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HomeMy WebLinkAbout0041 SACHEM DRIVE - Health 41 SACHEM DRIVE, CENTERVILLE A = i I SIIII A -J�,�,2�ICIEp�, IN UPC 12534 No. 2�15� 3LQR HASUNGS, MN TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE_ C Pil/f t'R /iLL ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. If A4 A C � t Sow SEPTIC TANK CAPACITY _ /, Goo i LEACHING FACILITY: v u/eHA/if (size) 4. G�► NO. OF BEDROOMS BUILDER OR 0 PERMTTDATE: COMPLIANCE DATE: i Separation Di§tance 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 0 I tl. TOWN OF BARNSTABLE I LOCATION /` C IZ,44 1-2/F SEWAGE # ofV VILLAGE C Pit/t I VIZZ ASSESSOR'S MAP& LOT a INSTALLER'S NAME&PHONE NO. J .M R C G A /1 f R f- S o A1 SEPTIC TANK CAPACITY /U O O * /e'f/�— D L V LEACHING FACILITY: (type)"AL u iV C/fir M,6 f 1f 'S (size) S G O, 6 4 ' NO.OF BEDROOMS Y BUILDER OR 0 PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: 41 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 it o % No. 7 Fee $ 5 0.0 0 THE COMMONWEALT7 _ H OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for �Diopooal *ps�tem Cow6truction Permit Application for a Permit to Construct( )Repair�X Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 41 Sachem Drive Centerville,Mass .. Russell & Susan Nesbit Assessor's Map/Parcel Q 26 Beach Plum Hill Road Installer's Name,Address,and Tel.No. S O - 5—3 3 3 8 Designer's Name,Address and Ter.No. ' J.P.Macomber & Son Inc . J.P.Macomber & Son Inc . Box 66 Centerville ,Mass . 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling XXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 4 0 gallons per day. Calculated daily flow 3 x 110=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank .Type of S.A.S. Description of Soil Loamy sand to medium sand to fine sand Nature of Repairs or Alterations(Answer when applicable) adding 3—5 0 0 gallon leaching chambers to an existing 1000 gallon tank and a gallon precast leaching pit -Packed in 4 ' of stone 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 issu by tl B d of ealth. e Signed Date 9 4/9 9 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued ' No. Fee$ 5 0. 0 0'/''_ �- ' THE COMMONW4-TH OF MASSACHUSETTS Entered in computer: Yes n` PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprtcatton for 0t5pogar *pgtem Congtructton Permit A lication for a Permit to Construct Re air X U rade Abandon pp � ( ) p � � pg ( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 41 Sachem Drive Centerville,Mass. Russell & Susan Nesbit Assessor's Map/Parcel A 26 Beach Plum Hill Road Installer's Name,Address,and Tel.No. 5 0 —7 7 5—3 3 3 8 Designer's Name,Address and Ter.No. J.P.Macomber & Son Inc. J.P.Macomber & Son Inca , Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Z Type of Building: , Dwelling XXNd.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 4 0 gallons per day. Calculated daily flow 3 x 110=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Loamy sand to medium sand to fine sand Nature of Repairs or Alterations(Answer when applicable)) add in g 3—5 0 001�a l l o n leaching chambers to an exisying 1000 gall tank and a gallon precast leaching Pit---Packed in 4 ' of stone Date last inspected: Agreement: The undersigned agrees to ensureRthe construction and maintenance of the afore described on-site sewage dispo al ssysTem ___,_, in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation unt' a Certifi- cate of Compliance has been issu by th' B d of Health. Signed j Date- 9 /99 Application Approved by (, f '1 Date Application Disapproved for the following reasons Permit No. Date Issued ———————————T--------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of CompYance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired�XX)U aded(t Abandoned( )by J.P.Macomber & Son Inc. at 41 Sachem Drive Centerville,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 61 dated Installer J.P.Macomber & Son Inc. Designer J.P. aco ber Son Inc . f .. 0 The issuance of this penjuit s all no be construed as a guarantee that the s stem will function as�d'eesigne&, 1 1 J Date Inspector �? /A �—' � lWi��l�/�-' (" No.� — -----------------------------Fee $ 50. — 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Xtgpogar *pgtem Congtructton Fermat Permission is hereby granted to Construct( )Repair�X)Upgrade( )Abandon( ) Systemlocatedat 41 Sachem Drive Centerville ,Mass/. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to t comply with Title 5 and the following local provisions or special conditions. Provided:Construction m st be comppllet within three years of the date of his permit/. /}� Date: ! 1 Approved b 1 ' PP Y �, f 116199 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, Joseph P.Macomber Jr . hereby certify that the application for disposal works construction permit signed by me dated 9/14/9 9 concerning the property located at 41 Sachem Drive Centerville ,Mass . meets all of the following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. V/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed There are no variances requested or needed. r The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will noI be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX. High G.W. Adjustment. DIFFERENCE BETWEEN A and B SIGNED f DATE: 9/14/99 [Sketch proposed plan of system on back]. q:hc&M folds:cent ::� =� I ... a �� � o �� �, ARDITO, SWEENEY, STUSSE, ROBERTSON & DUPUY, P.C. ATTORNEYS AT LAW MATTACHEESE PROFESSIONAL BUILDING 25 MID-TECH DRIVE,SUITE C WEST YARMOUTH,MASSACHUSETTS 02673 EDWARD J SWEENEY.JR TELEPHONE(SOS)775-3433 RICHAR P MOREWFI MICHAEL B STUSSE DONNA M ROBERTSON FAX(508)790-4778 PAUL R TARDIP MATTHEW J DUPU'/ CHARLES J.ARDITC rc CHARLES M SABATT 'aqo sommea in MAME PLEASE REFER TO FILE NUMBER C- CERTIFIED MAIL 02!/' R1E*EEa RETURN RECEIPT REQUESTED 7632 September 9, 1999 9904 E �LOUIS BERGER AND ASSOCIATES 295 Promenade Street/Providence, R.I. 02908J RE:°`°Subsdtface"Sewage ,Disposal Systems Dear Sir Please be advised that I represent .Russell and Susan Nesbit regarding their purchase of 41 Sachem Drive, Centerville, MA.3 i I have enclosed the following: 1. The Septic System Inspection Report performed by your company, dated 4/26/99. 2. A Septic System Report prepared by Joseph P. Macomber & Son. Inc. (hereinafter Macomber) dated 8/10/99. 3. An'"estimate to repair the system at a cost of $3765 .99 . On page 8, your company's report indicates that the soil absorption system has "no problems" . Macomber's report indicates in part on page 9: " . . .leaching pit is in hydraulic failure. New leaching area must be installed. . . " Your: act�i:'ons and 'report are .a violation of Massachusetts General Laws, Chapter 93A. This is the Massachusetts Consumer Protection Law. i September 9, 1999 Page 2 Please consider this husetts GeneralrI�aw,aChapterd 93Ater under the Provisions of Massac The failure to respond with a reasonable offer of settlement could result in the imposition of double or triple damages, legal fees and court costs. My client hereby demands $3765.00 from your company as damages to them based' on your preparation of an inaccurate septic system report. The septic system will be repaired on or before 9/21/99 . will await your response. V r u y , THE MJD/dmh cc: Russell and Susan Nesbit Attorney Scott Masse .7 h r, V ver-;a-us DATE: 8/10/99 PROPERTY ADDRESS:_ 41_ Sachem-priLe-_-_____ Centerville ,Mass . ------------------------ 02632 ------------------------ On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 gallon septic tank. 2 . 1-Distribution box 3 . 1-1000 gallon precast leaching pit . Based on my inspection, I certify the following conditions: 4 - This is a title Five Septic System. ( 78 Code ) 5 . The septic system is in hydraulic failure . 6 . A new leaching area must be installed . ( 95 Code ) 7 . Waste water is less than 6" below the invert pipe to the leaching pit - Solid waste has been carried over to the distribution box and the leaching pit . 8 . Leaching pit is over 4 ' below grade . SIGNATURE: J. Name:—,L---F-- Macomber Jr------- Company: Jose2h_P. Macomber_& Son , Inc . Address:, Box 66 -------------------- Centerville , Ma_-02632-0066 Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY 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 MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 TRUDY CO) Secreu ARGEO PAUL CELLUCCI DAVM B. STRU) Governor Co n r.:ssioc SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION Property Address: 41 Sachem Drive NameofOwnerRussel & Susan Nesbit Centerville ,Mass . 02632 AddressofOwrwe�6 Beach um Hill Road Data of l-P-6on:8/10/99 Osterville ,Mass . 02655 Narn. of 4s4pector:(Please Prirn)J o s e n h P.Macomber Jr . 1 am a DEP approved systam lnspector purwant to Section 15.340 of rrda 6 (310 CMR 15.000) company Nama:J. P.Macomber & Son Tnc_ . M&XngAddresa:Box 66 CPntPrvil.le ,Mass --02632 TAlephorsa Number: 5 o g 775 3Z3��S 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 lrtspection. The Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: i _ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fai s t ! Date:Inspector's Sigrsausre: ° • <�The System Inspect ' shall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department oRBnvlronmental Protection. The original should be sent to tvx system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS • revised 9/2/98 Page I of 11 �� YnnUC on Bsgc l•d v,pu . i t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTiCN FORM PART A CERTIFICATION (continued) Property Address: 41 Sachem Drive Centerville ,Mass . Owner. Russell & Susan Nesbit Data of Inspection: 8/10/9 9 INSPECTION SUMMARY: Check A, A C, o/ D: A. SYSTEM PASSES: I have not found any Information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: B. 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 of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all Instances. If "not determined', explain why not. 1 The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was installed within twenty(20)years prior to the date of the Inspection; or the septic tank, whether or not metal,Is cracked,structurally unsound, shows substantial Infiltration or exfiltration, or tank failure Is Imminent. The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. i Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(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 pipes) are replaced obstruction Is removed distribution box Is levelled or replaced - The system required pumphig-tnore than'four-dmea a yeardue to broken or obstructed pipe(s). The ay7tem willyess-- Inspection if(with approval of the Board of Health): - -- broken pips(s) are'repiaced obstruction Is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:41 Sachem Drive Centerville ,Mass. Owner: Russell & Susan Nesbit Date of Inspection: 8/10/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 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.PRQTECT THE PUBLIC HEALTK AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water , } Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. i 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING W A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: kA The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. jli' The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. l- The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance • 1/ (approximation not valid). 3) OTHER ,,� revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddress: 41 Sachem Drive Centerville ,Mass . Owrmw; Russell & Susan Nesbit Date of Inspection.-8/10/9 9 D. SYSTEM FAILS: You m st indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is Identified below. The Board of Health shoVId be contacted to determine what will be necessary to correct the failure. Yes No Backup of-sewage into feciRt"r•system component-due tto an overloaded orclogged-SiPlS-orceaapool. -�••--•`�•= Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in th distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. , e7 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 times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. / Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 1 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-then 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for •►coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: AM The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No/ / the system is within 400 feet of a surface drinking water supply �d the system-ia-witrrin 200 feet of-e-tributarytoaeurfsoadrinkiwgwatersupply - --- - _ 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 upgrade the system In accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforfttation. revised 9/2/98 Page 4or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 41 Sachem Drive Centerville ,Mass . Owner: Russell & Susan Nesbit Date of Inspection:8/10/9 9 Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following: Yes V-O , Pumping information was provided by the owner, occupant, or Board of Health. None of the system componants haua:baen poRMwd4oF8tleastt voaweeke andAlawaystem hasbeeovatceiviwgwrsasal.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. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. ,/ _ The site was inspected for signs of breakout. _ All system components,mcluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on•the site has been determined based on: _ Existing information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C Is at issue,approximation of distance Is unacceptable) S 115.302(3)(b)] The facility owner.(and.—spants..if diffarant from-owner).wxare provided.wUh infnuaation.an t►�Tluainteaaocaof SubSurface Disposal Systems. { I ; ( revised 9/2/98 Page 5orn I ]1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FJRM PART C. SYSTEM INFORMATION PropwtyAddress:41 Sachem Drive Centerville ,Mass . Owner: Russell & Susan Nesbit Date of Inspection/10/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: /,M_g.p.d./bedrog^ Number of bedrooms(design)- J Number of bedrooms(actual) Total DESIGN flow �YJ" .Z Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or no :_; If yes, separataJnspection•required Laundry system inspected yes r no) Seasonal use(Yes or no): / r% Water meter readings,if available(last two year's usage(gpd): /" / i�J{i1 uJ( / �+�J /V Sump Pump(yes or no):i1 ��1c� i61�•L�IYGi�i`f+�ih^ Xr �. �✓� v� �/ Last date of occupancy: l 1� COMMERCIALIINDU STRIAL: Type of establishment: 1 Design flow: d d,( Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 syste :(yes or no)� Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RERDS /d� urgeofnf atiQ� n: System p6mped as part o inspection: (yes or no) If yes, volume pumped: 7gPllon3 } Reason for pumping: �'� TYPE OF SYSTEM jel 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMAJE AGE of all components, date installediif known)-and source of-information:j_,,.✓ _ vv, - i7e7 Sews"odors detected when,arriving at the site:(yes or no)�Llb revised 9/2/98 Page 6of11 I07/21/1999 -08.,59 7785105 TIDEWATER PAGE 04 .,poaw^v.rw . 97 lJol�Y �� ���K-�yr «• 99'Z .�� T. �Z11 Of n PF'TER $ SULLIVAN �, �; l�1^.1�,;r,J �c�� 7'�� /Z�T� r/e. No. 2Z7331I NO ORAL • 07/21/1999 08:59 7785105 TIGEial,;TER PAGE 03 .. J vl E FAMILY - 3 i3CDlZcac�f`� No r--A?,6ACrG: G�.t►J OCtZ DAILY FLaW Ito x S .•330 G.P. C>. T1 c TANK. K- 3 3a v,-IsoA - 44 S u5E I aoo &AL. TA�4k. Dt S.pQsAL.. PIT' S►pCwALL AftCA - S-o 5p s, F A� Z .S' 3 7_5' G-P. 0. So7rcpM . AP-EA - So S.F, Sa 5-F. x 1. 4 , S'0 G. P. !a T'O TA L, DeSIGti1 T. 4,Z g &, P. 0, TTAL 1:AILV SLo,^) = -330 Fr-.P. D. PCZCnC,A7"je�N fZAT 1"f,j Z M,o�1 .02 L-FESS alfl-::I::;;, OF �l'a l•}ter; .��, ��'�" RS,, �� PETER. A " SULLIVAPI. $. BAXTGR No. 29733 No.2:caa �aT�R �� .r �b�. Q�sr�gE Fs,CipN N�� Ls~ P*e443 J. �1,.L,co«.taa,.r.. s z�v w,�+�►.Q.Qti/i.�/�f��� -CAPc f � ti 9L.S /000 • GAG �� BoX AvK G,q<.; /'� .,�� � � s Wlry� � v = ,� •• 1/�• 9so 95 Z . S W h S H�cD •• CE.2T/�/EL7 fad 4T pL.4,t/• STo,�E S,a A g , �310 SCALE Oa Tis' Rx— -v�,�,zr-.•sve��y.4.vo ��c�.�,�s� M • 7��'�•'S'sF.�'�c�✓..S.r6�C!/G p NET�,� .sY.+��/.�f,/•day,.-���.. . liSE"v 07/21/1999 08:59 7785105 TIDEWATER.. PAGE 02 ASSESSOR'S MAP N0, PARCEL L0CAT10NN I SEWAGE PERMIT NQ. Lo�4�-'..4 r- c.(.►e t" DIN-, VILLAGE A _ rINSTALLEA'S NAME y ADDRESS � R UIL0ER ' OR OWNER d PATE FKRMIT ISSME0 DATE Cq MPLIANCE ISSUED ���otA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) P►opertyAddress: 41 Sachem Drive Centerville ,Mass . Owner: Russell & Susan Nesbit Date of Inspection: 8/10/9 9 BUILDING SEWER: (Locate on site plan) Depth below grade: �r Material of construction:_cast iron 4/'40 PVC_other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting,evidence of leakage,-etc.) - - Joints appear tight . No evidence of leakage . SEPTIC TANK: 6N (locate on site plan) Depth below grade:�d Material of construction: concrete/%i�netal� FiberglassA!/±Polyethylene�other(explain) If tank is(petal,list age jJ2. Js.age.confirmed by Certificate of Compliances(Yes/No) ' . Dimensions: I'/f/,?,012 �l��l�� !✓ ti ✓//l W. Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 0 — Scum thickness: Distance from top of scum to top of outlet tee or baffle: (l Distance from bottom of scum to bolt of o I tee or baffle: How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, 3tructural4ntegrity, evidence of leakage, etc.) Pump tank every 2-3 years . Inlet and outlet tot-.-. are in =1 ara _ Tha tank i a etriirtnral 1 g ennnrd nnrd chnwc nn e-vld-enee of leakage . GREASE TRAP: (locate on site plan) Depth below grade: Material of construction //Oconcretw metaVt69Fiberglass,�.LPolyethylenel.,?other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of cum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Grease trap is not present . revised 9/2/98 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ProwtyAddress:41 Sachem Drive Centerville ,Mass . Owner: Russell & Susan Nesbit Date of Inspection-8/10/9 9 TIGHT OR HOLDING TANK;&LLQTsnk must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:10 Material of constructionNll concreteVA-metal4Fiberglass4kPolyethyleneVAother(explain) AM JA Dimensions: AIA Capacity: gallons Design flow: gallons/day Alarm present Alarm level: VA Alarm iq working order:Yes NqJ�* Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Tight or holding tanks are not present _ i DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (notelf level and distribution is equal, evidenee of solids carryover, evidence of leakage into or out of box, etc.) - — Distribution boxhas one lateral . There is avidpnra of colidg carry nvPr _ Nn avi ri-D-- of 1 eakaag jaUg or- g131; gj th.A LQX - PUMP CHAMBER:,I�L�' (locate on site plan) Pumps in working order:(Yes or No)k- Alarms in working order(Yes or Not Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Pump chamber is not present . revised 9/2/98 Page 8of11 i • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropartyAddres,:41 Sachem Drive Centerville ,Mass . Owner: Russell & Susan Nesbit Date of Inspection: g/10/9 9 SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible; excavation not required,location may be approximated by non-Intrusive methods) It not located, explain: Type: leaching pits, number.1 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields, number, dime s,lons: overflow cesspool,number: Alternative system: Name of Technology: >;7 ., Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to me(l; ,,m f; ng sand . I-eaehing pit is in hydiaul-ft, f alTed . Leachingit had never been dug in trie past year . SOils are and damp around CESSPOOLS: , the leaching pit . Solid waste has 'carried - over to the (locate on site plan) leaching pit . Number and configuration: Depth top of liquid to inlet Invert: AN, Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: �J inflow (cesspool must be pumped as part of Inspection) Cesspool is not prPsent _ Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of-vegetation, etc.) Cesspool is not present PRIVY:®it-ve, (locate on site plan) Materials of construction: .� Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) PrivV is not ;resent _ revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DLSPOSAL SYSTEM W TI SPECON FORM PART C SYSTEM INFORMAT10N fcon*Kjod) PropaMAddrau: 41 Sachem Drive Centerville ,Mass . Owrw: Russell & Susan Nesbit D`"of kapocdon:8/10/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmark& locate all wells within 100' (Locate where public water supply comes Into house) i 40v�� �j G t•. revised 9/2/98 gtoor)) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTInN FORM PART C SYSTEM INFORMATION(continued) PropertyAd&..,: 41 Sachem Drive Centerville ,Mass . owner: Russell & Susan Nesbit Date of Inspecdon:8/10/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Caller Shallow wells Estimated Depth to Groundwater;_?,b Feet Please Indicate all the methods used to determine High Groundwater Elevation: ZObtained from Design Plans on record bserved.Site(Abutting proportD observation hole, basement sump etc.) determined from local conditions Checked with local Board of health Chocked FEMA Maps II/Chocked pumping records Chocked local excavators,Installers Used USGS Date Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours Map . Gahrety & Miller Model , 12/16/94 revised 9/2/98 Page 11of11 d r.rnrw.—n.rm-rr- rnrmr•nsmr.-n..+++nrn.rnrr+wsrr�rn+nmr.stn�u.*s'.r��nnm s�.mcrry rn-r.-r-v+rrr—:.....r...` TOWN OF Barnstable WARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION ' �^•T!1^T••.•;:t—T.IIT.^.T.TT4T r111•II.19•I TIf!'R�1flR•RT1'r^M1•InVfR'7tn.1R^'�f.OANVIR�R�RA'I�r7 ItnIRTR/TnTn1TT:T171•.+�r T•R•1•�..� —TYPL OR PRINT CI.¢ARLY— PROPERTY INSPECTED STREET ADDRESS 41 Sachem Drive Centerville ,Mass . ASSESSORS MAP, BLOCK AND PARCEL # 209-008 OWNER' s NAME ' PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & Son Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Strvvt Town or Clty State tIp COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 .1 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 -inspect . 1on . Tile 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 ; Systeui PASSED The inspection t+hich I have conducted has not found any information which indicates that the system fails to adequately protect public hea1Lh or Lite 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 conaitcted has found that the system fails to Protect the j)tiblic health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date e; One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF 1111ALT11. * If the inspection FAILED, the owner or" porator shall upgrade within one year of the date of the eyetem inapection, unless allowed or required otherwise as provided in 3.10 CMR 16 . 306 . partd . doc lJ cn X7 THE COMONWEA.LTH OF MA, SSA.CH'USETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is her eby authorized to use the title CERTIFIER TITLE S 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_ /\ity Oir 'it. t of Ur l) wiul \VIct 1*011 C�nirl Lou 11 Berger & Associates, Inc. A MEMBER OF THE BERGER GROUP. e� 295 Promenade Street, Providence, RI 02908 Tel 401.521.5980 • Fax 401.331.8956 ENGINEERS • PLANNERS SCIENTISTS • ECONOMISTS • ARCHAEOLOGISTS A� April 26, 1999 kr 1 Od -d; 'Oil Sl Barnstable Board of Health o 19 367 Main Street Hyannis, MA 02601 Dear Sir or Madam: Enclosed you will find the completed Title V inspection form for the septic system located in Centerville, MA. If you have any questions, please call me at 401-521-5980. Sincerely, LOUIS BERGER& ASSOCIATES, INC. Louis Ragozzino, P.E. Principal Engineer Enclosures cc: , Richard Masse, Centerville, MA C O.N.1%ION WEALTH OF '_-"AZ%SSACHUSETTS 7� --n XECUTIVE OFFICE OF EN ONM r_ E. MENTAL F, AIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. NIA 02108 6i7-292-;500 R UDY CO>a WILLIANI D- 40// 14r sc=mr. Governor Q ID B'S7RUjj1 .-%.RG:-:O PAL1 C7_*_LI_;CCt Co7=__Z—=.Lomc Lt.Govcncr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE M F 0 PART A C=_RTlFiCATiON "let 4q, ?rope-,y Address: 41 Address of Owner- Date of inspec:ion: +124(T-1 (if different) Name of InSDecior- -Lo"is P!E. R 13.000) I am a DEP apDroved systeminSDec:or pursuant to Section 13.340 of Title 5 (310 Company Name: `-tows B.-,cjcr Maiiing Address: 295 C>zq(Ds Telephone Number: 401— 6-2 1— 59 30 CERTIFIGkTION STATEME-NT I certify :bat 1 have oersonaily inspected the sewage disposal systemat this address and that the information reported below is true. accuse and cr-InDiete as of the rime of inspection. The inso—e-son was penormed basedon my raining and experience in the prooer fanction and maintenance a,;on-site sewage diSDOsai sterns. The syszern: Passes Conditionally Passes Needs Further _valuation 5v the Loci Approving,Autn or;r., lnspec:or's Signature: Date: --yej The Svsiern. inspec-zor srtall sucmit a CODV Of inspec:ion reoor-E to the Approving AuthoritV within miry (30) dais of cornpfet!n, mis insoec-.;on. If the zvszem is a snared sysiern or has a design fiow of 1.0.000 gpd or ereater. the insoe,=or and [he :vszem owner shr21 Subrmt i ;; rt-nal chouid 'De sen, to me sysern crwne- the retort to:he 2-corocriaze regional trice of:ne -Department of Environmenta rotection. the a and cooies sent to.the .::uver. if applicaole^ and the approving authority. INSPECTION SUMMARY: Check A., B, C, or D: A] SYSTEM PASSE5: MR 1:_:_Z3. I have not found anv information whirl indicates that the system violates any of the failure L.iteria as defined in 31 C. Anv failure criteria not evaluated are indicated below. COMMENTS 81 SYSTEM CONDITIONALLY ?ASSES: m, One or more syszern components as described in the -Conditional Pass sec:ion need to be repiace-c or he syste uoo commietion of the replacement or repair, as approved by the Board of wealth. will pass. indicate ves, no. or not determined (Y. N, or 140). Describe basis of determination in all instances. !f-not aver-ined", exolair, why not. -he septic tank is rnetal, unless the owne- or ocierator nas provider :he system insoec:or wan a cloov of.a Cellilczte of Comoiiance :aazchedi lnd;caung :hat the rank was nsiaile-j within zwenry 120) -..,ears onor Z) :_e care or the !nsoeciion: c the seotic rank, whet.her or not mecai, is cracked. structurally unsound, snows woszantiai .17.1liz.aticri or exii1tration. or Lan- ;a6ure is imminent. The wstern will pass inspection 4 the existing seotic rank s repiacea a canto I rmin., optic :ank as acioroved by the Board of Health. )4'25 971 P.g_ SUBSURFACE SEWAGE DISPOSAL�y"STEM INSPECTION FORM PART CERTIFICATION (continued) s a c.ham••• l D rwe Property Address: 41 (�1a5sz Owner: Date of Inspection: BJ SYSTEM CONDITIONALLY PASSES icon[inue6l I wen approval bstrof the Sewage bac}up or breakout or high static`eater level obsz ved in the distribution box is due to broken or obstruced pipe.s� or due to a broken. settled or uneven distribution box. The system will pass insoec�on ,f l Board of_ealth). Describe ooservations: broken pipe is are replaced obstrucion s removed lacod distribution box is levelled or rea vc•em will Pass C`ed pipe'._;. The systzrn reouired pumping more than lour times a year cue to broken or o°stru-• oval of the Board of Health): insoec icn if twit" appr broken pipes) are replaced obstruction is removec C} FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: if the sys;e^� is tailing to protect the order ;o^Pip nine _ s rectuire further evaiva[ion by the Board cf Health ,n Conditions exist whit pubiic heaith. safety and the environment. ER " BOARD OF HEALTH DETERMINES THAT THE SYST"c.'v1 l5 NOT FUNCTIONING IN A MANN 1) SYSTEM WILL PASS UNLESS HEALTH AND SAF WHICH WILL PROTECT THE PUBLIC SAFE AND THE HNVIRpNME'd : within SO feet of a surace water feet of a bordering vegetated wetland or a salt marsh. Ce<_spoci or pricy is _ Czs;peoi or pries is within JO e tiUNES THAT UNLESS THE BOARD OF HEALTH (AND PU SLTHEWATER PUBLIC HEALTH AND IF SAOP� AND D HE 2) SYSTEM WILL FAIL 01 HR HEALTH PROTECT THE SYSTEM IS FUNCTIONING IN A MA ENVIRONMENT: c. - c tic rani: and soli absorption system (SAS) and the 5n5 is within 100 feet to a surace water supply or The system has a _ep — of a eub6c '•eater suociv well. tributary to a surface water su°pi�'• Within ; one CAS is .,vate water suooi• well. r(iC[ank tC sod absorption system and the _AS is within. 50 feet of a p• The system as a sew The system has a seottc tan" and toil absorption system and the feeounds indicates that c m has aseptic tank and soil absorption system fnd°1fio ba na,and volatile orbeanic comp r more from _ ,he Este ,p nitrate nitrogen is equal to or private water supply well, unless a well water analysis for presence of ammonia nitrogen and the well is free trom pollution from that facility and the P (approximation not valid). less than S ppm• Method used to determine distance 3) OTHER c`- -J ,=ev:sed Jai=S/9�1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORA PART A CERTIFICATION (continued) Property Address: JCO'zr~ -D::v� Owner: R i el,ae M aSSt� Date of Inspection: +12-4199 D} SYSTEM FAILS: You must indicate eii- er "Yes" or "vo" a< to eac^ of z:e following: have determined zhat the system violates one or more of the following faiiure c.itena as defined m 310 C�1R tS.�Cc_ The bans for iris determination is idenufied below. The Board of Heaitn should be contacted to determine .vhat will be ne_e-�ry to correct the failure. Yes do _ BnCkL'D 01 Sep+'ape into facility Or ;vsiem component cue t0 an Overl0oee0 or GOg�e7 SAS Or=°-`Spool. _ Discharge or bonding of enluent to the surace of the ground or surace waters due to an ovenoaded or c:og�'d SAS or cespcoi. Sfa;ic Iieuid level in the distribution box above outlet invert due to an overloaded or cio;ge SAS or c'- spool. _ _ieuid depth in cesspool is less than o" below invert or avaiiabie volume is less than 1i2 day f :io+•. _ Required pumpine more than times in the last year NOT due to clogged or obstructed pious). ,4umber of times pumped _ tion system, cesspool Or pr:vv is below Zile hie-n erounowat e er '.evation. env Qpr[iOn Or the :Cii absorp Any portion Of a Cesspool or privy is within 100 feet of a sur ace water suopiv Or tributary to a Sur-oz. water SUpD'tV. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any po ion of a cesspool or pri.y is within 50 feet of a private water Suopiv weii. 100 feet but recter than 0 feet from a private water supoiv well with no ?rn' portion of a c=scooi or pri.v is ,e_s :can e- +• of•.veil water anaivsis ;Or acreprbie water euaiiN anaivsis. If:he Weil has been ana:vzed zo be ac_ertable. artach cop. t coiirorm baceria. voiattle Organic compounds, ammonia nicogen and n:;:aie nitrOQen. Ej LARGE SYS i E-'1 FAILS: You rm;si indicate either -Yes- or"4e' as to eaci of the following: The followme c.aeria aoply to large systems in addition to the citena above: the syszern serves a `aciliry wan a design now of 10.000 gpd or greater (Large System: and the system is a significant threat to public health and safety and me environment because one or more of the followine conditions exist: Yes No ine system is within -100 feet of a surface drinking water supply he ;vstecn is within 200 feet of a tributary to a surace d y drinking water supply the sworn is located in a nitrogen sensitive area (interim Wellhead Protection .area - :'A;?A' Or a maDDed Zone II of a public water suepiv well) t'ne owner or operator'of any such system shall brine the system and faciii�• into 'uil compiiacce with ;he ground++ater treatment preeram ectruerrients of :1- 'NiR :.00 and 6.00. Please consult the local regional office cf ;ne Depa-"ient `or 'urge niorr-tauon. OSRA7 gYSTE.-M INSPECTION FORA SI BSiJRFACE SEWAGE DISP CHECKLIST �-( rl JG Property Address: Owner: j�:chcrr� Massce Date of Inspection: 4"124)9`1 "Yes" or 'No** as to each of the following-: Cne ck if the following have been done:You must indicate either Yes vo o rovied",� b,v the owner. occupant, or Board of Heaith. Pumping information P •t receiving normal o weeks and the syst has bee. g volumes of water have not been intrccuce; into the sys;em recently or None of the system components have been Largourre voi ,or at `w water flow rates3�OGPD during that period. Lar,e as part of this inspection. / As built plans have been obtained and examine, . Note t�,eY are not available ned .v�th �L - - she facility or dwelling was inspected for signs of sewage -a0:-'•%0- / non-sanitary or industrial waste flow The system does not receive `1 J _ the site was inspected.for signs of breakout. _ All system components• excluding the Soil Absorption S••s:etn, been site have bn located on: • I and a interior of the se. :ank was insoeC� for Condition of J _ The septic tank manhoies v+ere uncovered. opened• depth of:cunt. banfie� or tees, mater'ai of construction, dimensions, depth of liquid, depth of siud� ite mas been determined bast on- wr.er: were provided with info,,a.,ion on the proper maintenance of The size and location of t^e Soil Absorption Svstem on the s the facility, owner (and occupants. if different from o Sub-Surace Disposal System. Existing information. 'Ex. Plan at citena reta: to Par, C is at issue. x r-auon of distance is _ Determined in the :;eid 0i anY of the :allure unacceptap1e! [i 5.302c3)(b)l t_evas.d 91/=5/971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: +( 5cLoe _ Owner: 7,,o a,—Cj M`t55C- Date of Inspection: 412-n Iced T7 FLOW CONDITIONS RESIDENTIAL: Design flow: ?;?-,o p.dabedroom for S.A.S. vumber of bed:oorns: 3 .Number of Curren; residents: _ Garbaee grinder !ves or nor NO Laundry conneced to systern Ives or no',: YES Seasonal use tees or not:NO ((}} iva[er meter reapine�, if avaiiapie (last t%ti'o Q, year usage :gpoi: 199�: tog000 Gc!�or� lgq-7 IOS.co�) G7 Sump Pump (yes or no): WO Last date of occ::par.ci S�L»>'±�"' is us� COMMERCiAUINDUSTRIAL: Type of estabiishmeri: Design flow: zailorsJday Grease trao present: fives or noi_ Industrial Waste Holding Tanis present: Ives or noi_ Von-Sanitary waste Cisc-arzec :o the T,tie 5 system: :ves or no;_ Water deter re:C Ines. if avaiiabie: Last date of occ;tcanC:: OTHER: ;Describe! Last date of occ:_,oanC:: GENERAL INFORMATION PUMPING RECORDS ?rc source of Information: Systern ct:rnped as oar, of ir.spec=n: tves_or no; /_0 :f yes. volume pumpe : 2aiions Reason for pumoine: TYPE OF SYSTEM N_ Septic tank/distribution boxisoil absorption system Single cesspool Overflow cesspocl Privy Shared system Ives or not (if ves. attach previous inspection records. if any) I/A Technoioey etc. Coov of up :o date contras? Other APPROXIMATE AGE of all comoonents, date installed :if known) and source of :nformauon: Sewage odors detected when arriving at the site: :yes or io!NO w_a.d Ji/=5/9'} 7.q. 5 of 10 SLBSURFACE SEWAGE DISPOSRA7 CSYS+E,"A INSPECTION FORM PA SYSTEM INFORMATION (continued) Property Address: 4-1 Sq�he., ve— Owner. 9 ,GtiarA M GtSS� Date of Inspection: 4-f24119 SOIL ABSORPTION SYSTEM (SAS): `� approximated by non it:rusive methocs; ,,locate on site plan. if possible; excavation not requ,red. but may be If not determined to be present, exptain: Tvc': leaching o+ts. number:L leaching clambers, number:- leaching galleries. numoer:— leaching trenches. number.iensth:— 0 leaching 'ieids. number, dimensions: overflow cesspool, number: Iternative_systern: Name of Technologv: Comments: f condin condition of vegetation, tncte condition of soil,liens of hvdrauiic failure, levei o g. ��ew•s G=SPOOLS: _ lloc--te on site plan) cumber and configuration: Depth too of liquid to inie! invert: Depth of solids laver: eoth of scum laver. +rnensions of cesspool: .Materials of construction: indication of grounc.vater: as Dart of inspecton) innosr(cesspool must be punoec Comments: level of ponding, condition of veget--tion, etc.) tnote condition of soil, signs of hydraulic failure. PRIVY: ,locate on site plan) Dime, `tateriais of construction: -Depth of soi;ds:___ etc. Comments: thole conditior. of soil, signs of hvdraur+c 'a+iure, level of pond+ne. conoauon of vese'at+en. page 3 0! 10 ,=eviaed 04/25/97. SUBSURFACE SEWAGE DIS?OSAL SYSTEM INSPECTIO., FORNt PART C T SYS i E.'•t INFORMATION (continued) ?rooerty address: Owner: Date of Inspection: 4)ZA-I VI BUILDING SEWER: ;Locate on site piani i Depth beiow grace: 1,75 Material Of COnS;:G{On: G?S; tfOn ip PVC other (explain)� Distance from pnvate water supoiv weil or suGlon ime Diameter (n Comments: :.Conce::on of;oints, venting, evidence c: ieakase, etc) t SE?TIC TANK: v ,locate on site plan.) Depth below °race:Material of cons; vtoncrete _me*al _;_ibe'gia<_s _Poivemylene _othertexplaini _ cart;.-^e', by Cer; .ay!N G If tank IS meta;, 1i5: age _ is ate Dimensions: x 5" x Sludge depth: 1 ciS� Dis;ancL ircm = of s:ucze to bosom of outlet tee or bade: Scum thickness: Distance from :cc or scum io top of outlet tee or pis;ance rom '*c-om cf scum to bottom of cutiet i- or bat ie: How dimens{ors were determined: McGsu g R,o� J Comments> !recomme^•datic•^• for pumoinE. condition Ot inlet and outlet re-es or bartl�, depth or:iquid 'revel in ;e aticn tc c let inve!t. siruau:� inteen..-, evicence of ie3Kaee, etc.! rablew, GREASE TRAP: (locate on site Sian) Depth beiow trade: Material of construction: _concrete _metal _Ftbergtass _?otvethylene _othenexpiair.; Dimensions: Scum thickness: Distance from *,co of sa,m to top of outlet tee or oa-le: Distance from bottom of scum:o bottom of outlet tee or Barrie: Date of last pumping: Comments: (recommenca on for pumping, condition of in and outlet teds or barties. depth of liquid :eve; in elauon :o ouaet inye. . struGufai integnn•, evicence of leakage. etc.' 10 SUBSURFACE SE\vAGE DISPOS 7LCYSTEM INS?ECTION FORM PA SYSTEM INFORMATION (continued) Property Address: Lt'1 Sctcl,e�. �r` c Owner: n/Gt,G�d �IASSe Date of Inspection: moec prior to. TIGHT OR HOLDING TANK: i ank must be ?u or at time. or irsoecion) (locate on site pian) Depth beio- grade: le metal _iberglass _Polyethylene other(exo!ain) Material of construe,on: _concre. Dimensions: Qallons Caoacity:----- !(onvdav -NO Design 'low:— gz _ Alarm ieve!:�—Alarm in workinE order _� Cate of previous pumoing: Comments: itches. etc.) tcondition of inlet tee. condition of alarm and alcat .:w DfSIRIBUTION BOX:2 (locate on site plan) Depth of liouid level above outiet invert: ^. 25''QGIo�� 6raOC. ' of box. etc) Commence: uai. evidence of solids c2rrvover, evidence of leakage into or out (note ii levei and distribution is e? PUMP CHA,uBER:_ (locate on site olani Pumos in working order: (Yes or No)— Alarms in working order(Yes or Noi Comments: condition or pumps and appurtenances, etcl (note condition of pump chamber. P.qe 7 of 10 (_evla.d 04/25i97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMA PART C SYSTEM INFORMATION (continued) Property Address Owner: R t-k,.rG Ma55(i Date.oi Inspection: t�I241q� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least :'No permanent references landmarks or benchmarks locate all wells witnin 100' (Locate where public Water suppiy comes into house) 441 ,to i Ll 7 CL SI�GH�M DANE ,.4. s 0! :3 tiwiaed J�.:.!5-1 d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 4( Sa��e�+ ��� e Property Address: nn v Owner: iG�ar� mosse Date of Inspection: +)24-Igq Depth to Groundwater 2'4 Feet ?lease indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abuning property, observation hole. basement SUMOetc.: Determine it from lor,-1 conditions Check with local Board of health Check FEMA Maps Check Dumping records Check local excavators. installers Use USGS Data (Must be completed) Describe in.our own words how you established ;he iii2h Cround�vater :ievation. , ele��v,vr. wGS �5� w-�4c-c r j�o r cG ,^, , (,�_ S C; '!me- �jro GiW `tom. COX f ,4�1 e S �rdAuce C{ )j re V i eW �.S 1"�5 G u h ems,.! e.v e l Y J �o J , b US GS. 4-o -t-, cJia�..�..�s`�a-r o-4 y below c S r ce SCsdc s ppra Y. r.,etva 2q- -- { ql i I r to-y-99 qj s'm4kew. Dr. lckfti,I:/lt 4.Ca c (n.�,•,s ri+• Solids ObSGPvtd ova �;qv:Z ►h p �- o.�.oQ o r► �+• w►tl L•P• 4 C4N•I&S r h, .�yy F. Xf� 1 i.=�.�` ,�� i'. :' �v �,; _..� i �r +��•F+� /0-y-99 `� 1 Sa��.eK, Pam. Caht���:lle ill "4\044 114, C)l Ll- I k-e c., G6 cx'�.0 A'i III r, I'i ----�.. y i L e,L-c/ cam-., g e — ii/o ?,�i •�e to�e�t�c..v� t iJ r 1 to (�11 r C� t Cam— ";13 4o r.i ' 1 1 f r, 1kt e 1 }} (,s r+CF`�ff f A � tNETO Town of Barnstable y * Department of Health,,Safety, and Environmental Services *�BARNSPAB;.Fn NAM • R, a :u ...< a s659. �0 c Tealth D><v><s><on 4i'°rEcr,�oy°- 167'Main,Street'Hyannis,MA 02601:` Office: 508-790-6265 t Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Heal th October 15, 1999 Russell and Susan Nesbit 26 Beach Plum Hill Osterville, MA 02655 RE: 41 Sachem Drive, Centerville Dear Mr. &Mrs. Nesbit: On October 4, 1999, Jerry Dunning and Glen Harrington, R.S. Health Inspectors for the Town of Barnstable Health Division visited the property at 41 Sachem Drive, Centerville, MA. The Inspectors visited the property at your request to inspect the existing septic system. An inspection by Louis Berger & Associates on April 26, 1999 concluded the septic system "passed". Later, an inspection by Joseph P. Macomber on August 10, 1999 concluded the septic system"failed". The October 4th inspection by Health Inspectors Jerry Dunning and Glen Harrington consisted of a visual examination of the septic tank, distribution box and leaching pit. Conditions which were observed are listed below: Septic Tank The septic tank had'been pumped and cleaned by Macomber's as part of their inspection. Therefore, any evidence of historic liquid levels were inconclusive. There was evidence of solids in the invert of the outlet pipe. Distribution Box ~. _ Observations of:the distribution box did not indicate any evidence of historic surcharging e.g.: a liquid level'above the outlet invert, or black soil above or around distribution box). There was evidence of solids carry over due to the sludge layer in � s NESBIT 41 SACHEM DRIVE CENTERVILLE,MA the sump of the distribution box. The above observations were partly obscured due to the fact that the distribution box cover collapsed upon excavation. Leaching Pit The exposed leaching pit was approximately four feet below grade. Solids were observed on the bottom of the cover indicating that the leaching pit was surcharged at one time. Evidence of historic surcharging is considered to be one criteria of a"failed" soil absorption system. Solids were also witnessed to be on the liquid surface within the pit. Solids on the liquid surface indicates solids carry over which contributed to the hydraulic failure of the pit. A black soil layer was not observed above the pit cover. A black soil layer would indicate evidence of continuous ponding of effluent above the pit cover. Conclusions It appears that due to the lack of the evidence of failure in the septic tank and distribution box the leaching pit was working marginally as to not allow back-up of effluent back into the previous components. This may occur because there is an approximate two foot drop in elevation between the distribution box and leaching pit. The historic evidence of solids on the bottom of the cover would indicate previous surcharging and "failure" of the leaching pit. It is therefore concluded herein that the septic system"failed". If you have any questions or comments, please do not hesitate to contact our office. Sincerely, �� Glen E. Harrington, R.S. Health Inspector �FTHE Tn._� Town of Barnstable * �ast�, ; Department of Health, Safety, and Environmental Services 9� 1639. ••�°' Public Health Division iOrFn�� 367 Main Street, Hyannis MA 02601 FAX Date: JO Number of pages to follow: Z To: �J From: V/O Phone: q 5� Phone: 508- Fax phone: - / d-- L( 1 7 Fax phone: 508-790-6304 CC: REMARKS: Urgent For your review Reply ASAP Please comment ASSESSOR'S MAP NO. PARCEL LOCATION �' SEWAGE PERMIT NO. ,VILLAGE INSTALLER'S NAME ADDRESS e UILDER ' OR OWNER 26 Lev t-, 4, V-J S- i DATE PERMIT ISSUED S` DAT E COMPLIANCE ISSUED G r ` /; 1� 1 • _ � Y 1 �� �� �5�' . , � _ $p• �� i THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH Otic...- OF..... .A\2.1.A.6.77N,5A. .Qa................•-•-•-•--•---• , pplira#ion for DhipmFai i0orka Tonstrnrtion ramit Application is hereby made for a Permit to Construct (YQ or Repair ( ) an Individual Sewage Disposal System at: -•-•---•----•-••---- .................................... . ................................................... 0i t lner �ie; -•--•-------------------------------------- •-•----•--• -- �_ to------------ •-•---.........---•.... ..1.4 Installer �� Type of Building a� � Size Lot.'-�------ feet V Dwelling—No. of Bedrooms-----3..................................Expansion Attic,lb Garbage Grinder `4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ...............................:.. W Design Flow............15.5.....................gallons per person per day. Total daily flow........13AO..................... WSeptic Tank—Liquid'capacitylQ ..gallons Length6°-Ga..1'... Width -'--to.".. Diameter..............•. Depth:15_'_.q.e.: x Disposal Trench—No......... ..... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......... Diameter.......&......... Depth below inlet......4......... Total leaching area.2oO....sq. ft.' Z Other Distribution box �s Dosin ti nkPercolation Test Results Performed by... P6.._21...... SLR- .S......................... Date.... .`1 _0 `� a Test Pit No. l.LZ-.......minutes per inch .,:"Depth of Test Pit....12 .......... Depth to ground water 1301�y[Quo.t�CZij-j f=, Test Pit No. 2................minutes per inch' Depth of Test Pit.__...�7=n..... Depth to ground water-------..........._... 2 © ..... O Description of Soil............ 2 �L �--..AZ......��--...... !-A.1D................ x V ...•-••••••--•••••-••----...-•.............•-•----•---•-••••••-•---•--••••------•----------.....••-•---••••••----•-----•-•--••-•---•-----•------•-----•-••••-•-•--•••••••••-•--•--•-----••...........•••. ----------------------------------------------------------------=----------------------•--...---....----------------------------------------•- --...--•• . U Nature of Repairs or Alterations—Answer when applicable------ C ..:.:........��� -c -••--••••-••-•-•---•••••-••••--••-----•••-•• •-- . ••--- •... �hV .....•-••-••._.......•--•-•......---•--••-•--•-•--• ---•••-••---......•-• •-•-••-----------------••• Agreement:The undersigned agrees to installdescribed Individual Sewage Disposal System in accordance with the provisions of TITL4, 5 of the State Sanitary Code— The undersigned"�further agrees not to place the system in operation until a Certificate of ompliance has board of health. Signed J 4 ....e— ................. • ate A lication A roved B -....... -• --......-� - - ---••-------------------------------- 1 -------- PP PP Y ----- Date Application Disapproved for the following reasons:................................................................................................................ -•----•-----------------•---...--•--•-------•----------•-----...............-----------•---....--•------.._.........-•-----------•-----------•---•-•----------------------....---•-------•---••----•----- Date PermitNo................ - ......... Issuer.....----•---------------•--••--•-------------------.. Date JV No.... - j 1 FEZ_7_ ........' THE COMMONWEALTH OF MASSACHUSETTS BOARD�OF HEALTH I C7�,v n.l i£ A�Z ...... ........... ....................oF..........-----.......... ................................... ApplirFatiun for %ipaaFal Works Tontitrurtton rrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: '1 t ........... ." `� _!=.. ..................�_t-.....-----....---------•• --•--•----....::'�...........,..� -..... -- ation- ddre `- !�:! K► 5 ! u,T'............ ...........,ZZ..----.... T--.................. ` ... (� wn r 1 Addre a 1�-:.`Qf4 .__ e jbEs .. .......................��t!4 M........r. ' S Installe I J Add _ U Type of Building j Size Lot--- _ C Sq. feet a Dwelling—No. of Bedrooms.......:...................................Expansion Attic ( ,)) Garbage Grinder p-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ......................... •-•----••••-•----••-••---•-- Is�:. W Design Flow................................•...._._____gallons per person per day. Total daily flow-__--•-` _ .....................gallons, WSeptic Tank—Liquid capacity�.,�__-Qgallons Length�__<_..'._.. Width.`-:!�'... Diameter.............••• Depth. `�..`_ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...........t__.,.�.. Diameter.......?-. ........ Depth below inlet__....._........ Total leaching area._r�2 ....sq. ft. Z Other Distribution box (�( ;`� Dosing tank ( 0 Percolation Test Results Performed b ._ ?f `-.... ..............la 5 • ,-7 •.-• ---_--•. •••• Date------'--�. ....Y _ _. Test Pit No. I_ = .......minutes per inch Depth of Test Pit.... c_......... Depth to ground water.. �)..t;;VJ�v�.e f� Test Pit No. 2................minutes per inch Depth of Test Pit........... ..... Depth to ground water........................ ----------------------------------I...................................................••........-•-•-•--•-••••. Description of Soil.................. -2- - x V •••----••••-•-•----•••....--•-•••••-••••--•-•--••---•---••••-•....-•--•--•••---•--••......•--••-------•-•-•----••--•-•----••--••-•••-•---•--•-----••---••-•••-•••-•._....•-•-•••-•••--••---••-•--_--••- W -- -, -------- ------••- V Nature of Repairs or Alterations—Answer when applicable..... ... ---- [ ---�Kt-'r-f; .....t ...... s'�•-•• ti'A Agreement: The undersigned agrees to install the oredescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a.Certificate of Complian board of health. Signed .............. Diate Application Approved By............... . --•-•-• ........................................... QG 4 Date Application Disapproved for the following reasons:-............................................................................................................... --•-•-•........••••-•-•-•-•-•••-•......••-•-•-••...---•--•---••-••---•••-••••-••-..._•--••••-••••-•-•-----•-••-•.....••-•-•--••---•-•-•-•-•----•••••------•••---•----•-•------•----••--•--•-----•-•••-- �j Permit No.......... ! •-------- Issued........................................ Date ate Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (9rdif iratr of ToutpliFanrr T-H-IS I,S TO CERTIFY, T at the dividual Sewage Disposal System constructed ( ) or Repaired b ( ) (11 Installer has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as escribed in the �.,. application for Disposal Works Construction Permit No.___-�- �._!__C-----__... dated - -_ .-.•----•••••-• THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WF FUNCTION SATISFACTORY. DATE.........................I(s G..................................... Inspector. THE COMMONWEALTH OF MASSACHUSETTS �---- uu BOARD OF HEALTH o `- • �...N FEE-` ........... Permission is hereby granted.......................... j t --- o -----------------••----------..........•••-•..............• •............. to Construct ) r Repair ( n I lvldual Sewage Dispsal-System at No................ ' .- t 'A� .. -----••------•-------------------- ....... t Street ` _______ as's�hown on the application for Disposal Works Construction Permit No D ted_. aiy t , Board of Health1� "......................... DATE: r;_ �. ..............................lx FORM 7-2; OBBS & WARREN, INC., PUBLISHERS S I NG-L_E FAM t LY -- 3 BC-DkZ n P1 No fs�\Z13AG E GtzltJ oElz.. DAILY F —Ow = 11 o K 3 =.330 &R D. 5EPT1 C. TAN 1�. = 3 3 o'n I TOA - 444 S G'.P. D. USE l o0o GAi,,,,. TANSY. DIS?oSAL P► r vsE W loco CAL siDEWALL A2.EA ' S, r G. P. D. To AL G. P. C ToT/aL UP+ILV 1 l.o,n/ = 33,O 6-. P. D. 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