HomeMy WebLinkAbout0088 RUDDER ROAD - Health SS RUDDER ROAD,HYANNIS- - -
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LOCATION EZA26k ilO SEWAGE # _
VILLAGE G�Ur$Is,�)Yog ' •����W ASSESSOR'S MAP &LOT
INSTALLER'S NAME`&PHONE NO.
SEPTIC TANK•CAPACTTY
LEACHING FACILITY; (type (size)
NO...OF BEDROOMS
V.
11
BUILDER OR OWNER T/lAt�9i��
PERMUDATE: COMPLIANCE DATE: "
Separation Distance Between the: 17
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 xist
within 300 feet o9tachin fa Feet
Furnished b t
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DAT(/CG pci/1.5 98lic�F n
PROPERTY ADDRESS: •,88 Rudder Rbad t --f 00
Vf-
ro N 1998
West Hyannisport /VOFq
r.
'Mass. \P
On the above date, I inspected the septic system at the above address.
This system conslsts of the following:
1 . 2-6 'x8" Block Cesspools:
Based bn my Insc action, I certify the following conditions:
2 . This is not a title five septic system.•
3 . This is a sewage system that is in proper
working order at the present time. .
4. The overflow cesspool •is in perfect condition. n
5 . Overflow looks as if it were brand_new.
6 . The' system is twenty five years old.
SIGNATURr,:
Name : J . P.Kacomber Jr. i
-------,---------------
Company: J• P_Macomber & Son•_Inc
Address:_-Beac-66------a___..__
Cente�rvi1LeAeLsj,;_02•632
Phone: '
___50.8.�ZJ..S-.3338------- '• I
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
�OSEPH P. MACOMBER & SON, INC,
Tanks-C�upoola-LeachfleId6
PurnP' L InIt'llW
Town Sewer Connoctions
P.O. Box 66' Centerville, MA 02632.0066
77.5-3338 775-6412
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON, MA 02108 617-292.5500
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WILLIA;vi F.WELD TRUDY COXI
Govcmor Sccrctar
ARGEO PAUL CELLUCCI DAVID B.STRUR
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission
PART A
CERTIFICATION
Property Address:88 Rudder Road West HyannisportAddress of Owner: 17 Thatcher Shore Rd
Date of Inspection: 9/15/9 8 Mass. (If different) Yarmouthport,MAs s.
Name of Inspector: Joseph P.Macomber Jr. 02675
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: J.P.Macomber & Son Inc.
Mailing Address: BOX 6T Centerville,Mass. 02632
Telephone Number: 508-775-3838
CERTIFICATION STATEMENT
I cenify 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
ewage disposal systems. The system:
_
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: wo� < Date:
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:
j A) SYSTEM PASSES:
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.
COMMENTS:
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.
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, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspecion; or
the septic tank, whether or not metal, is 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 04/25/97) Page 1 of 10
DEP on the Worid Wide Web: http:/twww.mapnet.ttate.ma.us/dep
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
P(operty Address: 88 Rudder Road West Hyanni sport,Mass.
Owner: Thomas George
Date of Inspection: 9/1 5/9 8
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
pipets) or due to a broken, settled or uneven distribution box. The system will pass Inspection if(with approval of the
Board of Health). Describe observations:
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 plpe(s) are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
/VV Conditions exist which require further evaluation by the Board of Health In order to determine if the system is failing to procect the
public health, ufery 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:
I '
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
�p The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well.
V The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS 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 indiotes that
the well is tree from pollution from that facility and the presen a of ammonia nitrogen and nitrate niuogen is equal to or
less than S ppm. Method used to determine distance g(jy (approximation not valid).
3) OTHER
tr•vlo•d 01/3$/77) Y&0. 3 of 10
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 88 Rudder Road West Hyanni sport,Mass.
Owner: Thomas George
Date of Inspection: 9/1 5/9 8
D) SYSTEM FAILS:
You must indicate ei;%.er "Yes' or 'No' as to each of the following:
�_ 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 cornea
the failure.
Yes No
Backup of sewage into facility or system ;omponent 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.
—A)ON 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.
Y Required pumping more than 4 times in the last year NNOT due to clogged or obstructed pipe(s).
Number of times pumped J3,,.
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 I 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:
You must indicate either 'Yes' or-No' as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 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:
Yes No.
-4zlf the system is within 400 feet of a surface drinking water supply
AO'
ythe 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 Protegtion Area-IWPA) or a mapped Zone 11 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.
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(revised 04/1S/)7) )•9. 3 of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 88 Rudder Road West Hyanni sport,Mass.
Owner: Thomas George
Date of Inspection: 9/1 5/9 8
Check if the following have been done: You must indicate either 'Yes" or,'No' as to each of the following:
Yes No '
Pumping information was provided by the owner, occupant, or Board of Health.
components None of the system have been pumped for at least two weeks and the system has been receiving normal
_ Y
flow rates during that period. Large volumes of water have not been Introduced into the system recently or
as part of this inspection.
As built plans have been obtained and examined. Note if they are not available wit 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 forr,,signs
� of breakout.
_ All system components,*kluding the Soil Absorption System, have been located on the site.
_r4/644�_ 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:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) (15.302(3)(b))
ts.vi..d 04/23/37) D.y• 4 of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Add►ess: 88 Rudder Road West Hyanni sport,Mass.
Owner: Thomas George
Date of Inspection: 9/1 5/9 8
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 5340 g.p.dJbedroom for S.A.S.
Number of bedrooms:
Number of current residents:
Garbage grinder (yes or no):D
Laundry connected to system (yes or no): c✓
Seasonal use (yes or no): ab -
Water meter readings, if available (last two (2) year usage (gpd): 6 /`�4fifiit�'•5 h�us>r �r4� /Jfc�
Sump Pump (yes or no): 1100 j1*eAAlT AV I,' pot 7#?O-v7- s.
Last date of occupancy: U0
COMMERCIAUINDUSTRIAL:
Type of establishment: AM
j Design flow: AM ¢allons/day
Grease trap present: (yes or no)AM
j Industrial Waste Holding Tank present: (yes or no)A2
Non-sanitary waste discharged to the Title 5 system: (yes or no
Water meter readings, if available:
N
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING R CORDS and so rce o inform ion:
IV
,,JC19
vr e y*,�;4.vr
System pumped as pan of ins ction: (yes or no)_&
If yes, volume pumped: gallo's
Reason for pumping:
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Alb
Overflow cesspool
Privy
Shared system (yes or no) (if yes, anach previous inspection records, if any)
VA Technology etc. Copy of up to date contract)
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no)
(s.vs..a 04/35/)7) P.Q. 5 of 10
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 88 Rudder Road West Hyannisport,Mass.
Owner: Thomas George
Date of Inspection: 9/1 5/9 8
BUILDING SEWER:
(locate on site plan)
Depth below grade:Agq!v
Material of eonstr ction: st iro 40 PVC other (explain)
�' r a�=
Distance from rivate wa r supply well or suction line %D'
Diameter_�
Comments: (condition of joints, venting, evidence of leakage, etc.)
Pi t No evi dennp of 1 eakago
ys em is vented ro igli the house vent.
SEPTIC TANK;&btk
(locate on site plan)
Depth below grade:,'
Material of construction• concrete4)Ametal,,V4iberglass ?l,4Polyethylene.r</(;?other(explain)
Al
If tank is metal, list age Is age confirmed by Cenificate of Compliance (Yes/No)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: 414
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:_V/4
Distance from bonom.of scum to bottom of outlet tee or bafile:_A24—
How dimensions were determined:
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.)
Septic tank is not present .
GREASE TRAN.A h.4,C
(locate on site plan)
Depth below grade:—A.—)h
Material of eonstruaion>1�J4concrete�etal-i tFiberglass.4,L/ Polyethylene Vlother(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:AZ
Distance from bottom of scum to bottom of outlet tee or baffle:.
Date of last pumping: 1A
Comments:
(recommendation for pumping, condition of ir,let and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage,-etc.)
Grease trap is not ores.el-)t- _ _
(revised 04125/97) P.y. 6 of 10
A.
SUSS'_ ' ..C: S:Y,;,,:; DISPOSAL SYSTEM INSPECTION FORM
PART C
I':FORMATION (continued)
Properly Address:88 Rudder Roar. 'VieE: t H i. ,inispsort,Mass.
Owner: Thomas George
Date of Inspection: 9/1 5/98
TIGHT OR HOLDING TANK: uank -•1 't,e n.Y`. ' ; rior to, or at time, of inspection)
(locate on site plan)
i
Depth below grade:,
Material of con struction�concreteA/Amet ! : /:7 oe,gl,s ; %:Polyethylenelaother(explain)
I
Dimensions: A 14
Capacity: gallons
Design flow; gallons/day
Alarm level: Alarm�'in working o:_....G� 1'„ tV) �o
Date of previous pumping: Q
Comments:
(condition of inlet tee, condition of alarm an.
Tight or hoiding tanks ._, F__nc_t.._;:-Y'�sen .
DISTRIBUTION BOX:,W'!%e.
(locate on site plan)
Depth of liquid level above outlet inven:�.;
Comments:
(note if level and distribution is equal, evider•. :' ,o' s _r, evidence of leakage into or,out of box, etc.)
Distribution "box is not
d PUMP CHAMBER:,beg-
i
(locate on site plan)
Pumps in working order: fYes or No) 4
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition .n-.G)s ,.n.; .1r:),n�:nances, etc.)
Pump chamber is not pre rtt,
tr.ys..d 94/2s/17) r y. 7 of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 88 Rudder Road West Hyannisport,Mass.
Owner: Thomas George
Date of Inspection: 9/1 5/9 8
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: .
i leaching pits, number:
leaching chambers, number:
leaching galleries, number:_
leaching trenches, number,length:
leaching fields, number, dime sions:
overflow cesspool, number:
Alternative.system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
t arse sa�d,No signs of hydraulic
Z,OamV npW $4nH r•
Ia7H r pon ing;'�ge'1ration is normal.
CESSPOOLS:
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer: U it
Depth of scum layer:
Dimensions of cesspools At
Materials of construction: 7t.Z4T"
Indication of groundwater: 40,
inflow (cesspool must be pumped as pan of inspection)
-Cesspools are dry Did not pump_ Hoiisp vacant fir thin
last 1-8 months. • � F
Comments: -
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Cesspools are Cry. No signs of hydraulic failure or ponding.
Ail vege a ion is normal .
PRIVY:'dJAVW--
(locate on site plan)
Materials of construction: iL/J9 Dimensions: �J¢
Depth of solids:—A22L
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Priyy* i s not e rpgpnt
(revised 04/25/37) P490 0 of 10
to�e;� ► a►-r�. UP
SUBSURFACE SEWAGE OISPOSAI SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION Icontinved)
Propeny Address: 88 Rudder Road West. Hyannisport,Mass.
OW-nte Thomas George
0itc of Intipaciion: 9/1 5/9 8
SXETCH OF SEWAGE olSPOS kL SYSTEM:
inclvde ties to at least two permanent references landmarks of benchmarks
locale all wells within 100' (locate when public water svpply comes into house)
D
$Q,RuddeY Rd
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SUBSURFACE SEWAGE DISP(;: ,L SYSTEM INSPECTION FORM
C
SYSTEM INFOR.'.t JION (continued)
Property Address: 88 Rudder_.Road West Hyanni sport,Mass.
Owner: Thomas George
Date. of Inspection: 9/1 5/9 8
r
Depth to Groundwater a✓6' Feet
Please indicate all the methods used to determine High Groundwater ElLvation:
Obtained from Design Plans on record
Observation of Site Nbuning properDobservation hole, basernerst'sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
heck pumping records
heck local excavators, installers
Use USGS Data
Describe in your own words how you established the High GrouncKwaierElevation. (Must be completed)
Used Water Contours Map.
Gahrety & Miller Model
12/16/94
(s.vl..a 04/25/17) . P.y,. '.Dcr 10
y •.mar+.—nlrs.-tTSmrmr•nenrR-I+.rrn-rmnr.�5+5TarriT�*m.5 rsrrnv*ea>:aran rv-s+ .rn•re�-nn�+�:..t-.r••�
'!'OWN OF Barnstable BOARD OF HEALTH I
SUlISUlIFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D '- CERTIFICATION I
.� �«•TI'1«T•: ::5—T.111{��TT}I1T111'1f.'ff'IT+t1PlRRIS:rTT'r�.5'IT11RR1 iTRI—Tti•TTCOgT�i�il7 ,>flllA ..t•t1-T'T>•-�1•—..A
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS _88 Rudder Road West Hyannisport,Mass.
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Thomas George
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber� & Sopiw- Inc.
COMPANY ADDRESS Box 66 Centerville,lvIass . 02632 .
street Tow„ or City State LIP
COMPANY T.ELEPHONI ( 508 ) 775 - 3338 FAX ( 508 ) 790 4 578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate, and
complete as of the time of,.-inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Chec ne: 1
System PASSED 7
The inspection Irhich 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 15. 303 , Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have con acted has found that the system fails to
Protect the public health and the environment in accordance with Title
5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
r ,
Inspector Signature it^ 1Ade
DateOne copy of this rtifieatioh must be proo the OWNER, the BUYER
( where applicable ) and the 130ARD OF )ILrAL'I'll ,
* If the inspection FAILED, th'e owner or, operator shall u d
he
within o'ne ;year of the date of the inspection , unless allow.edortrequiredm
otherwise as provided in 3,10 ChJR 15 • 305 ,
partd.doc
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_ _ _ _ .._. _ � __ . _ .._ .. `. .__ � .I mil._ ��.. _J _ _w A s✓ _} i� l _ M1�i�5...�C R._ L/��_ ��}✓1�J �• A i J
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Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CER'ITEMD TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
lunc a. 1995
Acung Dircctor of the ion of Watcr Pollution Control