HomeMy WebLinkAbout1132 BUMPS RIVER ROAD - Health 1132 Bumps River Road
Centerville
A= 188-131
S M E A D
No.2-153LOR
UPC 12534
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'< 1132 Bumps River Road, Centerville M- 188 P - 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is p O. Box 1228, Ostervilie MA 02655 August 19, 2014
required for every 9
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Troy Williams
use the return key. Name of Inspector
Troy Williams Septic Inspections
Q Company Name
19 Hummel Drive
Company Address
/no South Dennis MA 02660
Cityrrown State Zip Code
(508) 385- 1300 S1682
Telephone Number License Number
B. Certification
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 ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
August 19, 2014
Inspector's Signature Date
The system inspector shall submit 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.
****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.
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t5ins-3/13 Title 5 Official Inspection Form:SuWaSewageDisposal System•Pagl 1 of 17
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e
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owners Name
information is required for every P.O. Box 1228, Osterville MA 02655 August 19, 2014
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 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:
System meets minimum standards set by Massachusetts DEP at the time of inspection only.This
inspection is not a guarantee or warranty on the future working conditions of leaching, pipes,
components or the future structural integrity of said components and only represents conditions found
at the time of inspection only.
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.
Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not
determined," please explain.
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.
❑ Y ❑ N ❑ ND(Explain below):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'< 1132 Bumps River Road, Centerville M - 188 P- 131
Property Address
John&Corrine DiSabato
Owner Owner's Name
information is p O. Box 1228, Osterville MA 02655 August 19, 2014
required for every 9
page. CitylTown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ 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 ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
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:
❑ 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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is p O
required for every P.O. Box 1228, Osterville MA 02655 August 19, 2014
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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:
❑ 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.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ 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 supply well"*.
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent 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:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® 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 clogged SAS or cesspool
❑ ® 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 %day flow
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is p O. Box 1228, Osterville MA 02655 August 19 2014
required for every 9
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® 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.
❑ ® 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 fecal coliform bacteria indicates absent 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
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® 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.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ 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 II 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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
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1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P - 131
Property Address
John&Corrine DiSabato
Owner Owner's Name
information is required for every P.O. Box 1228 Osterville MA 02655 August 19, 2014
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
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?
® ❑ 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, excluding 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:
® ❑ 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(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1132 Bumps River Road, Centerville M - 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is required for every P.O. Box 1228 Osterville MA 02655 August 19, 2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 13=32,000 gals.
g ( y g (gP ))' 12=31,000 gals.
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: occupiedDate
CommerciaUlndustrial Flow Conditions:
Type of Establishment:. N/A
Design flow(based on 310 CMR 15.203): N/A
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): N/A
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available: N/A
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
4 Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P- 131
Property Address
John&Corrine DiSabato
Owner Owner's Name
information is p O. Box 1228, Osterville MA 02655 August 19 2014
required for every 9 ,
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: N/A
Date
Other(describe below):
N/A
General Information
Pumping Records:
Source of information: Last pumped in Aug. 2012 per info from owner.
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ 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)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P - 131
Property Address
John&Corrine DiSabato
Owner Owner's Name
information is p O. Box 1228, Osterville MA 02655 August 19 2014
required for every 9 ,
page. City/rown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Tank, d-box and leaching were installed on 6/22/79 per compliance.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 18"+
feet
Material of construction:
❑ cast iron ®40 PVC sch 20 pvc
® other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Flushed lines and found clear at the time of inspection.
Septic Tank(locate on site plan):
'
Depth below grade: 1
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
5'X9'X6' 1000 gallon
Dimensions:
Sludge depth:
4"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is P O. Box 1228 O
required for every Sterville MA 02655 August 19, 2014
page. City/rown State Zip Code Date of Inspection
D. System Information (cont.) t
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
21810
Scum thickness thin layer
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? probe/measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Inlet and outlet tees were found present and in working order. No evidence of leakage or damage
was found. Tank was not in need of pumping at this time.
Grease Trap(locate on site plan):
Depth below grade: N/Afeet
Material of construction:
❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions: N/A
Scum thickness N/A
Distance from top of scum to top of outlet tee or baffle N/A
Distance from bottom of scum to bottom of outlet tee or baffle N/A
Date of last pumping: N/ADate
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
required fo is P.O. Box 1228, Osterville MA 02655 August 19 2014
required for every 9
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: N/A
Material of construction:
❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
N/A
Capacity: N/A
p gallons
Design Flow: N/Agallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: N/A Alarm in working order: ❑ Yes ❑ No
Date of last pumping: N/A
Date
Comments(condition of alarm and float switches, etc.):
N/A
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1132 Bumps River Road, Centerville M - 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is p O. Box 1228, Osterville MA 02655 August 19, 2014
required for every 9
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert level
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.):
D-box was found level and in working order.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
N/A
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1132 Bumps River Road, Centerville M - 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is required for every P.O. Box 1228 Osterville MA 02655 August 19, 2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1 -6'X6' pit with2'of stone
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ 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.):
Leach pit was found with 3' of water present dry with a visible stain line approx. 2.0' below inlet invert.
No evidence of hydraulic failure or problems in the past were found at the time of inspection.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration N/A
Depth—top of liquid to inlet invert N/A
Depth of solids layer N/A
Depth of scum layer N/A
Dimensions of cesspool N/A
Materials of construction N/A
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is required for every P.O. Box 1228, Osterville MA 02655 August 19, 2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
Privy(locate on site plan):
Materials of construction: N/A
Dimensions N/A
Depth of solids N/A
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 o►17
Commonwealth of Massachusetts
piTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P - 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is p O. Box 1228, Osterville MA 02655 August 19, 2014
required for every 9
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1132 Bumps River Road, Centerville M 188 P- 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is p O B 1228 O
required for every . ox sterville MA 02655 August 19, 2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
❑ Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: 16.0'+feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed. 1/30/78
Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
MIW 29 Zone D 9.0' 5.5'adjustment
You must describe how you established the high ground water elevation:
Test hole recorded on plan showed no water found at 12.0'. Hand augered 5.5' below bottom of
leaching with no water found at a depth of 15.3'. Groundwater adjustment at the time of inspection
was 5.5'. Bottom of leaching at 9.8'was found not to be located in the high groundwater elevation at
the time of inspection. USGS maps showed groundwater to be at 22.8'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1132 Bumps River Road, Centerville M- 188 P - 131
Property Address
John &Corrine DiSabato
Owner Owner's Name
information is p O. Box 1228, Osterville MA 02655 August 19 2014
required for every 9
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
- -
No..........r J ..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALT
( .... OF........ . ......... .. . ... �..... .........................
v Appliratiun -fur 4tupuuttl Worbi Tomitrnrtiun Prrntit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
S stem at
�J
Locatio ddress or Lot
.emu ^� �c.7'�. /®.
........................................................
Owner Address
W
Installer Address
Q Type of Building Size Lot__.....v/..d Sq. feet
U Dwelling—No. of Bedrooms__-__ _ - -.--._--_-Expansion Attic ( ) Garbage Grinder ( �.
per.., Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d Other fixtures �v -6
,�. ------•--•---••--•------ ------•-------•-•--•---------
W Design Flow.....% ..........................gallons pe`fe -pei'day. Total dail flow.............. _�r _____.__.._.gallons.
P4 Septic Tank—Liquid capacitVQQ_C2gallons Length----c?...... Width------ Diameter---------------- Dej)th- -----_------
xDisposal Trench—No. .................... Width-------------------- Total Length_---___-_---____--_ Total leaching area.-------------.-----sq. ft.
Seepage Pit No----Z______-_____ Diameter---/o_. Depth below inlet_- ?•®.f_..... Total leaching area.Z4 5�---�sq. f
z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed by.... �-�L - ......................... Date. _:--_._..__
4
Test Pit No. I..-�-.Z__mtnutes per inch Depth of Test Pit._�Y .._. Depth to ground water./l2.may. .
44 Test Pit No. 2----------------minutes per inch Depth of Test Pit---------------------Depth to ground water.-------Co��►---
Ix ------------------------------------------------•----------•--•--•--•...............--•--•----••---•...................................... --•-••--•-----
0 Description of Soil------- -' ........ ....... _ ✓ --------------------------------------------
_-�__.;�_ _. •------- .. ... .. ___ ..
w
--------------------------------------------------------------------------------------------------------------------------•-----------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable.-._-___________________------------------------------------------------_------------_----------
----------------------------------------------------------------------------------------------------------------------------------------------------- .
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
ened-- - ----------------------------------------•---------------------•--- ............
Da-----------------
Date
Application Approved B -........:.............. 7
PP PP Y. ... ate
Application Disapproved for the following reasons:-----•---------• ----------•-------•------------------------•-•------••-------•---•---------------•-
--•--••--•----•----•---------------------------------------------------------------------- -------------------------------•-_------------............--------- ...............................
-7 C Date
PermitNo.......................................................... Issued.--- P�-------------------------------------------
Date
..........�.................-. ----------------�------------
No.........'` -f - Fizz.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HE T �-
G
Appliratgun -for Ugopouttl Workii Tutwuurtiun Punfit
Application is hereby made for a Permit to Construct ( ' or Repair ( ) an Individual Sewage Disposal
System at:
�xr�Cs�r for_
................................ ............................... -----• -----------•..... ---------- -•--••......-•-- ---•--•--•----•-•-
Location:Address ,/ or Lot No.
-------------•-•-•. . . ...................................................... ........................................................
Owrie, Address
Installer Address
Type of Building Size Lot-A?
----- feet
Dwelling—No. of Bedrooms.....�:.................................Expansion Attic ( ) GarbageGrinder ( )
Other—,Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a
Other fixtures --•------------------------------ :�_'•-------- ----------•-----.------••------•-----_-.
-------------•------------•----------
W Desi n Flow..... ---------------------------gallons per+Ga: eper day. Total daily flow................. ...gallons.
WSeptic Tank—Liquid capacity/a?!; gallons Length-__ __.... Width---_"'Y...._.- Diameter................ Depth. .............
x Disposal Trench—No- -------------------- Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No'
-_._/------------ Diameter_.. :... Depth below mlet___��___ __`------ Total leaching trea.f �'____sq. ft.
z Other Distribution box ( ) Dosing tank 'e,
( ) -
are Test Results Performed by `-' Date. ..1-_� 4
Test Pit No. ---minutes per inch Depth of Test Pit .-y-_--- Depth to ground water..
(14 Test Pit No..2................mt u per er inch Depth of Test Pit---------":_.......... Depth to ground water_ _--------
----------------------------------------------------------------------------------------------------
Description of Soil------ C,.
x --------------------------------------/°y-- --------------------------r ---`------- --............ ..sue -�+ --- .--•----•------ -
W
UNature of Repairs`or,Alterations—Answer when applicable-----------------_----------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------
�.
_t
Agreement: ;
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the,State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
'.11 S• ned
,� y P to
Application Approved BY------------ /;. - -/1' "----------------------- ---- _7--
Date
Application Disapproved or the following reasons----------------------� ----------------_-----------------------............._______.__.__-_
PP PP f f 9 --------------
---------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued--------------------------------- ..x .................
Date i
v
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEA TH�
......... .............OF........ P:.,:L '......... .:`.......................
O.rrtifirtttr of Oouttilitturr
r
THIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by / ----- ........................ ------------------'------•---•----------------------•--------------------------------•---------•••---
Installer
at----- -- • -`--"------ ---=�........ '._ _
has been installed in accordance with the provisions of _ XI of The State Sanitary Code as desc *bed in the
application for Disposal Works Construction Permit No 911.d_1.-_.___-•______.___- dated._.t7-"./.*...�... ....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM '1,.JLL UNCTION,SA SFACTORY.
. v� 2 - � �
DATE Inspector--------- ---••- ---------------==-----------------------•-------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEAL .H.::
7
... . .. .of.... .. ..... ..........
..... ..................::....•---------------- --- � ='
No. 6-_.._...... FEE........................
Biuvu,sttl urk �unutrurtiunrrtnit
Per&C ,0,
nAepair
y granted-------'-
to Const ) ( ) n I viduallage_ isposal System
w
atNo.---- --- "- = ------ ..... ----- �j-----------
S reef
as shown on the application for Disposal Works Construction Pit ___ Dated---
-----------------------------------
Board _
- ., . � - _
of Hi
DATE -
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
--- TOWN OF BARNSTABLE •�
Lt CA-1O- N T ���Zss. ��+1�5 Q\��.� SEWAGE #
VILLAGE' CQAnI�� ASSESSOR'S MAP & LOT \
n
INSTALLER'S NAME&PHONE NO. `
SEPTIC TANK CAPACITY C)b 4 11** 1
LEACHING FACII.rTY: (type)_ (size) (0 Q
NO.OF BEDROOMS
BUILDER OR OWNER C'_Q 6.,Se- t�
'DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the ZU f Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) l Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
6
q � y
�1- 37 - 3®`
A�:- uo � 331 �°e
AL\_ g �
y� �`
l
LOCATION SEWAGE PERMIT NO.
L� 7 17
��rOU.
VILLAGE
INSTA LLER'S NAME i ADDRESS
A vi
BUILDER OR OWNER
1�fr
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED � � � �� 72
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5 c H E D. 4 O P V c" O,e --------F L O k/ ---— ------T
EQUf�[_ TO BEPT/G �L' o I
� rr7:n,rr►v�7 %�� Per foot �2 w,a.s�ieo' Stone
Epmiwl
L 1 6
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/ 000_—„Q4.. `5 PT/G TANK 2 'of 3/�"- /�t~ 'b • f • s i
\�• SCALE. -----
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6
�
o? y ±k�\ � i \ ��� _ _ p �- S � G AJ --- -- T E S T H O L C— L.. O < --
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(9 q , \ C "0 SiSp05er
t�_,: / �•.� �,rye �� M/N.//NCH Al/T N E S S •Q.----L. L —-T �` --
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1-44
�i C j ;(� / G�,E'T/Fy THf�T THE Bu/GO/IVC�
} (q J P�OfaOSE� ON THE G�'OC//IJG� r95
ti/
` SHOLVN Oti/ TH/S )c'LA/V W/LL FOR : SOT B OOk- 79 f-- 9/
G0AJFO)eM TO THE A5U1Z_O//l/G SET- BUMPS / !/� .� F' Ofa G
�,oa ./ BAGk �E'EGjv/�EME/�/TS OF THE
BLL�Cs+. ��T�ACK 7-0IA/A/ OF _�A�E'"5T eL� — _ G - AJTE )eV
�e C//,eE/,7 AJTS '�y�;i`' �HOFAJ,4 c P�2E /�A �2EO FOA2 : GG7/CP
F�e0AJT '�� FT. GEorrGE c off
I v RHE,
!
.� I v LOW J
/O o HINCKLEY I �,
t'�� �F U p 13230 o SG .5H0AAJA1 O �9TE : FHB)eUA/EY_ _�5��
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SUR�I�c �ss%Nat �'�
/L//C Fl I --q Av/v//v C S S O G / , 9 T-� s
S e s T O E ti/-//S , M,v s S.
SG /9LE : / = 30
., APPi2Ot/E O ----
GoP7-kovr-5 BOf�,@O OF HEr9LTH
— o—o-- proposed' contours _8 /9)eAJ5T�t?BL , /v7�155. ��r vv3i