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Home My WebLink About0057 LONGVIEW DRIVE - Health 57 Longview Drive Hyannis A=251-094 Commonwealth of Massachusetts Title 5 :Official Inspection form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 LONGVIEW DRIVE Property Address Rick Williams _ 2S I' cc)y ' Owner Owner's Name information is required for -OentefViRe ya h S MA' 02632 4/4/2012 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist of the end®f the form. Important: A. General Information When filling out forms on the } computer,use 1. Inspector: only the tab key to move your Wayne Archambeault cursor-do not Name of Inspector use the return key. Company Name Box 914 Company Address Hyannis.- AIIA 02601 rEaa» Cityrrown State Zip Code 508-775A 362 . 355 Telephone Number License Number B. Certification I certify that l 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 ❑ Fails ❑n Needs Further Evaluation by the Local Approving Authority F-- 4/4/2012 p ctor's Si ture Date The system inspector shall submit 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 god or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner. and copies sent to the buyer,:if applicable, and the approving authority. 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. t5ins•11110 Title 5 Official lnspe i n Subsurface Sewage isposal Sy tem•Page 1 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -:Not for.Voluntary Assessments � 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owner's Name.- information is Centerville MA 02632 4/4/2012 required for every page. CityfTown State Zip Code Date of Inspection Bo Certification (writ) e 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 Passesa ❑ 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. Check the box for"yes", "no"or"not determined (Y, tJ, ND) 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 infiltkation or exfltration 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. Y Ej N ❑ ND.(Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments «M 57 LONGVIEW DRIVE . Property Address Rick Williams Owner Owner's Name information is required for Centerville f MA 02632 4/4/2012 every page. Cityrrown r State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont): ❑ Observaticn 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):' El distribution box is leveled'or replaced ElY. El N [I ND(Explain below): 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' ❑ Y ❑ N ❑ ND (Explain below):, - ❑ obstruction,is removed ❑ Y- -❑ N ❑ ND (Explain below): 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 CHAR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety Arid 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts„ W Title 5. Officia�l Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 57 LONGVIEW DRIVE , Property Address Rick Williams Owner Owner's Name information is required for. Centerville i MA 02632 4/4/2012 every page. . Cityrrown State Zip Code Date of Inspection B. Certification (cont) , 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: 4 El The system has aseptic 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: I "This system passes if the well water analysis,performed.at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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: {, D) System Failure Criteria Applicable to All Systems: You must indicate"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 El Z due to an overloaded or clogged SAS or cesspool El ® 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 El than '/z day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 LONGVIEW DRIVE " Property Address' : Rick Williams Owner Owner's Name information is required for Centerville MA 02632 4/4/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cant) Yes No 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. «k ❑ E 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 400 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 fecal coliform bacteria indicates absent 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 co of the,anal sis p 99 PY Y . and chain of cUstody'must.be attached to this form.] ' t 'The system is a cesspool serving a facility with a design.flow of 2000gpd- 10,000gpd. ' 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 Systems: To be considered a large system the system must serve a facility with a design flow of.10,000 gpd to 15,000 gpd. For large systems, you must indicate either-"yes"or"no"to each of the following, in addition to the - questions in Section D. ' Yes No. El ❑ the:system is within 400 feet of a surface drinking water supply ❑ ❑ t the system is within.200 feet of a tributary to a surface drinking water supply. 0 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 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owner's Name information is Centerville MA 02632 4/4/2012 required for every page. City/Town State, Zip Code Date of Inspection Co Checklist . Check if the following have been done. You must indicate"yes"or no,,as to each of the following: Yes No ® F 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 o this.inspection? ® Were as built plans,of the system obtained and examined? (if they were not available note as.N/A)- ® E] Was the facility or dwelling inspected for signs of sewage back up? ' ® ❑ Was the site inspected for signs of break out? :0 0 Were all system components, excluding the SAS, located on site? ® M 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 theproper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on' ® 0' 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 ® El approximation,of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions:.. . 3 Number'of bedrooms(design): 3 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 1.10 gpd x#of bedrooms). 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official InspeCti®n Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments M a 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owner's Name information is required for Centerville 'MA 02632 4/4/2012 every page. City/Town State Zip Code Date of Inspection D. System Information Description: . Number of current residents, 0 Does residence have a garbage grinders ❑ Yes ® No Is laundry on a separate sewage systern? [if yes separate inspection required] ❑ Yes 'N No Laundry system inspected? ❑ Yes ® No Seasonal.use? ❑ Yes Z No. na Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? El Yes Z No . 10/23/11 Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): r d ) .. Gallons per day(gPd - Basis of design flow (seats/persons/sq.ft., etc.): - Grease trap present? ❑ Yes ❑ .No industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No , Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Foam:Subsurface.Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System;Form - Not for Voluntary Assessments ,M 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owner's Name information is Centerville MA _ 02632 4/4/2012 required for every page. Cityrrown State. Zip Code Date of Inspection D. System Informata n (cone:) Last date of occupancy/user Date Other(describe below): General Information Pumping Records: owner. Source of information: . Was system pumped as part of the.inspection? ❑ Yes ® 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 y Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 57 LONGVIEW DRIVE Property Address , Rick Williams . Owner Owner's Name information is required for . Centerville MA 02632 4/4/2012 _ every page. Cityrrown- State Zip Code Date of Inspection D. System Information (cola.) Approximate age of all components, date installed (if known) and source of information: unknown Were sewage odors detected when arriving at the site?., ❑ Yes ® No' Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑40 PVC oragngeburg to cesspool ®cast iron other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting,evidence of leakage, etc.): cats from house to orangeburg to cesspool repiace with pvc and tee i Septic Tank (locate on site plan): na Depth below,grade: feet Material of construction: - concrete ❑-metal El fiberglass . . ❑ polyethylene ❑ other(explain) f If tank is metal, list age: years is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No . i Dimensions: Sludge depth: t5ins°11/10 k Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 9 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owner's Name information is required for Centerville MA 02632 4/4/2012 every page, City/Town State Zip Code Date of Inspection D. System Ilnformetl®n (cont_) ; Septic Tank(coot.) Distance from top of sludge to.bottom of outlet tee or baffle Scum thickness , a .. . . . - 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? 4 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(locate on site plan): • , Depth below grade: feet Material of construction:. Ej 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: Date t5ins•1.1110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official-I nspectionform Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °7M 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owner's Name information is required for Centerville MA 02632 4/4/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information 1cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels.as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ' El concrete ❑metal .. ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: y Capacity: '. r i -.' gallons Design Flow:. gallons per day _ Alarm present: ❑ Yes ❑.No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,'etc.): A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System s Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - ,M 57 LONGVIEW DRIVE Property Address n. Rick Williams Owner Owner's Name information is required for Centerville -MA 02632 4/4/2012 every page. City/Town State Zip Code Date of inspection Do System Information. .,ont;) Distribution Box(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.): no distribution box Pump Chamber(locate on site plan):. Pumps in working order: ❑ Yes ❑ No w Alarms in working order: .:,` ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc:): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11%10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 it - Commonwealth of Massachusetts' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owner's Name information is required for. Centerville MA 02632 4/4/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cone) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: El leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool - number: ❑ innovative/alternative system Type/name of.technology: Comments(riote condition'of soil; signs of;hydraulic failure, level of ponding, damp soil, condition of.,. vegetation, etc.): cesspool empty 1' stain line at bottom Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): 2 Number and configuration Y 0 Depth—top of liquid to inlet invert Depth of solids layer 0 Depth of scum layer ' Dimensions of cesspool blocks Materials of construction Indication of g rou ndwater,inflow ❑ Yes ® No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owner's Name information is Centerville MA- 02632 4/4/2012 required for State Zip Code Date of Inspection - every page. City/Town D. System Information (c6nt:) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 2 cesspool no liquid in either first pool show signs of being full to outlet pipe overflow cesspool has stain line 5.5' below in let pipe. Privy (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.): Title 5 Official Inspection Form:Subsurfaze Sewage Disposal System t5ins•11/10 •Page 14 of 17 Official Commonwealth of Massachusetts W Title .5 Official Inspection Form Subsurface Sewage Disposal System.Form.-,Not for Voluntary Assessments 'M 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owners Name information is required for Centerville MA 02632 4/4/2012 - every page. City[Town State Zip Code Date of Inspection D. System information (cunt.) Sketch Of Sewage Disposal System: Provide a'view 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. Check one of the boxes below: ® hand-sketch in the area below .E drawing attached separately 3 I 00 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments a m wM 57 LONGVIEW DRIVE Property Address - Rick Williams Owner Owner's Name information is required for Centerville MA 02632 4/4/2012 every page. City/Town State Zip Code Date of Inspection Da System 9nformati6h.(cor t ) Site Exam: ® Check Slope .0 Surface water ® Check cellar ® Shallow wells y. > 12' Estimated depth to high ground water:. feet Please indicate all methods used to determine the.high ground water elevation: Obtained from system design plans on record If checked, date of design'plan reviewed: Date Observed site.(abutting:property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain:' - � 0C h`e,cked with,local excavators,t ors, installerss- (a tt ech documentation) , ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: hand augar to 12' no ground water, bottom of cesspools 8' sepe ration 4' ' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r r Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Forme-Not for Voluntary Assessments 57 LONGVIEW DRIVE Property Address Rick Williams Owner Owner's Name information is Centerville MA 02632 4/4/2012 required for every page. dY C' /Town State Zip Code Date of Inspection _ E. Report Completeness C.hecklist ® Inspection Summary- A, B,,C,,D, or E checked -® Inspection,Summary D.(Systern Failure Criteria Applicable to All Systems) completed ® System Information,Estimated depth to..high groundwater z Sketch of Sewage Disposal System.either drawn on page 15 or attached in separate.file 06 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17of 17 TOWN OF BARNSTABLE LOCATION5 7 o SEWAGE # VILLAGE �—*-- A i A &A"ISSESSOR'S MAP &LOT --O INSTALLER'S NAME&PHONE NO. �o SEPTIC TANK CAPACITY Io &--0 �I LEACHING FACILITY: (type) _�tr0--e" (size) 4? L✓ NO.OF BEDROOMS BUILDER OR OWNER_� /iVi l/i S PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility . Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 0 �� Z 3 b _ � ` � � '� �� , , � �, �� T .s cs- V m