HomeMy WebLinkAbout0260 NOTTINGHAM DRIVE - Health 260 Nottingham Drive
Centerville F
A = 171
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S�l_ I ;Ja0.E�YClFp�oy�
UPC 10259
No. H�1630R
HASTINGS UN
TOWN OF BARNSTABLE 1
LOCATION /LAC� SEWAGE #
VILLAGE �,,W ASSESSOR'S MAP & LOT
INSTALLER'S NAPS&PHONE NO.
SEPTIC TANK CAPAC=
P y
LEACHING FACIL=: (type) "�� (size) l D
NO. OF BEDROOMS c
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells ex°st
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leac 'ng Facility(If any-wetlands exist
within 300 fee o e n ' ty) Feet
Furnished y
ZCo NOAM96vy, 'Dr
i
a
DATE:--,
PROPERTY ADDRESS: 260 Nottingham Drive
-----------------------
-- Centerville,Mass_ (6
02632
------------------------
On the above date, I Inspected the septic system at th ��
This system consists of the following:
1 . 1 -1 000 gallon septic tank. MAR 0 7 2002
2. 1 -1000 gallon precast leaching pit. 6 'X9 '
TOWN OF BARNSTABLE
HEALTH DEPT.
Based on my inspection, I certify the following conditio
. 3 . This is a title five septic system. ( 78-.::Co_de )
4 . The septic system is in proper working order
at ,the present time.
5 . Waste water is 37" below the invert pipe of the leaching pit.
-/ATURE.
Name:_J_p _ Macomber �Tr1_____ SIGN
Company: Josej)h_P_ Macomber_& Son , Inc .
Address: Box 66
__Centerville , Ma_-02632-0066
Phone: 508_775_3338__
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
ftq'r"M
JOSEPH P. MACOMBER & SON, INC.
Tan ks-Cesspools-Leachflelds
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775-3338 775-6412
•
COMMONWEALTH OF MA.SSACHUSETTS
t EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 260 Nottingham Drive
en ervi e,Mass.
Owner's Name:El'inor_ K_eirstead
Owner's Address:
CantPrvilla Mass /176'42
Date of Inspection: 2 46 /n2
Name of Inspector: (please print)Joseph P.Maeomber Jr.
Company Name: J.P-Macomber on Inc.
Mailing Address:Box 66
Centerville,Mass. 02632
Telephone Number: 508-775-3338
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 Approving Authority
_ FailAox��4dj
Inspector's Signature: Date:
The system inspector shall bmit 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.
Title 5 Inspection Form 6/152000 page I
Page 2 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 260 Nottingham Drive
en ervi e, ass.
Owner: Elinor- Keirstead
Date of Inspection: 2/26/02
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. ystem Passes:
I have not found any informatio which indicates that any of the failure criteria described in 310 CMR
15.303 or to 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
The septic system is in proper working order
at the present time.
B. System Conditionally Passes:
_e One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass.
Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
r
Observation of sewage backup or break out or high static water level in th distribution bo ue to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
4 The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 260 Nottingham Drive
Cen ervl e,Mass.
Owner: Elinor Keirstead
Date of Inspection: 2 2 6 0 2
C. Further Evaluation is Required by the Board of Health:
4/io_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
.10 Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
.40 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.
.,e The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 1 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 260 Nottingham Drive
Centerville,Mass.
Owner: Elinor Keirstead
Date of Inspection: 2/2 6 10 2
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
ffl
ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
d Discharge or ponding of euent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
Static liquid level in th distribution box bove outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth depth in-sscs}aonl.is less than 6 below invert or available volume is less than 'h 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.
!v Any portion of a cesspool or privy is within a Zone 1 of a public well.
= 1 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. (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 failure criteria exist as
described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_/the system is within 400 feet of a surface drinking water supply
4 the system is within 200 feet of a tributary to a surface drinking water supply
2 L-' 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
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:260 Nottingham Drive
en ervi e, ass.
Owner: Elinor Keirstead
Date of Inspection:
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes Now
r/ Pumping information was provided by the owner, occupant,or Board of Health
Were any of the system components pumped out in the previous two weeks
Has the system received normal flows in the previous two week period?
Zmave large volumes of water been introduced to the system recently or as part of this inspection ?
-4 ^ere 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,; cluding the SAS, located on site?
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 ?
eb
— Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no J
t/ Existing information.For example,a plan at the Board of Health.
_4 — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)]
5
Page 6 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address260 Nottingham Drive
Cen ervi e,Mass.
Owner:Elinor Keirstead
Date of Inspection: 2 2 6 0 2
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): c3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): .5w"405V
Number of current residents:
Does residence have a garbage grinder(yes or no): kA
Is laundry on a separate sewage systems or no): Ida [if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use: (yes or no): A)O
Water meter readings, if available(last 2 years usage(gpd)):2 0 0 0—21 , 0 00 gal l ons=5 7.5 4 GPD
Sump pump(yes or no): V0 200-1- ;9B_9 gallons=73 . 98 GPD
Last date of occupancy:r�
COMMERCIAL/INDUSTRIAL
Type of establishment: ARR
Design flow(based on 310 CMR 15.203): WA gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):/V,4
Industrial waste holding tank present(yes or no):M
Non-sanitary waste discharged to the Title 5 system(yes or no):'tm
Water meter readings, if available:
Last date of occupancy/use:_
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: gallons-- How was quantity pumped determined? dV
Reason for pumping:
TY)�E OF SYSTEM
OF
tank, oil absorption system
,! d Single cesspool
Overflow cesspool
v Privy
S
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 systerA owner)
Tight tank Attach a copy of the DEP approval
/aOther(describe):
Appr ximate age of comp t date installed (if known)and source of information:
EGG Were sewage odors detected when arriving at the site(yes or no): 0
6
Page 7 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Add ress:260 Nottingham Drive
en ervi e,Mass.
Owner:Elinor Keirstead
Date of Inspection: 2 26 02
BUILDING SEWER(locate on site plan)
Lit
Depth below grade:
Materials of construction: cast iron Wd40 PVC Zother(explain): � y
Distance from private water supply well or suction line: l�t
Comments(on condition of joints, venting,evidence of leakage,etc.):
Joints appear tight No evidence of leakage System is vented
through the house vents.
SEPTIC TANK: (locate on site plan) ldOd�r' �S
Depth below grade: /Fit
Material of construction:_concrete&g metal,&�fiberglass4ZL6 polyethylene
/I)Dother(explain)
If tank is metal list age-./I& Is age confirmed by a Certificate of Compliance(yes or no)-,!LV(attach a copy of
certificate)
Dimensions:
Sludge depth-
Distance from top 2pludge to bottom of outlet tee or bafi>e:/"4ez,--
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: 1A4Co&
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as,related to outlet invert,evidence of leakage, etc.):
,Pump the septic tank every 2-3 years Inlet & outlet tees
are in place.The tank is structurally sound and shows no
evidence of leakage.Liquid level at the outlet invert is
lifty one ches .
GREASE TRAP/1 (locate on site plan)
Depth below grade: i
Material of construction:�concrete4metaW/ fiiberglass/l&polyethyleneli other
(explain):
Dimensions:
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:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Grease trap is not present
i
7
Page 8 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 260 Nottingham Drive
Cen ervi e,Mass.
Ownerhlinoe Keirstead
Date of Inspection: 2/2 6/0 2
TIGHT or HOLDING TANK4&T.(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: AM
Material of construction: concrete metal dAfiberglass 1 polyethylene y&other(explain):
Dimensions: ItH
Capacity: A/4 gallons
Design Flow: AM gallons/day
Alarm present(yes or no): A.G9
Alarm level: A)A Alarm in working order(yes or no): 41h
Date of last pumping:_ JA
Comments(condition of alarm and float switches,etc.):
Tight or holding tanks are not present.
DISTRIBUTION BOXAt j&(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 4R a
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of
leakage into or out of box,etc.):
Distribution box is not present.
ti.
PUMP CHAMBER4�(locate on site plan.)
Pumps in working order(yes or no): X41
Alarms in working order(yes or no): A14
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber is not present
f
8
Page 9 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:260 Nottingham Drive
e ervi e, ass.
Owner: Elinor Keirstead
Date of Inspection: /
SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required)
1 -Precast leachincr pit. 6 ' X 9 '
If SAS not located explain why:
Located. See page 10
Typ
leaching pits. number:
A leaching chambers,number:
0 leaching galleries,number: B
leaching trenches,number, length: 0
leaching fields,number,dimensions: d
overflow cesspool, number: Q
innovative/alternative system Type/name of technology: //T�� /`jam C 7,F&A>
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
Loamy sand to boney sand to coarse sand.No signs of hydraulic
failure or ponding.Soils are dry Vegetation is normal Waste
water is 37" below the invert pipe at the present time.
CESSPOOLS (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: 0
Depth—top of liquid to inlet invert: AO
Depth of solids layer:
Depth of scum laver:
Dimensions of cesspool:
Materials of construction: 1109
Indication of groundwater inflow(yes or no):
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
Cesspools are not present _
PRIVYAL/O-*Je— (locate on site plan)
Materials of construction:
Dimensions: e4
Depth of solids: 1414
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
Privy i s not present-
9
� I
Page 10 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued),
Property Address: 260 Nottingham Drive
C_entervi e,Mass.
Owner: Elinor Keirstead
Date orinspcctioo: 2/26/02
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch or the sewage disposal system including ties to as least two permanent rererenee landmarks or
benchmarks. Locate all wells within 100 reel. Locate where public water supply enters the building.
3o,G
c ,,
10
Page 1 I of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 260 Nottingham Drive
Centerville,Mass.
Owner: Elinor Keirstead
Date of Inspection: 2 26 02
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
i
Estimated depth to ground water (PD feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained fro system desia elans on record- If checked,date of design plan reviewed:
Observed site(abuttin grope_ bservation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(apach documentation)
Accessed USGS database-explain:
s
You must describe how you established the hi h ground water elevation:
Used; Gahrety & Miller Model 12M/94 Ground water elevation above
sea level.
Used; USGS Observation well June 1992
Used; USGS 92-0I10-1 _rn
Punte #2 Annual ranges of groLnd water eleva ; n
Leaching
Pit 'eet
Groundwater /Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the bottom
Of the leaching pit and the adjusted groundwater table is gr40
feet.
it
•nrnr+rn•r�r-r�—ie�rmr•nm,s�rrt asrrrs*ari:•r'+��er�sr-ermn ,1 TOWN OF Barnstahi p BOARD OF 11EALT11 l
0 SOBSURFACR SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D.,,.- CERTIFICATION I
•.—rrr•r-nr .—..d
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 260 Nottingham Drive Centerville,Mass 02632
ASSESSORS MAP, BLOCK AND PARCEL # 171 -038
OWNER' s NAME Elinor Keitstead
PART D - CERTIFICATION Y
NAME OF INSPECTOR Joseph P.•Macomber Jr. .
COMPANY NAME J-P.Macomber & Son Inc~'` ' ,
COMPANY ADDRESS Box 66 Centerville Mass.02632
Street Town or City State LIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 1 790 - 1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposaj system at
this address and that the information reported is true , accurate , and
omplete as of the time of -inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with •my training and experience in the proper function and maintenance of on-
site sewage disposal systems ,
Chec one :
System PASSED - ,
Tile 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 w11ic11 I have con -acted has found that the system fails to
Protect the j)ublic health and the environment in accordance with Title
6 , 310 CMR 15 , 303, and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature z A, Date
copy of this rt.ification must be provided to the OWNER, the BUYER
Dn.6
were applicable ) and the BOARD OF HEAL'I'll.
* If the inspection FAILED, the owner or" perator shall upgrade system
within one year of the date of the inspection,, unless allowed or required
otherwise as provided in 3.10 ChIR 16 . 305 .
partd .doc