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HomeMy WebLinkAbout1106 BUMPS RIVER ROAD - Health 1106 BUMPS RIVER RD. CENTERVILL_ E A=188-133 i �lll ® 2J�RE����Fo�o IN UPC 12534 No.2`153LOR HASTINGS,MN �f TOWN OF BARNSTABLE LOCATION / d SEWAGE # VILLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO.. SEPTIC TANK CAPACITY LEACHING FACILn Y: (type) '� �4® (size) /t20 NO.OF BEDROOMS T BUILDER OR OWNER '2'/d�� PERMIT DATE: COMPLIANCE DATE: 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet w;"*- ""0, feet of 1pohi facility) Furnisaed by i .:��. O � \ ! � /p� � � � \ � � ,� A � \��� � i � - � � � i ��,"� g 4� � � � � , `i +� � ►�©� 6urn�5 R��e� R,d , c�n�t�r` " Ili, v� ,h k07- LOATION t SEW PERMIT N0. Ho VILLAGE I N S T A LLER'S NAME & AD"ESS ArC. b co B UI-LDE R OR OWNER, DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ,o � 33 33 4� 6 �� -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r RECEIVED ,JAN 1 0 2001 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1106 Bumps River Road Centerville,Mass. Owner's Name: Estate Of Waldo Fraser Owner's Address:6 Woodland Road Harwich or (Maas_ 02F46 Date of Inspection: 1 /4 j101 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 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 4/_/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: /� Date: /— 9`z4l The system inspector shall �/bmit 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 1 ****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 Pa2e2ofII -t OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1106 Bumps River Road Centervi e,Mass. Owner: Estate Of Waldo Fraser Date of Inspection: 1 /4/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D System Passes. i A-)Q I have not found any information which 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: None B. System Conditionally Passes: —t) 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. A 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: NO 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: Ale 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 t.. Page 3 of 1 I `J OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1106 Bumps River Road Cen ervi e,Mass. Owner: Estate Of Waldo Fraser Date of Inspection: 1 4 01 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 failing to protect public health, safety or the environment. 1. System 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 which will protect public health,safety and the environment: AJO 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 system is functioning in a manner that protects the public health,safety and environment: AZD 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. / o The system has a septic tank and SAS and the SAS is within a Zone 1 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 100 feet but 50 feet or more from a private water supple 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 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. 3. Other: Nan 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:1 106 Bumps River Road Centerville,Mass. Owner: Estate Of Waldo Fraser Date of Inspection: 1 /4/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes NV,,Backup 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 'Static SAS or cesspool logged P Static liquid level in the distripution box above outlet invert due to an overloaded or clogged SAS or cesspool 'i4�h"4,v jr C ory �. Liquid depth in ce&Mx= as 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'—L. _ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of 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 1 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. (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/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 61/c a system is within 200 feet of a tributary to a surface drinking water supply nitrogen sensitive area Interim Wellhead Protection Area—IWPA or a mapped _ the system is located to a g (_ ) PP 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 "ves" 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 tinder Section D shall upgrade the system in accordance with 3 I O CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 1 06 Bumps River Road Centerville,Mass, Owner: Estate Of Waldo Fraser Date of Inspection: 1 f 4/n 1 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No -ZPumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks ? 2Has 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�.e�eluding 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 Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 1 1 a OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1106 Bumps River Road CEnterville,Mass. Owner: Estate Of Waldo Fraser Date of Inspection: 1 /4/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): :5 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of current residents: 0 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes oro: — [if yes separate inspection required] Laundry system inspected a or no): — Seasonal use: (yes or no): &VJ Water meter readings, if available(last 2 years usage(gpd)): � fy�- �lo,p^)'yjQ,�,�p�>sa Sump pump(yes or no):Lo fJs Last date of occupancy: l721.,v COMM ERCLAL/INDUSTRIAL Type of establishment: 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): d Non-sanitary waste discharged to the Title 5 system (yes or no):A/ Water meter readings, if available: AM Last date of occupancy/use: 16� OTHER(describe): '424 GENERAL INFORMATION Pumping Records Source of information: Al Was system pumped as part of the inspection (yes or no): If yes, volume pumped: /&Im galll9ns -- How was quantity pumped determined? /�6i9.S'L/I'c�� Reason for pumping: PAly 7C1/is9 rt TYV OF SYSTEM eptic tank,distribution box,soil absorption system &a Single cesspool Overflow cesspool To Privy NO Shared system (yes or no)(if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank/V_Attach a copy of the DEP approval Other(describe): Appr��it�to ace� all co ents, date installed (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):�l) 6 r. • T` _I Page 7 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1106 Bumps River Road Centerville,Mass. Owner:Estate Of Waldo Fraser Date of Inspection: 1 /4/01 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:&dcast iron 240 PVC426other(explain): AI�4 Distance from private water supply well or suction line: / ',1'- Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear f i ght Nn Pv;dencenf leakage System is vet through the house vent. IL 0 SEPTIC TANK: _(locate on site plan) l Depth below grade: �� � Material of construction: 4-1'6oncreteti4 metal,�p fiberglass.L67solyethylene AVLother(explain) /J If tank is metal list age: O is age confirmed by a Certificate of Compliance (yes or no)yl//�(attach a copy of certificate) / // Dimensions: P � ,e�l/lam, Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: (_ Scum thickness: d Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or ba e: How were dimensions determined: 10JOA, ed f 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 tank anually Garbage ..dispoGa1 ; G -nrPGPnt ,TnlPt & nutlet tees are present The tank is strurLiral-l �i sound and chnws no evidence of leakage. GREASE"TRAP:A/17 (locate on site plan) Depth below grade: Material of construction:xAconcrete,L/A metal/ fiberglass,(�polyethylene��other (explain): 164 Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: .4-114 Distance from bottom of scum to bottom of outlet tee or baffle: 60 Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage etc.): ,g N ";;5.402 AIL-rr 7 '- '`Page 8 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1106 Bumps River Road Centerville,Mass. Owner: Estate Of Waldo Fraser Date of Inspection: 1 /4/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: AO Material of construction: A1.4 concrete A)4 metal AJAfiberglass polyethylene &,d_other(explain): Dimensions: 414 Capacity: V,4 gallons Desien Flow: Aj o gallons/day Alarm present (yes or no): A),J? Alarm level: _A0_ Alarm in working order(yes or no):,gH Date of last pumping: M Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present. DISTRIBUTION BOX: Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: AQ 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 evidnce of solids carry over No evidence of leakage into or out of the box. PUMP CHAMBER:(locate on site plan) Pumps in working order(yes or no):_2 Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Pump chamber is not =rpseht 8 Pape 9 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:l 1 06 Bumps River Road Centerville,Mass. Owner:Estate Of Waldo Fraser Date of Inspection: 1 /4/01 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) Leaching pit was excavated If SAS not locat explain wh 1060 n� �n?.lE�[' a prr Tv�qpe K leaching pits. number: _4A leaching chambers, number: _A1A leaching galleries,number: leaching trenches, number, length: Vj leaching fields,number, dimensions: Q overflow cesspool, number: innovative/alternative system Type/name of technology: 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 hydraulir failure or ponding.Soils are dry.Vegetation is nnrma t,mhP 1 eaci ng pit was dry at time of inspection. CESSPOOLS:(cesspool must be pumped as part of inspect ion)(]ocate on site plan) Number and configuration: O Depth-top of liquid to inlet.invert: Depth of solids layer: A)14 Depth of scum laver: AM Dimensions of cesspool: S4 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:(locate on site plan) Materials of construction: iL Dimensions: A14 Depth of solids: '40 Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present - 9 Page 10 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 1 06 Bumps River Road Centervi e,Mass. Owner: Estate Of Waldo Fraser Date of Inspection: 1 4 01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells.within 100 feet. Locate where public water supply enters the building. doll 0 10 Page I I of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1106 Bumps River Road Centerville,Mass. Owner: Estate Of Waldo Fraser Date of Inspection: 1 /4/01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 1 feet Please indicate (check)all methods used to determine the high ground water elevation: btained from s t s on record- If checked,date of design plan reviewed: Observed site abutting property bservation hole within 150 feet of SAS) ecked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used water contours Man- C,ahrPty R Mi 1 1 Pr Madel 12 /, 1ti/A4 11 �••rnRrr^nrr--rrrnrrr.nms-+*n Sen•.rrrr.�+•r-tan:�rr-mrT nrrs-v*sa-erRr.9-n .. Tn-rrr-r—.r`_ - 'I'UWN OF Barnstable BOARD OF HEALTH SI111SURFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CEIZ'fIFICATION I - e•r...•..•. --.ir.-.--nrr.T•n:m rzir+rs+ram•.rn'r•n*••im+�nrmr-'rmn+evnr nr+enarrt+ner� rsn es'�mrnrsrn*rr.rr�ee:—.rrrr•� -..A -TYPL OR PRINT CI.EARL1'- PROPERTY INSPECTED STREET ADDRES$ 1106 Bumps River Road Centerville,Mass. ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Estate Of -Waldo Fraser PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Sert 'Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or Clty State r1P COMPANY TELEPHONE ( 5081 775 - 3338 FAX ( 508 1 790 -1578 CERTIFICATION STATEMENT 0r 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 ecoinme►►dations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Chec k one ; PASSED - The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh 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 wlticit I have cony lcted has found that the system fails to Protect the j-)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 . Inspector Signature Al A- 7 . � Date �U ne copy of t11is ce ification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALT'1I. * If the inspection FAILED, the owner or",operator shall u d within one year of the date of the inspection, unless allowed ort required he m otherwise as provided in 3.10 CMR 16 . 305 . partd .doc