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HomeMy WebLinkAbout0087 MARSTON AVENUE - Health 87 Marston Avenue Barnstable A = 288126 R o � 1 �l COMMONWEALTH OF MASSACHUSETTS H EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS b d DEPARTMENT OF ENVIRONMENTAL PROTECTION Y TITLE 5, OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTE F PART A CERTIFFICATION APR 2 5 20 02 Property Address: MkaST-0 ��� TOWHEOALBHARN DEPTABLE Owner's Name: Owner's Address:, Pa Q izao-60/ MAPZ%8 Date of Inspection: 14 1 PARCEL : 1,2(0 1 Name of Inspector: please print) LOT print) , �S �`�OL1-"?�. — Company Name: u-l'"la— ,;.- Spo Ui)sT;wc_T veil Mailing Address: 12,y. 6pyt 7 c)7— M4-t25'r0#J5 MIu-S, MA Telephone Number: 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: V/Passes Conditionally Passes:', Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 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 systern is a.shared system.or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit thi 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 ow different conditions of use. Page 2 of 1 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ' 7 M A 1E-S'rD NS &E; Owner: Date of Inspection: o Z 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"Conditiona/metal ed to b replaced or repaired. The system, upon completion of the replacement or repair, as ao of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the followi "not determined"please explain. The septic tank is metal and over 20 years old*or the septic tankr not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure' imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved the Board of Health, *A metal septic tank will pass inspection if it is structurally sou , 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 t or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled uneven distribution box. System will pass inspection if(with approval of Board of Health): b en pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain.- The system r uired pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if ith approval of the Board of Health): broken pipe(s)are replaced obstruction is removed explain: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �7 M A 46-ro,-5 I�VC Owner: Date of Inspection: ,2 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to dete e 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 R 15.303(1)(b)that the system is not functioning in a manner which will protect public health,sa 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 wetla or a salt marsh 2. System will fail unless the Board of Health(and Pu is Water Supplier,if any)determines that the system is functioning in a manner that protects the p .tic health,safety and environment: _ The system has aseptic tank and soil abso tion system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surfac ater supply. _ The system has a septic tank and S and the SAS is within a Zone 1 of a public water supply. The system has a septic tank nd SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic silk 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 passe f the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volati organic compounds indicates that the well is free from pollution from that facility and the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteri are triggered. A copy of the analysis must be attached to this form. 3. er: r Page 4 of 11 OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address MA-"-rDa} Av>✓ Owner: Date of Inspection: L D: System Failure Criteria applicable to all systems: You must indicate"yes" or"no"to each of the following for all inspections; Yes No _ 7 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.N T due to clogged or obstructed pipe(s). Number T 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 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. [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.] D (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 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• 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 er supply y the system is within 200 feet of a tribut to a surface drinking water supply — the system is located in a nit en sensitive area(Interim Wellhead Protection Area—1WPA)or a mapped Zone II of a.public wa supply well If you have answered" s"to any question in Section E the system is considered a significant threat,or answered "yes"in Section ove the large system has failed. The owner or operator of any large system considered a significant at under Section E or failed under:Section D shall upgrade the system in accordance with 310 CMR 15.30 . he system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �'7 1,4 ivg`roos AVM Owner: Date of Inspection: 2 Check if the following have been done. You must indicate"yes"or"no"as to each of the following; Yes No Pumping information was provided by the owner, occupant, or Board of Health 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? _N f A 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 Sail 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)] Page 6 of 11 OFFICIAL]INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 87 ivi rw_s-rctos Avu Owner: Date of Inspection: 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): ,2 DESIGN low based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3,30 Number of current residents: / Does residence have a garbage grinder(yes or no): A10 Is laundry on a separate sewage system(yes or no):Yo [if yes separate inspection required] Laundry system inspected(yens or no); n(D Seasonal use: (yes or no): Iv O Water meter readings, if av ilable(last 2 years usage(gpd)): Af0'r' AVA-1t A8L Sump pump(yes or no):No Last date of occupancy: Cu itg ff.txr COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/perso_n_s/sgft etc:): 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: —8t'A-(Li) or 4L74-OW Was system pumped as part of the inspection(yes or no): f S If yes,volume pumped: 50 allons--How was quantit pumped determined? I_AW L 6A-u6(: Reason for pumping: `TZC,-aLj r R.Gb P a, �r L-rxATa p4 EVAt a vn ctj 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: 14t_JJ -NcuJASIk�Pk)y 4o TPA No -Too /Lceorz-os Were sewage odors detected when arriving at the site(yes or no): N b I . Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: M t+-"Ten1S A vc Owner: Date of Inspection: 2 BUH DING SEWER(locate on site plan) Depth below grade: Y Materials of construction:-cast iron 40 PVC_✓other(explain): 6P—,+ J6&emu-G Distance from private water supply well or suction line: /1 M Comments(on condition of joints,venting, evidence of leakage, etc.): 60,13¢ S U td 0 i) SEPTIC TANK:_(locate on site plan) �J 11 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 detennined: 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) 01A 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): r Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1?7 Owner: Date of Inspection: o 2 TIGHT or HOLDING TANK: �/-hank must be pumped at time of inspection)(locate on site plan) Depth below grade; Material of construction: concrete metal fiberglass__polyethylene other(explain): 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.): DISTRIBUTION BOX: 41 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): DUMP CHAMBER: /1,l (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.): Page 9of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ��/ M A-"-co rjS "C- Owner: Date of Inspection: 2- SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: leaching chambers,number: leaching galleries,number: leaching trenches, number, length: leaching fields, number,dimensions: --�7 overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): M n Is 1 2s U4, r--u u. CESSPOOLS: -/ (cesspool must be pumped as part of inspection)(locate on site plan) Number and con-figurations- Depth—top of liquid to inlet invert: /o" itiJ Pki m ALAI q'i2 ff /aJ o d&2FtcttJ Depth of solids layer: 1211 &L)g Ta Pu jv�P t�U6 Depth of scum layer: N o,U e5' Dimensions of cesspool:�' ) , Materials of construction: STRz' 1� coG� Indication of groundwater inflow(yes or no):Flo Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.): 6 w D Cb�j b i Tt c�e-Lv) TD C-lZ-Al>C 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.): • r Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: MkpS-rzN6 A-L) Owner: Date of Inspection: k �- 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. t � a L A A L 2 4 3—61 GESsPoot `✓b�/r-t�z 1=r.�o v� '8 1 39-6 2 39 -6 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: $ m lk"To O� AU Owner: Date of Inspection: - SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 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) _�7 Checked with local Board of Health-explain: G 1 S .D ATA Fj�PTE�2 E--flAoD Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water>eleva ton: L�S0- (y1)9,V-e,4EE-1 aDAA 'BOA-P-D OF 1 �L"l� c'a>/kPA4L I tJ(— 61S C-ICUK(t6f3 UUIT14 WEIL r+-kb jI-SFD 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: MAQ90A 1045 A9. Owner: Gf it ds Dale of Inspection ,2;2..9 7 I SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks y Q bate all wells within 100' H000 .� POOP .N� Put / ° ioU Sysicrn fs 9ye Tidy. J J cc rd 0p dive c}`Q'-� % VEPTH TO GROUNDWATER th to.groundwater, �aZ lest / J � /. hod of detcrsninatlon A/�or approximation. n c.�(- t i f [ i t I �j ,1 Al go ° I, ��•jD2 !GL' aQcs' �� II y ti 0 LOT 12A �0 h� LOT 10 �o oa. LOT 38A i NOTE.- PRE=STINC A70NC0NF0RMI.NG RES.. ZONE- "RF-1" This MORTGAGE INSPECTION Plan is For FLOOD ZONE- "C' Bank Use Only TOWN: _ DUV -OET__----_-_ REGISTRY OWNER: ROhANNE'FAPP,.,"...__-___.____ DEED REF: -L24222-K--------BUYER: .�_FLVA.A'�----_--------------------- DATE: - 1 0�______------ PLAN REF: _P4/69 & 1VZ2/2 __--SCALE:I" 3ZFT. I HEREBY CERTIFY TO �AP_E_COl1_C�OPER.4YE YATvTkEE SURVEY BANK_ __________ _ ______THAT THE BUILDING tM'Qi SHOWN ON THIS PLAN IS LOCATED Oi�T THE GROUND AS CONSULTANTS SHOWN AND THAT ITS POSITION DOES CONFORM VA 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE � �y � INDUSTRY ROAD IVO TOWN OF _ f3AFNST.!BL0'-------------AND THAT IT DOES_ T LIE WITHIN THE SPECIAL FLOOD HAZARDS MARSTONS MILLS,' MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED_?/�/9�__ �' 8!g'�{A "EL: 42840055 o i t --Pa �50001 0006 D dk v FAX: 420-5553 _ ___ _ THIS PLAN NOT MADE FROM MENT 31176 LM PALL M�ER HEW. P --u— SURVEY NOT TO BE USED FOR FENCES ETC.