HomeMy WebLinkAbout0031 SOUND VIEW ROAD - Health 31 Soun view Road
Centerville
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Health Complaints
24-May-01
Time: 2:05:00 PM Date: 5/23/2001 Complaint Number: 2873
Referred To: GLEN HARRINGTON Taken By: GLEN HARRINGTON
Complaint Type: TITLE V SEWAGE
Article X Detail:
Business Name:
Number: 31 Street: SOUND VIEW DR.
Village: CENTERVILLE Assessors Map-Parcel: 247040
Complaint Description: SEWAGE BACKING UP INTO HOUSE. NOT
OVERFLOWING IN YARD. WIFE IS HOME
ALL DAY SO JUST STOP BY. OWNER
INSTALLED ILLEGAL HONEYCOMB
CESSPOOL LAST YEAR.
Actions Taken/Results:
Investigation Date: [-C40 Investigation Time: 3`y�
C9
1 •
>_. ) TOWN OF BARNSTA.BLE
LOCATION 31 SOUwCVJCW w SEWAGE #
VII,.LAGE W. ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY CRSSP&V
LEACHING FACILITY: (type) ('11.SSnUbl (size)
NO. OF BEDROOMS S
BUILDER OR OWNER RO("c/ ✓h e,�I O
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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
1 Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet o(leaching facility) 11 Feet
Furnished by S'�( tL tnSDe �'o/� 1It2�i19 0=
"A ' 33
g1_ al ,;
A a .00
- a�° ��►�k
13a- 573 A Aboot-
Overflow
r� ITOWN OF BARNSTABLE
LOCATION J S6h. d U i P-W RC� . SEWAGE #
VIIIAGE " " - A t ASSESSOR'S MAP&_LOT P 040
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) UVIZAW Ce-SSFOGI (size) 'B XS
NO. OF BEDROOMS 1
BUILDER OR OWNER ROG-e� rvx l O
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the: 1 '
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 leachin facility) ++ Feet
Furnished by ���^'� �� .� ,R�sP�ct��.�
AL�
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/ MELLO REAL ESTATE TRUST Ng 1 Aram 00002040
149 HATHAWAY ST T rid e 00 `
/ WAREHAM MA 02571 \ ws G 00 0000 000�� Y
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s� ° Lrd/ 000041900 t tnSF [ � /
000114700 �#�a a�a>'t1rsS 0000000900
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Commonwealth of Massachusetts
Executive Office of Environmental Affairs
-Department of
-Environmental Protection `'
WWI WNd SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
GOVO
Trudy Coxs PART A
'E El CERTIFICATION
Dwld S. r hs �p
Ssn�� v►e.� Kc� -ry I//e-
Property Address: 31 Soundview Road, 4° r1-MA Address of Owner: 149 Hathaway Street
Date of Inspection: October 31, 1996 (If different) Wareham, MA 02571
Name of Inspector: James M. Ford
Company Name,Address and Telephone Number:
James M. Ford, P.O. Box 49, Osterville, MA 02655 (508) 775-7927
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 Eva ion By the Local Approving Authority
Fails
Inspector's Signature: Date: November 10, 1996
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:
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 8/15/95) I
One VAnter Strest • Boston,Massachusetts 02108 • FAX(617)SWID49 a Tsl omm(617)292-&WO
Mid on RwgdW hpn
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
D] SYSTEM FAILS (continued)
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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
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 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] 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
the system is located in a nitrogen sensitive area(Interim Welhead 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.
t
(revised 8/15/95) 3
` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
Check if the following have been done:
✓ Pumping information was requested of the owner, occupant, and`Board of Health.
✓ None 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..
n/a As built plans have been obtained and examined. Note if they are not available with N/A.
✓ The 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.
✓ All system components, excluding 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 (and occupants, if different from owner) were.provided with information on the proper maintenance
of Subsurface Disposal System.
a
(revised 8/15/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder (yes or no): No
Laundry, connected to system (yes or no): Yes
Seasonal use (yes or no): No
Water meter readings, if available: _Usage: 1994 - 11 Z 000: 1995 - 146,000 gal.
Last date of occupancy: Presently unoccupied.
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: gallons/day
Grease trap present (yes or no):
Industrial Waste Holding Tank present (yes or no):
Non-sanitary waste discharged to the Title 5 system (yes or no):
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
None (per owner).
System pumped as part of inspection (yes or no): Yes
If yes, volume pumped: 1500 gallons
Reason for pumping: Inspection /maintenance
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)
Other (explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information: 1961'(per owner)
Sewage odors detected when arriving at the site (yes or no): No
(revised 8/15/95) 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 31 Soundview.Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
TIGHT OR HOLDING TANK: None
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP _other (explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: None
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or'out of box, etc.)
PUMP CHAMBER: None
(locate on site plan)
Pumps in working order (yes or no):
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 8/15/95) 7
" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references, landmarks or benchmarks.
Locate all wells within 100'.
Uv�Je-r Deck
33
Li t 5
a�
DEPTH TO GROUNDWATER:
Depth to groundwater: 15' +/- feet
Method of determination or approximation: Hand augered test hole to 13'. No water was observed.
(revised 8/15/95) 9
COMMONWEALTH OF MASSACHUSETTS �j 6
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: 31 Soundview Road
West Hyannisport, MA _-
Owner's Name: Roger Mello 1 a
Owner's Address: 149 Hathaway Road
Wareham, MA 02571 rap
Date of Inspection: November 29, 2000 r Parc t�
i � A:
4 1 Name of Inspector (Please Print) James M. Ford lj
Company.Name: M.James Ford o
fw�'� f
Mailing Address: PA Box 49 o® J
e6sr .
Osterville,MA 02655-0049 a
Telephone Number: (508) 862-9400
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
Fa
Inspector's Signature: Date: November 30, 2000
The system inspector shall submracopy 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
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
:. CERTIFICATION (continued)
Property Address: 31 Soundview Road
West Hyannisport, MA'
Roger Mello
Owner:
Date of Inspection: November 29, 2000
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ 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:
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,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:
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:
_...__.... __ ..._._Thesystem-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 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 31 Soundview Road.-..-
West Hyannisport, MA-_
Owner: Roger Mello ------
Date of Inspection: November 29, 2000
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,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 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 tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 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 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 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 form.
3. Other:
3
r
4
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 31 Soundview Road
West Hyannisport. MA
Owner: Roger Mello
Date of
Inspection: November 29 2000
D. System Failure Criteria applicable to all systems:
You must indicate either`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 '/z 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.
✓ Any portion'of a}cesspool or,privy is within a Zone.4;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 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 form.]
No (Yes/No)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 System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
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)
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.
4
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Page 5 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM
PART B
CHECKLIST
Property Address: 31 Soundview Road
WestHyannisport, MA
Owner: Roger Mello _
Date of Inspection: November 29, 2000 ~....'
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?
n/a 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?'
✓. ' 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:
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 Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)].
5
Page 6 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
{+ SYSTEM INFORMATION
Property Address: 31 Soundview Road
West Hyannisport, MA
Owner: Ro er Mello
Date of Inspection: November 29, 2000
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): n/a Number of bedrooms(actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a
Number of current residents: 6
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system,(yes or no): . Yes -[_f yes separate inspection required] The discharge pipe goes out
Laundry system inspected(yes or no): No into the backyard.
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): 1999-206 000 gals.• 1998-175.000 gals.
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERC TRIAL
Type of establishment:
Design flow(based on 310 CMR,15.203): _ _ gad. ._---..... _..._........ _._
Basi's of design flow{seats/persons/sgft;et".) f '' . . ._...
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped 1 %years ago-per owner.
Was system pumped as part of the inspection(yes or no): 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)
;Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age'of all components,date installed(if known)and source-of information:_... _
_ Unknown
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM
PART C
'SYSTEM`.INFORMATION (continued)
Property Address: 31 Soundview Road
West Hyannisport,MA
Owner: Roger Mello
x
Date of Inspection: November 29, 2000
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints;venting,evidence of leakage,etc.):
SEPTIC TANK: None (locate on site plan)
Depth below grade:
Material of construction: _concrete metal _fiberglass _polyethylene
other(explain)
If tank is metal list age: . . _. ._Is age confirmed,by a Certificate of Compliance(yes or no):. (attach a copy of
certificate)
Dimensions: _. ._.
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
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.):
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete metal _fiberglass _polyethylene other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
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.): `
7
w
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM'INFORMATION (continued)
Property Address: 31 Soundview Road-
West Hyannisport,MA..
Owner: Roger Mello
Date of Inspection: November 29, 2000
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal _fiberglass _polyethylene other(explain):
1
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.): _
f
.l i.. ... -__. .. .:f-J tl. .. le .. lirt ,.. 1!{ (.i {�... .... ..u.... �� ., ✓.� ... t_ .. tfJ
:DISTRIBUTION BOX:.!-None- (if present must be.opened)•:(locate.on site,plan)
Depth of liquid level above outlet invert:
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.):
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM,INFORMATION (continued)
Property Address: 31 Soundview Road
West Hyannisport, MA
Owner: Roger Mello
Date of Inspection: November 29, 2000
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
.t_
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
_... .. _ . . .._✓ ...overflow.cesspool,number: 1
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.):
The overflow cesspool was 6'Wx 6'Tx 7'6"bottom to grade and was installed.recently. The overflow had 2'6"ofwater on the
bottom The scum line was at the same level. There were solids in the overfowu The cover was 12"below grade.
CESSPOOLS: ✓ (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: 1 w/overflow
Depth-top of liquid to inlet invert:Above
Depth of solids layer: 6"
Depth of scum layer: 20"+
Dimensions of cesspool:S'W x 4'T x 6'bottom to grade
Materials of construction: Block
Indication of groundwater inflow(yes or no): No
Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
The outlet pipe was higher than the inlet pipe. This should be fixed or will cause backups. The scum and sludge level were thick.
Recommend pumping as soon as possible. The cover was to grade.
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 31 Soundview Roa
West Hyannisport, MA ;___
Owner: Roger Mello
Date of Inspection: November 29, 2000
Map:
Lot:
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 ..Above B , . . . .• ____..
A
I
y
' I
I I
Ai - 33
C;
Aa- aU
Oc,Lp ga- 53
over POW
10
Page l l of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
.SYSTEM'INFORMATION (continued)
Property Address: 31 Soundview Road
' West Hyannisport, MA
Owner: Roger Mello
Date of Inspection: November 29, 2000
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
✓ 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:
4
You must describe how you established the high ground water elevation:
The bottom of the overflow to grade was approximately 7'6" I inspected this system in 1996 and hand auQered down to 13'below
grade and no water was observed Using the Cape Cod Commission Technical Bulletin the high groundwater adjustment for
this site(Ml W 29 Zone B. 10/00)was 3.8
This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a
warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,
either expressed,written or implied, relating to the system, the inspection and/or this report.
11
.�+ NO V
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection .
WlUkun F.Weld SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
GOMM
Trudy Coxs PART A
'E FA CERTIFICATION
Danld�fhs
.�,,j Vreu eol /e-
Property Address:_ 31 Soundview Road, 14wnniPet�-MA Address of Owner: 149 Hathaway Street
Date of Inspection: October 31, 1996 (If different) Wareham, MA 02571
Name of Inspector: James M. Ford
Company Name,Address and Telephone Number:
James M. Ford, P.O. Box 49, OsteMlle, MA 02655 (508) 775-7927
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 Eva Qion By the Local Approving Authority
Fails
Inspector's Signature: Date: November 10, 1996
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:
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 enfiltration, 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 8/15/95) 1
One MNMsr 8trest a Boston,Massachusetts 02108 • FAX(617)556-1049 • TMephon•(617)29245M
40 IMMed an PAvOW Pslw
-SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
B] SYSTEM 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 pipe(s) 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
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
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
PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to
a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
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 8/15/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 31 Soundview Road, Flyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
D] SYSTEM FAILS (continued)
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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
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 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] 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
the system is located in a nitrogen sensitive area (Interim Welhead 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.
(revised 8/15/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
Check if the following have been done:
✓ Pumping information was requested of the owner, occupant, and Board of Health.
✓ None 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.
n la As built plans have been obtained and examined. Note if they are not available with N/A.
✓ The 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.
✓ All system components, excluding 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 (and occupants, if different from owner) were provided with information on the proper maintenance
of Subsurface Disposal System.
(revised 8/15/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder (yes or no): No
Laundry connected to system (yes or no): Yes
Seasonal use (yes or no): No
Water meter readings, if available: Usage: 1994 - 11 Z 000: 1995 - 146,000 gal.
Last date of occupancy: Presently unoccupied.
CO1M[1M[ERCIALANDUSTRIAL:
Type of establishment:
Design flow: gallons/day
Grease trap present (yes or no):
Industrial Waste Holding Tank present (yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
None (per owner).
System pumped as part of inspection (yes or no): Yes
If yes, volume pumped: 1500 gallons
Reason for pumping: Inspection /maintenance
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)
Other (explain)
APPROXIIM{ATE AGE of all components, date installed (if known) and source of information: 1961 (per owner)
Sewage odors detected when arriving at the site (yes or no): No
(revised 8/15/95) 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C '
SYSTEM INFORMATION (continued)
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
SEPTIC TANK: None
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP _other (explain)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
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
integrity, evidence of leakage, etc.)
GREASE TRAP: Done
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP _other (explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
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
integrity, evidence of leakage, etc.)
(revised 8/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
TIGHT OR HOLDING TANK: None
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP _other (explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: None
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER: Norte
(locate on site plan)
Pumps in working order (yes or no):
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 8/15/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 31 Soundview Road, kannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
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:
Type:
leaching pits, number:
leaching chambers, number:
leaching galleries, number:
leaching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool, number: 1
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Sandy soil with grass covering system. No signs g} hydraulic failure. Bottom g¢ cesspool is 8'6" $oom grade.
CESSPOOLS: ✓
(locate on site plan)
Number and configuration: I - overflow
Depth-top of liquid to inlet invert: 2"
Depth of solids layer: 2"
Depth of scum layer: 1,,
Dimensions of cesspool: S' wide X 8' tall
Materials of construction: concrete block
Indication of groundwater: none observed
inflow (cesspool must be pumped as part of inspection) Both cesspools purled. No groundwater infiltration observed. Ab tees
present. Recommend tees be installed.
Continents: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Grass covers cesspool. Ab signs ¢ hvdraulichilure.
PRIVY: Alone
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 8/15/95) 8
SUBSURFACE SEWAGE LISP®SAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 31 Soundview Road, Hyannisport, MA
Owner: Roger A. Mello
Date of Inspection: October 31, 1996
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references, landmarks or benchmarks.
Locate all wells within 100'.
Uhler 6eA
33�
yi 15
Js
DEPTH TO GROUNDWATER:
Depth to groundwater: 15' +/- feet
Method of determination or approximation: Hand augered test hole to 13'. No water was observed.
(revised 8/15195) 9