HomeMy WebLinkAbout0060 FARM HILL ROAD - Health 5. 60 FARM HILL RD: CENTERVILLE
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PROPERTY AOORESS; 6Q, Farm Hi115-,.Road
^Centerville,Mass._--_-_
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on Iho aboye date, I Inapootod the oeptfo oyite'M at the aboyo addre33
Th►s 3y3(sm con313t3 of (he following:
1 . 2-6 'X8 ' Block- cesspools in series.
eased on my Inspecllon, I corilfy the following oondltlonal
2. This is not a title five septic system.
3. This is a sewage system. The sewage system is in proper
working order at the present time.
4 . The overflow cesspool was dry at the time
of the inspection. SIQNATURE's./ _../�t�K
N"a me : luSQattC..,!_ram_—_---
Company;�o� � ph_Pw_N� comber-6 $on , Inc ,
Addre33 ;__Box- 66--_.,_,......,...._..
Concsryillf - 02632-0066
:= Tni3 CeRTIfICATION OOC9 NOY CON9TIYVTC A OVARANTY OR WARRANTY
+ r I
JOSEPH P. MA00M8ER & SON, INO,
T+nk� 0�:+Pool ll,�ichll+id�
PymPjd G Inll+Ilid
Town 3+w+r Conn+ollont
P,O, 89x 66 Cinl+nrlll+, MA 02637-0060
776-m0 77$44 )2
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�y0y�2 BOG Ar 4.
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l COMMONWEALTH OF MASSACH'USE'I`TS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 60 Farm Hill Road
en ervi e, ass.
Owner's Name: William Webster
"3T A ex_an er way
Owner's Address.
Dux ur Mass.
Date of Inspection: 10 12 01
Name of Inspector: (please print) J.P. Macomber Jr.
Company Name:Joseph P. Macomber & Son Inc
Mailing Address: P_n= Box 66
rpntpr-» 1 1 e Ma 02632
Telephone Number: 508-775-3338
CERTIFICATION STATEMENT
I certify that l 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
rraining and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to ection 15.340 of Title 5(310 CMR 15.000). The system:
1 r'� Passes
_ Conditionally Passes
_ Needs Further Evaluation by the Local Approving Authority
_ F ils�
Inspector's Signature: ,�4aA /. s Date:
The system inspector shallVbmit a copy of this inspection rep r 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
authoriry.
Notes and Comments
"This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 60 Farm Hill Road
en ervi e, ass.
Owner: William Webster
Date of Inspection:
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
Vave not found any information hich indicates that any of the failure criteria described in 310 CMR
15.303 or to 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
The sewage system is in proper workinq order
at the present time.
B. System Conditionally Passes:
A 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.
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:
/14��Observation of sewage backup or break out or high static water level in th distribution box a 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:
AADThe 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
Page 3 of I 1 �,
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY-ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 60 Farm Hill Road
Centerville,Mass.
Owner:William Webster
Date of Inspection: 10/12/01
C. Further Evaluation is Required by the Board of Health:
4111 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
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:
VO 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.
4Z 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 eet but 5 feet or more from a
private water supply well". Method used to determine distance_f
'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:
This is a sewage system. Has two 6 'X8 ' block cesspools
In series. Second cesspooi is dry. Has c can sand bottom.
Stain ine s ows a i is never been higher than
28 or 44 be ow the invert pipe. Sewage system is in
proper working order at the present time.
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: 60 Farm Hill Road
Centervil e,Mass.
Owner: William Webster
Date of Inspection: 1 0/1 2/01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_AA,())& Static liquid level in the =butionbove outlet invert due to an overloaded or clogged SAS or
cesspool
�iquid depth in cesspool is less than 6"below invert or available volume is less than ''A day flow
equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped 0 .
Ay portion of the SAS, cesspool or privy is below high ground water elevation.
Zy 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.
_ j/ y portion of a cesspool or privy is within 50 feet of a private water supply well.
�y 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.]
NP (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 now of 1o,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
<tsystern is within 400 feet of a surface drinking water supply
u to a surface drinking water supply
_ �system is within 200 feet of a tributary, g
_ the system is located in a nitrogen sensitive area(I_nterim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
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OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 60 Farm Hill Road
Cen ervi e,Mass.
Owner: William Webster
Date of Inspection: 1 0/1 2/01
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes N/Ppo
_ mping 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 /A
Was the facility or dwelling inspected for signs of sewage back up? 4
_ Was the site inspected for signs of break out?
Were all system components,f/kluding the SAS, located on site?
Were th septic tank anholes uncovered,opened, and the interior of the tank inspected for the condition
of the baffles or tees, ma eria of consavction, 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 n/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
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Page 6ofII
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 60 Farm Hill Road
en ervi e, ass.
Owner: William Webster
Date of Inspection: 10112701
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): j Number of bedrooms(actual): ���
DESIGN flow based on 310 C1 15.203 (for example: 110 gpd x#ofbedrooms):��11�"��
Number of current residents:
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system or no) [if yes separate inspection required)
Laundry system inspected(ves or no):
Seasonal use: (yes or no):
Water meter readings, if available(last 2 years usage(gpd)): 9Q9 AA43
Sump pump(yes or no):
Last date of occupancy:
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203 zvd
Basis of design flow(seats/persons/sgft,etc.): 41
Grease trap present(yes or no):A0
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available: 4f/"r
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:None available
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: allons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
7 Single cesspool
Overflow cesspool
jj 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)
/b�Tight tank ��Attach a copy of the DEP approval
Other(describe): .l),'O
A��x'mat ale of all oynponents, date install f known)and source of information:
�� 6
Were sewage odors detected when arriving at the site(yes or no):1256
6
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Page 7 of 1 I } `.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 60 Farm Hill Road
Centerville,Mass.
Owner: William Webster
Date of Inspection: 10/12/01
BUILDING SEWER(locate on site plan)
Depth below grader
Materials of construction: cast iron /40 PVC 2. other s explain): � L�
Distance from private water supply well or suction line: ?`'
Comments(on condition of joints, venting, evidence of leakage,etc.):
Joints appear tight.No evidence of leakage_ System is vented
through the house vents.
SEPTIC TANK4&,,(locate on site plan)
Depth below grade:
Material of construction concrete metal,f�,4 fiberglass Akpolyethylene
41 other(explain) A
If tank is metal list age: A& Is age confirmed by a Certificate of Compliance(yes or no):�(attach a copy of
certificate)
Dimensions:
Sludge depth: AM
Distance from top of sludge to bottom of outlet tee or baffle:—A-4
_
Scum thickness: A W
Distance from top of scum to top of outlet tee or.baffle:
Distance from bottom of scum to bottom of outlet tee orb a ffl e: —�
How were dimensions determined: ,),4
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of.leakage, etc.):
Septic tank is not present.
GREASE TRAPOJ�&(locate on site plan)
Depth below grader
Material of construction:q/J9 concretet4 metaWA frberglassfApolyethylene�9 other
(explain): 14M
Dimensions: �4
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: fN
Date of last pumping:_ 114
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Grease trap is not present
7
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A.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 60 Farm Hill Road
en ervi e, ass.
Owner: William Webster
Date of Inspection: 10 12 01
TIGHT or HOLDING TANK4*9, (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: AA
Material of construction: concrete metal-44 fiberglass &Y polyethylene.4y, other(explain):
Dimensions:
Capacity: allons
Design Flow: gallons/day - ' J' '
Alarm present(yes or no):
Alarm level: A)A Alarm in working order(yes or no):
Date of last pumping: AM
Comments (condition of alarm and float switches, etc.):
Tight or o in- an s a
DISTRIBUTION BOXA, se (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
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.):
DiG t r;b , ;ten box is not present
PUMP CHAMBER"4 (locate on site plan)
Pumps in working order(yes or no): ZM
Alarms in working order(yes or no):
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber is not—pre. ent
8
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+�-- i s Page 9 of 11 1 ,�
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:60 Farm Hill Road
en ervi e, ass.
Owner: William Webster
Date of Inspection: 10 12 01
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
2-6 'X8 ' block cesspools in series.
If SAS not located explain why:
The sewage ystem is in prover working order at
the present time_
Type
4)6 leaching pits, number: O
k)p leaching chambers,number: Q
A)a leaching galleries,number:
A2.Q leaching trenches,number, length: 0
A)6 leaching fields,number, dimensions: 0
overflow cesspool,number: ,
innovative/alternative system Type/name of technology: k.
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,6ondition of vegetation,
etc.):
Loamy sand to medium fine sand No signs of hydraLlic
failure or ponding-Roils arP 8ryVPgPtatinn is nnrmal
The overflow is presently dry. It has never been full.Clean sand
visible once bottom.Stain line shows that has been as high as
CESSPOOLS: (cesspoo)Aust ha-pumped as part of inspection)(locate on site plan)CC// 28" or44" below
tt�7 Number and configuration: invert pipe.
Depth-top of liquid to inlet invert, X,91 IFpry!
Depth of solids layer: (y"
Depth of scum layer:
Dimensions of cesspool;
Materials of construction: G
Indication of goundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
Same as above
PRIVY�jQ(locate on site plan)
Materials of construction: 4110
Dimensions: A/h
Depth of solids: A&
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: 60 Farm Hill Road
Centerville,Mass.
Owner: 1 0/1 2 01
Date of Inspection:William Webster
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.
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OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 60 Farm Hill Road
Centerville,Mass.
Owner:William Webster
Date of Inspection: 10 1 2 01
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
i
Estimated depth to ground water feet
Please indicate (check)all methods used to determine the high ground water elevation:
_Obtained from system design plans on record- If checked,date of design plan reviewed:
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:
You must describe how you established the high ground water elevation:
Used; Gahrety & Miller Model. ( groundwater above sea level )
USGs;92-000-1 Plate #2
USGS;Observation Well Data June 1992
Top of Ground
Leaching r
Pit eet
GroundwaterM t=eet Below Bottom of Pit
Therefore, the vertical separation distance between the bottom
Of the leaching pit and the adjusted groundwater table is.
feet.
11
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1 TOWN OF Barnstable WARD OF HEALTH ,
,SUIISURFACF SFKA(;F DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
•••T•y^T'•-•• -l.Iif.^.�TTI.T{T.'1.1'.t.•ftri T11r1R�fTTT�'t^^!.'i rlR+r771'R1.T-T+•I.A.wr/T�.�'1AT�7 7w111 ..-tl-T'T•�. -..�
-TYPE OR PAINT CI.EARLY-
P/IOPERTY INSPECTED
STREET ADDRESS 60 Farm Hill Road Cente�rjvillllae�,Mass. '
ASSESSORS MAP , BLOCK AND PARCEL #
OWNER' s NAME William Webster
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P. Macomber Jr.
COMPANY NAME Joseph P. Macomber & Svn Inc
COMPANY ADDRESS P.O. Box 66 Centerville Ma 02632
Street Town or City State ZIP
COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578
R
A
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposaj system at
this address and that the information reported is true , accurate , and
omplete as of the time of ,inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Chec one ;
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
healLh or, the environment as defined in 310 CMR 151303 . 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 j)ublic health and the environment in accordance with Title
5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signatur ) Date
ecopy of this c rtlfication must be provided to the OWNER, the BUYER
On
where applicable ) and the BOARD OF HEALTH.
If the inspection FAILED, the owner or"" ' orator shall u* ti FI p pgrade ' the system
within one year of the date of the inspection, unless allowed or required
otherwise as provided in 3.10 CMR 16 . 305 .
partd .doc