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Home My WebLink About0038 BREZNER LANE - Health 38 BREMER LANE, CENTERVILLE A= i 3 4 � ® �J��CVCCEocoy� UPC 12534 a No.2 1__ �, �` HASTINGS.UN r DATE:_5/24/00_--_ PROPERTY ADDRESS: 3$_Brezner_Lana_______ _-Centerville_Mass_-_--- ---02632---------------- On the above date, I Inspected the septic system at the above address. This system consists of the following; 1 . 1 -1000 gallon septic tank. 2 . 1 -1000 gallon leaching pit. Based on my Inspection, I certify the following conditions: 3. This is a title five septic ,sy.stem. ( 78 Code. ) 4. The septic system' i`s in proper working order-,., , at the present time. 5. The waste water is 42" below the invert pipe of the leaching pit. SIGNATURE:./ Name:_,L,3.�ltss.Qaktr .lL --- Company: Joaa.Rh_P_ Nacombsr & Son , Inc . Address:_Box-66—_ __Centerville Ha__02632-0066 Phone:___ 508_775_3338____-_- THIS CERTIFICATION GOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P', MACOMBER & SON, INC- Tanks-Of sspools-Leachflelds pumped L Instilled Town Sewer Connections P,O, sox 6775•33J tervl1le, M 02632.0066 ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-6600 TRUDYCOXE Secretary ARGEO PAUL CELLUCCI DAVM B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PropenyAddre": 38 Brezner Lane NifT1eofowfW69 William Onthank Lane �etiotf rvi le,Mass. Address;ofOwrw: Sou oro, ass. 01772 . Name of Inspector: (Phase Pr4rtlJoseph P. Macomber Jr. I am a DEP approved system kWwctor pursuant to Section 16.340 of TWe 5(310 CMR 15.000) co,vwryName: Joseph P. Macomber & Son Inc. MaiQV Address: SOX 66, Centerville, Ma. 02632-0066 Tel.pr,on.Number: -3 CERTIFICATION STATEMENT 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 end experience In the proper function and maintenance of on-site sewage disposal systems. The system: /Passes Conditionally Posses _ Needs Further Evaluation By the Local Approving Authority _ Falls Inspectoi s Signature: Date: ��•"�� The System Inspector ?aIlsubmit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)WhNn 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 end the system owner shall submit the report to the appropriate regional office of the Department cKnvirenmentaf f atect(on. The original should be sent toVu system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS • Put" E JUN 2 2000�4 go"o€ � �N�� r 4 revised 9/2/98 page Iof11 `� Printed on Recycled Paper SU93URJrAC9 SEINAOE DISPOSAL SYiTEM INSI'ECMN FORD PART A �•,, + i CERTWICATWN (oondnu*43 Pro., 'yAddrsss: 38 Brezner Lane Centerville,Mass. owr+ar: David Anghinetti t>ea of in.9—': 5/24/00 Fl.SPECTION SUMMARY: Check Aq B, C, oe P. A. SYSTEM PASSES: ; 1 have not found any Information which Mdlcatos that any of the fallurs condWons described In 310 CMR 14.303 sx.14L Any faL crhoris not evaluated are Indicated below, B. SYSTEM CONDITIONALLY PASSES: A,�A One w more system sompononta as dosortbod M the 'Co"donal Pass'osodon nood to be replaced a ropalrod. The eystam. completion of the roplasoment w ropalr, as approved by the hoard of Health, wW pus. Indcote yes, no, or not dotorminod(Y, N. or ND). Doautbe basis of dotwmlrwdon In all 4wtanoos. If 'not determined•, explain why not. The sopdc tank Is meld, uriess the ownw or opwotw has provided the system Uwpeotor whh a copy of s CervAcato t Compilaneo (attached)lndlesdng that the tank was InaWWed within twenty(20)years pdor to the date of Cho U-Poovvo the eopdc tank, whether or not metal,Is srookod, otrusarally unsound, shows subetandal InNVadon of extWedon. w :allure Is Imminent. The system wW pose Inapeedon If the exJsdng sopdo tank Is replaced with a eomplytng sopdc taro approved by the Board of Health. /ll SOwege bockup or brsakout or high stado water level observed M the dleVlbudon box Is due to broken at obstrvcud p+ or due to a broken, sotded or unsvomdlsVlbudon box. The system will pose Inspection If(whh approval of VW Bos+o 0 Health). broken pipo(s) we replaced obswcdon Is removed dlsvibudon box Is levelled or replaced . The eyonom foquked purnptnQ-more dwt'iourdmes o"ardu•to brokenvrob.trvclod pip.$W. the oloam wfrV — Wpoctlon If(with approval of the Board of Hoslth): broken pipe(+) arrroplacid obswcdon Is removed revised 9/2/98 nf;elof11 c > SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION (continued) P,. tyAddr.u: 38 Brezner Lane Centerville,Mass. owns: David Anghinetti. Estate Of Joseph Anghinetti Date of lnsp.ctior,:5/2 4/0 0 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 falling to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICKYALL.PRQTECT THE PUBLIC HE LTRAND SAFETY AND THE BCdBONMB'r1 Jlf6 Cesspool or privy Is within 60 feet of surface water Cesspool or privy Is within 50 feet of a bordering vegetated wstland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 tributary to a surface water supply. Az The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 60 fset of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 60 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 smmonis nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance -Ath (approxJmation not va0d).- 3) OTHER uv AM X Nof revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 38 Brezner Lane Centerville,Mass. owner: Estate Of Joseph Anghinetti Date of 4,spec6-:5/2 4/0 0 D. SYSTEM FAILS: You must indicate either "Yes" or"No" to each of the following: N I have determined that one or more of the following failure conditions exist as described In 310 CMR 16.303. 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. Yes No J Backup of sewage irnofeciRty"orr►sterr+component due tto an overloaded ormcleggedS,ASor-ceespod. •j--'• ' ' Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _,UdAX Static liquid level in thedigxibutl n,hff above outlet Invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below Invert or available volume is less than 1/2 day flow. Required pumping more tha 4'times In the last year NOT due to clogged or obstructed pipe(s). / Number of times pumped . r Y 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 then 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 Z•.coliform bacteria, volatile organic.compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: j!Vnificant threat to public � The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a gig health and safety and the environment because one or more of the following conditions exist: Yes No . f� the system Is within 400 feet of a surface drinking water supply the system•i9-witl4n 200 teetaf•+-tflmlKA rV49t 4 wrfaoadrkwk4P9•waW•surplY - -- •• - _ _ 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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,. PART B CHECKLIST Prop"Address:38 Brezner Lane Centerville,Mass. own«: Estate Of Joseph Anghinetti Date of trupection: 5/2 4/0 0 Check If the following have been done:You must Indicate either'Yes" or'No" as to each of the following: Yea No i y Pumping Information was provided by the owner, occupant, or Board of Health. None of the systemsompoaents ha+w:baan prawood4owaCJeasttwo•awealcaaad4be•trystsm hasbwovecetawgwwasal?fow 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 receive non-sanitary or industrial waste flow. _✓ _ The site was Inspected for signs of breakout. _ All system components; Muding the Soil Absorption System, have been located on the site. 4 _ 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 Soil Absorption System on•the site has been determined based on: ZExisting information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C Is at Issue,approximation of distance is unacceptable) (15.302(3)(b)) _ The facility ownw Iand.^._. upant Jf diNaraw frog ovmw),w&rA4Wavldrdawtih ln}nrra tloacn thA prcpag mai^t f SubSurface Disposal Systems. revised 9/2/98 Page Sof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Proq"Ad&"x:38 Brezner Lane Centerville,Mass. owner: Estate Of Joseph Anghinetti Dou of Inspections/2 4/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: aig L(d*g" dro ./ e m. Number o}bedroom Number of bedrooms(actualTotal DESIGN flow • f_ A Number of current residents: Garbage grinder(yes or no):-Ay Laundry(separate system) ( es or�g :_; If yes, separa .1rupaction.required Laundry system Inspecto a r no) Seasonal use (yes or nol: Water meter readings,if available(last two year's usage(gpd): >g9� 0/.t�J/� Sump Pump.(yes or no):_a Lost date of occupancy: , COMM ERCtAL/W DUSTRIAL: Type of establishment: A44 Design Flow: A)d gpd ( Based on 16.203) Basis of design flow Ahf Grease trap present: (yes or no)_d(oP Industrial Waste Holding Tank present: (yes or no)AY Non•sarutary waste discharged to the Title 6 system: (yes or no)A—)/It _ Water meter readings,If available: AJ/4 Last date of occupancy:_,6/ OTHER:(Describe) AM Last date of occupancy: GENERAL INFORMATION PUMPING RECO S and soyrc f Information: System pumped as part of in action: (yes or no)." it yes, volume pumped: gallons Reason for pumping: TYPED SYSTEM Septic tank/dFs4r41sutieA-i>aex/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or not (if yes, attach previous Inspection records,If any) A I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank 4joPf Copy of DEP Approval Other .4J04/lP l APPROXIMATE AGE of all components, date installed4H known)-and source of4ofomwtion: Sewage odors detected when-arriving at the site: (yes or no) revised 9/2/98 Page 6of11 SEWAGE DISPOSAL'SYSTEM INSPECTION FORM L SUBSURFACE ,. PART C SYSTEM INFORMATION(continued) : 38 Brezner Lane Centerville Mass. Property Address Centerville, Mass. Estate Of Joseph Anghinetti Dote of Inspection:5/2 4/0 0 BUILDING SEWER: (Locate on site plan) it Depth below grade: Material of construction:4Z/cast Iron 40 PVC Vother(explain) 14 Distance from private water supply well or suction line Diameter l',_ Comments: (condition of joints, venting, evidence of foakase,•etc.) Joints appear i ght Nn Air;r1,=nr•e,nf 1oaka9e. SEPTIC TANK: D A) (locate on site plan) ,r Depth below grader Material of construction: oncrete�metal�Fiberglass l/,12Polyethylene4)2other(explain) If tank Is metal,list age A .1s.age.confirmed by Certificate of Compliance (Yes/No) �' Dimensions: �r Sludge depth: _. Distance from top o slud s to bottom of outlet tee or beffie ,L Scum thickness: Distance from top of scum to top of outlet tee or bsffie:,�� Distance from bottom of scum to bo of outlet tee r baffle: •lLA Mow dimensions were determined: Comments: (recommendation for pump'( g:cdndiligh of inlet and outlet tees or•baffles,'depth of liquid level,in relation to outlet invert, structureHotegrity, evidence of leakego,etc.) mp t e septic tank every 2-3 years rnl t & gut 1 Pf tees are in Dlace. on i nc-hP an 1 s ruc ura y soun a ge. GREASE TRAP: (locate on site plan) Depth below grader Material of construction:A�A-concrete�metalA)rlFiberglass�tJ Polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle:4f� Date of last pumping: AIX 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.) revised 9/2/98 Page 7oril SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(coertlrx►ad) PropertyAd&—: 38 Brezner Lane Centerville,Mass. Owrw: Estate Of Joseph Anghinetti D"'of Inspection. 5/2 4/0 0 TIGHT OR MOLDING TANK-A&C(Tank must be pumped prior to, or at time of, Inspection) I 1 (locate on • plan) site Depth Dhow grads: AM Material of construct)on:A/�concreteA/�/metal�tfibsrpluv✓�PolysthylmsA�4othsr(sxplaln) Ahl Dimensions: /14 Capacity: gallons Design flow: gallons/day Alarm prssent Alarm level: Alarm In working order:Yeses NoX24 Date of previous pumping:A_ Comment&: (condition of Inlet tee, condition of alarm and float switches, etc.) DtSTRIBUTION BOX pAlZ (locate on &lie plan) Depth of liquid level above outlet Invert: AM Comments: _ (note If level and distribution Is equal, evldenoo of solids carryover, evidence of leakage Into or out of box, etc.) Visr-ribu7tion box is not ant, PUMP CKAI.IBER:A�o (louts on site plan) Pumps In working order:(Yes or No) A4 Alarms In working order(Yes or NO—" Comments: (note condition of pump chamber, condition of pumps and appunanances, etc.) Pumn r-hArnha-r is net revised 9/2/98 P.i'�of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corAkajed) ProWtyAddreu: 38 Brezner Lane Centerville,Mass. Own«: Estate Of Joseph Anghinetti Data of kw"c*m:5/2 4/0 0 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,If possible;excavation not required,location may be approximated by non-Intrusive methods) If not located, explain: Type: , leaching pits, number: leaching chambers, number: leaching galleries, number:_ leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: Inots condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) Loamy sand Oo _L da � mgaud -No i"�fgis�X His a wa r is a owthe invert Ripe_ CESSPOOLS: (locate on site plan) Number and configuration: a Depth-top of liquid to Inlet invert: A110 Depth of solids layer: AO Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of Inspection) esspoo s are not p resPnt- Comments: (note condition of soil, signs of hydraulic failure,level of pending,condition of.vegetation, etc.) CeSSQ001S ArP nnf- a rpgPnt PRIVY:A� Z (locate on site plan) Matedals of construction: AV Dimensions: Depth of solids: AJ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) None Privy is nni- =rPgant revised 9/2/98 Page 9orII SU93VRFACI IEWAGI OLSPOSAL IY9TID4 W31PICT10N FORJA • FART C . . SYiTVA WFOR$dAT1ON(oondrti+oE) 38 Brezner Lane Centerville,Mass. Owner: Estate Of Joseph Anghinetti D.v of h`°"` " 5/2 4/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include de$ to et Isa$t two permanent reference landmuks or benchmarks locate all well$ wltNn 100' (Locate where publlo water wpply Come$Into house) t3 $� revised 9/2/98 Pa�eloorll SUBSURFACE SEWAGE DISPQSAL SYSTEM INSPECTION FORM PART C • �. �. SYSTEM y1FORMATION (condinued) Property Addreaa: 38 Brezner Lane Centerville,Mass. Owrw: Estate Of Joeph Anghinetti Dete of{nap.ctlon: 5/2 4/0 0 NRCS Repon name Soil Type_ Typical depth to groundwater USOS Date website visited Observation W*Us checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells I Estimated Depth to Groundwater ' 1Q Feet Please Indicate all the methods used to determine High Groundwater Elevation: _Obtained from Design Plans on record / f/ baerved Site fAbuWng propertyIobservation hole, baaemeoVsUmp etc.) determined from local conditions _ Chocked with local Hoard of health _Checked FEMA Maps 1" Checked pumping records L chocked local excavators. Installers Used USOS Data Describe how you established the High Groundwater Elevation. (•1!W be completed) Used water contours map. Gahrety & Miller Model 12/16/94 revised 9/2/98 PatallofIt •11.T.�R.TI��TT�111IT I.R'I.f.R/lT.T1TT.lR1f•.�Tw'�1IlTRR11T Tt.1L 1'.lwt-Ilrt'1 �r��.�.. �.,r... 'I'OHN OF Barnstable BOARD OF HEALTH SUI;SURFACR SFHAGF DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I •••T'7R••.••.'.-T...►�.�TTi.'IrA•...'.rl rflrJfl/7RT►T•Tt1r•ItTR -�T7�I�•1R7 �.11 •.�'trT'T�'1. -..w -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRES$ 38 Brezner Lane Centerville,Mass. ASSESSORS MAP, BLOCK AND PARCEL # 3() nl� � OWNERRIs NAME Estate Of -Joseph Anghinetti PART D - CERTIFICATION NAME OF INSPECTOR _ Joseph P. Macomber Jr, COMPANY NAME Joseph P. Macomber &"`Son, Inc. COMPANY ADDRESS Box 66 Centerville MA. 02632-0066 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( 508 ) 790 - 1 578 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 omplete 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 ; //1`System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh 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 con meted has found that the system fails to Protect the i-)ublic 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 . "r Inspector Signatur Date9-,OKV`oe ne copy of this certification must be provided to the OWNER, the BUYER ( Where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, We owner or operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 , 305 . partd .doc