HomeMy WebLinkAbout0051 CAMP OPECHEE ROAD - Health (2) 96 Indian Trail
Centerville P
A 210 001
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DATE: 8/3/02
PROPERTY ADDRESS: 98 Indian Trail
-----------------------
Centerville ,Mass . pd - �/
- _
02632
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On the above date, I inspected the septic system at the above adAgEIVED
This system consists of the following:
AUf, 8 2002
1 . 1-1000 gallon septic tank
2 . 1-Distribution box . TOWN OFBARNSTABLE
3 . 1-1000 gallon precast leaching pit . ( 6 ' X9 ' ) HEALTHDEPT.
Based on my inspection, I certify the following conditions: Z(D 5
4 . This is a title five septic system . ( 78 ; Code )
5 . The septic system is in proper working order
at the present time .
6 . Waste water is 32" below the invert pipe of the leaching
pit .
SIGNATUR `--
N a me:- J .-P. -Macomber-Jr.
-- -- ------- -------
Corripany:Joseeh P._ Macomber & Son, Inc.
A d d res s:__Box
Cen �rv_ille,_Ma-_02632-0066
Phone: 508-775-3338
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
INA
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
•
J6,
1
COMMONWEALTH OF MASSACHUSETTS
= EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 98 Indian Trail
Centerville .Mass .
Owner's NameKatie Grune.r ,
Owner's Address: Same
Date bf Inspection:
Name of Inspector: (please print) Joseph P. Macomber Jr.
Company Name: _ Joseph P_ Ma _omher & Son, Inc .
Mailing Address: gnx Fr,
('Pnt-arvi 1 1 e� MA 02632-0066
Telephone Number508-775-3338
CERTIFICATION STATEMENT
1 certify that 1 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
2pproved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15,000). The system:
I✓ Passes
_ Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: —4E�L-61,p
The system inspector shall mit 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.
Notes and Comments
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.
Title 5 Inspection Form 6/15/2000 page 1
r
Page 2 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 98 Indian Trail
Centerville , Hass .
Owner: Katie Qru,ner-
Date of Inspection: 8/3/0 2
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
6 I have not found any information hich 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:
The septic system is in proper working order at the
present time .
B. System Conditionally Passes:
—0 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.
Answer -es, no or not determined „y (Y,N,ND) to the for the following statements. If"not determined please
explain.
_4,!d The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
•A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
4 The system required pumping more than 4 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
ND explain:
2
Page 3 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Proper Address: 98 Indian Trail
entervi e , ass .
Owner: Katie uru3ef ,
Date of Inspection: 8/3/02
C. Further Evaluation is Required by the Board of Health:
410 Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failutg to protect public health, safety or the enyi orunent.
I. S*stem Hill pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner wbich will protect public bealtb, safety and the environment:
40 Cesspool or privy is within 50 feet of a surface water
ZU 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 any) determines that the
system is functioning in a manner that protects the public health, safety and environment!
VCJ 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 SAS and the SAS is within a Zone I of a public water supple
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well
The system has a septic tank and SAS and the SAS is less than 1 0"Feet buL 50 feet or more from a
pnsate eater supply well Method used to determine distance
'This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facilir) and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are rriggered. A copy of the analysis must be anached to this form.
3. Other:
3
• Page ; of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property address: 98 Indian Trail
Centerville .Mass .
Owner: Katie UTuner,
Date of inspection:s /,I /r2
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "no" to each of the following for all inspections:
Ycs N
_ _ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or pondtng 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 dismbution box above outlet invert due to an overloaded or clogged SAS or
_Zcesspool
Liquid depth in c 4speel is less than 6" below invcn or available volume is less than 'h day now
_ Requvcd pumping more than 4 times in the last year NOT due to clogged or obsrmcted pipe(s). Number
/of times pumped —0—,
y ponion of the SAS, cesspool or privy is below high ground water elevation.
�/ Any ponion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
/ water supply.
y ponion of a cesspool or privy is within a Zone I of a public well,
iJ y ponion of a cesspool or privy is within 50 feet of a private water supply well.
Any ponion of a cesspool or privy is less than 100 feet but greater than 50 feet.from a private water
T supple well with no acceptable water qualiry analysis. jTbis system passes 111'the well water analysis,
perlormed at a DEP certified laboratory, 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, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this forma
I (YcsNo) 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 Boare
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 now of 10,000 gpd to 15,000
gpd
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)
des n0
L the system is within 400 feet of a surface drinking water supply
l/ system is within 200 feet of a tributary to a surface drinking water supply
1�
_ the system is located in a nirrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped
Zone 11 of a public water supply well
you have answered "yes" to any question in Section E the system is considered a significant threat, or answered
es" in Section D above the large system has failed. The owner or operator of any large system considered a
s:en:iicant (weal under Section E or failed tinder Section D shall upgrade the system in accordance with 310 CMR
5 The system owner should contact the appropriate regional oMce of the Department.
4
Page 5 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 98 Indian Trail
C_enterville . Mass .
Owner: Katie Grun.er-
Date of lospectioo:8/3 E
Check if the following have been done. You must indicate "yes"or"no" as to each of the following:
Yes 1v'o/
Pumping information was provided by the owner, occupant, or Board of Health
4—/Were any of the system components pumped out in the previous rwo 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 pan of this inspection ?
ZWere as built plans of the system obtained and examined? (If they were not available note as N/A)
Z. — 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,�luding 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:
Yes no /
Existing information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of distance
is unacceptable) (310 CMR 15.302(3)(b))
5
Page 6 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 98 Indian Trail
Centerville , Mass .
OwnerKatie Gr--ag 'r-y
Date of Inspection: 8/3/02
FLOW CONDITIONS
R-ESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms (actual):
DESIGN flow based on 310 Cl 15.203 (for example: 110 gpd x q of becirooms):J X/,O ^�Pe/�dZ),
Number of current residents:
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system.(ycs or no):, (if yes separate inspection required)
Laundry system inspected (yes or no): (S
Seasonal use: (yes or no): 4b
Water meter readings, if available (last 2 years usage (gpd)):2000-36 , 000 gal lons=98 . 63 GPD
Sump pump (yes or no): 4.V 00 — gallons=164 . 39 GPD
Last date of occupancy:
COMMERCLgU1NDUSTRIAL
Type of establishment:
nt.
w 'Design flow (based on 310 CMR 15.203): gpd
Basis of design now (seats/persons/sgft,etc.). ^/
Grease trap present (yes or no): li�o
Industrial waste holding tank present (yes or no):A-44
Non sanitary waste discharged to the Title 5 system (yes or no):4e
Water meter readings, if available:
Last date of occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as pan of the inspection (yes or no):
If yes, volume pumped: n _gallons -- How was quantiry pumped determined?
Reason for pumping: ,
TYP OF SYSTEM
Septic tank, distribution box, soil absorption system
d1 Single cesspool
Overflow cesspool
yf Privy
�IShared system (yes or no)(if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the cturent operation and maintenance contract (to be
obtained from system owner)
/(h/Tight tank Attach a copy of the DEP approval
wOther(describe): 116�
Approximate ase of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site (yes or no): .t
6
f
Page 7 of 1 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 98 Indian Trail
Centerville ,Mass .
Owner: Katie Gruner-
Date of Inspection:8/3/0 2
BUILDING SEWER (locate on site plan)
y
Depth below grade:
Materials of construction: . cast iron Z40 PVCiffU other(explain): „rltf
Distance from private water supply well or suction line: /D`-il—
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight . No evidenQe of leakage - The system
is vented through the house vents .
SEPTIC TANK: Zoocate on site plan)
Depth below grade: /4?
Material of constructionncrete,,tU etal/liefiberglasV_Ppolyethylene
416other(explain) AI
If tank is metal list age: _ is age confu-med by a Certificate of Compliance (yes or no):/11O(attach a copy of
certificate) ell
Dimensions: Eek-142 'Y;O X,f146
Sludge depth /iJ��a ��
Distance from top of sludge to bottom of outlet tee or baffle: ;.7rr4 e_el
Scum thickness: _
Distance from top of scum to top of outlet tee or baffle:/��21e.,
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Pump the septic tank every 2-3 years Inlet & outlet tees
are in place .The tank is structurally sound and shows
no evidence of leakage .Liquid level at the outlet invert
is fifty otle inches .
GREASE TRAP locate on site plan)
Depth below grade:A�
Material of construction;,aconcreteol/�metaLf/�fiberglass /Ipolyethylene other
(explain):_. AA
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle: '*�v—
Distance from bottom of scum to bottom of outlet tee or baffle: _
Date of last ptunping:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Grease trap is not present
I
7
Page 8 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 98 Indian Trail
entervi e , ass:
Owner: Katie (T ne-i-y
Date of Inspection: 8 3 02
TIGHT or HOLDING TANK,f� (mnk must be pumped at time of inspection)(locate on site plan)
Depth below grade: Ad
—
Material of construction:;(10 concrete/L,!� metal fiberglass A/�polyethylene,�+V other(explain):
Dimensions
Capacity: gallons
Desien Floµ: gallons/day
Alarm present (yes or no):
Alarm level: 1J%l} A larTn in working order(yes or no):,A
Date of last pumping: 4JA
Comments (condition of alarm and float switches, etc.):
Tight or holding tanks are not present .
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: lflk)
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.):
Distribution box has one lateral .No evidence of solids
carry over . No evidence of leakage into or out of the
box .
PUMP CHAMBEM'b < locaie on site plan)
Pumps in working order(yes or no): Z)1Y
Alarms in working order(yes or no):
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber is not present
I
8
Page 9 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 98 Indian Trail
entervi e , ass .
Owner:Katie_ --runer-
Date of Inspection; 8/3 02
SOIL ABSORPTION SYSTEM (SAS): Zlocate on site plan, excavation not required)
_1-1000 gallon precast leaching pit . ( 6 X9 )
If SAS not located explain why:
Locate ee page
j
leaching pits. number:
leaching chambers, number:
leaching galleries, number:
d leaching Trenches, number, length: )
leaching fields, number, dimensions:
_ overflow cesspool, number:
innovative/alternative system Type/name of technology: --/7 'Comments (note condition of soil, signs of hydraulic failure, level of ponding, dam
etc.): p soil, condition of vegetation,
Loamy sand to medium fine sand - No signs of hydraulic
ponding . Soils are dry , egetat-.L is no
Waste water is 32" below the invert pipe .
CESSPOOLS,.4"(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: Q
Depth — top of liquid to inlet invert:
Depth of solids layer:
Depth of scum laver: j
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
6esspools are not presen
PRIVY,6kAe0ocate on site plan)
Materials of construction: AJ�
Dimensions:
Depth of solids: i_r
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Priv is not present .
9
Pig( 10 of 11
OFFICLAI_ INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continvcd)
PtQpCrn .,00fccc: 98 Indian Trail
CentPrville ,Mass ,
OrOcr: gar;�, Cirljn.er
Oslc of In)9(moo: R Pif—n 9
SKITCH OF SEWACE DISPOSAL SYSTEM
Pto,ioc s skccch of the scwjIc 4ispotsl systcm inclvftS Ilcs to it Icast two permancni rcrcrcncc IanCmcrxt
oenermuki t occic to wells within 100 (cct. l.oecte where pvblie water svpply enters the pvildin6.
1111 hJ'd�ld� S} uv?f"U 1 S b
/ D
io
Page l I of 1 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 98 Indian Trail
Centerville ,Mass .
Owner: Katie Gnun.er
Date of Inspection:8%g/-0 2 r
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water Af feet
Please indicate (check) all methods used to determine the high ground water elevation:
(LO_,Obtained from system design plans on record - If checked, date of design plan reviewed:
;�Aserved sttePautting prope bservation hole within 150 feet of SAS)
ec<e wtt a oar o ealth explain:
,,Checked with local excavators, installers- (attach documentation)
ES Accessed USGS database-explain:h t t p ; //town . barns to b 1 e .ma . us .
You must describe how you established the high ground water elevation:
Used ; Gahrety & Miller Model 12/16/ 94 Ground water elevations above
sea ievel .
Used ; USGS ; Observation we data June
Used ; USGS ;; Technical bulletin 92-000-1 Plate # 2 January Annua
Ulvuflu ranges of ground water elevations .
F
ingt la6 � ,eet
r- -
��y
Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the bottom
of the leaching pit and the adjusted groundwater table is
feet.
ll
TOWN OF Barnstable WARD OF HEALTH
0 ^,SUflSURFACR 9EWA(;R I)f f'OS 1L SYSTEM I N9I'FCTION FORM - PART D - CERTIFICATION
rsa�rnra'e+rrs'Z mn n'**rrrr*r,rv-r'mrrer.•,r.rrr r-• ,. ._..
—TYPE OR PRINT CI.EARLY—
PROPERTY INSPECTED
STREET ADDRESS98 Indian Trail Centerville ,Mass .
ASSESSORS MAP , DLOCK AND PARCEL
OWNER' s NAME Katie �_r.unery
PART D - CERTIFICATION r
NAME OF INSPECTOR Joseph P.Macomber Jr .
COMPANY NAMEJ. P.Macomber & Son Inc:'r '
COMPANY ADDRESS Box 66 Centerville , Mass . 02632
Street Town or City Stat a ttIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1578
R
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
omplete as of the time of 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 site sewage disposal systems ,
Check one ;
- System PASSED
The inspection Irhich I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or Lhe environment as defined in 310 CMR 16 - 303 , Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA sectiol) of
this form ,
System FAILED*
The inspection which I have conaticted has found that the system fails to
Protect the public health and the environment in accordance with Title
5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form ,
It
..
Inspector Signature Date %'dam
onecopy of this ert.ification must be provided to the OWNER, the BUYER
where applicable ) and the I30ARD OF HEAL'I'll.
* If the inspection FAILED, the owner or"operator shall upgrade ' the system
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 310 ChJR 16 . 305 .
partd , doc