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Home My WebLink About0379 BUMPS RIVER ROAD - Health 379 Bumps River Road,Centerville A= °A!h UPC 12534 A No.2-153LOR k'�meo HASTINGS,MN I DATE:12/:15/95 PROPERTY ADDRESS:_:; 79--Bumps River 'Road Centerville ,Mass . 0263� ' 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. l0 2 . 1 -Distribution box. '{d 3 . 1 -1000 gallon leaching; pit . � AFC Based bn my Ins.nection, I certify the following conditions: � � 1 . 'This is a title five s .ptic s-ys.t:em. ( 78 Code' ) 4 �,9 2. The�sep.tic system is in proper work�rrg or'der.. at the present time . ti 8IGNATURF5 Name: J. P.M'acomber Jr., i Company:_J. P.Macomber & Son-_Inc Address:_-$-e_x_66----__�___,-- __Centqrvil1,e LMasj__0.2-632 Phone:---�Q8. 73338---THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • JOSEPH I MAC0M ER & SON, INC. Tanks Ceu�oois-Leschflalds Pumped 4 Insta{fed To►yn Sewer Connections P.O. Box 66' Centerville, MA 02632-0066 775-3338 775-6412 Commonweofth of Massachusetts Executive Office of Environmental Affairs Department of. • Envirronmenta1 Protection v(Illlam F.Wold , Oo.•mw • Trudy Cox• • $"I a afy, 0'01 David B. Struhs commlutonu SUBSURFACE SEIYAGFDISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Owner: of Property Address: 379 Bumps River Road Add(If drress ess of Date of Inspection: 12/15/9 5 Name of Inspector: Jopeph 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: _Zpasses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails , ✓/ Date: Inspectors Signature: s i 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 repon 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: �ave not found any information which '•ndicate.s that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. Bt 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 determinatiun 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 approved by the Board of Health. (rcviscd 8/15/95) 1 Ono Wlntor Stroot 0 Boslon, Maciachusotti 02108 • FAX(617) 55fr1049 9 Tolophons (617)292.5500 U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 379 Bumps River Road Centerville ,Mass . 02632 Owner: Richard Syrn Date of Inspection:12/15/9 5 BJ SYSTEM CONDITIONALLY PASSES (continued) V 90 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 �^ 1 he 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 CJ 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) 'SYSTEA1 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: „ibu; The w5lem nd> a >euu� ldnn onu )uii au�utpUuii iyilenl JI�4 �� "„��, lv f 1':v cc, tG a surface a;C; supp,!)' C. ' a�,' IC a surface water supply. The system has a septic tank and tail 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-, 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: _ 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. bb Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/55) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 379 Bumps River Road Centerville ,Mass . Owner: Richard Syrn Date of Inspection: 12/15/9 5 D) SYSTEM FAILS (continued): Static liquid level in the distribution box 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. b Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped I%ny portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or pri•.y 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 h& Any portion of a cesspool or privy is within 50 feet of a private water supply well. .rL(0 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 u coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. EJ 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 the 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; compliance The owner or operator of any such s6500 Pleatem tsercro suit the the tem localnreg onlalyoffitcef oflthe Departmenttforhfurther groundwater amationtment program requirements of 314 CMR 5.00 (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART B CHECKLIST Property Address: 379 Bumps River Road Genterville ,Mass . Owner: Richard Syrn Date of Inspection: 12/15/9 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 Aater 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. 2The facility or dwelling was inspected for signs of sewage back-up. .he system does not receive non-sanitary or industrial waste flow V The site was inspected for signs of breakout. , ZAll system components,Mcluding the Soil Absorption System, have been located on the site. �!• — e septic tic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or t es, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods /he facility pv.ne c:c.:,,:::,;s. :f diiierent frwn owner! were provided with information on the proper maintenance of Sub- Surface Disposal System. Recommendations 1 . Risers put on pit . 2. Risers put on Distribution box. trevised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 379 Bumps River Road Centerville ,Mass . Owner: Richard Syrn Date of Inspection: 12/15/9 5 FLOW CONDITIONS RESIDENTIAL: Design flow:) G all s� ✓ c:��y Number of bedrooms: Number of current residents: Garbage grinder (yes or no):_6 Laundry connected to system (yes or no):ye-S Seasonal use (yes or no): E 6r�t ''T �C ! �y � .c�N �� Water me gr readings, if available: 1 3" Last date of occupancy:&„size COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)A Industrial Waste Holding Tank present: (yes or no) NIq n-sanitary waste discharged to the Title 5 system: (yes or no)bO ater meter readings, if available: /LEA Last date of occupancy: OTHER: (Describe) AAA — Last date of occupancy:A_ GENERAL INFORMATION PUMPING RECORDS and source of information: S System pumped as pan of inspection: (yes or no)AZ If yes, volume pumped Cil gallons Reason for pumping. TYPE O�YSTEM r Septic tank/distribution boxAoil absorption system N r Single cesspool _"(_ Overflow cesspool AJP Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: S cage odors detected when arriving at the site: (yes or no)jJ (revised 8/15/95) 5 C7) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (cuntinued) Property Address: 379 BUmps River Road Centerville ,Mass . Owner: Richard Syrn Date of Inspection: 2/1 5/9 5 SEPTIC TANK: ILL��A y IoWk (locate on site plan) Depth below grade:__ //�1 Material of construction: ! Concrete _metal _FRP —other(explain) Dimensions' r Sludge depth: r , ri Distance from t�sludge to bottom of outlet tee or baffle. �3 Scum thickness: &/Ic Distance from top of scum to top of outlet tee or baffle ALJ—r-�- Distance from bottom of scum to bottom of outlet tee or baffle` - C:"r— Comments: r•--ommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural ;city, evidence of leakage, etc.) P lmnaanrti (-. tank every two to t-h—rpe YP�a?' ; Tn1 at. Rr nutl Pt T�_Septi c. tank i S strur-tIIra11 ) Gn1inc3 and shows no si-gns or lenkgge . No re�pnjrs eeded at this time , GREASE TRAP: (locate on site plant Depth below grade.V)+ matenal.of construcarontlAconcrete _rne;,l _FRP _other(explam; Dimensions: A Scum lluckne». O Distance from top of scum to top of outlet tee or bane: D!, .nee fro-, hullo", n i !rr'n". C1; ir.,i •i i •,• r p;i :ii_• Comments (recommendation for pumping, cunurtioc. or u,fel and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage-. etc , 4,124 _ lre�:sed 6/.5/s5l L SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 379 Bumps River Road Centerville ,Mass . Owner: Richard Syrn Date of Inspection: 12/1 5/9 5 TIGHT OR HOLDING TANK: (locate on site plan) ` Depth below grader material of construction: concrete _metal _FRP _otherteaplain) Dimensions: ( Capacity: gallons Design flo%+•: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:S (locate on site plan) Depth of liquid level above outlet inver,:- Comments: Mute ii ie -i.al) d„t•1L ;,,.;. . L., .a'. c,,; ncc „' c{: o•.e e;'Igence of Icak e int Qr ut of box, etc.) his ribution box is fevel ;No evidence of sool1 s carryover or ea age in or out of the ox. No repairs needed at this time . PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)�rtr4 Comments: (note condition of pump chamber, condition of pun-:ps and appurtenances, etc.; (rev.sed 8/15/95) 7 l0 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) operty Address: 379 Bumps River Road Centerville ,Mass . ner: Richard Syrn to of Inspection:1 2/1 5/9 5 r� { IL ABSORPTION SYSTEM (SAS): cate on site plan, if possible; excavation not required, but•m-y be approximated by non-intrusive methods) not determined to be present, explain: pe: ' leaching pits, number:_ leaching chambsrs, number:0 leaching galleries, number: leaching trenches, number,length: leaching fields, number, dim sions: overflow cesspool, number: mments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) oam to medium sand norma o re airs n L. .COLS: Lble, cate on site plan) umber and configuration: epth-top of liquid to inlet inven:_ A)A _ epth of solids layer: It1fQ epth of scum layer: It)fl imensions of cesspool: aterials of construction: AAA dicatron of groundwater: ) inflow (cesspool must be pumped as part of inspection) 11iA omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) �RIVY: A,'?) locate on site plan) r materials of construction: /l' ' Dimensions: N epth of solids: omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) /IJ ` revised 8/15/95) B 1 L% SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 379 Bumps River Road Centerville ,Mass . Owner: Richard Syrn Date of Inspection:12/15/9 5 SKETCH OF SEWAGE DISPOSAL SYSTEM; • include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Town Water r. I �J 379 6umPS Ce -te-c i) \-e— DEPTH TO GROUNDWATER Depth to groundwater: f 'Meet method of determination or approximation: See image 10A Plan on file at the Barnstable Board Of Health. No water encountered at 121 . (revised 8/15/95) 9 L .:_.-....._. SHEET I OF 2 ,51 TE PLAN 9y t, oT I I F V 5T Ic ` 1 V� MIN. / O N P 48,v. N 1 ' LOT I L,DT 12 - 1 I 1 � is•.RYII`.K IC71�, j 'TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 379 Riimj)R RjyRr Rand aa��(��Pnt.arwJiJ,lJl a�Ma�G _ ASSESSORS MAP , BLOCK AND -PARCEL # _ 2 OWNER' s NAME Rinbnrd q3*z-r]2 PA1?T 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 State LIP COMPANY TELEPHONE ( 508_) .775 3338 FAX 508 790 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage dispos6l system at this address and that the information reported is true , accurate, and complete as of the time of .iinspection . Tile inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with iny training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: XXXXXXXSystem; PASSED The inspection which 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 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 conducted has found that the system fails to Protect the ptiblic health and the environment in accordance with Title 6 , 310 CHR 15 . 303 , and. as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 12/15/95 One copy of this ce ication must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEAL'I'll. If the inspection FAILED, the owner or"�'�e-rator shall upgrade ' the eystem within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CHR 15 . 305 . 1 ��. ..��•. SIC W � v � THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL- PROTECTION BE IT KNOWN THAT 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 '"On of Water Pollution Contro