HomeMy WebLinkAbout0760 SOUTH MAIN STREET - Health 760 SOUTH MAIN ST., CENTERVILLE
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UPC 12543
Now JT.CpS1
HASTINGS,0,1
DATE: 1 /9 95
PROPERTY ADDRESS: 260 South Main Street
-- Centerville ,Mass
0/6 02632
0
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. 2-61x8 ' block cesspools .
Based on my inspection, I certify the following conditions: OV 1
1 . This i•s a title five septic system. ( 78 Code ) oFA
11%'9
2. Both cesspools are clean and dry. ` ir�nF
3 .The septic system is .in proper working order at
the present time . `
SIGNATURE:
Name:,,JQ.s_Qj2bi_j._ Macomber Jr .__
Company:-J_P_Macomber-& Son Inc .
Address: Box 66
Centerville ,Mass . 02632
--------------------
P h o n e:_ 5 0 8_72_5=3jj8--------
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tan ks-Cesspools-Leachfields
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
.775-3338 775-6412
an commonweafth of Massachusetts
Executive Office of Environmental Affairs
Department of ;
Environmental Protection
William F.Weld
Go emor
Trudy Coxe e
S�,r,.y,EOEA
David B.Struhs
Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 760 South Main Street Address of Owner:
Date of Inspection: 11 /6/9 5 (if different)
Name of Inspector: Joseph P. Macomber Jr.
Company Name, Address and Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature i «�"' Date: l ✓
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 gpd 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 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES:
10 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 why not)
The septic tank is metal, 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 conforming septic tank as
approved by the Board of Health.
(revised 0/15/95). 1
One Winter Street • Boston, Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION.(continued) „
Property Address: 760 South Main Street Centerville ,Mass .
Owner: Neva Baine C/O Neva Murphy
Date of Inspeclion:1 1 /6/9 5
B) SYS1 EM CONDITIONALLY PASSES (continued)
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 pipets) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE:BOARD OF HEALTH:
AV 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.
2) 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:
t The system nab a SePUL kink drw >Uii dU:'UrpLiull iystem and iS vr;thir. 100 feet to a Sur(acc wa..er Supply Or t:ibata:'j Ic a
surface water supply.
11�z The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
d12 The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
&r 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 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.
D) SYSTEM FAILS:
I have determined that the system violates 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 of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
(revised 8/15/55) 2
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
i CERTIFICATION (continued)
Property Address: 760 South Main Street Centerville ,Mass .
Owner: Neva Elaine C/O Neva Murphy
Date of Inspection: 11 /6/9 5
D) SYSTEM FAILS (continued): •
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
j� Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
�Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
A? Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
�0 Any portion 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.
/V Any portion of a cesspool or privy is within 50 feet of a private.water supply well.
/lip 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
U coliform 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 design flow of system is 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 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
phi 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 5.00 and 6.00. Please consult the local regional office of the Department for further information.
r
(revised 8/15/95) 3
V
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 760 South Main Street Cc�nanterville ,Mass .
Owner: Neva Baine C/0, Neva Mur�&
Date of Inspection:1 1 /6/9 5
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of Health.
2None 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.
4�xBAs built plans have been obtained and examined. Note if they are not available with N/A.
ZThe 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.
\,J
All system components, uding 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 or
approximated by non-intrusive methods.
, The facility owner. land occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
I
(revised 6/15/95) 4
• I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 760 South Main Street Centerville ,Mass .
Owner: . Neva. Bain C/O Neva Murphy
Date of Inspection? 1 /6/9 5
FLOW CONDITIONS
RESIDENTIAL-
Design e
flow: 0.6�1) Rallons&dk/
Number of bedrooms:
Number of current residents:
Garbage grinder(yes or no):
Laundry connected to system (yes or no):
Seasonal use (yes or no):
Water meter readings, if available: •qq'r3,
. /
Last date of occupancy:-�
COMMERCIAUINDUSTRIAL:
Type of establishment:. A'W —
Design flow:A))P gallons/day
Grease trap present: (yes or no)�I
Industrial Waste Holding Tank present: (yes or no)_
n-sanitary waste discharged to the Title 5 system: (yes or no) -d
`,Ater meter readings, if available:
Last date of occupancy:
OTHER: (Describe) NA
Last date of occupancy: l,1
GENERAL INFORMATION
PUMPING RECORDS ands urc of information:
tir�r i , 1�.
System pumped as part of inspection: (yes or no)/LVI
If yes, volume pumped. AW gallons
Reason for pumping:
TYP!E,PO,f SYSTEM
Septic tank/ ' soil absorption system
Single cesspool
_A,0 Overflow cesspool
Privy
4V Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other(explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information: le
,image odors detected when arriving at the site: (yes or no)
(revised 6/15/95) S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
i PART C-
SYSTEM INFORMATION (continued)
i Property Address: 760 South Main Street Centerville ,Mass .
Owner: Neva Baine C/O Neva Murphy
Date of Inspection:) 1 /6/9 5
SEPTIC TANK: I�'9�19 �
(locate on site plan)
Depth below grade:!D
Material of construction: Zncrete_metal _FRP other(explain)
Dimensions:
Sludge depth:_
Distance from top of sludge to bottom of outlet tee or baffler
Scum thickness:_
Distance from top of scum to top of outlet toe or baffler_
Distance from bottom of scum to bottom of outlet tee or baffle:,
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
i tegrity, evidence of leaka e, e •)
A
GREASE TRAP:
(locate on site plan)
Depth below grade:,/
Material of construction: _concrete _metal _FRP—other(explain)
NA
Dimensions: 4%,
Scum thickness:
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of From tn bottom of outlet fee or bahle:h$_
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth-of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) �P
(revised 6/1$/95) 6
Y SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 760 South Main Street Centerville ,Mass .
Owner: Neva Baine C/O Neva Murphy
Date of Inspection: 1 /6/9 5
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grader
Material of construction: concrete_metal_FRP_other(explain)
AW
Dimensions: Nd
Capacity: I allons
Design flow: IV gallons/day
Alarm level: 194
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: J
(locate on site plan) n
Depth of liquid level above outlet invert: ILF�1
Comments:
(note ii level and distribut.w. i.equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)JV�
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised�8115/95) 7
i
i
SUBSURFACE SEWACE DISPOSAL.SVSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 760 South Main Street Centerville ,Mass , 02632
Owner: Neva Baine C/6 Neva Murphy
Date of Inspection:11 /6/9 5 •
SOIL ABSORPTION SYSTEM(SAS): •
(locate on site plan, If possible; excavation not required, but may be approximated by non-intrusive methods) '
If not determined to be present, explain:
I '
Type;
leaching pits, number: n
leaching chambers, number:
leaching galleries, number.,,,
leaching trenches, number,length:
leaching fields, number, direr gn ons:
overflow cesspool, number:;,
' Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
CESSPOOLS:
(locate on site plan)
Number and configuration: (o
Depth-top of liquid to inlet invert:
Depth of solids layer: Qk'
Depth of scum layer: R
Dimension's of cesspool:
Materials of construction:
Indication of groundwater: QRY
inflow(cesspool must be pumped as part of inspection) Day
Comments: (note condition of oil, signs of hydr ulic failure, I vel of pon •ng, con ition of vegetation, etc.)
PRIVY: •
Ns-
(locate on site plan)
Materials of construction: NA Dimensions: A,W
Depth of solids: Q,r
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 6115195) 8
TOWN OF BARNSTABLE
n
LOCATION "`1'p FPG,t2 7)22 �7.W e-V 7 SEWAGE #
VILLAGE �r:% ��yt AL ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) C (size)
NO.OF BEDROOMS c� r��7 spGC1104
1
BUILDER OR OWNER
PERMITDATE: 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) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
-- � �.
/�
� YID' %/o f�'�►
� A^
`� �r
(� .�qui'le "�f1�+n s� can-r�rv�i�l�e� ,
3vusvRtRLt 7EFYKGE�I�P05A7 5SILM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 760 South Main Street Centerville ,Mass .
Owner: Neva Baine C/O Neva Murphy
Date of Inspection: 11 /6/95
•
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
Town Water
r r R
ii
7 <qu ri) m6li-n
TH TO GROUNDWATER
th to groundwater: 20± feet
hod ofdeincoun e e` 'm o Installed s•ytem next door. Test hole 131 no water
' on knoll
+ised 8/15/95) 9
ll ,
>•rmnrn.—rtrrs+-'.'n— rtrrmr•nts*rrrnn rerrmarnrrr!rnr:�+rrenrm m-v rim. tr,rs� '
TURN OF Barnstable BOARD OF HEALTH
�J h•••41N.T•!_;;,_T•Iln_.SUI1SUf►FACF 9F,HAUF I)ISI'USAL SYSTEM IN�9IFCTION FORM - PART D^T CEIZTIFICATIUN�:' -,
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 760 South Main' Street Centerville ,Mass .
ASSESSORS MAP , BLOCK A..NJ PARCEL #
OWNER' s NAME Neva Bain C/O Neva Murphy
PART D - CERTIFICATION r
NAME OF INSPECTOR Joseph P. Macomber Jr.
COMPANY NAME J.P.Macomber & Son Inc.
COMPANY ADDRESS Box 66 Centerville ,Mass . 02632
street Town or City 8tat� LIP
COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( 508 1790 1578
A
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal 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 :
XXXXXSystem PASSED
The inspection sihich 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 ►lealtli and the environment .in accordance with Title
5 , 310 CMR 16 , 393 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signatur Date 1 ��
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF 11JUAL7'11.
* If the inspection FAILED, the owner or" parator shall u d
within one year of the date of the inspection, unless allowedortrequi;redhe m
otherwise as provided in 3.10 Chjn 15 , 305 , "
U
�..
W
UI �C1
r
ASS 1��C`
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