Loading...
HomeMy WebLinkAbout0382 OLD CRAIGVILLE ROAD - Health 3 82 Old Craigville Road Centerville d A=247—022 SttleQl�m GW UPC 10259 ' No.H 1�OR MA&TINGS..MN I I� 4 a 4-7- o a-Q­-- Commonwealth of Massachusetts �M1 T Mp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments s l%� 382 Old Craiqville Road Property Address r-�a James Carbone Owner Owner's Name -- information is / required for every Centerville d MA 02632 January 29, 2019 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information --7 filling out forms M S��' on the computer, use only the tab Patrick T. Sullivan key to move your Name of Inspector cursor-do not Ready Rooter Excvatin use the return --- g key. Company Name PO Box 89 Company Address Forestdale MA 02644 _ City/Town State Zip Code 508-509-0802 __ _ _S112843 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails --� January 29 2019 Inspector's Signature Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 IL S Commonwealth of Massachusetts y -SIP Title 5 Official Inspection Form - _- 1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 382 Old Crai ville Road Property Address James Carbone _ Owner Owner's Name - — - information is required for every Centerville MA 02632 January 29, 2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: 19 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) 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,9"he replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y/N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* ' r the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exf� ration or tank failure is imminent. System will pass inspection if the existing tank is replaced wit a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspectio if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is ess than 20 years old is available. ❑ Y ❑ N ❑ N (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form 17 - I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 382 Old Craigville Road Property Address — - - James Carbone Owner Owner's Name _ - information is required for every Centerville _ MA 02632 January 29, 2019 page. CityfTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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(�are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstructi 9�n/is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced p ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): i ❑ obstruction is removed />' ❑ Y ❑ N ❑ ND (Explain below): ---- 7' - — —-- i 3) 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 failinrq to protect public health, safety or the environment. a. 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: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 1H Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `aA 382 Old Crai ville Road _ Property Address James Carbone Owner Owner's Name --- information is required for every Centerville _ MA 02632 January 29, 2019 _ page. CityrFown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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: ❑ 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 aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private ater supply well". Method used to determine distance: r — i *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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 his form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts .-�,p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ash 382 Old Crai ville Road _ Property Address James Carbone Owner Owner's Name information is required for every Centerville MA 02632 January 29, 2019 _ page. City/Town _ State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/z 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 water supply 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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:. For large systems, you must indicate eit "yes" or"no" to each of the following, in addition to the questions in Section CA Yes No / ❑ ❑ the /1WPA) ithin 400 feet of a surface drinking water supply ❑ ❑ the ithin 200 feet of a tributary to a surface drinking water supply El ❑ the scated in a nitrogen sensitive area (Interim Wellhead Protection Arear a mapped Zone II of a public water supply well i t5inspAoc•rev.7/26/2018 / Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 5 of 18 i Commonwealth of Massachusetts - - , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t:T _ '1ry �. % 382 Old Crai ville Road g — Property Address James Carbone _ Owner Owner's Name information is required for every _Centerville MA 02632 January29, 2019 _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ 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? ❑ ® 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? ® ❑ 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 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: ® ❑ 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(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form — 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 382 Old Crai ville Road Property Address James Carbone Owner Owner's Name information is required for every Centerville _MA 02632 January 29, 2019 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 - DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 340 GPD Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: --- ---- Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2017= 131 GPD g ( y g (gp )) 2018= 126 GPD Detail: ---- Sump pump? ❑ Yes ® No Last date of occupancy: Current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts qI , Title 5 Official Inspection Form -- I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments j� 382 Old Craigville Road Property Address James Carbone Owner Owner's Name information is ,a Centerville MA 02632 Janu 29 2019 required for every _ _ _ r r page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) — 2. Commercial/Industrial Flow Conditions: Type of Establishment: — Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: — Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Ready Rooter Records: Pumped July 2018 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 15insp.doc•rev,7126120111 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 16 I Commonwealth of Massachusetts _ Title 5 Official Inspection Form 13 I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 382 Old Crai ville Road Property Address James Carbone Owner Owner's Name information is required for every Centerville _ MA _ 02632 January 29, 2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: System installed 05/05/2003. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan).- Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): — Distance from private water supply well or suction line: n/a feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Offirial Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 382 Old Craigville Road Property Address — — James Carbone Owner Owner's Name information is Centerville required for every MA 02632 January 29, 2019 _ page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 6. Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: — years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' x 5.5' x 5'_ 1500gallons Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 32 - - Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 6 - Distance from bottom of scum to bottom of outlet tee or baffle 1 How were dimensions determined? Dip tube and to a measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet tees in place. Liquid level at outlet invert. Inlet has slight backpitch. Recommend adjusting to avoid backup. Risers bring covers within 6" of grade. Recommend maintenance pumping every two years_ t5insp.doc-rov.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts � _- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 382 Old Craigville Road Property Address --James Carbone Owner Owner's Name — -- information is required for every Centerville _ MA _02632 _ January 29, 2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: > feet Material of construction: ❑ concrete ❑ metal / ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scu�to top of outlet tee or baffle --- Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: - Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: j f Material of construction: 1 ❑ concrete ❑ metal' ❑ fiberglass ❑ polyethylene pol eth/ y y ❑ other(explain): r Dimensions: Capacity: — gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form t I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ( ash 382 Old Craigville Road �lJ� - Property Address James Carbone Owner Owner's Name information is Centerville MA 02632 January 29, 2019 required for every ry page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No i Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm a float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert p 11 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.): One inlet, three outlets. Speed levelers in place. Light solids carryover present. Not affecting system opperation. No high water staining over outlet inverts. Riser brings cover within 6" of grade. D-box 2.5' below grade. _ t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System• age 12 of 18 Commonwealth of Massachusetts -_=--=, Title 5 Official Inspection Form -- I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 382 Old Craigville Road Property Address James Carbone _ Owner Owner's Name information is Centerville MA 02632 January 29, 2019 required for every _--_ -- _ ry page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) / 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: / ❑ Yes ❑ No* Comments (note condition of pump hamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: — - — ® leaching chambers number: 3- 500 gal ea. w/ 2.5' stone. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: — ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 382 Old Craigville Road Property Address James Carbone _ Owner Owner's Name information is Centerville MA 02632 January 29, 2019 required for every ry page. Cityrrown State Lip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Camera used to locate and inspect chambers. Units 3' below grade. No riser found. Liquid level 1.8+-' below invert. High water staining 2"over present level. Clean stone visible in side wall. No sign of past draulic failure. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan).- Number and configuration — -- Depth—top of liquid to inlet invert — Depth of solids layer i Depth of scum layer Dimensions of cesspool 1� Materials of construction Indication of groundwater enflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): / t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 382 Old Craigville Road Property Address James Carbone Owner Owner's Name information is Centerville MA 02632 January 2 _required for every _ _ ram9, 2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): i i Materials of construction: Dimensions ---- Depth of solids — — Comments (note condition of soil, signsiof hydraulic failure, level of ponding, condition of vegetation, etc.)-. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 1�1_ "N\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �,- .��� 382 Old Crai ville Road Property Address James Carbone_ Owner Owner's Name information is Centerville _MA 02632 January 29, 2019 required for every — _ � _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately VV p I r, 6 I `.. r" n a o -, 0 i cl 7 t5insp.doc•rev.7/26/2018 ritle,5 Offnal Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 382 Old Craigville Road Property Address James Carbone Owner Owner's Name — — information is required for every Centerville MA 02632 January 29, 2019 page. Cityrrown _ State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to h '5 p high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 03/28/2003 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database -explain: maps.mass is.state.ma us/oliver.p p __ You must describe how you established the high ground water elevation: Test hole in 2003 found no ground water at 135" (elv= 38.9). Base of chambers at elv= 44.9 (5.9' separation) per engineered plans. Accessed local ground water contours and topo mapping. No high ground water in area of s ststem. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts - -_-;p Title 5 Official Inspection Form = h Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .� � 382 Old Craigville Road Property Address — -- James_Carbone----.--- Owner Owner's Name -- --- information is Centerville required for every MA 02632 January 29, 2019 _ page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Offdal Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pphratton for Migozal *pgtem Conotruction Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or J�o o. / Owner's Name,Address and Tel.No. ssessor's Map/Parcel Instaallller's Name,Address,and Te.No. Designer's Name,Address and Tel.No. 5^0F > -;;, s 36� Type of Building: Dwelling No.of Bedrooms 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 Nature of Repairs or Alterations(Answer when applicable)S � -A7/a2 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 issued by this Bo of He Sign Date IV Application Approved by Date Application Disapproved for the following reas ns Permit No. Date Issued No s" Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: (/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Mi5po.5al *paem (Con!truction Permit Application for a Permit to Construct( )Repair.( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or L / Owner's Name,Address and Tel.No. oc C�/1� AZ<l �< v� �f' /C � G .QS d •tJ ssessor's Map arcel f a lz z. Installer's Name,Address,and Tel.No. t Designer's Name,Address and Tel.No. 3c2 Type of Building: Dwelling No.of Bedrooms '� 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 Nature of Repairs or Alterations(Answer when applicable) e"'-b /2 t le' T� 77 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 issued by this B000f He Signe Date f 3 Application Approved by Date Application Disapproved for the following reas ns - Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site,Sewage Disposal System Constructed ( )Repaired ( )Upgraded( ) Abandoned( )by_A 2 at vi /r 2 �hasgconstructed in accordance with the provisio s of Title 5 and the for Disposal System Construction Permit No led Installer 2 C /rf Designer The issuance of t 's rmit shall not be construed as a guarantee that the syste will functio _ s designed. r Date h Inspector l N Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS liopool *paem Conotruction. Permit Permission is hereby granted to Construct( )Repaire Upgrade( )Abandon System located at 3 �/2 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:Co t4tiustbo pleted within three years of the date of this , Date:_ Approved by TOWN OF BARNSTABLE LOCATION,-3 /G/�J 1� r y e49 �/ � SEWAGE # Zo 'v-,LLAGE CF ?F 2 v/ le ASSESSOR'S MAP & LOT QJI-U' INSTALLER'S NAME&PHONE NO.; /% 5-7 S'o F S ?S ",3 SEPTIC TANK CAPACITY C � a a �✓>>lla .y LEACHING FACILITY: (type)(f3)S'0v Cf' 4 :S,2S (size) 3 NO. OF BEDROOMS BUILDER OR OWNER o st/ PERMITDATE: Y O3 COMPLIANCE DATE: - �LIZIQ3 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 exist 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 nD r`' 23D � 39 � ya � Cc 3 '7`1 C //3 5- G �----- TOWN OF BARNSTABLE LOCATION 01,0 Z0'J9® SEWAGE # :✓II.LAGE ASSESSOR'S MAP & LOT 7 INSTALLER'S NAME&PHONE NO. O�SEPTIC TANK CAPACITY LEACHING FACU-=: (type) (size) NO.OF BEDROOMS BUILDER OR O_N -R 461.✓sA4 9 &A PERMUDATE: 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 exist 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 �/. „� y -- ', ,�z�,, s�oa� � /�'� l�J TOWN OF BARNST E rA LOCATION �a2 flX N O� G!�/� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT Qj n2 a INSTALLER'S NAME&PHONE N0Al2- 6-� s7 -S'o 5 SEPTIC TANK CAPACITY J-o a /lla LEACHING FACILITY: (type)(f3)Soo e � 9 �e 2s (size) 3© X / d X NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: o 3 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 exist 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 i G�3-9 � � a y3V, r FAILED INSPECTION DATE:9/19/02 PROPERTY ADDRESS:3-82_Qid_CLrai_gy_ille Road West HYannisp .-------- -- 02601 — -- --- - --------------- On the above date, I inspected the septic system at the above address. This system consists of the following: RECEIVED 1 - 1 -6 ' X6 ' block cesspool. 2. 1 - 1000 gallon precast leaching pit. ( no Stone around ) SEP 2 5 2002 TOWN OF BARNSTABLE Based on my inspection, I certify the following conditions: HEALTHUEPT. 3 . This is not a title five septic system. 4 . This is a sewage system. Pit was added to the existing cesspool. Leaching pit does not have stone around it. Waste water �s 29' below the invert pipe.There is settling araudd the leachingC+�Sand is being taken in to the pit. 5. Board Of health will have to make a ruling on the pass pr failure of the sewage system,We feel that anew title five e is system s ould . be installed. SIGNATUR . _ Name :a n J .- P . -Macomber-jr . C o rri - -- ------- ------- p y : Joseph Pam_ Macomber Son, Inc. \ Address : aQx _� ------------- w��°'d' e( �lob. --�en�arYill�,_M��-2.2632-0066 � �� Iu3� (AJU n S Phone :_-508-775_3338 -------- r se THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY U0`o�`J �S JOSEPH P. MACOMBER & SON, INC. s� Tanks-Cesspools-Leachflelds Pumped & .Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632 0066 775 3338 775.6412 COMMONWEALTH OF MASSACHUSETTS r 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:382 01.d Craigville Road Wt�s' ' w,ra n--,sport,Mass. Owner's Name: E.H La:'son Owner's Address: Same Date of Inspection: 9/19/02 Name of Inspector: (please print) Joseph P.Macomber Jr. Company Name:J.P.Macomber & Son Inc. Mailing Address:Box 66 Centerville,Mass. 02632 Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is torte, 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 q r£uant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes onditionally Passes 7 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 4 Date: e-7—,)q—15;i The system inspector shall submit a copy of this inspection's ort to\the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the sy4fem is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authoriry. Notes and Corrunents ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:382 Old Craigville Road West Hyannispor , as Owner: E_H.Larson Date of Inspection: 9/1 9 02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: r Lee, I have not found any information which indicates that any of the failure criteria described 15.303 or in 310 MR 15.304 exi-----s Any failure criteria not evaluated are indicated below. in 310 CMR C Comments: Leaching pit is not stone packed. Settlement is taking place around the laeching pi an i We rec: that a new i e LIve septi sy5teftt—fie— nst�' ' �r' B. System Conditionally Passes: _Q 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. le/j��The eptic tank metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhi its 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 bo due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System wt 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: 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 I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 382 Old Craigville Road West Hyannisport,Mass. Owner:E.H. Larson Date of inspection: 9/1 9/0 2 C. Further Evaluation is Required by the Board of Health: 1 t�i� 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 envirotunent. 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: oo Cesspool or privy is within 50 feet of a surface water �1 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: aThe 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. UV The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 5 feet or more from a private water supple 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: This is a sewage_ system— The System cnnsiGtc' of 1 -6 'X6 ' hl r)rk r-Psspnnl wi th a 1 000 ga 1 1 nn prPr-ast pi t as an nvPrf 1 ow Pit is not GtonP par-kPr1 , SPtL PmPnt i a takeel ace Arniinrl the leaching pit. Sand is being taken in.Board of Health will make a decision if system passes or fails.We feel a new title five septic system should be installed. 3 Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:382 Old Craigville Road West Hyannispor ,Mass. Owner:E.H.Larson Date of Inspection: 9 1 9 02 D. System Failure Criteria applicable to all systems: You must indicate "yes" or"no" to each of the following for all inspections: Yes , ''o _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to m 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 iquid depth in cesspool 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 obst-ructed pipe(s). Number of times pumped �. y Any portion of the SAS, cesspool or privy is below high ground water elevation. And ponion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface — water supply, y ponion of a cesspool or privy is within a Zone I of a public well. nportion of a cesspool or privy is within 50 feet of a private water supply well. y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water qualiry 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.) �i (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. Needs further evaluation by the Town Of Barnstable E. Large Systems: Board Of Health. To be considered a large system the system must serve a facility with a design now of ]0,000 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 _ e 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 If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered eves" 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 5 304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I ' OFFICIAL INSPECTION FORM — NOT FOR VOL INSPECTION ASS FORM SUBSURFACE SEWAGE DISPOSAL PART B CHECKLIST Properry Address: 382 Old Cr e Road We HyanniGnnrt -Mass. Owner:E.H.Larson Date of Iospecuoo: 9 1 9 Check if the following have been done. You must indicate -yes" or"no" as to each of the following: Yes No _ A/ Pumpin; information was provided by the owner, occupant, or Board of Health /Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period ? /Have large volumes of water been introduced to the system recently or as pan of this inspection ? ZWere as built plans of the system obtained and examined? (If they were not available note as N/A) ✓ _ Was the faciliry or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out ? 4/ Were all system components,diuding the SAS, located on site ? Were the eptic 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 faciliry 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 _ L- 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 ;s unacceptable) (310 CMR 15.302(3)(b)) 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 382 Old Craivi1le,Road West Hyannisport,Mass. Owner.Z.H.Larson Date of Inspection: 9/1 9/0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms (actual): �Z DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): } ICE e✓ ��� Number of current residents: a Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or no):d/0 [if yes separate inspection required) Laundry system inspected yes or no):Y4 S Seasonal use: (yes or no): ; Water meter readings, if available(last 2 years usage(gpd))2000-35, 000 gallons=95. 89 GPD Sump pump(yes or no):_4fp 2001 —41 , 000 gallons=1 1 2. 33 GPD Last date of occupancy: COMMERCIAL/WDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): 100 Grease trap present(yes or no): dZA Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no):,d& Water meter readings, if available: Last date of occupancy/use: OTHER(describe): /Jfi4 GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection (yes or no): iQ If yes, volume pumped: 4,N gallons-- How was quantity pumped determined?'e,J Reason for pumping: TYPE OF SYSTEM r AV Septic tank,distribution box, soil absorption system Single cesspool /�, Overflow sspc kArJjl' sr te Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) /Night tank tO Attach a copy of the DEP approval /Other(describe): Approximate aee of all components, date installed (if known)and source of information: CP-;gPoo140-45 years old Pit is 15 + years old Were sewage odors detected when arriving at the site(yes or no): NO 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 382 Old Craiqville Road West Hyannisport,Mass. Owner: E.H.Larson Date of Inspection: 9 /1 2I o BUILDING SEWER(locate on site plan) Orangeberg pipe from the 11 house to the cesspool. Depth below grade: PVC pipe from cesspool to Materials of construction: cast iron if _other(explain):}hg it Distance from private water supply well or suction line: /� f Comments(on condition ofjoints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage.The system is vented through the house vents. SEPTIC TANKe(locate on site plan) Depth below grade: WO Material of construction:concrete eAmeta(fZ.4 fiberglass&i?polyethylene Azgother(explain) M If tank is meal list age:, Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: _ Distance from top of sludge to bottom of outlet tee or baffle: 40 Scum thickness: 16 i Distance from top of scum to top of outlet tee or baffle: _leo Distance from bottom of scum to bottom of outlet tee or baffle: -flo How were dimensions determined: 410 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of-leakage, etc.): When o#' if the present system is graded. The main cesspool should be pumped 2-3 years . If system is upgraded. The tank should be pumped every 2-3 years. GREASE TRAP41 (locate on site plan) Depth below grade: , i Material of construction:,&concreteff�meta144 fiberglassr/A�olyethylene�i/g other (explain): Dimensions: Scum thickness: A44 Distance from top of scum to top of outlet tee or baffle: ,,d i Distance from bottom of scum to bottom of outlet tee or baffle: ,� Date of last pumping: yf14 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Grease Trap is not present. 7 Page 8 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addres082 Old Craigville Road West Hyannisport,Mass. Owner:E.H.Larson Date of Iospectioo; 9/19/02 TIGHT or HOLDING TANKX&0 .(.tank must be pumped at time of inspection)(locate on site plan) : o Depth below glade: �/ r Material of construction: concrete metal d,,LfiberglassA/d�olyethylcne/lfA•other(explain): AM Dimensions Capacity. gallons Design Floµ gallons/day Alarm present (yes or no): Alarm level: -_," Alarm in working order(yes or no): Date of last pumping: _a_ Comments (condition of alarm and float switches, etc.): Tight or holdim4 tanks are not presen DISTRIBUTION BOX/l� (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level,4nd distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc,):, DistribUtion box—is-not present. PUMP CHAMBERf,&,�e—(locate on site plan) Pumps in working order(yes or no): A arms in working order(yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): PUMP chamber is no presen 8 Page 9 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add ress:E.H. Larson craig—vl-Tle Road Owner: West Hyannispor ,Mass. Date of Inspection: 9 1 9 02 SOIL ABSORPTION SYSTEM (SAS): Y (locate on site plan, excavation not required) 1 -6 'x6 ' cesspools and a 1000 gallon precast leaching pit as an overflow,The pit is not packed in stone. Settlement has begun. If SAS not located explain why: Located: See page 10 T}'pe leaching pits. number: .406leaching chambers, number: ,LQ leaching galleries, number: __ NO leaching trenches, number, length: [7 leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system m Type/name of technology: 0 etc.): Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, LOamy sand to medium fine sand No signs of hydraulic failure or Ponding. Soils are dry Ve etation is normai.Ma , te water is below invert pipe of cesspool and 29" below the invert pipe of the leache(cesspool pit-The pit is not tone. cked CESSPOOL' must e pumped as part oltnspectto relocate orf site plan) Number and configuration:)j Depth' top of liquid to inlet invert: VIP' Depth of solids layer: Depth of scum laver: ` Dimensions of cesspool: �— Materials of construction: �. Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Same as ahnvr� PRIVYr9, (locate on site plan) Materials of construction: low Dimensions: 0&0 Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privv is not present 9 Pagc 10 oft t OFFICL-' INSPECTION FORK( — NOT FOR VOLUNTARY ASSESSMEN?'S SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION F ✓ . OR, , PART C SYSTEM INPORM.ATION (coniinvcd) P,Cfl,rr� A001(„ 382 Old Craigville Road west- Hyannisport,Mass. 0 R_H_Larson Di(c of Inigmtoo: aL -L 2 SK..ITCH OF SCWACC DISPOSAL SYSTCM Pio"oc , itt,cn of,nc tc..cic 4iipot,l tyttcm Inclvding Ilct to 11 Icut cwo permcncnt rcrcrcncc ItnCmuc, o• Dtn(,VnVt, Loc„c III w,Ll, ..;thin 100 fcct. Locc,c whcrc pvblic wctcc tvpply cntcrt UUc ovi1 4inj, • C-/ a r, c'P Io Page 1 1 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 382 Old Craigville Road West Hyannisport,Mass. Owner: E.H.Larson Date of Inspection:9 19 0 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- if checked,date of design plan reviewed: NA YES Observed site(abutting property/observation hole within 150 feet of SAS) NI) Checked with local Board of Health-explain: NA YES Checked with local excavators, installers- (attach documentation) YES Accessed USGS database-explain:http: //town.barnstable.ma.us. You must describe how you established the high ground water elevation: sed: Gahrety & miller Model. 12/16/94 Ground water elevations above a level. sed: USGS: Observation well data June 1992 sed: USGS; Technical bulletin 2-0.00-2 January 1992 Ann ,al rang,--, of c1rcundTy _ _rroun -P1 Pva i-i nn•e. _!"., Leaching Pit /rh ;eet - L Groundwater Feet Below Bottom of P,it High Groundwater Adjustment 1.8 ft per Frim ter P P Method Therefore, the vertical separation distance between the bottom i Of the leaching pit and the adjusted groundwater table is 1,04 feet. 11 yy. rnn rr.-nrr.-.'rr irn-+rr.nr..rrs-.r.-z-r.rr..r.:-.�+-r-4rr:mn-rnrn m�vnaarrsrr .� 1' TOWN OF Barnstable BOARD OF IIEALTII ,Sll(1511(IFACR 9EHA(;F ()i F'USAL SY� STF,M INgI'FCTION FORM - PART D •- CERTIFICATION ism n�nsrr*rstarTrr.+rrtr.•.-,r rr r••�. ._.. -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRES$ 382 Old Craiaville Road West Hvannic8 t Mass ASSESSORS MAP , BLOCK AND PARCEL # 247-022 OWNER' s NAME E.H. Larsdn PART D - CERTIFICATION 1 NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J•P•Macomber & Son Inc.-`* COMPANY ADDRESS Box 66 Centerville,Mass 02632 Street Town or CSty State COMPANY TELEPHONE (508 ) 775 - 3338 FAX (508 ) 790 -1578 tIP !i CERTIFICATION STATEMENT I certifythat I have personally inspected the sewage disposal system at t his 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 ne : System Needs further evaluation by the Town Of Barnstable Board Of Health. The inspection ;ghich I have conducted has not found any information which indicates that the system fails to adequately protect public IlealLh 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* Tile inspection wilic11 I have con `Doted has found that the system fails to Protect the 'public health and the environment in accordance with Title 6 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this i spect ' on form . 1 aInspector Signa Date ��`d e copy of t certification must be provided tothe OWNER, the BUYER here applicable ) and the 130ARD OF }{EALT'I(, * It the inspection FAILED, the owner ors perator shall upgrade aYste within one year of the date of the inspection , unless allowwedorthe requiredm otherwise as provided in 3.10 CPIR 16 . 305 , partd -doc W M ASSESSORS MAP : 2„�� NOTES: TEST HOLES LOGS �. PARCEL : 2.2- 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD ZONE: C. SO I L EVALUATOR :D. McJE-F��6% THIS PLAN,_1995 MASSACHUSETTS TITLE V & TOWN OF WITNESS : N IQ J fh STAWE BOARD OF HEALTH REGULATIONS. REFERENCE: DATE: P'tku�,H 2' z0b �a 2) THE INSTALLER SHALL VERIFY .THE LOCATION OF UTILITIES, Qp PERCOLATION RAT 2 '""" SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO 6LA-55 -1 SotL =(, A-12- = O.?y I INSTALLATION. b" Od TH- I GL.66.2. TH-2 t 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION e LO R / i ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE rr I Dy�"3/ , q i DETERMINATION. / 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS SIN r (DY R. (7 SPECIFIED OTHERWISE) LOCATION MAP(Q;T.S,� 7J� - -- ---�1a L 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A UVE 7 GARBAGE DISPOSAL. E 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON 2.SYS A BASE OF 6"OF CRUSHED STONE. -1 tiC 7)(—=Yl 57 CESSA:p&L.S Na G+,a 0 1 w-o 3$5b M/,,&VF- >P -P. T 7 Lrz-\/ Fi Lt,!^,16Le N SEPT I C SYSTEM DESIGN ) FLOW ESTIMATE &Xis-n1* S �',.� BEDROOMS AT (l0 GAL/DAY/BEDROOM - 3 GAL/DAY }' SEPTIC TANK �30 GAL/DAY x 2 DAYS GAL Ip USE I r>OOGALLON SEPTIC TANK --/-/Ei ,? W ° /o" S SOIL ABSOI2PT I ON SYSTEM ► o � � �= UaV '''��1i�3 ,� 2,s r ,SToN� oN SI,I�S �3vi�. tywxZ'�� G a ax I DE` AREA: 0 ?L/ / j yo r ----''r d`'r `v FIOTTOM AREA: ,3p i U x 0. 7 L/ j X�STIf _ SEPTIC SYSTEM SECTION req . Toy= 's .35 ----_ �r� lsti I r S� I 0 GAL cs Ox wev ,,, ,_ ,-. �.. SEPT 1 C TANK jD 1e► we s I=. 1= 1�7 Q0 a � 1 .. N OF Mqs R E S I TE AND SEWAGE PLAN yl Y No. 1140 LOCATION : 2 `ULD 0-1 1 6 VIU—e RID- SAW!TARS P� 0 PREPARED FOR : DARKEN M. MEYER R.S. SCALE: 4F 43 VINESTREET DATE: .. ..G? P C. 'PI,S �� Z `/ DUXBURY, MA 02332 W Z A9-e,H l f I� ;. ATE HEAL H A (781) 585-0293