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Home My WebLink About0063 LOOMIS LANE - Health (3) 64. Loomis Lane Centerville P A = 230 106 No. 4210 1/3 ORA LIP-D, E-11-1.1 cogn) SK 105% 0 0 ® o r TOWN OF BARNSTABLE LOCATION yJ'� 6��11,5��e, SEWAGE # VMLAGE_�/—.�i�l�e. /y��- ASSESSOf 'S MAP & LOT INSTALLER'S NAME& PHONE NID_; �//��E// SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size)/U NO. OF BEDROOMS / BUILDER OR OWNERIiI/ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility --___Leet 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 L chi Facility (If any wetlands exist within 300 feet of c f i ' ) Feet Furnished by f F t e 7/8/02 D AT E : ----------- ao� oGt7Tv ODPESS 64_Loomis -Lane _________ RECEIVED Center.villeA4as __- ___- - 02632 JUL 17 2002 -- - - - ------- ------------ TOWN OF BARNSTABLE HEALTH DEPT. On the above date, I Inspected the septic system at the above address. This system consists of the following: 4 1 . 1-1000 gallon precast leaching pit . ( 6 ' X10 ' ) 2 . 1-1000 gallon septic tank . 2. 1-Distribution box . lo, Based on my Inspectlon, I certify the following conditions:- . MOM 4. . This is a title five septic system. ( 78 Code ) 5 . The septic system is in proper working order dw at the present time . 6 . Waste water is 66" below the invert piPe of the leaching pit . 7 . System was installed June of 1993 . Permit # 93-212 SIGNATURE :,- Name _z _�- MacoTber Company : Joseph-P _-Macomber-& Son , Inc , ress : Box 66 _ __ _ MAP �3b Cent: erv : lle _ -Ma_- 02632-0066 PARCEL ' 1O� LOT ' Phone : --- 508_775^ 3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tank$-Cesspools•Leachflelds Pumped & Installed Town Sewer Connectlons P.0 Box 66 Centerville, MA 02632.0066 775 3338 77 6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:64 Loomis Lane Centerville . Mass . Owner's Name: Fnid Bodensi ek Owner's Address: 58 T.n n m i ., Tan a l'antarvi 11 e , MagS Date of Inspection: 7 19 /9 2 Name of Inspector: (please print) J o s e p h P .Ma c o m b e r J r . Company Name: J.P .Macom er & Son inc . Mailing Address: o x bb Centerville ,Mass . 02632 Telephone Number: 508-7 75-3338 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 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 15.340 of Title 5(310 CMR 15.000). The system: ��Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature-2bmit , Date: The system inspector shal 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 I Page 2 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Loomis Lane en ervi e , ass . Owner: Enis Bodensiek Date of Inspection: 7 8 0 2 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes• 4)D I 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: The septic system is in proper working order at the present time B. System Conditionally Passes: _b 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 yes, no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. 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: IN 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: 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) Properr Address64 Loomis Lane Centerville . Mass . Owner: Enid Bodensiek Date of lospectioo: 7/8/D2 C. Further Evaluation is Required by the Board of Health: 40 Conditions exist which require funher evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b) that the system is not functioning in a manner wbich will protect public bealtb, safety and the environment: AV Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 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: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or rributary 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 supply. 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 109 feet but 5D feet or more from a private water supple well•• .Method used to determine distance "This system passes if the well water analysis, performed at a DEP cenified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that faciliry 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 anached to this form. 3. Other: i 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWACF DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Loomis La ne en ervi e ,i,iass. Owocr: Enid Bo ensie c Date of lospection: 7 8 02 D. System Failure Criteria applicable to all systems; You must tndieate "yes" or "no" to each of the following for all inspections: Yes MDschaige ackup of sewage into facilic, or system component due to overloaded or clogged SAS or cesspool or pondcng of eFnucm io the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool S.atic liquid level in the disrn'ouuon box above outlet inven due to an overloaded or clogged SAS or cesspool Liquid depth in eass.paa{ is Icss ;.h>_n 6" below inven or available volume is less than 'h day flow Rcquvcd pumping more than a mr;cs in the last year NOT due to clogged or obstructed pipe(s). Numbcr �of times pumped �. _ y ponion of the SAS, cesspcol or privy is below high ground water elevation. �y ponion of cesspool or privy is within 100 feet of a surface water supply or rributary to a surface water supply �/ Any ponion of a cesspool or pri-e is within a Zone I of a public well. _ M/aAnny ponion of a cesspool or pr,.", is within 50 feet of a private water supply well. Y y ponion of a cesspool or pfi,"� is less than 100 feet but greater than 50 feet.from a private water supply well with no acccptao!c ,, icr quality analysis. 1Tbi5 system passes If the well water analysis. pert,rmed at a DEP cenificc I:.boratory, for coliform bacteria and volaille organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen i� equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of Ih? �D::lysis trust be attached to this form.) VtYWINo) The system fails. I ha,— ictcrmincd that one or more of the above failure criteria exist as described to 310 CMR 1 S 301 (f,rrcforc the system fails. The system owner should contact the Boar- Health to determine what wi11 Dc necessary to correct the failure E Large Systems: To be considered a large system the systrtn must serve a facility with a design now of 10,000 gpd to 15,000 gpd. You must indicate either "yes" or "no" to ca_', of the following: (7he following criteria apply to large sysic!-ns .n addition to the criteria above) ses no/ �/the system is within 400 feel of s,.;face drinking water supply v the system is within 200 fcci of , trbutary to a surface drinking water supply "/the system is located in a n,noscn sensitive area (Interim Wellhead Prolection Area — IWPA)or a mappee Zone 11 of a public water supply ".'cll !f yoc nave answered "yes" to any qucstio. rt Section E the systcrn is considered a significant threat, or answered ses- to Section D above the large system as failed. The owner or operator of any large system considered a s:en:f;cant tiveat under Section E or fall-, .:racr Section D shall upgade the system in accordance with 310 CMR ;04 The system owner should contact me appropriate regional office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddress:64 Loomis Lane Centeruille ,Mass . Owner: Enid Bodensiek Date of Inspection: 7/8/0 2 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 �V'ere any of the system components pumped out in the previous two weeks Z— Has the system received normal flows in the previous two week period ? /Have large volumes of water been inRoduced 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 N/A) Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for signs of break out l� Were all system components,*cluding the SAS, located on site ? 27— Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of conswction, dimensions, depth of liquid, depth of sludge and depth of scum ? /_ Was the faciliry 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 1ao 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(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: 64 Loomis Lane Centerville , Mass . Owner: Enid Bodensiek Date of inspection: 7 8/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 11 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x q of bedrooms): /X'mo Number of current residents: _ Does residence have a garbage grinder (yes or no): Is laundry on a separate sewage system (yes or no):,,e,16 (if yes separate inspection required) Laundry system inspected (yes or no):.,O Seasonal use: (yes or no):a Water meter readings, if available (last 2 years usage (gpd)): Has no meter . Water comes Sump pump (yes or no): e main house Last date of occupancy:lX& ( 58 Loomis Lane ) COMMERCIAL/INDUSTRIAL Type of establishment: '4M Design now(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): 4 19 Grease trap present (yes or no):/1.2A Industrial waste holding tank present (yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no):,V/� Water meter readings, if available: A0 Last date of occupancy/use: OTHER (describe):o GENERAL INFORMATION Pumping Records Source of information: /1Z1> 2 Was system pumped as pan f the inspection (yes or no):40 If yes, volume pumped: gallons •• How was quandry pumped determined.) Reason for pumping: TYP OF SYSTEM Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy 77111 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 robtained [Tom systeffn� owner) / lA�Tight tank iaAttach a copy of the DEP approval /& Other(describe): y� Ap.2roximate ase of all com on ts, d to to talled.(i wn) source of info Were sewage odors detected when arriving at the site (yes or no): _ t 6 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: 64 Loomis Lane Centerville , Mass . Owner: Enid Bodensiek Date of Inspection: 7/8/0 2 BUILDING SEWER (locate on site plan) Depth below grade: —Cle Materials of construction: - 'cast iron Z0 PVC other(explain): A,24 Distance from private water supply well or suction line:Id?, Comments (on condition ofjoints, venting, evidence of leakage, etc.): Joints appear tight . No evidence of leakage .The system is vented through the cottage vents . SEPTIC TANK: Zlocate on site plan) /Gl�1l�'fl1f P� Depth below grade: /Material of constructi on: 0/concrete/de metal�fiberglass,/t polyethylene ,&ther(explain) 4)lf If tank is metal list age:IV Is age confirmed by a Certificate of Compliance (yes or no):,W (attach a copy of certificate) y�l Dimensions: ('v"�Q.t}j y�(�'Cl�� 6 / j Sludge depth: �p� Distance from top ofsludge to bottom of outlet tee or baffle: Scum thickness: f Distance from top of scum to top of outlet tee or baffle: ./4vee-- Distance from bottom of scum to bortoTif outlet tee or baffle: How were dimensions determined: Q, a 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 . GREASE TRAP(4k(locate on site plan) Depth below grade: .U/d Material of construction:,v/Oconcretq/0 metale fiberglas�y/�9polyethylene&other (explain): A14 Dimensions: _AJX Scum thickness:4— Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_ a,,4 Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): �R. 7 i 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:64 Loomis Lane s . Owner: Enid Bo ensie c Date of lospectioo: 7 8 02 TIGHT or HOLDING TANK, &Vmnk must be pumped at time of inspect ion)(locate on site plan) Depth below grade: AM Material of consrmcti n: concrete AM metal 111V fiberglass jLif thylene,d a other(explain): Dimensions Capaciry: gallons Desien Flow: _gallons/day Alarm present (yes or no): AJ11 Alarm level: �A Alarm in working order(yes or no): A//l Date of last pumping: Aft Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present . DISTRIBUTION BOX: Z (if present must be opened)(locate on site plan) Depth of liquid level above outlet inven: .f4 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 oT the box . PUMP CHAMBER (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): J4 Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present . I 8 Page 9 of•I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Loomis Lane Centerville ,Mass . Owner: Enid Bodensiek Date of Inspection: 7/8/0 2 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) 1-1000 gallon precast leac ing pit . ( 6 X9 ) If SAS not located explain why: Located see page Tye l leaching pits, number: 6�� Q leaching chambers, number: A/0 leaching galleries, number: Q 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.): Loamy sand to medium fine sand No signs of hydraulic failure or ponding Soils are dry . Vegetation is normal . Waste water is 66" below the invert pipe . CESSPOOLSl&�4,(cesspool must be pumped as part of inspection)(locate on site plan) Nurgber and configuration: Q Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: 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.): _Cesspools are not present . PRIVY(locate on site plan) Materials of construction: /fJ Dimensions: Depth of solids: l Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present . 9 Pagc 10 0( I OFFICLAI fNSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM fNFOR- ATION (conlinucd) property Ado fC Is:64 Loomis Lane en er . 0"ocr:Enid Bodensie Oil( of Inip<c600: 1 f 8/02 SKETCH OF SEWACE DISPOSAL SYSTEM PTo.ioc I Iktich of the "wllc dilpolll IYllcm lnclvding i1cl to at IMI rwo permancnl rcfcrcncc Icnd�ntrk, o, o<n<Nnvk, l odic III wclli ..ilhin 100 fccl. Loctic whcrc public w4Icr Iupply entcrl the building. Lac c Y `" I0 Page 1 1 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Loomis Lane Centerville ,Mass . Owner: Enid Bodensiek Date of Inspection: 7/8/0 2 SITE EXAM Slope Surface water Check cellar Shallow wells r Estimated depth to ground water�feet Please indicate (check)all methods used to determine the high ground water elevation: rObserved o stem design plans on record - if checked,date of design plan reviewed: te(abutting prope /observation hole within 150 feet of SAS) t oca oar o Health-explain: NA th local excavators, installers- (attach documentation) SG S database-explain: h t t p : town , b a r n s t a b l e .ma . us You must describe how you established the high gground water elevation: ;ed ; Gahrety & Miller Model . 12/ 16/94 Ground water elevations above sea1e__v_el . ;ed ; USGS ; Observation well data . June 1992 ;ed ; Technical Bulletin 92-000-1 Plate # 2 ( USGS ) January 1992 Annual rang e�"PR'LH'und water elevations . Leaching Pit �' ,eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom i Of the leaching pit and the adjusted groundwater table is feet. 11 y'•r.nr+�n.'r•►*-•*r ern.-mr•nmra-++r..re,-r.mr.:-.tee-r�v.r:+.r.�*+r-n rr.�-s.r*ra�rr<r.rrn .rirt�-tr-n-.r..-.. 1'UHN OF Barnstable BOARD OF HEALTH r SU(1SURFACF S NAUF DISPOSAL SYSTF,M INSPECTION FORM - PART D - CER'fiFl 1 CATION ••1•T•••..t—T..1:�-.T.T.�`n•n:Tl"ZT.TI'T.if'T•TP.-.�•.•I^."T+tl.lsnnT T1�ITR�1YrRn.TRfT.P9CTf Tnfl r ..� -TYPL OR PRINT CI.EARLY- PIlOPERTY INSPECTED STREET ADDRESS 64 Loomis Lane Centerville , Mass . 02632 ASSESSORS MAP , BLOCK AND PARCEL # 230-111 OWNER ' s NAME Enid Bodehsiek PART D - CERTIFICATION NAME OF INSPECTOR Joseph P .Macomber Jr . COMPANY NAME J. P .Macomber & Son Inc-:4' COMPANY ADDRESS Box 66 Centerville , Mass., 02632 5trevt Town or City State 11P COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 _ 1578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at Dt his nddress and that the information reported is true , accurate , and omplete as of the time of :inspection , The inspection was performed and any ecommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Chec one : -:-A1Systevi PASSED The inspection which 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 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 conarcted has found, that the system fails to Protect the 1')ublic 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 . Inspector Signature Date wZ ne copy of this rt.ification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HBAL'I'll , * If the inspection FAILED , the owner or " 'P' arator shall upgrade eyetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 ChiR 15 , 305 . partd . doc