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HomeMy WebLinkAbout0471 OLD STAGE ROAD i a t '4+ rkt+' _ �'u d. na Y �.' +�„ .3 ^s ^�r� Jtt c.- �k�- E . ,. `.x !'U�� "r. C ' t iR•3,e'` , %fit r '�t '��r "�' .-i �.d 'it'r = �day'tf _��'�S'� y•:. :I E ,'•y fn ^r s, ?�'�, fix .mot � 'r t :',kr ._-� r t � � ,s .s-� •.'�.f- � c t `" +. t 9 AT PROPERTY ADDRESS 47'1`�ld Stag"e Road `B V 4 #. t Centery111111,Mass,. 1 ;fn� � s"'r �- �� +4 �� a y� 3 r�ls> r 026,3t2 H i EtiLTN Iv ; ' s t TOVIAN OF SAE On the above date, I Inspedtedthe septic system at the, above address. This system .consists o! the' loliowing: fi - 1 . 2.-Bloch `cesspools 1!.x5�� ,':& 6-f 6 flow..G Based do my Insosection, I certify.+the. following conditions. 1 This is _not a title five sxeptc s t�e�n +h: 2h�. Asa sewageCesspoo�l's,� ) he °sewage sytem:_'is presently w�rk�ng�LL Thee pis_ hery root intrusion: Wyeighly rec, .that the, cyst } be �zpga �l_ t � t1°e five se:ptactF� '' - - ?� , A• a, To 51 G N AT U R'' Name:_J_P_Macomber _Jr:'T' __ 4 � Company.: .�.P.Macoc�ber. Inc Add.ress._�e�c—bb---- —�— Centerville Mass �0.2632X ' t x i Phone:--- ,. Jh�" .. r4'�«+,d r tv v. r 365��. xf { �rh�..�,a"'✓�4 •r +N Rre, gym+ ¢ r ° R - t -. .;4.' 1. ,, .-.!.. .'� yE rJ.p 4� �Ae*r..� ��"t�°''°�. '?1`r�(�",� ,y�}a�'+"�n d.•�?it Y+� x-�J $x # �s+�an�.%f y� � ..., j i., THIS CERTIFICATION DOES NOT CONSTITUTE. GUARANTY OR WARRANTY F i . ;,•t , -*,,Ttr yy',y,. �,^c '7r .r .t .r •g r .a.. �, a -.: z7 )` ,i 44 t.�, ^� 32 • ;.Y ! L�: r*' ?ice s ,� ,;; •i".: � JOSEPH P, MACOMBER Tanks-Cesspool Is-Leadhileld: : 4 `� T xr •Pumped l"InsWied tt }F Town Sewer Connectlons P.O. Box 66 .'`'CenterAlle,'MA 026.32-0066 �.77��-3338 >"�775�64,,12 r as k ... V Cxs C • V 0(61 . Commonwealth of Massachusetts Executive Office of Environmental Affairs (Department of • Environmental Protection WUllam F.Weld Trudy Cox@ aor.n of 8-su q Ary@o Paul Celluccl David B.'Struhs tL Gowmw c4mmWo1w I• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address 471 Old Stage Road Centerville,MA AddrossofOwner. Donald Chisholm Date of Inspection: 8/2/96 (If different) 137 Scudder Road Name of Inspector.. Joseph P. Macomber Jr. •'` Osterville,Mass. Company Name,Address and Telephone Number. 02655 J.P.Macomber & Son Inc. Box•,66 Centerville,Mass. 02632 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 inspection. The inspection was performed based on my training and experience in the proper Amction and maintenance of on-sits sewage disposal systems. The system: — Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: /%�!� Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 go or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner,And copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A.B,C,or D: A) SYSTEM PASSES: " I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CUR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: / One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. 'Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain.wby not) Mxt The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfrltration,-or tea failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) I One Winter Street a Boston,Massachusetts 02108 a FAX(617)SWID49 a Telephone(617)292•Sb00 ��Printed on UgAW P•peu SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: L71 Qld Stage Road Centerville,Mass. 02632 Owner. Donalfi Chisholm , Date of Inspection: 8/2/9 6 B]SYSTEM CONDITIONALLY PASSES (continued) WAVO- Sewage backup or breakout or h0h static water level observed in the distribution box is due to broken or obstructed pipa(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is lmUpd or replaced A0 The system required pumping more than four tim..s 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 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH; _0 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM.IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: dLQ The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. Qo The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. Q(Q The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. �© The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for ooliform bacteria and volatile organic compounds indicates that the well is free from pollutio$from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. 3) OTHER , The system consists of two block cess ools. 35" years old or older. Cessp000-Ls are opera b,, have hRA-yv root intrusion. e Rec: the system be upgraded to a title five septic system. (revised 11/03/95) 2 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) Property Addreaw 471 Old Stage Road Centerville,Mass . Owner. Donald Chisholm Date of InspeotIon:8/2 96 D) SYSTEM FAILS: , • _ I have determined that the system violater one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component-due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface U the ground or surface waters due to an overloaded or clogged SAS or cesspool. /U�Ji fi Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. d(() Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of tunes pumped- Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no w w acceptable water quality analysis. If the well has been analyzed to be acceptable,attach co of well ,ter for P q tY Ys �Yx P � PY analysis eoliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serve, Q fn,illty with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the Yyatcri 6 within 400 feet of a surface drinking water supply the system is within 200 foot of a tributary to a surface drinking water supply /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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for Auther information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST i Property Address: 471 Old Stage Road Centerville,Mass . Owne,. Donald Chisholm Date of Inspection: 8/2/9 6 • , Check if the following have been done: Pumping information was requested of the owner,oc*ant,and Board of Health. ZNone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A JL/The facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-aanitary or industrial waste flow , The site was inspected for signs of breakout. , All system components,e'ecluding the Soil Absorption System, have been located on the site. A?4A The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baflles or tees,material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _jy The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propbo tyAddicao: 471 Old Stage Road Centerville,Mass . Owner- Donald Chisholm Date of Inspootiou:8/2/96 FLOW CONDITIONS RESIDENTIAL Design flow: 9W na iA il\ s Number of bedrooms: V Number of current residents 1/l Garbage grinder(yes or no):1C•'' Laundry connected to system(yes or no):2--L7 Seasonal use (yes or no):VP / Water meter reqdings, if av ble: Last date of occupancy: COMMERCIAL/INDUSTRIAL- Type of establishm nt:_ � . Design flow: ons/day Grease trap present: (yes or Industrial Waste Holding Tank present: (yes or no) R. -24 Non-sanitary waste discharged to the Title 5 system: (yes or no),� Water meter readings, if available: tlh /Vk . Last date of occupancy:_/) OTHER. (Describe) It'14 Last date of occupancy: GENERAL INFORMATION PUMPING 0 Spnd source of information: System pumped as part of inspection: (yes or no) j If yes,volume pumped: G�9 o►u Reason for pumping t<: /< <�'Y % � '✓`j��" . i TYPE OF SYSTEM Septic t"Vdistribution box/soil absorption system single cesspool Overflow cesspool 40 Privy —�4'0 Shared system(yes or no) (if yes, attach previous inspection records, if any) A `' Other(explain) APPROXIMATE AGE of all components, date installed (if luiown) and source of information: ✓ +�1� �,/ Sewage odors detected when arriving at the site: (yes or no) A (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: 471 Old Stage Road Centerville,Mass . 1 Owner: Donald Chisholm Date of Inspection: 8/2/96 SEPTIC TANK:A We— (locate on site plan) Depth below grade:, Material of construction:�concrete —metal —FRP —other(explain) ,r 1,4. . Dimensions•_ , WI Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:.,,,- Scum thickness:_ ..A4 Distance from top of scum to top of outlet tee or baffle:_ , ; Distance from bottom of scum to bottom of outlet tee or baffle._. Comments: (recommendation for pumping, condition of inlet and outlet tees or baffle. depth of liquid IPvel in relation to outlet invert, structural ,,rity eyid�snce of leakage, etc.) GREASE TRAP.,,&itie— (locate on site plan) Depth below grade:,'ili1� Material of consiri, ti6n/Wzoncrete metal FRP other(explain) Dimensions',—.A/AL Scum thickness:.,. Distance from top ut scum to top of outlet tee or baffle: A44 Distance from bottom nr srum to bonnm of ouUe( tee or baitle•4) ,— Comments: (recommendation for pumping, condi—rl of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc._i �Vcn -�'�Y1112 (revised 8/15/9s) 6 Ir SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) PropettyAddreaw 471 Old Stage Road Centerville ,Mass . Owner. Donald Chisholm Data of Inspection: 8/2/9 6 TIGHT OR HOLDING TANK:11,02"('-� (locate on site plan) s Depth below grs&:_/V 1 Material of constructions concrete_metal_FRP_other explain) - /11 Dimensions: 41A Capacity: /I W sallons Design flow: ons/day Alarm level: Comments: (condition of inlet tee ndition of alarm and float switches, etc.) DISTRIBUTION BOX: cn;C_ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box,etc.) PUMP CHAMBER: 't'_, (locate on site plan) Pumps in working order:(yes or no) ltl` Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 . U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 471 Old Stage Road Centerville ,Mass .. Owner. Donald Chisholm Date ofInspeotion: 8 2 96 SOIL ABSORPTION SYSTEM(SA9h '� S; 1 (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) e If not determined to be present,explain Type: �.. leaching pits,number. - . leachin8 chambers,number•. •"` leaching galleries,number leaching trenches,number,length: L% leaching fields,number,dime ions ovw1low cesspool,number: Comments:(note condition of soil,signs of}lyd{au i failure,1pvel of popd�ng,condition of vegetation,stc.) Medium sand;No signs o y rau is allure or ponding; All vegetation j �e nnrmal �1 CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids laver. �• Depth of scum layer. 37 Dimensions of oeaspool: -�� �_ ` "�✓ Materials of construction !G Indication of groundwater: inflow(cesspool must be p pod as of inspection)/ �� �� �✓' J /7�i9 Comments:(note con ition of soil,signs of hydraulic failure,level of ponce,condition of vegetation,etc.) Medium sand. No signs of hydraulic failure or ponding, All vegetation is normal. (locate on site plan) ' Materials of construction: �L' F Dimensions: 2� ' Depth of solids: /I Comments-(note condition of soil,tips of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95), 8 ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION •FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L=SPOSAL SYSTEM: include ties to at least two permanent references landmarks.'or benchmarks locate all wells within 100 ' Centerville Osterville Marstons Mills Water Company 428-6691 DEPTH TO GROUNDWATER pRth,od of...determihation 'or�approxi.mati�on: t - -ter,.., �- ..`. ,t_ � "-_..'}� 4. '• tiY�! "•'� _. - .:�.0 ,f..1•v.. - .yam.I.- � _"^_ _.�' � •- : ��•yjM�.�iy _ . � I 1 G' Gj l G S�yV 3r�1 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ion of Water Pollution Control :t 1TTTIrR•RT.TT-1Tif:lRf'RitRfTT1lSTT.rT'T:..TT!T4frlTlv"Rtirt•I fTT�tTJ 1�9��6Tlit �� . TOWN OF Barnstable BOARD OF HEALTH SUIlSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D '- CERTIFICATION \�' �•••�••:•T".'::1—T.tll.••.�Tnr.^n•.T:rrir..err.Tr1TT7:r•e*-t:T:rt'L:1Strrrr�T+T1'RaT ilTTTi"Tq'M1TO stn n'T1TrrnrRv -TYPE OR PRINT C1.EARLY- PROPERTY INSPECTED STREET ADDRESS 471 Old Stage Road Centerville ,Mass . ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Donald Chisholm PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber. Jr. COMPANY NAME J.P.Macomber & Sec` Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City Stat• ZIP COMPANY TELEPHONE ( 08 775 3338 FAX ( 508 790 - 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 complete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: XXXXXXXXXX Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signatu Date eFfZ One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF 11EAL1'11. * If the inspection FAILED, tMe owner ors• erator shall upgrade ' the ayetem. within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 ChIR 16 . 305 . _-... n n«4•d TOWN OF B STABLE LOCATION `�` GI D ��4 !6� SEWAGE # eRP_ VILLAGE 2Ulam^ 4Z ASSESSOJ S MAP & LOT /?6'1-M� R�NAME&PHONE NO.�—��/ �¢C:D or.�!^ ��J.�t/G SEPTIC TANK CAPACITY LEACHING FACILITY: (type) � (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: B 7!k COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feel, Edge of Wetland and Leaching Facility(If any wetland exist within 300 Letof lea ngili ) ` w Feet Furnished b. 4-7 -A TOWN OF BARNSTABLE \� �(�3 LOCATION AZ d 0 174a ,f SEWAGE# T1?X"Ob VILLAGE CE'��c=�` /'`l�✓ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. t0Q 1�10' AS SEPTIC TANK CAPACITY %, ?/ LEACHING FACILITY:(type)L (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Y) QL %`c(__Ca(Le3�`/ DATE PERMIT ISSUED: I d lI C DATE COMPLIANCE ISSUED: /P�.yLv2 VARIANCE GRANTED: Yes No '�} 1 � ' © _ r -- � � �� � ,�� �1.� �._ h� `��, _