 , 3.10 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . e 41 Inspector Signature Date ' d� ne copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEAL1'1I, * If the inspection FAILED, the owner or"operator shall upgrade • the system within one ,ear of the date of the inspection , unless allowed or required otherwise as provided in 310 CMR 15 . 305 , partd -doc TOWN OF BARNSTABLE a L�OCATIV 7 d&A& j, SEWAGE # VILLAGE ASSESSOR'S MAP & LOT SEPTIC TANK CAPACITY IeO'' LEACHING FACILITY: (type) ��/ �X9�• (size) NO. OF BEDROOMS_ BUILDER OR OWNER ��/ PERMITDA Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 fee of leaching facility) Feet Edge of Wetland Le ng Facility (If we ands exist within 300 t f 1 c ' tlity) Feet Furnishe y G� � � �r / \ /� \ �� / r p / p \ ,.. 'I - � � , LOCQTIO 5EWQf4E PERMIT UO. IwST&LLERS U&DIME. ADDRESS BUILDERS tJ &MF- ADDRESS liNTE PERNA T ISSUED DATE COMPLI W'ACE ISSUED : f� `>