HomeMy WebLinkAbout0021 BUMPS RIVER ROAD - Health 21 BUMPS RIVER ROAD
Centerville
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SFI OF S9P
WVANSFFWX4M0W
ATE: 8/20/02
PROPERTY A RE :21 Bumps River-Road----
Centerville,Mass .
ti ------------
02632
On the above date, I inspected the septic system at the abovFaS9VE�
This system consists of the following:
1 . 1 -1000 gallon septic tank. 3 2002
2 . 1 -Distribution box. ARNSTABLE
3 . 1 1000 gallon precast leaching pit. H DEPT.
Based on my inspection, I certify the following conditions: ( /
4 . This is a title five septic system. ( 78 Code )
5 . The septic system is in proper working order
at the present time.
6 . Pumped the septic tank at time of inspection.Heavy scum & solids
layers were present. ( Garbage disposal present. )
7 . Waste water is 60" below the invert pipe of the leaching pit.
SIGNATUR
Name:— J.—P.—Macomber—jr . _
RECEIVED
Cortipany: Josgg) p,_ Macomber & Son, Inc.
AUG 2 8 2002
Address:__Box _��________---_
TOWN OF
DE BLE
HEAL
viUfe,_Ma--Q2.632-0066
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
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
r
TITLE 5
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:21 Bumps River Road
en ervi e, ass.
Owner's Name:
Address:
Owner's 6 20 02
Same
Date of InspectionB/20/02
Name of Inspector: (please print)Joseph P.Macomber Jr.
Company Name:J.P.Macomber & Son Inc.
Mailing Address$ox 66
C _n v; ll ,Mass_ 02632
Telephone Number: S08-77S-J1118
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 the inspection. The inspection was performed based on my
training 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:
✓�Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
F ils
Inspector's Signature: Date: P-,w-e
The system inspector shal mit 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
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Page 2 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 21 Bumps River Road
Centerville,Mass.
Owner:Harold Flemming
Date of Inspection: 8/2 0/0 2
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. ystem Passes:
?) �I have not found any informatio hich indicates that any of the failure criteria described in 310 CMR
15.303 or to 3 0 CMR 5.304 exist. ny failure criteria not evaluated are indicated below.
Comments:
The septic system is in proper working order at the
' present time,
B, System Conditionally Passes:
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.
/U6 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
existing 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:
/t1b 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:
A0 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:
i
2
Page 3 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Propem Address21 Bumps River Road
Ctmnterville,Mass.
Owoer:Fia,r_e1r3 Flemming
Date of lospectioo; B,—a0T02
C../ Further Evaluation is Required by the Board of Health:
R16 Conditions exist which require further evaluation by the Board of Health in order to determine if the system
!s failing to protect public health, safety or the envirorunent.
I. S,stem will 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 health, safety and the environment:
100 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 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:
/PO The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supple or rributary to a surface water supply.
,Ri 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 well
The system has a septic tank and SAS and the SAS is less than IDO feeAt b 50 feet or more from a
prl\ate �yater suppl.\ -ell" Method used to determine distance �C�
"This system passes if the well water analysis, performed at a DEP cenified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facilir5 and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are rriggered. A copy of the analysis must be anached to this form.
3. Other: A)
3
Page 4 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:21 Bumps Ri_vPr Road
C ntPrvillP.,Mass _
OwnerHarc)l r3 F1 ammi ncr
Date of Inspection: gJ20,102
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
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
Static liquid level in he distribution box above outlet invert due to an overloaded or clogged SAS or
l cesspool H--141
V Liquid depth in ccsspoZii is less than 6" below invert or available volume is less than '/, day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped �.
/Any portion of the SAS, cesspool or privy is below high ground water elevation.
V Any 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 I of a public well.
y 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 form.]
(Yes,fNo)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>
1/ the system is within 400 feet of a surface drinking water supply
e system is within 200 feet of a tributary to a surface drinking water supply
_ the system is located in a nitrogen sensitive area (Interim 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
Property Address:21 Rumps Ri yPr Road
c-'Pnterui 1 1 NL�.
Owner��r„1 .a >.1 cmmi nn
Date of Inspection: 8/20/Q2
Check if the following have been done. You must indicate'yes" or"no" as to each of the following:
Yes No/
�/ Pumping information was provided by the owner, occupant, or Board of Health
Were 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 ?
Y Were as built plans of the system obtained and examined?
— p y mined. (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,4luding 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 ?
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 of 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 Pan C is at issue approximation of distance
is unacceptable) (310 CMR 15.302(3)(b))
5
• Page 6 of 1 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:21 Bumps River Road
Centerville,Mass.
Owner:Harold Flemming
Date of Inspection: 8/20/02
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms):] JM ✓Z6
Number of current residents:
Does residence have a garbage grinder(yes or no): Ye's
Is laundry on a separate sewage system`( es or no)�d [if yes separate inspection required]
Laundry system inspected (yes or no):YtvS
Seasonal use: (yes or no)- _ `Ye2.9
Water meter readings, if available (last 2 years usage (gpd)):2 0 0 0—2 3, 000 gallons=63 . 02 GPD
Sump pump(yes or no): X)O 2001 —1 8, 000 gallons=49 . 32 GPD
Last date of occupancy: Qy
COMMERCIAL/INDUSTRIAL
Type of establishment: UfJ
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present (yes or no): "
Industrial waste holding tank present(yes or no): ZO
Non-sanitary waste discharged to the Title 5 system (yes or no):100
Water meter readings, if available:
Last date of occupancy/use: 1414
OTHER (describe): 1459
GENERAL INFORMATION
Pumping Records
Source of information: AF_ 13�4)11<1 d'�O�
Was system pumped as part of the inspection (yes or no):
If yes, volume pumped: /d'Pgallons-- How was quantity pumped determined?� f/
Reason for pumping:
TY E OF SYSTEM
K Septic tank,distribution box, soil absorption system
Single cesspool
,y9 Overflow cesspool
/W Privy
11/2) Shared system (yes or no)(if yes, attach previous inspection records, if any)
/VGA Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
ti0 Tight tank 4.1'0 Attach a copy of the DEP approval
/0 Other(describe): 10 1
A pro,3cm ,age o all c�rnponents, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site(yes or no):
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:21 Bumps River Road
Centerville,Mass.
Owner:Harol d Flemming
ng
Date of Inspection: g�20.1 Q 2
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: cast iron a'40 PVC sue;'other(explain): le-
Distance from private water supply well or suction line: /p'/-
Comments (on condition of joints, venting, evidence of leakage, etc.):
Tni nt-s apnP.qr ti qht No evidence of 1 eakaT ThP c=v_stem is
vented through the house vents .
SEPTIC TANK: Zlocate on site plan) Idoef p?Aok�.'JS
o/
Depth below grade: 14
Material of construction: concretemetalfiberglass polyethylene
iL other(explain) ,,$
If tank is metal list age: J,�p Is age confirmed by a Certificate of Compliance (yes or no):XPO(attach a copy of
certificate) ri .
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
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:
How µere dimensions determined:Pumped tank a time of i nspeeti on.
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 annually Garbage disposal is prPsPnt
Tnlet & outlet tees are in place_ThP tank is structurally
sound and shows no evidence of leakage.
GREASE TRA (locate on site plan)
Depth below grade:
Material of construction:,, concrete/ metal.�fiberglass�olyethylent Wother
(explain): AIA
Dimensions:
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: Id-1.
Date of last pumping: AjA
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: 21 Bumps River Road
CPntPrvillP ,MasS.
Owner: Harold F1 ammi ng
Date of Inspection:lt420102
TIGHT or HOLDING TANX dG (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: ,{y concreteAr 4 metal eO fiberglass tl/_/I polyethylene/ other(explain):
NA -
DimensionsAM
Capacity: A1.4 gallons
Desien Flow k�q gallons/day
Alarm present (yes or no): ItW
Alarm level: 4/i9 Alarm in working order(yes or no): Abl
Date of last pumping: ILIA
Comments (condition of alarm and float switches, etc.):
Tight or holding tanks are not present
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Ild
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 has one lateral No evidence of solids
carry aver-No evidenng of leakage into or out of the box
PUMP CHAMBER- ✓4 i(locate on site plan)
Pumps in working order(yes or no): _
.Alarms in working order(yes or no):
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber is not present
8
Page 9 of 1 I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address21 Bumps River Road
Centerville,Mass.
Owner:Harold Flemming
Date of Inspection: 8/2njn2
SOIL ABSORPTION SYSTEM (SAS): �ocate on site plan, excavation not required)
1 -1000 gallon precast leaching pit. 6 'X10 '
If SAS not located explain why:
Located: See PROP I6
Type
leaching pits. number:
A10 leaching chambers, number: B
VP- leaching galleries, number: _
sv leachin trenches number, length:
_� gf�
k6leaching fields, number, dimensions: (Y
,00overflow cesspool, number:0
'U&'innovative/alternative system Type/name of technology:/i >'/L'G' C /er4r/"e,
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
fa; l „ra nr nnnr3inq Soils arP dry Vegetation is normal
Waste water is 60" below the invert pipe.
CESSPOOLSA, cesspool must be pumped as pan of inspection)(locate on site plan)
Nuinber and configuration: 0
Depth -top of liquid to inlet invert: Z,1,4
Depth of solids layer: 1
Depth of scum laver:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Cesspools are not present.
PRIVY. 6(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Privy is—nc)t-r^,-esent
9
pw 10 of I I
OFFICLA—L INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION F O RIYt
PART C
SYSTEM fNFORM.ATION (conHnvcd)
p,operr7 A00rf11: 21 Bumps River Road
en e , s.
0„0crHaold Flemming
'Jiic o1Inlpcclioo: 8/20/02
SK—f*TCH OF SEWACE DISPOSAL SYSTEM
Pio.ioc i Ixn<h 0f the Icwcjc dhpolcl lylicm inclvd(ng tic, Io 11 Ica;[ two permtncm rcrcrcncc Icn Cmuxc 0,
ocncnm�xi lo<cic cu wclli . ichin 100 I'm Loccic whcrc pvblic wlicr jvpply cnlcrt the bviloinj.
2, I
,,
W�TFR
LINE-
I
10
Page I 1 of 1 I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 21 Bumps River Road
Centerville,Mass.
Owner:Karold F1 emmi ng
Date of inspection: g/2()/()2
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
f
Estimated depth to ground water,f� feet
Please indicate check all methods used to determine the hi ,(check) high ground water elevation:
NLD Obtained from system des* Tans on record - If checked, date of design plan reviewed: (//}
Observed site abutting property bservation hole within 150 feet of SAS)
ec e wtt oca oar o ealth-explain:
Checked with local excavators, installers- (anach documentation)
�tccessed U SGS database-explain:http: //town,barns tabl e.ma.us.
You must describe how you established the high ground water elevation:
7sed: Gahrety & Miller Model . 12/16/94 Ground water elevations above sea level .
Ised: US GS: Observation well data_. June 1992
Ised: USQSe Technical bulletin 92-000-1 Plate #2 January 1992 Annual ranges
of gro.und.watuna
er elevations-
Leaching s7
Pit
Groundwater Feet Below Bottom of Pit ' Hrgh 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.
ll
1
•.'[�//JS~]/.(f};_...'T'\ T'1"i—liT,.—fT,'AT�TfTTf'�eT.T.T:.'Tr'TRT:"1"TtrTT
TOWN OF Barnstable BOARD OF HEALTH
0 ,S118SURFACF SEWAGE I)i POSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION
rrs-mrnsen••nn mnei•►mr�ensvrrmrr+r.•.—rrrr•-. ....�
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS21 Bumps River Road Centerville,Mass.
ASSESSORS MAP , BLOCK AND PARCEL # 120/001 /007
OWNER' s NAMEHarold Flemming
PART D - CERTIFICATION I
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J. P.Macomber & Son InC:` '
COMPANY ADDRESSBox 66 Centerville Mass. 02632
Street Torn or CSty State LIP
COMPANY TELEPHONE ( 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
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 ;
�XSysteln PASSED
The inspection tihich I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or Lhe environment as defined in 310 CMR 16 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form ,
System FAILED*
The inspection which I have co Ucted has found that the system fails to
protect the public health and the environment in accordance with Title
5 , 3tQ CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form ,
,f 1
Inspector Signature —:�
Date
...�.. 7�
ecopy of this b rt.ification must be provided to the OWNER, the BUYER
On
where applicable ) and the BOARD OF H EALTJI.
* If the inspection FAILED, the owner or " `p' erator shall upgrade ' the system
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 3,10 CMR 15 . 305 .
partd . doc