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HomeMy WebLinkAbout0444 MAIN STREET (COTUIT) - Health 444 Main Strcet, Cotuit r a t, `, { A 1 � COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENT 61 DEPARTMENT OF ENVIRONMEN ROTECTI a'ti c ONE WINTER STREET. BOSTON, MA 0210 -292.554e, l9 `f 01 ='� TRL DY COXT WILLIANI F 'AELD ,B9q. �a GovcmorFAs9� 9J Sc roan lF ARGEO PAUL CELLUCCI DAVID B STRUI-tS� Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE FORM Commissioncr PART A ket II CERTIFICATION Property Address: 444 Main Street Cotuit,Mass. Address of Owner: Date of Inspection:8/20/97 (If different) Name of Inspector: Joseph P. Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Joseph P. Macomber & Son•Tnc , Mailing Address: gox 66, Centerville , Ma . 02632-0066 Telephone Number: --775—�JJ8 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 Evaluation By the Local Approving Authority Fails Inspector's Signature?all -!f —� K"' 7, Date: d The System Inspectorbmit 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 god 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: AI 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. COMMENTS: B) SYSTEM CONDITIONALLY PASSES: lvLl 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 inspection, 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 World Wide Web. hnp:ltwww.magnet.state.ma us/Cep Printed on Recycled Paper N SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:444 Main street`Cotuit Ma Owner: Robert Litwin Date of Inspection: 8/2 0/9 7 B) SYSTEM CONDITIONALLY PASSES (continued) tee- Sewage backup or breakout or high static water level observed in the istribution 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 (he Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced J.,Zjj 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 CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: lvi3 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: )L) Cesspool or privy is within 50 feet of a surface water ud.�176 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: D 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. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. EC) 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 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, Method used to determine distance ,//d (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 444 Main Street Cotuit Ma Owner: Robert Litwin Date of Inspection: 8/2 0/9 7 D) SYSTEM FAILS: You must indicate ew 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 Ch1R 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. Yes No/ Backup sewage e into facility or system component due to an overloaded or clogged SAS or cesspool. g xx Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. I-0AJ e_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth depth in ee-rispeel is less than 6" below invert or available volume is less than 1/2 day (low, _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped CL 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. 4 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: fir. . 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 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 /T 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) 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 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 444 Main Street Cotuit Ma Owner: Robert Litwin Date of Inspection: g/2 0/9 7 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes N� / Pumping information was provided by the owner, occupant, or Board of Health. i� 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 recewly or as pan of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. -lam _ 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,Aekluding 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: The facility owner (and occupants, if djfferent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. Y _ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) (15.302(3)(b)J (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Address: 444 Main Street Cotuit Ma Owner: Robert Litwin Date of Inspection: 8/20/97 FLOW CONDITIONS RESIDENTIAL Design flow. .p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or ct no): j �1 Laundry connected to syste (yes or no):/ Seasonal use (yes or no):_&_� q Water meter readings if available (last two (2) year usage (gpd): / ✓"C 8 Sump Pump (yes or no): _' Last date of occupancy � T. COMMERCIAUINDUSTRIAL: Type of establishment: J Design flowgallons/day Grease (rap present: (yes or no) � industrial Waste Holding Tank present: (yes or no)_&Il Non-sanitary waste discharged to the Title 5 system: (yes or no) - V,'ater meter readings, if available:0.9 Last date of occupancy: kIft OTHER: (Describe) Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS and source pf in ormation: System pumped as part of inspection: (yes or no) . If yes, volume pumped: /4l' gallons Reason for pumping: TYPE OF STEM - ,,'— Septic tank/ a+reft-6e+JsoiI absorption system 1,16 Single cesspool f, r% Overflow cesspool Privy Shared system (yes or no) (if yes, anach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: �✓�kLd!t� " Sewage odors detected when arriving at the site: (yes or no) � (r•vii•d 04/25/97) Pago 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 444 Main Street Cotuit Ma Owner: Robert Litwin Date of Inspection: 8/2 0/9 7 BUILDING SEWER: (Locate on site plan) Depth below grader Material of construction: _cast iron 40 PVC _ other (explain) Distance from private water supply well or suction line 4 J _ Diameter y/rr Comments: lconditipn of joints, venting, evidence of leak ag , e(c.). Se 1J Jr SEPTIC TANK:J"fro (locate on site plan) Depth below grade: f Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age&2 Is age confirmed by Certificate of Compliance/%�(Yes/No) Dimensions:'n Sludge depth: Distance from top sludge to bottom of outlet tee or baffle: Scum thickness: 1"We ? Distance from top of scum to top of outlet tee or baffle: %J Distance from from bottom of scum to bottom f outlet tee or bffle:�i 'G�� How dimensions were determined: Comments: (recommendation for pumping, conditi n of inlet and outlet tees or baffl s, depth of liquid level in relation to outlet invert, structural ng inty, evidence of leakage, etc.) 1 _; GREASE TRAP:, (locate on site plan) Depth below grader Material of con struction:-"Aoncrete'�&`etala.�iberglass4VAPolyethylene6✓Qother(explain) AM Dimensions: Scum thickness: 6 Distance from top of scum to top of outlet tee or baffle:�/q Distance from bottom of s um to bottom of outlet tee or baffler Date of last pumping: 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.) OF (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 444 Main Street Cotuit Ma Owner: Robert Litwin Date of Inspection: g/2 0/9 7 TIGHT OR HOLDING TANK��GTank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade:Si 1' material of con struaion: 1 concrete,(metal,V Fiberglass.4.yolyethylene,fAother(explain) Dimensions: AM Capacity: Aj6 gallons Design flow:_ gallons/day Alarm level: Alarm in working order _ Yes; — No Date of previous pumping: �,'/4 Comments. (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:khve. (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.) A,-S )21hZ fiAg 1 V, )S n 16T &.56%t1= PUMP CHAMBER:'$L/we. (locate on site plan) Pumps in working order: (Yes or No)—Z.?14- Alarms in working order (Yes or No)—" Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 444 Main Street Cotuit Ma Owner: Robert Litwin Date of Inspection: 8/2 0/9 7 SOIL ABSORPTION SYSTEM (SAS): AW� ,All-14) 97 ;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: D leaching chambers, number: leaching galleries, number:= leaching trenches, number,length: leaching fields, number, dime ions overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition f soil, si ns of hyydraulic allure, level of ponding, condition of vegetation, et .) C / a �1 rr CESSPOOLS: r (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert:�1/� Depth of solids layer: Depth of scum layer: AA Dimensions of cesspool: 42-4 Materials of construction: X IQ indication of groundwater: inflow (cesspool must be pumped as part of inspection) a1 i Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 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.) (raviaad 04/25/97) Page 6 of 10 r I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propeny Address: 444 Main street Cotuit Ma Owner: Robert Litwin Date of Inspection: 8/20/97 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supply comes into house) s \ P /. p U`6 3q �� r4 A,k 0 b66v (r•vi•.0 04/25/97) Page 9 of 10 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 444 Main Street Cotuit Ma Owner: Robert Litwin Date of Inspection: 8/20/97 r Depth to Groundwater J Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record i Observation of Site (Abutting property, observation hole, basement sump etc,) _ZDetermine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records _ZCheck local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) Cape Cod Commission Map September 95. Water Table Contours and Public Water Supply and Wellhead Protection Areas. Monomoy Lens (r*vixed 04/25/97) Pa9. 10 of 10 t r+�� n .T�TT' i'n�IT'n t•T/'PTr>,*'I.T.t;•.T'-1'�TT:TTT'+R.1 RR1L 1•TRTOn Tn .'eTi.+i-^a'rtTv��-.--+— - _ i ruwN OF Barnstable LIOARD OF HEALTH 9011SUNFACR SFHA(;F. I)ISNSAL SYSTF,M IN911FCTION FORM - PART D CFICCIFICATic��r �— I'.. —- � •. .— .I.-� �.�•.�rt.T TIT.4T ."1"TT'r •.1-1T'\RT1T'•'1'+I.'.C'1OY T7 RTnTrti"r'r ."l�Tm�+� —ram.-- r- � _. -TYPO OR PRINT CLEARLY- PROPERTY INSPECTED STREET A DDRCSS 444 Miin Stret Cotuit,Mass. ASSESSORS MAP , ©LOCK AND PARCEL # OWNER ' s NAME Robert Letw2n PART D - CCIZTIFICATIOIY NAME OF INSPECTOR Joseph P. Macomber Jr . COMPANY NAHE Joseph P . Macomber & tcn , Inc . COMPANY ADDRESS Box 66 Centerville , Ma . 02632-0066 Street Tovn or City COMPANY TELEPHONE (508 1 775 -3338 FAX ( 508 ) 790 -1578 CERTIFICATION STATEMCNT I certify that I have personally inspected the sewage disposal system n ; this address and that the information reported is truej accurat e ) and complete as of the time ofiinspection . The inspection was performed and an,., 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 , jChecA�on Sy, PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect pubic healLh or Lhe environment as defined in 310 CMR 15 . 303 , Any fai ! (ire criteria not evaluated are as stated in the FAILURE CRITERIA sec tie:) o : this form . System FAILED The inspection which I have con acted has found that the system fni ! s .o protect the public health and the environment in accordance with 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE' CRITERIA of this inspection form . i ,Inspector Signature rill9 �//-`': �� Date �✓�--�7 one copy of this ce1 ification must be provided to the OWNER , the BUYER ( wh IICable ) and the BOARD OF IIEALTII . • IC the inspection FAILED , the owner or "oporator ehall upgrado t h o eyate^ � ir.hin one year oC the date of the inspection , unless allowed or requireC otherwise as provided in 310 CHR 15 . 306 . part c- << * VG W 7 � y SbyV 3��1 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE S 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 8. 1995 Acung Dircctor of the on of Watcr�POUW�Iionontrol