HomeMy WebLinkAbout0288 STONEY CLIFF ROAD - Health 288 STONEY CLIFF RD, CENTERVILLE
A=190-158
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UPC 12534
No.21 53 QR �`9r
HASTINGS,YN
10/26/00
DATEt_________-- �.
PROPERTY ADDRESS:?? Stoney Cliff Road
—_ 02632 __
On the above date, I Inspeoted the septlo system at the above address,
This system conslsts of the following;
1 . 2-1000 gallon precast leaching pits.
eased on my Inapectlon, I certify the following oondltlonv
2 . This is not a title five septic system.
3 . This is a sewage system. 1st, pit acts as a septic tank. Solid waste
is contained in the 1st pit. Waste water passes from the 1st pit
to the 2nd pit.
4 . The waste water pit is presently dry.
5 . The sewage system is in proper working order J 'f�
at the present time. SIGNATURE:,./
6 . House has been vacant for 2-months.
Name :_ -K�s.smttr—.,ir--__..___
Company:-Lo'•.Ph_P: Hacomb.r-& Son , Inc ,
43
Address :_ box_66--------------- r� ,Zo
CentervilleHa�_02652-0066 Phone __ 508_775_ 3338m
THIS CERTIFICATION OOES NOT CONSTITVTS A OVARANTY OR WARRANTY
JOSEPH P, MACOMBER & SON, INC,
T�nks•Q�sspools•L�ichfl01d4
Pump:d L Installfd
Town Stwor Connsotlons
P.O. Box 6776.3339o�77, MA 02632.0066
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE %INTER STREET, BOSTON MA 02108 (617) 292.6600
TRUDY COKE
Secrvtiry
ARGEO PAUL CELLUCCI DAVM B. STRUHS
Comm:utoner
Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPI:CT)ON FORM
PART A
CERTUiCJ►TION
228 Stoney Cliff Road Narn.ofQ_ Richard Miller
Property Adersaa. Address of Ownw: W 1 ye
Centerv� lle,Mass. 02632
te Da of vapecvon: Edgewater Maryland 21 037
N,,,s, of h,p.c=: (please pry J o s e p h P. Macomber Jr.
I ant a DEP approved syswn irupector purvwrt to Sectlort 16.340 of Thde 6(310 CUR 16.000)
cor,p.mN,,,,.; Joseph P. Macomber & Son Inc.
u,i„gAddr*": ox "I Centervii1e , M 632-0066
T etep►rone NIsrnbw' — —
CERT1FiCAT10N STATEMENT
I cart ty that I have personally Inspected the sewage disposal system at this address and that the Information reported below Is true, accurate
end complete as of the dme of "pectlon. The Inspection was performed based on my training and experience In the proper function and
me,ntanence of on-site sewage dlsposal systems. The system:
;zL Passes.
_ Conditionally Passes
_ Needs Further'Evel stion By the Local Approving Authority
Fails
Ile,
yupecrtw s $ignrture: Dau: Il
The System Inspecto hall submit a copy of this Inspection report to the Approving Authority(Board of He&" or DEP)wltNn 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
mail submit the repon to the appropriate regional oMcv of the Department oM-tvkonm*r%TW f'ratectlon. The original should be sent Comm
system owner and copies sent to the buyer. If applicable, and the approving authority.
NOTES ANO CONIMENTS
revised 9/2/98 Pigs, lorii
" Pnnted on ftecyckd Prper
Y � i
SV&SVRFAC9 SEWA09 DISI OSAII SYSTDA W3£CTION FOFW
PART A
CERT'ViCAMN (corrtLti-s-041
f'yop.�tYAda.aa: 228 Stoney cliff Road Centerville,Mass.
01WTW-. Richard Miller
(>- -1 10 2 6/0 0
awS.EC'no A, 6, C,
A S STD.( PAs
kl?)_ I have not found .ny Information wNch lnd)cates that any of the faAvre otx►d)dona described In 310 CIVIR 14,303 ssl#t. Any faJ
crherta not svaJuated us Ind)coted below,
COW-lF M;
1. SYSTDJ CONDMONJU.LY (ASSES; c
One a more system sompononu a described In the 'Co"doeW /as' soodon Mod to be repl000d a repaLed. The sy-st.m,
cwnpledon of the rspJasement or repair, ea approved by the Dowd of H*aJth, wW paaa.
tndcote yes, no, or not dotorminod (Y, N, w ND). Dacrtbe baaJ* of dotwminadon In all butanes*. If 'not determUwd', sxpJeln why rwt.
The septic tartk Is motel, urj#e# the owner w opwotw has provided the system Inapootor whh s sopY of a C+rVA"'a
Compusnc• (snached)Indcedno that tho WA wee ktat"ed wl%Nn twenty(20) yew#prior to the date of ttu wp.cvc
the septic tank, whether or not metal, la orooked, strtrawrally unwound, show# avb*tandaJ In&V#don w oa"610 n, a
rally# Is ImmJnent, The system will po#e kupeodon If the *xJ#dno aepda tank 1# replaed with a oomp1y4n9 eepvc un
approved by the ioard of Hoalth.
Sewage backup or brsakout or high #tado wets(level observed In the dJeVlbudon box 1# due to broke++ w oartrvct.d v
or dve to a broken, ►styled or uneven dl#Vlbudon box. The system wW pas Irupoodon If lwflm approval of V%4 604uo c
HealN.
broken plps(s) we replaced
obsvucdon la removed
dJ►Vtbudon box Is levelled w replaced
• The sy+nem reQuksd pumpMpinot'a W broWvna obaovotod pipolel. the vYvtvm p'+r-V'r"-
In#pectlon II (with spprovd of the to" of Heslth):
broken pipe(s) are r*pJ#d9d
obsvvcdon Is (*moved
revised 9/2/96 hcelwrit
t � �
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIRCAnON (aontlrxHE)
PrvpartyAdd,-": 228 Stoney Cliff Road Centerville,Mass.
ow,..,: Richard Miller
C. FURTHE3t EVALUATION IS REOUIRED BY THE BOARD OF HEALTH:
Conddons exist which require fvrther •v►lu+tlon by the Board of Health In order to determine If the system le f►Mng to protect tta
public health, safety and the environment.
16,303 CUR
1j SO INYNOTT FVNCTIONIN0 Ag W Hl
YALL PASS MANNEA CKWLLl PAO ECfT THE PUB•UC bEALTHAND '1iAFM&iD Thff1Ea80�iJ.Bs' SYSTE]1
Cesspool or privy 11 within 50 foot of wrloce water
"[T��/• Coeepool or privy Ir wlthln 60 foot of a bordering vegetated wotl►nd or ► left marsh.
2) SYSTE)a HdlL1 FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUP7'LMR,IF A)M DETUUAD F3 THAT THE SYSTBe tSS
RJNCT10NIN0 W A MANNER THAT PROTECT3 THE PUBLIC HEALTH AND sAFM AND THE glVtFtON&LENT:
The system has o septic tank and loll absorption system ISASI and the SAS is wlthln 100 feet Of a wrf►ce water wppry or
trlbvtary to a surface water supply-
/��1 The system has a septic tank and loll absorption system and the SAS is within a Zone I of a publi4 w►t*f wpprY wvu
The systam has o ►opUc tank and loll absorption system and the 3A3 is within f50 lost of a private water w99+y "
The system has a septic tank and loll obsorptlon system end the 3Aa t Isla then 100 lost but co Isot r+c°t'o's' tn.t v
private wetu supply well. unless a well water analysis for cc
lllorm bocLarl+ end en fnvo4atld Nvat� Ntro9e+t is eQuaJ to a sell
well Is free horn pollvtlon from that facility and the press cs of smmolNmadoGnonot v►ild),
than 5 ppm. Method vied to determine distance
)I 'OlTHER
Pale l of 11
revised 9/2/98
. I
I
i
SUBSURFACE SEWAGE DISPO A A SYSTEM INSPECT"FORM
PART
CERTIFiCAT10N (eptdr-ed)
ProgertyAddt—: 228 Stoney Cliff Road Centerville,Mass.
owner: Richard Miller
oa"ef : 10/26/00
D. SYST'DA FAILS:
You must Indicate either 'Yes' or 'Nor to each h the following:
1 1 have determined that on or more of the Board
of H<hlshouldre nbedcontacted to deteOns exist as rimin.iwhatt willllfbe necessary to omw VW t•i
detfrminsoon Is Identified below. The Board o
Yes No oompon•nrdoeto on over4oe4ed ofviegged"0.'Of
Backup of Nw+9e Irno4eclllty-o--s"*l rtt
Discharge or ponding of effluent to the surface of the ground or Surface waters duo to an overloaded or c 9.d SAS of
cesspool.
Static liquid le •I I he distrl utlon box &boys outlet Invert due to on overloaded or clogged SAS or C•NpooJ.
1,W-1I - _ "V 9wi#4
Liquid depth In4P* Tpo'ol Is less than C below,invert or evallabie volume IS IeS+that o day flow.
Required pumping more than 4 times In the last year No due to clogged or obstructed d plpelsl,
"— Number of times Dumped M
System, cesspool or privy Is below the Ngh groundwater elevation.
Any Donlon of the Soil Absorption
- � ithin 100 teat of a surface water supply or tributary to a surface water wDDrr
Any portion of a cesspool or privy IS w
Any portion of a cesspool or privy la•within a Zone I of • public well.
Any portion of a cesspool or privy Is within 60 feet of a private water Supply well.
L s•th&n 100 fast but greater than 60 fast trom a private water wPPsy we
Any portion of a cesspool or privy It 'as ll witJ�
acceptable water quality analysis. II the well has been analyzed to be acceptable. attach copy of wall water snarys's
Ntr
-coliform bacteria, volatile org&nlo•compounds, ammonia nitrogen and nitrate o9en,
E. LARGE SYSTEM FAILS:
You must indicate either 'Yes' or 'No* lto eachof elrfollowing addlVon to the criteria above:
The following criteria apply r 9 systems
The system serves a facility with a design flow of 10,000 gpd or greater(large System) and the aYSLsm la a si9nlAoant went t
health and s.letY and the environment because one or more of the following conditions axial:
Yes NZ J
v the system is within 400 feet of a surface drinking water Supply
— _. er -le a eurfaoe�sirt�9'M"eereu►flY .• .
the system is-wltn 200 Nat of+-M ►L 1r
the system Is located In a nitrogen sensitive area(Interim Wellhead Protection Area.IWPA) or a mapped Zone ii of e
water supply will)
The owner or operator of any such system shall upgrade the system In &ccordancs with J10 CMR 16.�04(21. Pte+++ conauit t7te iocar
office of the Department for further Inforpstion.
Psgt 4 of 11
revised 9/2/98
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART I '
CHECKLIST
P1w,1rAdd1a11: 228 Stoney Cliff Road Centerville,Mass.
own«: Richard Miller
v+ap.ct3on:1 0/2 6/0 0
Check If the following have been done: You must Indicate either 'Yet' or 'No' as to each of the following:
Yet NO
Pumping Information was provided by the owner, occupant, or Board of Health.
None of the aystomtornooa+nts 1►+s.sba+n pow+ ed+baeatJaast two-%ar ka awoi4WVyetam ha+b "goo,,oq...o+ I
rate# during that period. Large volumes of water have not been Intrtiduced Into the system recently or as part of trvs
Inspection.
As bvIII plans have been obtained and exemlned. Note If they are not available with N/A.
The facility or dwelling was Inspected for signs of sewage backup,
The system does not receive non•sanitory or Industrial waste flow.
_ The she was Inspected for signs of breakout.
All system componen1s.:1;.Iuding the Soil Absorption System, have been located on the site.
_,VOW_ ^The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for cor4bon of bs
or lose, material of constructlon, dlmenslons, depth of liquid, depth of sludge, depth of scum.
The slit and location of the Soil Absorption System orrtho slit has been determined based on:
_/ ✓/ Existing Information. For example, Plan et B.O.H.
_Y _ Otterminod In the Mold (If any of the failure criteria related to Part C Is at Issue, approximation of distance Is vmcc•ptat
1c6.102(Jllbll
_ The faculty owner L".=c Pa^f=.Jf dtluaas frocLzieo r),wara p4auldad,wUh lnfar=arloaon the Pimps,_ta
SubSurface Disposal Systems.
revised 9/2/98 iti�es°rll
I _ I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Prop-tyAd&—: 228 Stoney Cliff Road Centerville,Mass.
OWTW: Richard Miller
Dou of k"POC60n:10/26/00
FLOW CONDMONS
RES IDENIIAL:
DesJgn flow:.aQ_g•p•d•ro•dro
Number of bedrooms d $ig 1' Number of bedrooms (Actual):27
Total DESIGN flow
Number of current residents: 1� f1'�'T k10
Garbage grinder(yes or no):NO
Laundry Iseparat• system) or o� If y►►, ►►pu+t�ln+p+ctJon•nqulr►d
Laundry system Inspected a or no)
Seasonal use lyes or no):
Water meter readings, If available (last two year's usage (gpd):
Sump Pump(yes or no): , e0o 4, .4" y
Lost data of occupancy:&'41V may► Gt�c� ='ft
C'OMMEACIAL)%NDVSTRLAL;
Typo of establishment:
Design now: d ( Based on 16.203)
Balls of design Row
Grease trsp present: (yes or no)
Industrial Waste Molding Tank present: (yes or no)-42
Non•s"tary waste discharged to the TItJ• 6 system: (es or nol�/�
Water meter readings,It available:
Last date of occupancy: A.id
OTHER:(Describe)
Last date of occupancy: AM
GENERAL INFORMATION
PUMPING R OROS on sou of Infor stion: i �"� I M
System pumped as part of Inspection: (yes or no)_10
If yes, volume pumped: gallons
Reason for pumping: tit
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
,-- Privy
Shared system (yes or no) (If yes, mach previous Inspection records,If any)
11A Technology etc. Ansch copy of up to date operation and maintenance contract
Tight Tank _Copy of DEP Approval
other 2-1000 gallon
=�rllqm
all components, d►te Inetallediif known)-and sourov o44Morm+tiW
Sowage odor's detected when arriving at the site. (yes or no)
revised 9/2/98 Pstt6ofII
SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM .�
PART C
SYSTEM INFOMATION (continued)
Prop+rtyAddreea:228 Stoney Cliff Road Centerville,Mass.
Dwrw: Richard Miller
Dote of b.apection: 1 0/2 6/0 0
BUILDING SEWER:
ILocate On site plan)
Depth below grade:__
Material of construction: 'cost Iron J, av PVC.G, other ( xplaln)
Distance ho ,?rival# water supply well or auction line
Diameter
lc ndition of of tt, v nang, evidence of t"k"0,-+tc,)
s � appear tight No evidence
is ven e
SEPTIC TANK:
(locate on she plan)
Depth below grede')JI4
Material of constrvction:A1Aconcrete{e�metal.�i4 Flberylass�y1 Polyethylenther(ezplaln)
it tank Is fnetal, list ape&j is.►ge.confirmed by Certificate of Compliance (Yes/No)
Dimensions:
Sludge depth:
to bottom
Distance from top of sludge ttom o} outlet tee or bsMr. IIf1}
Scum tNckness:4_
Distance from top of scum to top of outlet tee or battle: A A
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined: ,U/Q
Comments:
Recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level In relation to outlet invert, svuctur6"ntegrrty.
evidence of leakage, etc.)
e is an
GREASE TRAP: 1".
(locals on *he plan)
Depth below grade: 112
Materiel of cone truc don:C14ConcrCo4. &metal./ Fiberglass,yQPolyethyfeno&.4other(expl&in)
Dimensions:_
Scum thickness:
Distance from top of scum to top of outlet tee or batfle:�j� .
Distance horn bottom of scum s,�sc bottom
um to of outlet tee or baffler
Date of last pumping: A�4
Comments: egret.
(recommendation for pumping, condition of Inlet and outlet tees or belles, depth of liquid level In relation to outlet Invert,.atrtrctur&J nt
evidence of leakage. etc.)
rease ,
revised 9/2/98 Psee7ortt
1 SU93URIACE SEWAGE D(3I03AL SYSTEM 1,NSIECTt0N FOIW J J
TART C
SYSTVA INFORMATION (c*n w-d)
P„..,,y A,,,.":228 Stoney cliff Road Centerville,Mass
o,.n«: Richard Miller
10/26/00
T)CHT OR NOLDWO TANK: (Tank n1v1t be pumped prior to, or a%time of, Inspection)
(locale on 1111 plan)
Oepth below 9rsds:�X
M►111N of conitn CVOn: wCQncretl,l�met+ Rb�r91�►���i /olrothyl/no.� othor(�xplaln)
1
plmen11on1:
CIpsclry: plions
011ion Row: gallonsldry
AIIrm prow.
Alarm 11r/1: Alarm In jV orking order:Yes Ncio
0111 el prlvlovr pvmpinpl
Comments:
lcondroon or Wet Iee, condltlon of alarm snd floe% switches, e10.1
TqritO tankaEe Flet
wTni9v'10N SOX:-'L)wt'
110CIII on Nt1 plan)
01pth of IiQvld 11ve1 sbove ovtiel Invert: AO
Comments:
moll 11 11ve1 and 6111rlbv0on Is eQvsl, evtdlnw of Iolld• carryover, .vIOMc• of leakap•irtto,or out 01 ►oa, •tc.
ion box
pUmp c}tAUBER:
%lochs on ►Its plan) ,/
►vmps In working order:IYes or No) VP
Alarm) In workino order IY11 or No) niiT�l,
Cornmenll:
mole condition of pump chamber, condition of pumps end sppurNnancel, etc,
m
revised 9/2/98
Nit Ierll
� i 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
r
PART C
SYSTEM INFORMATION (con*wod)
P,� Ad&*-: 228 Stoney Cliff Road Centerville,Mass.
Own«: Richard Miller
Deer of Insp.ctiort: 1 0/2 6/0 0
SOIL ABSORPTION SYSTEM ISAS):_L-'o'/
(locate on site plan, If possible: excavation not required,location may be approximated by nonanwalve metfioda)
If not located, explain:
Type.
leaching pits, number:
leaching chambers, number:
leaching galleries, number:,
leaching trenches, number, length:
leaching fleids, number, dimensions:
overflow cesspool, number:
Alternstivs system: Z
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.(
Loamy sand to
ai ure or gnnding of s are ry_lLegPt^t-i nn , g nnrma I
CESSP LS:
(locate on site plan)
Number and configuration:
Depth top of liquid to Inist Invert:
Depth of solids layer: AIA
Depth of scum Isysr:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater,
Inflow (cesspool must be pumped as part of Inspection)
ess oo s are notes rPGPnt
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,condition of.vegetatlon, etc.)
Cesspools are not present -
PFJVY:AI $(,
(locate on site plan)
Materiila of construction: �S� Dimensions:
Depth of solids: Ald
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.)
P
revised 9/2/98 Pegc9ofII
3U&3URFACL S WAOL 013►OSAL iygToA WS►ECTION FORM
►AAT C
iyiTDA WFON NATION (oondrti+.Q1
P,%pwyA6&*":228 Stoney Cliff Road Centerville,Mass .
ow^•': Richard Miller
Dww °'h'°"`s�"1 0/26/00
SXXTCH OF SEWAGE DISPOSAL SYSTEM:
lmovd, 0$ to at lo►,t two p#rm+nont reloronct landmuki 01 bonchm(u`i +,1
10c.0 NI w,ll, wlWn 100' ILocitu whore publlo watsr FupplY
com 4p i
• ✓ I
p►l, 10 0(11
revised 9/2/98
f
SU&SVRFACE SEWAGE OLSP93AL SY3TE7d WSPECTION FORM
PART C .
3Y3TEA1 1rIFORwAnON lcondrwdl
IhogwtyA"*":228 Stoney Cliff Road Centerville,Mass'.
Ownw: Richard Miller
0'*" "'°" : 10/26/00
MRCS Report name
SoU Type_
Typlcal depth to provndwatel
VS05 Oete webllte Allied
Obiervotlon Weill checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Svrlace water
Check C.II.r
3haJlow well•
Erumated Depth to Oroundweler� Feel
►I►er► Indicate all the methods used to detorrrJne High Groundwater E7evatlon:
Obt.lned from 0e►Ipn Plans on record
Observed She IAbvtdnp p(operty, obaervetlon hole, b.aemeot wmp etc,)
0►termined Irom local condltlon►
Chocked with local Solid of health
Checked FEMA Maps
Chocked pvmpinp record►
Chocked local ascavatorl, In►tallar►
Vold 1.1503 Data
0►►cribe how yov established the High Orovndwatar Vovadon, 1MYjj be oompleted)
Used:
Gahrety Miller Model
12/ 16/94
revised 9/2/96 hill Ilof11
�.
'I'UWN OF Barnstable WARD OF HEALTH
SUNSURFACE SEWAGE DISPOSAL ,SYSTEM INSPECTION FORM -• PART D •- CERTIFICATION - I
..�n-� -..,i.-..rr�w.r+�wTn�w.r�q.�'.�.�.•�r�+. w�w-�n�w�w�.wwwn�• ww w•r+- .--�.
-TYPO OA PAINT CI•rAALY—
PROPERTY INSPECTED
STREET ADDRESS 228 Stoney Cliff Road Centerville,Mass.
ASSESSORS HAP , BLOCK AND PARCEL 0
OWNER ' s NAME Richard Miller
PART D - CEiRTIFICATIOK
NAME OF INSPECTOR Joseph P . Macomber Jr,
COHPANY NAHE Joseph P . Macomber &''Son, Inc.
COMPANY ADDRESS Box 66 Centerville MA. 02632-0066
3 t r 9 t Tom or City stet• lip
COMPANY TELEPIIONC ( 508 ) 775 - 3338 FAX ( 508-790 - 1 578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposa`1 system nt
this nddress and that the Information reported is true , accurate , and
omplete ns 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 maintennnce of on-
site sewage disposal systems .
Check one : ;
�ZSy_steoi PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
he.altll or the environment as defined in 310 CHR 16 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form ,
System FAILED;
The. inspection which I have 'con licted has found that the system fails to
protect the E)tiblic henlLh and the environment in accordance with Title
5 , 110 CHR 15 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this Inspection form ,
Inspector Signature Date
Dn e
copy of this ce ification must be provided to the OWNER , the BUYER
+her• 4pplloabl • ) and the BOARD OV HEALTJI ,
• If the Inspection FAILED , thv owner or operator shall upgrade the system
within one year of the dnte of the inspection , unless allowed or required
otherwise as provided in 3.10 CHR 16 - 306 ,
partd , doc