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Home My WebLink About0113 LAKEVIEW DRIVE - Health '113 Lakeview Drive Centerville P A = 214 035 UPC 10259 No�H163_0R , HA8TiN0i. YN _ J IV I i D� q lzd r: s y, COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 RECEIVED OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY A SESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FO MAR 10 2004 PART A CERTIFICATION TOWN OF BARNSTABLE HEALTH DEPT. Property Address: 113 Lakeview Drive Centerville V+ Owner's Name: Damon Wirtanen MAP Owner's Address: ® r� PARCEL ; Date of Inspection: 3/4/2004 `CT 10 _ Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)88MO55 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: _/Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: —� Date: 3 _5 O 4' The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. 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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 113 Lakeview Drive Centerville Owner: Damon Wirtanen Date of Inspection: 3/4/2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: ave not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: f One or more system components as described in the"Conditional Pass"/s�hon need to be replaced or repaired.The system,upon completion of the replacement or repair,as apprgwed 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: Observation of sewage backup or break out or/high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obsruction is removed distribution box is leveled or replaced 1, ND explain: t' The system required pumping lnore 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 i obstruction is removed ND explain: f Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 113 Lakeview Drive Centerville Owner: Damon Wirtanen Date of Inspection: 3/4/2004 C. Further Evaluation is Required by the Board of Health: 1 . Conditions exist which require further evaluation by tt}eSoard 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 de ines in accordance with 310 CMR 15.303(Z)(b)that the system is not functioning in a manner wih will protect public health,safety and the environment: _Cesspool or privy is within 50 fed of a surface water Cesspool or privy is within 50 fbet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,i any)determines that the system is functioning in a manner that protects the public health,safety and vironment: _The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ' The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. —The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is4ess than 100 feet but 50 feet or more from a private water supply well**. Method used to determinerdistance **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 analysii must be attached to this form. f sr ff i 3. Other: x Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 113 Lakeview Drive Centerville Owner: Damon Wirtanen Date of Inspection: 3/4/2004 D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for all inspections: Yes No _,,Z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _,Z 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 and overloaded or clogged SAS or cesspool __Z Liquid depth in cesspool is less than 6"below invert or available volume is less than'/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 SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _ Any portion of a cesspool or privy is 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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.] .� (Yes/No)The system fails. I have determined that one or more of the above 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 fa Gty with a design flow of 10,000 gpd to 15,000 d You must indicate either"yes"or"no"to each of the follog: (The following criteria apply to large systems in additi9 to the criteria above) f yes no the system is within 400 feet of a surfa £drinking water supply t / the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitr%) en sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a public water supply well If you have answered"yes"to anquestion 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 owneyshould contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 113 Lakeview Drive Centerville Owner: Damon Wirtanen Date of Inspection: 3/4/2004 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health _jZ'Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site? V`-_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _%_/'_ Was the facility owner(and occupants if different than 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 No 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)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 113 Lakeview Drive Centerville Owner: Damon Wirtanen Date of Inspection: 3/4/2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): _ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: _ Does residence have a garbage grinder(yes or no): _y c, Is laundry on a separate sewage system(yes or no); if yes separate inspection required] Laundry system inspected(yes or no):— Seasonal use: (yes or no): Yc Z Water meter readings,if available(last 2 years usage(gpd)): , — t Sump Pump(yes or no): go Last date of occupancy:<-<,j.y- COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CUR 15.203):— god Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ 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: I Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the i on(yes or no): If yes,volume pumped: l scogallons--How was quantity pumped determined? Reason for pumping. ,rN 1 - TYPE OF SYSTEM —/Septic tank,dis �soil absorption system _Single cesspool Overflow cesspool —ivy —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) Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: �,/s��-w�• J`.;�� c rr-.-�S -cam�,.,�,�.. �►� �,��,ram � 'K�.a.�... Were sewage odors detected when arriving at the site(yes or no): A j Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 113 Lakeview Drive Centerville Owner: Damon Wirtanen Date of Inspection: 3/4/2004 TIGHT or HOLDING TANK: (tank must be pumped atpfue of inspection)(locate on site plan) i Depth below grade: ,` Material of construction:_concrete_metal fibergltiss___polyethylene_other(explain): f. Dimensions: ,'F Capacity: gallons .' Design Flow: gallons/day,.`r Alarm present(yes or no): Alarm level: Alarm in workinp,66 er(yes or no): Date of last pumping: , Comments (condition of alarm and R at switches,etc.): DISTRIBUTION BOX: (if present must be open! )(locate on site plan) Depth of liquid level above outlet invert: Comments(not if box is level and distribution ets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): f� Alarms in working order(yes or no): Comments(note condition of pump chamber, con"Mon of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 113 Lakeview Drive Centerville Owner: Damon Wirtanen Date of Inspection: 3/4/2004 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _,,,-'leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): i_ ��-., v-1_'C 'x \ - l_•�`.- � �zip\ .rl'r• j`�`� tic �� `ems 1rir�' 'h��,... CESSPOOLS: (cesspool must be pumped as part 9finspection)(locate on site plan) 1 Number and configuration: Depth—top of liquid to inlet invert: , Depth of solids layer: s` Depth of scum layer: ' Dimensions of cesspool: ` Materials of constriction: Indication of groundwater inflow(yes car no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): l PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): f f f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 113 Lakeview Drive Centerville Owner: Damon Wirtanen Date of Inspection: 3/4/2004 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. 01 _ �C ` I t ® tit = t � sC I Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 113 Lakeview Drive Centerville Owner: Damon Wirtanen Date of Inspection: 3/4/2004 SITE EXAM Slope Surface water Check cellar✓ Shallow wells Estimated depth to ground water Z1Q 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 the 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: G'-D Cr^4„s.1`c�1 r X., o l:[C'C•.••r-� wg�—w �a + J., l�� ({ G \\n TOWN OF BARN—STABLE .s LOCATION -VII�.AGE ASSESSOR'S MAP & LOT _ INSTALLER'S NAME Q PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) PV-r C iaS Prr— (size) 6 xw w NO. OF BEDROOMS PRIVATE ,�i ��W TER BUILDER OR OWNER DATE PERMIT ISSUED: '— Z, DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Per r 1 J 2.� 37 J I� �` 10oCGT�S�itC Eic-�tSTiW� 1 oob CYt� QT�rr- `000 GAL LOCATION SEWAGE PERMIT NO. VIL}LAGS CC-,ai ro(•IIc INS TA LL'ER'S NAME & ADDRESS B UIIDE R OR OWNER LT PERMIT ISSUED � �9 COMPLIANCE 1.SSUED ♦�f . � l r�Qy� �� ®tea � �� .� � �`o _�._._r i �� f�; 1 N FRim ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARDr HE TH - ............. t�_ ----..:.OF........, ....... ........................... Appliration for Uhipviial Workii Toustrurtion Vrrufit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ---ylk.Z.j .............................. .................................................................................................. Local r' -.Ad or Lot No --------—---- C .. j --V1 ,el----------------------------- .. ..... Owner Address ...... ------- ............. nst'all-er----------------------------------------- .............................................�ddres`s............... ......----------- n, Type of Buildi Size Lot............................Sq. feet U ;�9_ Dwelling—No. of Bedrooms.._ ....................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons...._....._..........__.__.. Showers Cafeteria ( ) P-4 Other fixtures ..................................................................................................................................................._ Design Flow lions per person per day. Total daily flow.:------- �--- e -----------------gallons. --------- Diameter________________ Depth................ 9 Septic TanV_Liquid capacity/- ___�__ allons Length________________ Width....._.____..___ Disposal Trench Width .......... Total Length .... Total leaching area___.._....___. esq- ft. ----------&- .... _/ "' ...sq. ft. Seepage Pit No_____ -------------- Diameter...... .... Depth below Total leaching area.;�L Z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.............._____. Depth to ground water..:_.._.............._... Gx Test Pit No. 2................minutes per inch Depth of Test Pit...___._....____._.. De t ground water_._________-____--____. j.................................... ... . . .. ............ .................................. ------------- 0 Description of Soil............... ..::::i.......... ...... ..................................I....... ...... -- ------),---- - -- ----- W U .................................................................................................................................................................................................. ---------------------------------------------------------------------------------------*------------ ...................... U Nature of Repairs or Alterations—Answer when applicable._'__................................................................................................................................................ ---------------------------------................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTi,17, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in ,L- operation until a Certificate of Compliance has been issued by the board of health. igne ......... .. ........................................................... ----------------------- 2ate Application Approved By---------. �_-"--PY--------- Dat Application Disapproved for the following reasons:................................. ............................................. .............................................................................................................................................................................................---------- Date PermitNo......................................................... IssuedL....................................................... Date L � (71), No.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD 00,�,.- HE, 41 ............. ..... _......0 . ............. .............................. Appfiration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: y ...................... ............................................... .......................................... 0 A46 'I ..i....................... ................................................................................................. Loca Add ,� Owner Address ......... 770. ............................... .................................................................................................. Installer ' Address tl� Type of Buildi Size Lot............................Sq. feet U P'No. of BedrOOMS--rn-'-**w�.........................Expansion Attic ( ) Dwelling Garbage Grinder a Other—Type of Building ............................ No. of persons__...__......._...__._.._... Showers Cafeteria Other fixtures ............... < , Design Flow .............. lions per person per day. Total daily flow. �_ �--_----------_----gallons. ---------------------------------*--------------------------------------------- 9 S "-/---- -- eptic Tank capacity _"_�W_ gallons Length................ Width..._._.......__. Diameter......_._.__.... Depth.... ------ Disposal Trench IN ... .... Width... ..... Total Length........ ........ Total leaching area........ ;q. ft. --- ------- Seepage Pit No....7 _.. I ------- Depth below inlet.._..60.......... Total leaching a.....................sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by.............mm_m............M.....................................m.... Date....................................... Test Pit No. I................minutes per inch Depth of Test Pit___._......_......._ Depth to ground water--_-_-_-______......._.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Deufh 'ground water_.-_....._.._._......... ... ........ ....... ................ 'ZZ---------- 0 ........... Description of Soil.................. .............. ............... ............................................ ....... ...... ............... U ......................................................................................................M..........................M........................................... ..... -------------------------- ................. U Nature of Repairs or Alterations—Answer when applicable.... ---------M....... ......T-40 ........I.......... i3tl .................. ................ ........................................................................M...................M.................... ............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f'TTLE 5 of the State Sanitary Code— The undersigned,further agrees not to place the system in the provisions o L operation until a Certificate of Compliance has been issued by the board of health. . . .................................... 2ignecL...... ......... ........ .............................. �at D ........ Application Approved By........ . ...S.......... ... ........ Application Disapproved-for,the following reasons:........................ ............7................... ......................................... ...............................................................................M.....................................................M.................... i i I, I Date PermitNo--------------------------------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Ofi .7HEALTH OF..... (Int' iratr of TomViianrr T11M IS FY, .Th Ntthe dividwal Sewage Disposal System constructed or Re aired G. L-1141. . ....... ----------- -------------------- .1X h _f _M . ...........M...... ............ by...... . ..... ........ ... ....... . .............. ......... .......... .........JL. at (1;5........ .. ...... ....... ....... .......... _Zr r I has been installed in accordance with the provisions of T T 5 of The State Sanitary Cody as d 'be 5es d in the C application for Disposal Works Construction Permit 'IN, ............. ........ dated....._-M,.........----- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM, WILL FUNCXION SATISFACTORY. DATE:................ ----------------------------------- Inspector - . ..................................... THE COMMONWEALTH OF MASSACHUSETTS . BOARD ....HEALTH 7G ............. ....04-7.... OF...... VG 'ie..... ........ No...... ............. FEE........................ r� /� k� ' ��r c rt�lnt� Permission is h4erebD ante &__10------- ........... ------------------ ---- r----- ----------------------- ........... to Con epair an ividual Sewag Sal L at S UC P 4b...... ?P1/0 No... ...... ...........// 41�..4....� MA;;.,� Street as shown on the application for Disposal Works Construction Permi ----- 010o, -7 ............ . ............. ated .. .......... ......./�*-------- ...M...... ......M.... .... ........................... Board of Health DATE--------------- .................................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS