The URL can be used to link to this page

Home My WebLink About0019 CAP'N CROSBY ROAD - Health 19 Cap'n Crosby Road,Centerville A = C UPC 12534 ' No.2159LOR HA{TINOO !Ny J Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection Grad One winter Street Boston, JohnSepti • n,Ma. 02108 Septic D.E.P. Title V Sc Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor ARGEO PAUL CELLUCCI 1O 11 l� Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A CERTIFICATION Cb REcFwEO Property Address: 19 Captain Crosby Rd.Centerville Address of Owner: NOV q )� Date of Inspection: 1116197 (If different) 1 0 .1997 L Name of Inspector: John Oraci Joan D'Eri 70WN0FB I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) HEALTH RN TABLE co Company Name,Address and Telephone Number: 8 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: X Passes This Inspection is based on criteria dented In Title V _ Conditionally P sses code 310CMR16.303.My findings are of how the system Is performing at the time of the inspection.My Inspection does _ Nee/ubmit rth Evaluation By the Local Approving Authority not Imply any warranty or guarantee of thelongevllyofthe Fail septic system and any of Its components useful Ilfs. Inspector's Signature: Date: 1116197 The System Inspector shall a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 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: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] 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 determination in all instances. If "not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Co1hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,Is cracked,structurally unsound, shows substantial Infiltration or exilltiation, 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. (revised 04R7H7) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 is Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 Captain Crosby Rd.Centerville Owner: JoanD'Eri Date of Inspection:1116197 _ Sewage backup or.hreakout or hioh static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The 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 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 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) SYSTEM 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: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid) 3)Other . D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: 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. Yes No _ — Backup of sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. (revlsed 0412V97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 19 Captain Crosby Rd.Centerville Owner: Joan D'Eri Date of Inspection:1116197 D]SYSTEM FAILS(continued) Yes No 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. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 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: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04J27)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 19 Captain Crosby Rd.Centerville Owner: Joan WEri Date of Inspection:1116197 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: x_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with NIA. x The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)(15.302(3)(b)] s (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 19 Captain Crosby Rd.Centerville Owner: JoanD'Er1 Date of Inspection:11r619T FLOW CONDITIONS RESIDENTIAL: Design flow: 440 g•p•d./bedroom for S.A.S. Number of bedrooms: 4 Number of current residents: 3 Garbage grinder(yes or no): Yea Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: rda COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no)No Water meter readings,if available: nra Last date of occupancy: n1a OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped In 9196 System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons Reason for pumping: n1a TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(If known)and source Information: 1974 With a new pit Installed In 1989 by Ellis Brothers Sewage odors detected when arriving at the site:(yes or no) No (revised 0027197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 19 captain Crosby Rd.Centerville Owner: Joan D'Erl Date of Inspection:1116197 SEPTIC TANK: x (locate on site plan) Depth below grade: 8" Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le•e^H5-7^w4'10^ Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: is" How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum 10 bottom of outlet tee or baffle: rda Date of last pumping, Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: v Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction lin0o— Diameter: 4" r,daomments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 19 Captain Crosby Rd.Centerville Owner: JoanD'Ed Date of Inspection:1116197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nla Capacity: nla gallons Design flow: rva gallons/day Alarm level:pia Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nta DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nia Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) nla PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)tdo Alarms in working order(yes or no)_yes Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) nfa {revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 19 Captain Crosby Rd.Centerville Owner: JoanD'Ed Date of Inspection:1118197 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits,number: Y•1AOOgaeon leach plts leaching chambers,number:No leaching galleries,number: No leaching trenches,number,length: No leaching fields,number,dimensions:No overflow cesspool,number:No Alternate system: No Name of Technology:_Na Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The leach pits are structurally sound and functioning property.The leach pit D has not been more than Trull. CESSPOOLS: (locate on site plan) Number and configuration: No Depth-top of liquid to inlet invert: Na Depth of solids layer: No Depth of scum layer: Na Dimensions of cesspool: Na Materials of construction: No Indication of groundwater: No inflow(cesspool must be pumped as part of inspection) No Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.) No PRIVY:_ (locate on site plan) Materials of construction: Na Dimensions: Na Depth of solids: We. Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) We (revieed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 19 Captain Crosby Rd.Centerville Joan D'Ed 1116197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) vtaf� g A C � d " 1A L A� AC AD DAAD �► 't 37 �0 Page ! of 10 (revised 0427197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 19 Captain Crosby Rd.Centerville Joan D'Erl 1116197 Depth of groundwater Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revlsed04f27197) page 10 of 10 ank N44--lZe.- ............................. THE COMMONWEALTH OF MASSACHUSETTS -----, BOARD OF HEALTH .—:;7- ........)./A.)................OF................. - ---- -- Appliration for Disposal Works Tonstrurtion thrmit Application is hereby made for a Permit to Collstruct or Repair (�an Individual Sewage Disposal System at, Thl ...System ...........Z ................A 0/V------------------ .................................................................................................. 'Addrey t ................................................ .......................................... ...... 01 X.�..5... ....... ram ..... ....... 0 n....... .... . ...... ....... Installer Address Type of Buildifig Size Lot............................Sq. feet U Dwelling=No. of Bedrooms............................................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons_....__........_.....__..... Showers Cafeteria Otherfixtures ............................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width..__.._......___ Diameter._-_.._..._..... Depth.............._. Disposal Trench—No..................... Width......_._...._...... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No_____________________ Diameter.._.._...___.__..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------- •-'------------•-..•-- Test Pit No. I----------------minutesperinch Depth of Test Pit.._.____............ Depth to ground water..__...___..........___. tT4 Test Pit No. 2................minutes per inch Depth of Test Pit.._____............. Depth to ground water.-_..........._....._... 9 ..... ...................................................................................................................................................... 0 Description of Soil........................................................................................................................ ......................................... W U ...................................................................................................................................................................................................... --------------------------------------------------------------------------------- ......1.................. -------------- .... U Nature of Repair Alterations ..... ons—Answer when applical 'e. .. .... i A 457� W Z ------ ...... ......... ............................ ............ 'sc 5.1; Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITM14, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has eeen iss d by the boardAAqalth. 4F t W Signe ..... ...... . ... .... .....Aae------- Date . .. .. ........ .. ................................. .......... Application Approved By............. D ....... • Date Application Disapproved for the following reasons:................................................................................................................ .........................................................................................................I.............................................................................................. Date Permit No.........3.1-L...J_7---6................. Issued.............j........................................ Date o C� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` �y�V................OF..........,��. .. ti Appliration for RspwiFal Works Tomitrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (E-1/an Individual Sewage Disposal System at / FLo ti9n tjdres e,00 - JX hl// 110 e o. Owner - Add ess .� InstallerAddress Type of Building Size Lot............................Sq. feet �-, Dwelling-—No. of Bedrooms............ ____.__.____•-------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .......................................................... Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area................ ft. Z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed b Date............................ .� a Y .... Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.... f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._._.5. -------------------•-----•--•--••----•---•--------•••--•-----•-•-•--•---............•--•----...............----..........-•--•-...---•-' ODescription of Soil.........................................................................-------•-------- ........................................... = s ... V ......................................................................................................................................................................................I................. 'U Naturer of R a •A.� .on — whenapplicable. .�-.... �.}�+ .... -�' ............................. ..... : ... � .........Y. z ... Ageement .mot tTheundersigned agrees to install the aforedescribed Individual Sewage Disposa-.System in accordance with /-%the provisions of TITI:I� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Leen issp4d by the lioa'rd"~Jealth. Signe ... —1�-- � -••-••-•-•-• - ---- -- - . . --• -- Date Application Approved BY------------� - -,. -� {. - ......... ��.. �1 Date Application Disapproved for the following reasons:------•-----------•------•-•-------•-------------------•--------------------------•-••......--------.__----•-_.. ............•-•...............•••--••------•-•-•---......................_.___.......---••-•••-•----••---•••--•--•-•••-•-••-----•---------------••-•--••---•--------------•---••••----------•-------•-•- G Date Permit No..........L!..-/ ... -...6.-------••------- Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................oF....../ / f'.......................... Trrtifirate of Toutph anrr THIS IS R�7FY, That the Indiv', 1 Sewage D}'�osal System constructed ( ) or Repaired by................`'L ��:1...5....... i�`�S it/�T.(��` •..... at e --'-... ..... eT has been installed in accordance with he provisions of T"!'1'iZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------- -.__�..�f�..... dated.....------------------------------------------- THE ISSUANCE OF-THIS CERTIFICATE SHALL NOT BE CONSTRUE®AS`A GUARANTEE THAT THE SYSTEM-WILL FUNCTION SATISFACTORY. ' DAT ---•-•. _ { In's tor__.•-•-•........... �� t .. i.!' .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................OF................... ............................... No......................... FEE... •-- DisposFal Workii Tonstrurt' n Permission is hereby granted..._.. _._.�. k. to Construct or Repair an I dividual Se rage Dispo yst at No.. -" �.... ------ 71NWv1__orks lliell-A ......_ 11� � -`----•-----------------..Street as shown on the application for Dispo Construction Permit No...__________/79. Dated.......................................... ................................... • ................................................... DATE...............�.."--�--�----...... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS O OF BARNSTABLE I �g v LOCATION GtA6p„yJ!c-- SEWAGE # 2-17F VILLAGE /9 ,ea�Sh`/ rf�-- 7 ASSESSOR'S MA P'& I:OOcam' INSTALLER'S NAME 6z PHONE NO.E-11,S 89os C,,q�S�, 34.2-ate SEP11C TANK CAPACITY /, 000 LEACHING FACILITY:(type) -2 Siapoe /J, C'kL47 (size) /, GOO .NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED:_ gllilfq DATE COMPLIANCE ISSUEta �¢ VARIANCE GRANTED: Yes No c s (I clZoL Y �