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Home My WebLink About0039 SETH PARKER ROAD - Health 39 Seth Parker Road Centerville A= 170-200 rs gr d o� it I andaflo�' OEss & 4210113 ORA 10% P4 i : , 3 _ I 77 ! Bo r - -- --� F 111 wa , —r- I i i ' Ir ' ---F-,I► 'ma's L_�� _ t -. .---- --- ._.. �.. I -�- I Iva- eei - I , Cc 76 i - ----- , I i I I I i I 1 _ I R ; eJ({� I I i � , , i C11 1 141 x EE ! !_ = a ' I , ' ! I i i,• I I I I � I 'I I ! I I ; I ? � I � is . , Lett Ll i ' ! I I I ' -'1'- +_. I i I i i —i �-_T I � I I .�•. _ + '___ 'F f'rs�'u. _- ,- 1I . Commonwealth of Massachusetts A Title 5 Official Inspection Form 1�, r1$ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M . 'r� 39 Seth Parker Rd l° vl 0 Property Address Rigney Owner's Name '�INA' Centerville MA 02632 10/15/08 � Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name 25 Deer Ridge rd Company Address Mashpee MA 02649 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/15/08 Inspector 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. ul i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 City/Town State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Pumping suggested every 3 yrs to prolong the life of the system 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 win' naa`. Ali_ far yes, no or not determined (Y, N, ND) in the ❑fir.he following statements. if"not deter minea.Y piease expiain. ❑ T he septic tank is innetal and over 20 years old*or tie septic yank(whether metal or Hot". is eiruvturaiiy unsound. exhibits SUDStanvai innitration far exiinration 'J'r tans Saiitire IS imminent. Ssst m ill pass inspection i_ t^e_eats__n tank i:s r msF.a_mod z .t a rm-1 v-1_n� 9_ iC i n^-_ nn n ;Pprc,vPctl hv the Board of Health - 6 met;i septic nk wi'-i nas- ino_ rtir+n it i- i struci�'ralk,--i- n_ ° ;s in n�i i. f`e-i€n to -_ - _��a - -=Je-e _- - - - - _v_`3�. ..:SE a ..err.a.-: s- a __.Lase ;f Compliance indicating that the tank is less than 20 years old is availat=le_ ND Explain: ❑ f?I�s rtJ ib i sew%af 6 to€=lC[3q�y �'r heal flit er ii l� 7 sir W f r level in th€_dicitrihiitinn MY r1 €e i°,r v s r -we " r,r r.e,+n s-. °y. 5' s�Ysi-^�..; n? t v-E n "nee 11,0. 1 .v arc+_. Iis s :fJ,er or Ga�e.liV�ae i€s�{S 01 °-U-- to a DWOKen, ettie v, i s e cos 4:�€:Eeiacf,ti: ud�. Zg39L-- ;�Eiii pass inspection '! (with approval of Board of Health" Cj broken pive(s) are replaced obstruction is removed ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 Cityrrown state Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health(cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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 this form. 3. Other: D) 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 ❑ ® 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 %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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 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 acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliforrn 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ 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"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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 NIA) ® ❑ 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)] i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): unk Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date 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 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): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: pumped every 2-3yrs per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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: 1986 per age of home Were sewage odors detected when arriving at the site? ❑ Yes ® No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2'6" feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) tank equipped w/risers If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000g Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle n/a Scum thickness 1/8 Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y< 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cunt.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert level w/the bottom of the pipe II 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.): D-Box is 2'6" below grade. No adverse conditions at this time Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Pit is 3' below grade and equipped w/a riser. It has about 1'of liquid in it at this time. No adverse conditions at this time Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >40' 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: 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: You must describe how you established the high ground water elevation: Cape Cod Commision well data Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Seth Parker Rd Property Address Rigney Owner's Name Centerville MA 02632 10/15/08 Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i D- A I3 ( ,-ate S 31 ' c 3� �J 3(0 D a-9 a L� G 4 9 �- � a} � i 604*3T SEWAGE PERMIT N0. LL A " £ NsTA L R'S HA ME ADDRESS v M'U i L D E R 0R. OWN EN 41;q1j 4 A 4 ATE PERMIT IssuEO 17 l-o r G 5'3 �3�oclC. r 3L' 3 THE COMMONWEALTH OF MASSACHUSETTS BOARD-QF HEALTH -tlo. ....A— Application is hereby made for a Permit to Construct �04) or Repair ( ) an Individual Sewage Disposal System at: eV kf2l �> /0 Address ...owo............................ ........;K-�00�- ...... -------------------------------------------------------- Ins—taller Address Type of Building Size Lot! J!!��Sq. feet Dwelling—No. of Bedro Garbage Grinder Z Other Distribution box Dosing tank .........................................................................................................................................................................`............................ undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �t e visions of'1IT, j 5 of tate Sanitary Code—The undersigped further agrees not to plac esy min P e��--Msr 5 1 arc e -I- e pliance has Xbeed b�y thQMZ 0 ion of health. -- ----- --------------- pl, pproved y......................... ...... ........ ......... .................. ... .......... Date plication Disapproved for the �^ \/ ..............---..---..............................................--'r---------------- --- | Permit No------------.......................................................- —Issued....................................................... / --- | -~~-----''''---'''—'--------'--' ' Ap w No-..............._....... Flcs.......... .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD- OF HEALTH r ....... .... ....................OF...-..-.....:..................._....._.... Apphration for Disposal Works Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct ( ,. ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. W n Owner Address Installer Address UType of Building Size Lot__..........................Sq. feet 1—I Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) el Otherfixtures -----------------------••--------------- W < Design Flow___________________________________________gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------•-----------------------------------------------•--------...-•--•----•••..__...-••------•......................................................... 0 Description of Soil........................................................................................................................................................................ W U -------------•-•--------••----•-•-•-•-•-•••••------...••••-----.....----•-•._..._..--••...•--••----••---•----•----•••-----••-------•----•••------•----•---•--••----•----•..._..-••-••--••-----•---•--•- W x -------------------------------------------------------------•-------•----•---•-•-------•---•-•--••-------•••--------------••--...----•--•--•------•-•-----•----- ..................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------------- -----------------•--------•---•-------------•---•-._..........----•-•-••-•••----------------•-----•-•-------------•----••-•---- ...................................... Agree nt: undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t p visions of TIT = 5 of t State Sanitary Code— The undersigned further agrees not to place the system in op on u i a. r h ,e mpliance has been issued by the board of health. Signed...............I.......... --------•-•-- ----------- ---••-•-----•-•••-••. ............ P • t• pproved y.......................... = ---- ...._ .. }----- ..... ......... A ate lication Disapproved for the following�easons-------------•---------------._...----------------_..---•---•--------------•-•••----••--•----- •-------•----- ----•..............••--•--•...---•-._...--•-•-•-•-...--••---•...--------••••-••-------.......----•-•......___....•-------•-•-•--•--•-----•-•----•-•---•-••--........................................... Date PermitNo......................................................... Issued-............-.......................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..........................--....................................................._... Tnrtifirair of (Sontplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by---------------------------------RG0_-P,-TA------------ -------------------------- - Installer has been installed in accordance with the provisions of TITIF 5 of The State Sanitary Code as de c 'bed in the application for Disposal Works Construction Permit No..•__________ �i__'_ dated_-...-__.-.t _ ......... TIME ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE HAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--�i_�-____--•--•-•--------•----•-----.. "Inspector ---=-= ��------------------------------•--.....---...--------•---.....: t . THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH .............OF No..... 1�j FEE- _......... Disposal Works Tonstnu#ion 11nmit Permission is hereby granted..............--f 4:��e•'�`-�---___-_C.U.-K.............................................................................. to Construct ( or Repair ( ) an Individual Sewage Disposal System at No..................-....... ..............a£.'Tq P. y_st*!- Street as shown on the application for Disposal Works,Construction Permit No.__ ._:;). Dated________� .�_ _ l f B :a ► 9�_ ---•-----• 4o�Hhand DATE__ _�_ FORM 1255 A. M. SULKIN, INC., BOSTON DE51C,N D/-TT/-\ t� �-rnINGLE FAMtt`I - 3 BCptZc�nI`1 5CTk-� PAa-K--(L k2 I ,No 64W-QA&E G9-It1 DCtZ SIP FLavj = Ito x 3 330 G.P. t�:" t oo, on' , SEPTI c T G.P• D• ' ' , U5E %o0o . .-. GAL. TAK�1L O�SPoS�L PST v5E C1) t000 GAL. 1z' ' 37-';" fT P. O. FN p S fo-r 'oM A 9-EA = So S•F. b S"L m z T67-A L. OESIG+V 4ZS G. P. O. i ToTAL CA Flow/ - 33o CT. P. D. l - , P J47 iory P-A 11"ItU Z M,Al 02 UESS 11pic - vZN.OF y •tN b 14 '_.. .. PETER Gam,.: ' ; IS�I�j 2 s•F. 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