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Home My WebLink About0057 BAY LANE - Health 57 Bay Lane,Centerville { A= a 1� Jll7/)/ieQ� UPC 12534 i No.2_ 1_ HASTINGS. MN TOWN OF BARNSTABLE 'S— LOCATION SEWAGE # VILLAGE Odd,2L!!IZAI�-, ASSESSOR'S MAP&LOT —D INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER / PERMTTOATE: 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)- 11 __ _ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ,.ram � , �s f PROPERTY ADDRESSi_ 57 Bay_Lane_Centerville ,Mass . O Centerville ,Mass . ------------------------ 02632 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . r P 1 -5r x8 block cesspool. fft1 -61x8r block cesspool. 8 �0 Based on my inspection, I certify the following conditions: 1 . This is not a title five septic system. S �, 2 . This is a sewage system. 2-cesspools . 3 . The sewage system is in proper working order at the present time . SIGNATURE: Name: Joseph P. Macomber Jr. Company:. J.P.Macomber & Son Inc. ------------------- Box 66 Address: -------------------- Centerville ,Mass . 02632 -------------------- Phone: 508-775-3338 --------------------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY � tl CP. MACOMBER & SON, INC. Tanks-Cesspools-l.eachfields Pumped & Installed Town Sewer Connectionsx 66 Centerville, MA 02632-0066 775-3338 775-6412 ► Environmental rotection Wiliam F.Weld c3orma . Trudy Coxe S., tuy.EOEA e David B. Struhs Commlulonal SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 57 Bay Lane Centerville Mass Address of Owner: Date of Inspection: 11 /1.5/95 (If different) Name of Inspector: Joseph P. Macomber Jr. Company Name, Address and Telephone Number: J. P.Macomber & Son Inc. Box 66 Centerville•,Mass . 02632 508-775-3338 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: 2passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Gte%r 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 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: Check A, B, C, or D: A) SYSTEM PASSES: _�/l 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 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 \J approved by the Board of Health. (revised 8/15/95) 1 One Winter Street 0 Boston, Massachusetts 02108 0 FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 57 Bay Lane Centerville ,Mass . 02632 Owner: William Friedberg Date of Inspection: 1 1 /1 5/9 5 BJ SYSTEM CONDITIONALLY PASSES (continued) V A!S 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 Abe' T:ie 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: IV D_ 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: /y�1' Cesspool or privy is within 50 feet of a surface water den 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: �R The system nds d seow. tank anu >uii iLturpliun systen•, and is vti;thir, 100 fee; to a surface v,a;cr supp!'j cr t ib ;a^, 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 systen•r 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: --f .- 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 effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A i CERTIFICATION (continued) Property.Address: 57 Bay Lane Centerville ,Mass . 02632 Owner: William Friedberg . Date of Inspection: 1 1 /15/9 5 v Dj SYSTEM FAILS (continued): • " pB Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. �r^ Liquid depth in cesspool Is less than 6" below invert or available volume is less than 1/2 day flow. &ZL Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped /✓C, Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. 60 Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. A:r 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. El 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 hLti the system is within 200 feet of a tributary to a surface drinking water supply bra the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area OWN or a mapped Zone II 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 8/16/95) 3 U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 57 Bay Lane Centerville *Mass . , Owner: William Friedberg e Date of Inspection: 1 1 /15/9 5 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 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. 2As 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. V The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. ZAII system components, e*ccluding the Soil Absorption System, have been located on the site. t2A 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. 4Z 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. The facility ov;ne: (and occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 8115195) 4 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 57 Bay Lane Centerville ,Mass . Owner: William Friedberg Date of Inspection: 1 1 /15/9 5 FLOW CONDITIONS RESIDENTIAL: ; Design flow: allons Rev,&iAq Number of bedrooms: Number of current residents:-1 Garbage grinder (yes or no):AJ Laundry connected to system (yes or no4,,!iF Seasonal use (yes or no):�-. a f � Water meter readings, if available: �1= 10'J 0C� i4 A) RUN Last date of occupancy:j�'1r •� COMMERCIAUINDUSTRIAL: d Type of establish,mnent: Design flow: II.7f Rallons/day Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no)AA+ n-sanitary waste discharged to the Title 5 system: (yes or no)—,&W ,,,ater meter readings, if available: Last date of occupancy: /11 OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING 7E`,#RI,QS and source of information:SO V n System pumped as part of inspe ion: (yes or no),0 If yes, volume pumped. allons Reason for pumping: lvk TYPE OF SYSTEM n/i5_ Septic tank/distribufion box/soil absorption system Single cesspool _L Overflow cesspool Nb Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXI TE AGE of all components, date installed (if known) and source of information: 4�" �� '0 -ew?es ✓age odors detected when arriving at the site: (yes or no) (revised 8/15/95) S TYPE a . � tr4 tank/d�stribu6n-bok/soil abord o ,ystg i � N" .� - �_ ' �L�Pnvy r�� s �: . • i �. ;hared !# ?${yes or noj,i4 `5, attach previous,a , M1 M1 S Other APPROXI. TE AGE of xlf components, date installed of kr o-4a ,j 1,7.E wage odors detected when arriving at,the site: (yes or,noF r 'j ircvised I/iS/95)i 4 "t', ..J:'r atr..r„ ��.>;.'+ 9..n:• •fir^.„�'�5. s;.. _ k. }�.�: ��;,e.+. , �J -friedberg, William .57 Bay .Zane T 71- yea �- Centerville , 6111182 Py}mping 72.00 location 44 00-pd-iLl Xg070 ,pump Jc� `J �;�� Criy�1 ��" �CG'lJ ci `i(,� •�'v / J?Cr i�i •� J� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: 57 Bay Lane Centerville ,Mass . Owner: William Friedberg Date of Inspection: 11 /15/9 5 o SEPTIC TANK." � (locate on site plan) Depth below grader Material of construction:l&concrete _metal _FRP_other(explain) Dimensions: Sludge depth: A Distance from top of sludge to bottom of outlet tee or baffle:iV,4 Scum thickness: &'fi Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: A 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 leakagg, etc.) fl7�nT� GREASE TRAP:L4 (locate on site plan) Depth below grade: wA Material of construction:4*oncrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of calm to bottom o) outlet tee or bafle: NR 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.) L,!OA t?� (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57 Bay Lane Centerville ,Mass . Owner: William Friedberg Date of Inspection: 11 /15/9 5 TIGHT OR HOLDING TANK:[ �Y I (locate on site plan) Depth below grade: Material of constry ct ion: oncrete_metal _FRP —other(explain) Dimensions: Capacity:_ iN) Qallons Design flow: Me gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) 11�a+ae_ DISTRIBUTION BOX:&4 (locate on site plan) Depth of liquid level above outlet invert: Az& Comments: (note if level and distribut.w. i, equa% evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:k (locate on site plan) Pumps in working order:(yes or no)Nt Comments: (note condition of pump chamber, of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57 Bay Lane Centerville ,Mass . Owner: William Friedberg Date of Inspection: 1 1 /15/9 5 SOIL ABSORPTION SYSTEM (SAS): ` (locate on site plan, if possible; excavation not required, but 4 lay be approximated by non-intrusive methods) It not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, numberz leaching trenches, number,length: - :� leaching fields, number, dime sions: overflow cesspool, number. omments: (note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Loamy sand medium sand to fine sand No signs on ing vege a ion is normal. CESSPOOLS: (locate on site plan) ��//// t Number and configuration: �`��T(� t t^ � let Depth-top of liquid to inlet invert: Depth of solids layer: 'TiQL4C� Depth of scum layer: Dimensions of cesspool: rX ' 1414101 Materials of construction: Yf, 1 Indication of groundwater: 4n inflow (cesspool must be pumped as part of inspection) A:� 4,4ydY L?/Ll�v 9-Zr �+ �,2��1 Ss r.�rQk comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Loamy sand to medium sand to fine sand No signs of hydraillic fnilllre or on ing, egetation is normal. PRIVY: s (locate on site plan) Materials of construction: A129 Dimensions: Depth of solids:4rk Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) lL�� • Ss (revised 8115195) 8 �" l0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57 Bay Lane Centerville ,Mass . Owner: William Friedberg Date of Inspection: 11 /15/9 5 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Town Water p r DEPTH TO GROUNDWATER Depth to groundwater: 1 6 I + feet method of determination or approximation: Installed overflow cesspool 20+ years ago . No water encountered at that time. (revised 8/15/95) 9 FOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE CTION FORM PART D .- uwrl FI CATION -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 57 Bay Lane Centerville ,Mass , ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME William Freed berg PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr.. COMPANY NAME J.P.Macomber & Son Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City S t IL to LIP COMPANY TELEP14ONE 508 ) 775 - 3338 FAX (508 790 -1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and complete as of the time of.iinspection . 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 oil- site sewage disposal systems . Check one: XXXXXXXSystem PASSED The inspection ;Yhich 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 CHR 16 - 303 - Any failure criteria not evaluated are as . stated in the FAILURE CRITERIA section of this form. System FAILED The inspection wjIjcjj; I have conducted has found that -the system fails to protect the public health and the environment in accordance with Title 6 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector 8ignatur Date 11 /27/95 ---------- One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF IMAL711. If the inspection FAILED, the owner or-.1.o,pe.rator shall e upgrade ' sYete within on year of the date of the inspection , unless allowed orthe requi.redm otherwise as Provided in 310 cMR 16 . 305 , I w. V) THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Ca Joseph P. Macomber, Jr. Has •satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ion of Water Pollution Control