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Home My WebLink About0067 HIGHLAND DRIVE - Health 67 IIIGHLAND DR. CEMIRVILLE A = 190 0:50 �III_ �__ff �J�KECYCLppCpy� UPC 12534 No.2_ 153 OR HASTINGS. UN .;_ C01ENTONWEALTH OF MASSACHL;SETTS _ EXECU TnTE OFFICE OF EI VIRON MENTAL AFFAIRS F DEPARTMENT OF ENVIRONMENTAL PROTECTION ors OE IT ON DLL 0210c Iil' 292-SSU�NR \ : TRL DY COIE Secreta_-y ARGEO PAUL CELLUCCI DAVID B STP.-'HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION P►operty Add►ess: 67 i, bland pe . , Name of owner Kristen Farrar L eta r�111 e Address of Owner: Date of Inspection: �"-? Name of Inspector:(Please Prirrt)WM. E . Robinson Sr. I am a DEP approved system inspector r m suant to Section 15.340 of Title 5(310 CMR 15.000) Copany Name: Wm. E . Robinson pact Service Mailing Address: PO Box 0 9. Centerville . MA Telephone Number: 7 7 5- 7 7(� 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: _L,+/a s s e s Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: cL) L' /�'� Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to ttte system owner and copies sent to the buyer, if applicable, and the approving authority. 'NOTES AND COMMENTS ✓lJ iO mi of 000 revysed 9/2/98 page iorlt n i• -ted o,Recvcied Pane, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) "rowly Address; 67 Highland. Dr . , Centerville Owner: Kristen Farrar Date of Inspection: INSPECTION SUMMARY: Check A, B, C, Or D: A. SYS PASSES: I have not found any information which indicates that'any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: 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. Indicate ye , 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 Compliance (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 exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health)• broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ 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 revise^ 9/2/98 Page 2of11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prop"Address: 67 Highland. Dr . , Centerville Owner: Kristen Farrar Date of Inspection:,I/ 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 W ACCORDANCE WITH 310 CMR 15.303(1)(b)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 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Highland. Dr. , Centerville owner: Kristen Farrar Date of Inspection: ��,C� z� D. SY TEM FAILS: You mus indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this d termination is identified below. The Board of Health should be contacted to determine what will bi necessary to correct the failure. Yes No Backup of sewage into 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 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 1/2 day flow. 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 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 I 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. LAR E SYSTEM FAILS: You must ndicate either "Yes" or "No" to each of the following: he following criteria apply to large systems in addition to the criteria above: T e 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 alth and safety and the environment because one or more of the following conditions exist: Yes o 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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST Prop"Address: 67 Highland. Dr . , Centerville Owner: Kristen Farrar Date of Inspection: G"O Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _C// _ Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. V _ All system components, excluding the Soil Absorption System, have been located on the site. _✓ _ 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. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.N. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)) L/ . _ The facility owner (and occupants,if differeru from owner) were provided with information on the proper maintanaac."f SubSurface Disposal Systems, re isea 9/2/96 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ! SYSTEM INFORMATION 'rop"Address:67 .Highland. Dr . , Centerville Owner: Kristen Farrar Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:'/ 6 g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual) Total DESIGN flow4/G 6 Number of current residents: I Garbage grinder(yes or no):LL 0 Laundry(separate system) (yes or no)/2 U; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):Al 0 Water meter readings, if available (last two year's usage(gpd): 1999 47 , 000 gal. Sump Pump(yes or no)://O 1998 48, 000 gal. Last date of occupancy:—; COMMERCIAL/INDUSTRIAL: Type establishment: Design ow: qpd ( Based on 15.203) Basis of esign flow Grease t ap present: (yes or no)_ Industri Waste Holding Tank present: (yes or no)_ Non-sa tary waste discharged to the Title 5 system: (yes or no)_ Water eter readings, if available: Last d e of occupancy: OTH : (Describe) Last to of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)—A O If yes, volume pumped: gallons Reason for pumping: TYPE OF STEM 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)_() revised 9/2/91c Pagc6(if II • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontirwed) 'ropenyAddress: 67 Highland. Dr. , Centerville Owner: Kristen Farrar Date of Irapecbon: G�..,_0-.e) B DING SEWER: U oc to on site plan) Depth below grade:_ Materi I of construction:_cast iron_40 PVC_ other(explain) Distan a from private water supply well or suction line Diamet r Comm nts: (condition of joints, venting, evidence of leakage,-etc.) he SEP C TANK:_ (locate on site plan) t Depth below grade: Material of construction: l✓concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: �- Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle�/ 7 Scum thickness:_ ?` Distance from top of scum to top of outlet tee or baffle: 1 Distance from bottom of scum to bottom'of outlet tee or baffle:L� How dimensions were determined: Al w -'omments: (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.) L Lit ) S 0 G G SE TRAP: (loca on site plan) Depth elow grade:_ Materi I of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimens ons: Scum t ickness: Distanc from top of scum to top of outlet tee or baffle: Distanc from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comm nts: (reco mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evi a ce of leakage, etc.) rev-4 sed Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , :> PART C SYSTEM INFORMATION Icontinued) brop"Address:67 Highland. Dr . , Centerville OWrw= Kristen Farrar Date of Inspection: T1G TOR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (loco t on site plan) De)ition low grade:_ Maof construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dins: Ca gallons Deow: gallons/day Alaesent Alael: Alarm in working order: Yes_ No_ Darevious pumping: Cots: (co of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: `_ . (locate on site plan) Depth of liquid level above outlet invert:�� Comments: (note if level and distribution is equal, evide oe o!,solids ca ryover, evidence of leakage into or out of box, etc.) - PUMP HAMBER:_ (locate r site plan) Pumps i working order: (Yes or No) Alarms i working order(Yes or No) Comme ts: (note c ndition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/92 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cortonued) top"Address: 67 Highland. Dr . , Centerville Owrw- Kristen Farrar Date of Ins on: SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible:excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number: leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of pon ing, damp soil, condition of vegetation, etc.) CESSPOOLS:_ (locate on site plan) b Number and configuration: Jv"r Depth-top of liquid to inlet invert: ')epth of solids layer: b )epth of scum layer: V Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comm nts: (note c ndition of soil, signs of hydraulic failure, level of ponding. condition of vegetation, etc.) PRIVY: (locate o site plan) Materia of construction: Dimensions: Depth f solids: Com ents: (note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) rev see 5/2/9". Pair 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION(continued) Nop"Address: 67 Highland Dr . ,Centerville Jwner: Kristen Farrar Jate of Inspection:3e-7" SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) I . Ll J �bGl� v • a'i i revised 9/2/98 Pige10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ►op"Address: 67 Highland. Dr . , Centerville Owner: Kristen Farrar Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site fAbutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data r Describe how you established the High Groundwater Elevation. (Must be completed) �3 6 o, revise.-' 9/2/98 Page 11 of 11 TOWN OF BARNSTABLE C— , LOCATION CZ Ni4k1K,y9 RoAO SEWAGE # . --7a:;L_ VILLAGE—Ce—)J P'Q& ASSESSOR'S MAP'& LOT 151 6 U6 INSTALLER'S NAME&PHONE NO. 13r G �B Iy�sc�si� 7�� - �� SEPTIC TANK CAPACITY LEACHING FACILITY::(type) UN uK[LS (size) 12 X;Z Y aS 'NO.OF BEDROOMS +3 BUILDER OR OWNER PERMIT DATE: - —Ov COMPLIANCE DATE: 7—00 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist N on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by K x � ' d2f. �.�;,t. ti b� s _ �, ,hh .3� - �---, � � . . No. moo " ao ri. Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprtcation for Dioont *pgtem Com5truction Vermit Application for a Permit to Construct( epair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 67 Highland. Dr . , Cen _ . Lle Kristen Farrar Assessor's Map/Parcel ��►► Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service PO Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand. Nature of Repairs or Alterations(Answer when applicable) Title—5 septic system consisting of a tank, D-box and. 2 concrete leach chambers with ,. stone all around.. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by this and ealth.� / Signed / `i ) ✓� Date Application Approved by �,w,� Date =� — D 6 Application Disapproved for t folio ing reasons Permit No. — � Date Issued + No. 0,00 Q Fee $5 0 THE COMMONWEALTH MASSACHUSETTS OF MA A Entered in computer: SS PUBLIC HEALTr DIVISION —TOWN OF BARNSTABLE, MASSACHUSETTS Yes 'Zippr catioit)for Mioogar *potent Construction Permit Application for a Permit to Construct( T),Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. h.,� Owner's Name,Address and Tel.No. 67 Highland DrGnti^, iT],e Kristen Farrar Assessor's Map/Parcel ` I lip Installer's Name,Address,and Tel.No. \ Designer's Name,Address and Tel.No. Wm. E. Robinson Septic S dice PO Box 1089, Centerville Type of Building: ' Dwelling No.of Bedrooms 3 LottrSize sq.ft. Garbage Grinder( ) 1 Other Type of Building No. oAPersons Showers( ) Cafeteria( ) Oth$r Fixtures Design Flgw gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date --Title Size of Septic Tank Type of S.A.S. Description of Soil Sand. Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system consisting of a tank, D-box and. 2 concrete leach chambers with s one I a aroun . Date last-in-spected: . I , Agreement The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the�pEgylsions-of`Titl`e`5 ofthe Environmental Code and not to place the system in operation until a Certifi- cate.of-Compliance has been iss ed by this and ealth.�J Ap1 Signed Date�?-,3-<5-0 plication Approved by Date V-- On Application Disapproved for fo11 ing reason i L-'Perm-3t No. Date Issued --------- _ C �--...,,,TH",OMMONWEALTH OF MASSACHUSETTS Farrar - --� BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (X )Upgraded( ) Abandoned( )by Wm. E Robinson Septic Service at 67 Highland Dr. , Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No jQm- �� - dated Installer Wm. E . Robinson Sr .,;` Designer ' The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date L� - `7 . l _ r Inspector r,\ , � V � — ---------------------------- No. c —cJ. 4ee./1'5d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Farrar 'Wiq pog;af *potent Construction Permit Permission is hereby g an en ey- i11ted to Construct( Repair(X Up rade( )Abandon( ) System located at Highland. DZ�. , Ce and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: Approved by -o a 4� 116199 NOTICE: This Form Is To Be Cased For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERIL U(WITHOUT DESIGNED PLANS) I, W ill iam E. Robinson,S,%ereby certify that the application for disposal works construction permit signed by me dated concerning the property located at+"67w Highland nr rPntarville meets all of the following criteria: • The fail is connected to a residential dwelling only. There are no commercial or busiucss uses associ led with the dwelling. The soil is assified as CLASS I and the percolation rate is less than or equal to 5 n ainutes per inch. There are wetlands within too feet of the proposed septic Stistem There are o private wells within 150 feet of the proposed septic system There is o increase in flow and/or change in use proposed • There no variances requested or needed. The om of the proposed leaching facility will Mt be located less than five feet above the maxi tun adjusted gttwndaraier table elevation.' f Adjust the groundwater table using the Frimptor me when applicable] • [f e S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposes leaching facility wiligg be located less than fourteen(14)feet above the maximum adjusted groundtvitter table elevation, Plet*cgUlpletse the tbllowing; A) Top Ground Surface Elevation(using G1S information) � �+ B) 4YPeya4on +the lvlAX. HighG.W. AdJm=ent.-------- 7 Off ERgI11 13bTWEEN A and 5 SIGNED : DA-rE: [Sketch proposed plan of system on back). 4-hesiM folder:an r,,r �� , i� ��C ff�� } ' � � <_ ti .s� '� i � '� � •� ��: f 7�� \� 1 . _ , l �;� i�igh�C�d �j r. C�ex�e,�v i l�e� 67 Highland Drive Centerville ,Mass . 02632 Kristen Farar 1-6 ' x8 ' bloc cesspool/ . 3—bedrooms . S �+ r® D AT E:__ZLV—Q-Q---- PROPERTY ADDRESS: 67._Hi_8112E _Driv_e Centerville Mass 02632 ------------------------ On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1-6 ' x8 ' block cesspool . Based on my Inspection, 1 certify the following conditions: 2 . This is not a title five septic system. 3 . This is a sewage that is 30 years old or older . 4 . "The sewage Isystem is in hydraulic failure . 5. _The sewage system _should be upgraded to a. title ,five 'septic: system. ( -9ff Code ) 6. The waste water is up and over the invert pipe . 7 . Cesspools needs to be pumped . SIGNATURE:,.f - N a m e:_,L,��-Kossmkp.r--J.�------ Company: Jose.2h_P- Macomber_& Son , Inc . Address:_ Box—66___ CentervilleL Ma__02632-0066 Phone:___508 775_3338__ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY [06SEPH P. MACOMBER & SON, INC. anks-Cesspools-Leachf fields Pumped & Installed Town Sewer Connections 66 Centerville. MA 02632-0066 775.3338 775-6412 RECEIVED i- t d 0 8 2000 TOWN OF BARNSTABLE HEALTH DEPT. COMMONWEALTH OF MASSACHUSETTS 1Vj EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR'S DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292.6500 TRUDY C Sec: ARGEO PAUL CELLUCCI DAVID B. STF Corn-; Governor , SUBSURFACE SEWAGE DISPOSAL SYSTEIrA iNSPECT)ON FORMA PART A CERTWCATION Property Addreaa: 67 Hyland Drive Name of owns Kristen F a r a r Cent e r v l l.e a $ 02632 Address of Owner: Data of 9;4o . , / /�0 Joseph P.Macomber Jr . Narne of Inspector:(Pt.ase Print) P 1 am a DEP approved system Inspector pursuam to Section 16.340 of Ttr1. 6 (310 CMR 16.000) Company Name: .T _ P.M a r o m b p r R S n n In r _ µa&V Address: 02632 Telepfwrw Number• — — CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage dlsposal system at this address and that the Information reported below Is true, occurs,,@ and complete as of the time of Inspection. The Inspection was performed based on my ualning and experience In the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes sods Further Evaluation By the local Approving Authority Fails J1 Inspector's Signatureeh.Jl f — --- The System Inspectoubmit a copy of this tn.pctlon report to the Approving Authority(Board of Health or DEP)whhln thirty (30) days completing this Inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater,the irupo6tor and the system ow. 'shall submit the report to the appropriate regional offlce of the Department oK:nvironmstmd Protection. The original ahouldta,sent to'fw system owner and copies sent to the buyer. If applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I of 1) �,Prinled on Recy6ed Np, f SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION (contirxwed) Property Address: 67 Highland Drive Centerville ,Mass . Owner: Kristen Farar Da"of k►spectlon: 2/'2/0 0 WSPECTiON SUMMARY: Check A, B, C, o/ A A. SYSTEM PASSES: I have not found any Information which indicates that any of the failure conditions described in 310 CMR 1{.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: z1a 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. Indicate yes,no,or not determined(Y,IN,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 Compliance(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 exfiltration, or tank failure is imminent. The system will pass Inspection if the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health. / Mle. Sewage backup or breakout or high static wAlor level observed in the button box s due to broken or obstructed pipe(s) or due to a broken, settled or uneven strlbution box. The system will pass Inspection if(with approval of the Board of Health). broken pips(s)are replaced obstruction is removed distribution box Is levelled or replaced The system required pumphig•mors than•four-dmes a•yeardue to broken or obstrocted pipe(s). Thevystem with ers inspection If(with approval of the Board of Health): _..._. _ broken pips(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 a r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) property Address: 67 Highland Drive Centerville ,Mass . Owner: Kristen Farar Dow of hspecd= 2/2/0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N 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 W ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING W A MARINER WHICHINLL1LPRQ3ECT THE PUBLIC HEALTH AND SAFETY AND.THE ERMSONMENL• Cesspool or privy is within 50 feet of 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 ARTY)DETERMINES THAT THE SYSTEM IS FUNCTIONING W A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: /n 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 soil absorption system and the SAS is within a tone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 13 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 pros nce of-ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance 12(approximation not valid).- 3) OTHER System consists of one 6 ' x8 ' hlork rPcc nnl The cPsspnn1 is in hydraulic €a}1-upe revised 9/2/98 Page 3of11 e r� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIRCATION(continued) Property Address: 67 Highland Drive Centerville ,Mass .. .. Owner: Kristen Farar Date of Inspection: 2/2/0 0 D. SYSTEM FAILS- YqU must Indicate either"Yes" or"No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described 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 ofsewage into4sciH"r•vyutemvornponentduetto.en overloaded orcloggedSA&or-ces =3-- 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 istribution bo bove 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(a). Number 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 I 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 organio-compounds,ammonia nitrogen-and nitrate nitrogen. - L LARGE SYSTEM FAILS: You must indicate either "Yes" or"No" to each of the following: A The following criteria apply to large systems in addition to the criteria above: 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 publi health and safety and the environment because one or more of the following conditions exist: Yes No / l/l the system is within 400 feet of a surface drinking water supply the system•is-within 200 watersupply•••• - - — 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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforpation. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 67 Highland Drive Centerville ,Mass . Owner: Kristen Farar Dab of Inspection: 2/2/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: A0 g.p.d./bedro m. Number of bedrooms d sig Number of bedrooms(actuaq: Total DESIGN flow_, Number of current residents:19 Garbage grinder(yes or no):d Laundry(separate system) or on :_;. If yes,separateJnspection.required _ Laundry system Inspected IVe_or no) Seasonal use(yes or no):-10— Water meter readings,if av lable(last two year's usage(gpd): Sump Pump(yes or no): J - r/ 77 ,V Last date of occupancy: --A COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: sad (Based on 16.203) Basis of design flow - Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or nok& Non-sanitary waste discharged to the Title 6 system-(yes or no)& Water meter readings,if available: Last date of occupancy: IVAA OTHER:(Describe) Last date of occupancy: J' GENERAL INFORMATION PUMPING RECORDS and source of Information: 11 4 8 System pumped as part of Ins action:(yes or no)40 If yes,volume pumped: gallons ` 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) i/A Technology et .Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other W101 APPROXIMATE AGE of all components, date Instagediif known)-and source of4nfomxtlon:.; Sewage odors detected when arriving at the site:(yes or no)leD revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 67 Highland Drive Centerville ,Mass . O1Mfer Kristen Farar Data of Inspection: 2/2/0 0 Check if the following have been done:You must indicate either'Yes'or'No' as to each of the following: Yes No , Pumping information was provided by the owner,occupant,or Board of Health. • ..None of the systerneornpoaants.Marneiman awradllow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this Inspection. As built plans have been obtained and examined. Note If they are not available wi NlA. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The she was Inspected for signs of breakout. _ All system components,Obluding the Soil Absorption System,have been located on the site. The-septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected for condition of baffles or tees,materlal of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on•the site has been determined based on:.- Existing Information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C Is at Issue,approximation of distance is unacceptable) _ The facility owner.(and-w-p—m-.2 differ- lnformattoaDn thA prnpag raan*&n, ^f SubSurface Disposal Systems. , I j i revised 9/2/98 page sorli 8'$ e ` v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) prop"Addross:67 Highland Drive Centerville ,Mass . Owner: Kristen Farar Data of Inspection: 2/2/0 0 BUILDING SEWER: (Locate on site plan) Depth below grade: ) -� Material of constru ti n:C Cs rorv!e40 PVCAO other(explain) h/1 Distance fro plate wafer su ply well or suction line ff Diameter Comments:(condition of joints,venting,evidence of leakage,-etc.) Joints appear tight No PviriPnrP of 1Pakaga SEPTIC TANK; (locate on site plan) Depth below grade: Material of construction:Mconcrete,c4metalA/.*iberglass4vA Polyethylene they(explain) If tank Is(natal,list age 13.age.confirmed by Certificate of Compliance (Yes/No) Dimensions Sludge depth: Z74 �. Distance from top of sludge to bottom of outlet tee or baffle .UlP 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: How dimensions were determined: IA Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert,structuraHntegrity, evidence of leakage,etc.) GREASE TRAP: (locate on site plan) Depth below grade: —�! Material of constructionA±concrete.f/14metal*AFiberglasar Polyethylene4?other(explain) AA Dimensions: in 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: Date of last pumping: r Comments: (recommendation for pumping, condition of Inlet and outlet toes or baffles, depth of liquid level in relation to outlet Invert,structural integrity, evidence of leakage,etc.) ME'ase t rap is not pro-,go-nt- revised 9/2/98 Page 7of11 46 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Highland DRive Centerville ,Mass . Owner: Kristen Farar Date of Inspection: 2/2/0 0 TIGHT OR HOLDING TANK:,&&yATank must be pumped prior to, or at time of,inspection) (locate on she plan) Depth below grade:AAO' Material of construction- concreteDametaV&Flberglas4aPolyethylenoA)Aother(explaln) AA Dimensions Ah Capacity: &d gallons Design flow: gallons/day Alarm present Alarm level: Alarm working order:Yesdl) No&W Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Tight or holding tank.-, nrP not pgacent DIET munON BOX:,il *, (locate on site plan) Depth of liquid level above outlet invert: Comments: (note-if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box, etc.) — -— . -Distribution box is not lrP.Pnt PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No) -94 Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Pagt9of11 t Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Highland Drive Centerville ,Mass . Owner: Kristen Farar Data of Inspection, 2/2/00 SOIL ABSORPTION SYSTEM(SAS):_Z (locate on site plan, If possible:excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number:0 leaching chambers,number: 0 leaching galleries,number:_ leaching trenches,number,length: 7 leaching fields,number, dimensions: overflow cesspool,number: d Alternative system:. )� Name of Technology: 11r ICY Comments: (ncondition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) o • oils are dame Cesspool i a i n h3 haul 1C f8lllir-g Waste wieste water — CESSPOOL#: (locate on site plan) Number and configuration: Depth top of liquid to Inlet I very Depth of solids layer: Depth of scum layer: Dimenslohs of cesspool: Materials of construction: Indication of groundwater: ve Inflow(cesspool must be pumped as part of inspection) Did not pijmp infInw cQssTool . Fulnp�ln ! 1-,/98 ee atgfta of—urm"A : ntt•rfei-e Comments: (note condition of soil, signs of hydrauUc failure,.level of ponding,condition of,vegetation, etc.) S^mP ac nhnire PRfVY:Abet (locate on site plan) Materjals of constructs n: �� Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) Privy is not present . revised 9/2/98 Page 9ofII .s w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Highland Drive . Centerville ,Mass . O` rw: Kristen Farar Date of Inspection:2/2/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes Into house) • i i i i 1 �7 N�9hl ,Ncl d r. C.efitry i Ike. revised 9/2/98 Page 10of11 ( SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C SYSTEM INFORMATION(corrdruied) PropertrAddress: 67 Highland Drive Centerville ,Mass . OwnK: Kristen Farar Dete of l"we"i'on:2/2/0 0 NRCS Report name Soll Type_ Typical depth to groundwater USGS Date webalte visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Collar Shallow wells Estimated Depth to Groundwater&Feet Please Indicate all the methods used to determine High Groundwater Elevation: 0 tained from Design Plans on record Observed.Site(Abuttin property, bservation hole,basomoot sump etc.) Determined from local conditions Checked with local Board of health ked FEMA Maps :;�CZ5.ked pumping records :� local excavators,Installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours Map. Gahrety & Miller Model 12/16/94 revised 9/2/98 Page 11of11 v . •/•RnT rRtTfr•9"r�\Trl�J11I'l.lnf/lTI1I�.IA�fr11"�TwTl�T.'I.T At1«ti1'�t-{�T .T7l7Tr�.77T11*��..�-.I— 'I'OWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D•- CERTIFICATION �•TTI T•!�::f�T.11►�.TT'T'U.'1•.nl'R.T<T11�1R\fR�Rf7•l�tY r44TR�lR1Rw—TAI�.�r�nR� �RI yly�rT�•►►.�1 �• -TYPO OR PRINT CI,EAALY- PROPERTY INSPECTED STREET ADDRESS 67 Highland Drive Centerville ,Mass . ASSESSORS MAP, BLOCK AND PARCEL 0 OWNER' s NAME Kristen Farar PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . . COMPANY NAME J• P.Macomber & Sea' Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street To►m' or City State LIP COMPANY TELEPHONE ( 508 1 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT 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 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 . Check one: 1 's System PASSED ' The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of his form. ` System FAILED# The inspection which I have con\\"�Mted has found that the system fails to protect the public 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 Signature Date ne copy of this c rtification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEAL'I'll. * 1 If the inspection FAILED, the owner or `o' orator shall u p pgrade ' the system within o'ne year of the date of the inspection , unless allowed or required otherwise as provided in 3,10 CMR 16 . 306 , partd .doc