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Home My WebLink About0053 KNOTTY PINE LANE - Health 53 KNOTTY PINE LANE, CENTERVILLE A= I DATE: 3/24/00 PROPERTY ADDRESS: 53 Knotty Pine Lane ----------------------- Centerville,Mass. ------------------------ 02632 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: p 1 . 1 -1000 gallon septic tank. / D 2. 1 -Distribution box. 3 . 2-1000 gallon precast leaching pits. Based on my inspection, I certify the following conditions: 4 . This is,. a title Five Septic Sysem. ( 78 Code ) 5. The septic system is in proper working order at the present time. SIGNATURE:s J. Name:_J_P J . P. Macomber Jr__ Company: Joseiph_P. Macomber-& Son , Inc . Address: Box 66 RECEIVED Centerville , Ma . 02632-0066 MAR 2 8 2000 -------------------- TOWN OF BARNSTABLE Phone: 508_775_3338___-_-- HEALTH DEPT. THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775.6412 • I - COMMONWEALTH OF MASSACHUSE'M'3 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292.6600 TRUDY c 3.c.r ARCEO PAUL CELLUCCI DAVM B. STF Governor COMM-AJ SUBSURFACE SEWAGE DISPOSAL SYSTFM-WSPECTION FORM PART A CERTI9CJ1T10N Property Agar,,,: 53 Knotty Pine lane Name of Ownw Bernarr Quitt Centerville Mass. AddreasofOwrw: 4Waterside rive Dauofhapocisw: 3/2 0 Centerville,Mass. 02632 Nart,. of r,sp.ctn.: (Pt..s.P►Int) Joseph P.Macomber Jr. I evn a DEP oval system kupocw punKwd to Section 16.340 of Ttdo 6 1310 CUR 15.000) C,ro"My N,,T1e: J�.Macomber & Son Inc. _ Ma Mry Addrau: 02632 Tea'aphor,e Numbw — — 338 CERTIRr,ATtON STATEMENT certify that I have personally Inspected the sewage disposal system at this address and that the Informadon reported blow Ia true, accurst@ and complete as of the time of 4upectlon. The Inspection was performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems. The system: ��Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails y trup.ctora Slpnanxe: . / Date: %-' , d The System Inspect: all submit a copy of this Inspection report to the Approving Authority(Board of Hsalth or DEP)withln thirty (30) day, complsting this Inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater,the Wpottor and the system o.. • shall submit the report to the appropriate regional office of the DepartmentoNfs,vironmemW Protection. The original shoulclu.sent to-TV system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page of11 �� ►MIW on R.cyc4d Paper SUBSURFACE SEWAQE DISPOSAL SYSTEM INSPECTION FORM PART A ; CERTUICATiON (continued) PtopertyAddr.": 53 Knotty Pine Lane Centerville,Mass. 0-- Bernarr Quitt Date of Inspection: 3/2 4/0 0 INSPECTION SUMMARY: Chock A. B, C. or D: A. SYSTEM PASSES: ivy I have not found any Information which Indicates that any of the failure conditions described In 310 CMR 11.303 ex)st. Any fanwe criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDI110NAUY PASSES: One or more system components as described In the'Conditional Pass'section need to be replaced or repslred. The system.upon completion of the replacement or repair.as approved by the Board of Health,will pus. Indicate yes, no,or not determined(Y. N.or NO). 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 whh a copy of a Certificate of Compilance(attached)Indicating that the tank was Installed within twenty(20)years prior to the data of the Irupecdon; Of the septic tank, whether or not metal,Is cracked,structurally unsound, shows substantial Infiltration or exVIrstion, or tank failure is Imminent. The system will pass Inapectlon 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 obsVuctad pipeisl or due to a broken, settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health). Woken pipe(&)are replaced obstruction Is removed distribution box Is levelled or replaced • The system squired pumpirfgnnon than•1ourYftnes ti•yeardus to broken o/obsbvcted pipe(s). The>fymm wW-pc— Inspection If(with approval of the Board of Health): broken pipes) are replaced obstruction Is removed revised 9/2/98 hgt2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) P►operty Address:53 Knotty Pine Lane Centerville,Mass. owner: Bernarr Quitt Dete of 4'spec6an: 3/2 4/0 0 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, 11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CUR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH YWILLPROXECT THE PUBLIC HEALTILAND SAFETY AND THE OW80NMENT. Cesspool or privy is within 60 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 end 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 then 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 smmonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm. Method used to determine distance •.leis' (approximation not valld).- 3l OTHER revised 9/2/98 Page 3ofIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIRCA71ON(con*wW) Prop"Ack,e$: 53 Knotty Pine Lane Centerville,Mass. own«: Christina Bernarr Date of 4►spection: 3/2 4/0 0 D. SYSTEM FAILS: You must Indicate either "Yes" or "No" to each of the following: AO I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The basis for this determination Is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of towage inW teclRtlrer-e,et+nt cornponent•dne to an overloaded or•dagged-S,A&oreeaspod. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level4ne djjtr bution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in.ceaepeel is less than B"below Invert or available volume is loss than 1/2 day flow. Required pumping more than 4 times In the lest year NOT due to clogged or obstructed pipe($). 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 1 of a public well Any portion of a cesspool or privy Is within 50 feet of a private water supply well. f� Any portion of a cesspool or privy is less-then 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has boon 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" to each of the following: The following criteria apply to large systems In addition to the criteria above: 4)0 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/ f/ the system Is within 400 feet of a surface drinking water supply 21 the system•ie-within 200 taet of ftrilwtarir tom aurfaoe dFinklAq watw+u►Yly• the system is located In a nitrogen sensitive area(Interim Wellhead Protection Area 1WPA)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 4oriI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop.rtyAddr.u: 53 Knotty Pine Lane Centerville,Mass. Owner: Bernarr Quitt Data of Inspection: 3/2 4/0 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. _Z� None of the systemton*oaents hamaj~puw►mxWopat least twoaweeka andaw-vystem hasbeeoincaimiagov ssttal sow 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 N/A. _ 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. _ All system components,-viecluding 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 orr the site has been determined based on:- Existing information. For example, Plan at B.O.H. 4 _ Determined In the field(if any of the failure criteria related to Part C Is at issue,approximation of distance Is unacceptable) (15.302(3)(b)) The facility owner land.—ipaots.Jf differaW frnrn tner)awere prnyidad with lofot=doo:nn dwp nper wain•a^9MA of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 I t' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 7 PART C SYSTEM INFORMATION PropoetyAddress: 53 Knotty Pine Lane Centerville,Mass. Owner: Bernarr Quitt Date of lrt:pectkm: 3/2 4/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow:_,&_g.p.d./bedro Number of bedrooms 4d0 i Number of bedrooms(actual):: Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) ( es or o :_ If yes, separatelnspection.required Laundry system inspected ea r no Seasonal use(yes or no): 'Y'i 40 Water meter readings,If available(last two year's usage(gpd): drl e AV 7Y Sump Pump(yes or nol: � rf'Ja 91 ,� ,0� Last date of occupancy:. CO M M ER CIA LfIN D U S TR IA L Type of establishment: Design flow: AW cpd ( Based on 16.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present:(yes or no).,& Non-sanitary waste discharged to the Title 6 system: (yes or nouy Water meter readings,if available: Last date of occupancy:_ 4>f OTHER:(Describe) Last date of occupancy: IVIJ i GENERAL INFORMATION PUMPING RE C R�D$ar}d urce of infV motion: vvr System pumpped as part 4ofnspection:(yes or no) W ` If yes, volume pumped: gallons Reason for pumping: TYPE SYSTEM Septic tank/distribution box/soil absorption system &)4 Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous Inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank W,$ Copy of DEP Approval Other wa AGE of all co^ipo nts, date installed known)•ond ounce a#•information Sewage odors detected when arriving at the site:(yes or no) revised 9/2/98 Page 6of11 r ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(aontirsued) P.opertyAddress: 53 Knotty Pine Lane Centerville,Mass. Owner: Bernarr Quitt Date of Ir►:p°` :3/1 4/0 0 BUILDING SEWER: (Locate on site plan) Depth below grade: 15911 Material of construction:_cast Iron k140 PVC.14 other(explain) .I/0 Distance from private water supply well or suction line Diameter-_ Comments: (condition of joints,venting,evidence of fwkas&,-otc.) - Joints appear tight -Nn Pvi 8PnrP of 1 ealca ge SEPTIC TANK: (locate on site plan) Depth below grade. Material of construction: rconcrete,met&W)l .FiberglassAlPolyethyleneo(Aother(explain) If tank Is Enetal,list age &ff Js.age.confirmed�bvy Certificate of Compliance / (Yes/No) Dimensions; Sludge depth: V Distance from topp�sludgs to bottom of outlet tee or baffla•.�, Scum thickness: Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bolt of o tiet tee or baffler How dimensions were determined: Comments: (recommendation for pumping, condition of Inlet and outlet tees or-baffles, depth of liquid level In relation to outlet invert, structursHntegrity, evidence of leakage,etc.) PUMP the septic tank every�2- Inlet & outlet to i uialevel at the outiet finer 1s titty one inctie.s.The tank is struj-tttrallU cnitnrl and GREASE TRAP: (locate on site plan) Depth below grade: Material of construction-40 concret&40 metalAAFiberglassAM Polyethylene4#other(explain) Dimensions: Scum thickness: Alof Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffler 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.) Grease trap is not present- revised 9/2/98 Page 7of11 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ; PART C SYSTEM INFORMATION(con*xmd) P►op"Addr.: 53 Knotty Pine Lane Centerville,Mass. Owner: Bernarr Quitt DO"of aup'e'0":3/2 4/0 0 TIGHT OR HOLDING TANK:_,(j/j2L(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grade: Material of construction-.Affconcretok&metal4Y.Fiberglass�Polyethylendlaotherlexpiain) A, —— — Dimenslons: Capacity: 09 gallons Design flow: AM gallons/day Alarm present Alarm level: 414 Alarm in working order:Yes No Date of previous pumping: — M Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Tiqht or holding tanks are not =ragant DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet Invert:_ Comments: (note if level and distribution Is equal, evident of solids carryover, evidencalof leakage Into or out of box, etc.) — D' tributi n box One ine is higher than the clesign.195 evidence of so-Licis carry over.No evidence of 1ea cT acte in o or out of the hnx PUMP CHAMBER:4jA/t'— (locate on site plan) Pumps in working order:(Yes or No) A Alarms In working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) umiD chamber is not a rpcpnf- revised 9/2/98 PeetIofII I SUBSURFACE SEWAGE DISPOSAL SYSTE W INSPECTION FORM PART C r. SYSTBA INFORMATION(con*YjW) Pro,.AyAd&.":53 Knotty Pine Lane Centerville,Mass. own..: Bernarr Quitt Dau of inapec kmB/2 4/0 0 SOIL ABSORPTION SYSTEM(SAS)` (locate on airs plan.If possible;excavation not required,location may be approximated by non-Intrualve methods) If not located, explain: Type: leaching pits,number:, leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number, dlms &Ions: overflow cesspool,numbsr: Alternative system: AhIr Name of Technology: Comments: Incts condition of soil, signs of hydraulic failure,level of ponding, damp sob,condition of vegetation, Ste.) Loam ai ure or pon ina_Soi l s arP r7r vAgP _.t_f'n normal. CESSPOOLS:,d&Ae (locate on site plan) Number and configuration: Depth-top of Liquid to Inlst AIR Depth of solids layer: AM Depth of scum layer: AIR Dimensions of cesspool: Materials of construction: Indcation of groundwater Inflow(cesspool must be pumped as part of Inspection) CesspoolG arP not p]..1=.seni- Commenu: (not@ condition of soil, signs of hydraulic failure.-level of ponding,eondtion of.vegetatlon, etc.) essDOols are nnf jarPcant PPJ Y:&kl ' (locate on site plan) Materials of construc.0qn: Dlm�f►slons: �l� 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 PaQ@9of11 TOWN OF BARNSTABLE LOCATION k : a)e.,, SEWAGE # VILLAGE ��]F�yyi �� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Z ';2�� SEPTIC TANK CAPACITY 1000 dAz LEACHING FACILITY:(type) 7� (size) >00 Oem' NO. OF BEDROOMS -3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: J�0 3 96 DATE COMPLIANCE ISSUED: (� VARIANCE GRANTED: Yes Noy OWN OF BARNSTABLE LOCATION �� ;��G SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. /j,*Cptw ep- SEPTIC TANK CAPACITY LEACHING FACILITY:(type) V"j (size) ' NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ihZ I .� o �. r i�� ,6� �. � � �� .. r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFCR"TION fca*vued) ProapwTyAd&&": 53 Knotty Pine Lane Centerville,Mass. Own«: Bernarr Quitt Dou of tr";.Cdw. SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at Fast two permanent reference landmarks or benchmarks local•all wells within 100' (Locate where public water supply comas Into house) n Ems, rp, -J revised 9/2/98 Psgc10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C • SYSTEM INFORMATION(continued) P.opertyAddreaa:53 Knotty Pine Lane Centerville,Mass. own«: Bernarr Quitt Data of Inspection: 3/2 4/0 0 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 Feat Please Indicate all the methods used to determine High Groundwater Elevation: /Obtained from Design Plans on record Observed Site(Abutting property, bservatlon 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 Date 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 II or II •.�nr+ —n•rsr7Ttrnrmr•nsenls-T.ras.RrTlrr.�+1+n►r�.RwTrn erw7/�tt7n�nRT T7rrrT-1.r•sr-..--,r•� TOWN OF Barnstable BOARD OF HEALTH SWISURFACR SEWAGE DISPOSAL SYSTEM INSPRCTION FORM - PART D - CERTIFICATION I•••rr`t^T••,••.•.—�.11►.^.�e9srtr+nrtrrrTTlrtrrn�T:r-.•.9 rtuTnlarnl.T^9'�.1O.A► f inn ..rrrr'•T-1.—..^ -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 53 Knotty Pine Lane Centerville,Mass. ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Bernarr Quitt PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME J.P.Macomber & So,w Tnc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 ) 790 - 1 578 . CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at ID his address and that the information reported is true , accurate , and omplete as of the time of ,inspection . The inspection was performed and any ecommendations 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: !y Systeui 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 this form. System FAILED* The inspection which I have con acted 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 certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or•'*operator shall upgrade - the within one ,year of the date of the inspection, unless allowed orre required otherwise as provided in 3.10 ChIR 15 . 305 . q red partd .doc