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Home My WebLink About0046 PENELOPE LANE - Health _ 46 PENELOPE LANE; COTUIT w t A='039 047 i a AUK 'q' CERTIFIED SEPTIC SYSTEM REPORT G 996 Pak LOCATION , 46 PENELOPE LANE COTUIT, MA A 039 PARCEL 04 LOT 4 PREPARED FOR SELLER MR JOSEPH M CAPONE P .O . BOX 51 N . CARVER, MA 02355 — BUYER NONE. AT THIS TIME PREPARED BY HILLIARD HILLER P .O . BOX 250 CENTERVILLE, MA 02632 508-778-1472 F n, Commonwealth of Massachusetts Executive Office of Environmental.Affairs Department of Environmental Protection' I WARM F.Weld Trudy Core aoe.ri,« sevvwy Argeo Paul Celluocl David S.Struhs u armor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION ' Party A&h%ss: Ve, /IF4 EGvro< L,o t/.0 Address of Owner. Date of Inspection: p/a/yG a fFIIA19 of different) P':::;1 Name of Inspector. Company Name,Address and Telephone Number. 'dp Boa 77Ft i 417,2 . 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: y asses Conditionally Passes ' Needs Further Evaluation By the Local Approving Authority _ Fails J Inspectoes Signatm-e: 000F 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 erigiaal should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: t Cbscp,C,or D: A) SYSTEM PASSES: I haw aft famd any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any Whir*criteria not evahuted are-indicated below. - B) SYSTEM CONDITIONALLY PASSES: One or nose system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined',explain why am) 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 11/03/95) 1 One Wk ter Street a Boston,Massachusetts 02108 • FAX(617)556-1049 a T*I000ne(617)292-5S00 q0 Primed on Recycled Papa , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ;fto 10/FA-11C 419V9,[ Lf1.vG� Gof—iT Owner. Arl.,v Date of Inspection: BI SYSTEM CONDMONALLY 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions wrist 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 PROTECT 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 I 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 aseptic 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 hum pollution from that facility and the, presence of ammonia nitrogen'and nitrate nitrogen is equal to or loss than 5 ppm. a) ' OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 4/6� Owner. Date of Inspection: DI SYSTEM FAILS: I bare 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 cos- the fat7ure. 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. 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 112 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 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 leas 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 eoliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. c El LARGE SYSTEM FAILS: 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 mist: 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 wen) I The owner.or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program rsgttiremonto of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for huther information. (revised 11/03/95) 3 c1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property wddnws: Owner. ��imj Date of Iospeotion- 'Chsck if the following have been done: Bumping information was requested of the owner, occupant, and Board of Health. _ one 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 see been introduced into the system recently or as part of this inspection. vAs built plans have been obtained and examined. Note if they are not.available with N/A. !iThe facility or dwelling was inspected for signs of sewage back-up. ' &-The system does not receive non-sanitary or industrial waste flow, v Me site was inspected for signs of breakout. yAll system components,Q�Iuding 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 bates or teas, material of construction,dimensions, depth of liquid, depth of sludge, depth of scum. .ZThs size and location-of the Soil Absorption System on the site has been determined based.on existing information•or approximated by non-intrusive methods. ZThe facility owner(and oo=pants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION Property Address: �,If4c. ,C ,sit crr/�j Owner. Date of Inspection: FLOW CONDITIONS RESIDENTIAL Design flow:______pallons Number of bedrooms: 3 Number of current residents: O Garbage grinder(yes or no): No Laundry connected to system(yes or no): YG" Seasonal use(yes or no): ? Water meter readings, if available: fl-75- Last date of occupancy: (/kR 5A9•2,9 oic 1 Oiy iG y v5. COMMERCIAL/INDUSTRIAL Type of establishment: Design flow: aaallondday Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non.eanitary waste discharged to the Title 5 eystem: (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:, System pumped as part of inspection:(yes or no)YF'3 If yea,volume pumped: Ze eallons Beason for pumpia& TYPE OF SYSTEM _ �8eptie�n boa/soil absorption system Bungle oaa>rpool - • Overflow cesspool privy Shared system(yes or no) (if yes,attach previous inspection retards, if any) Other(explain) APPROIDUTE AGE of all components,date installed(if known)and source of information:, G�.�I. «*i�G . ,b1,0 /?��'/ Sawa`e odors detected when arriving at the site: (yea or no) (revised 11/03/95) 6 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 Owner. Date of Inspection: YZA�/1L SEPTIC TANK (/ (bate an site plan) Depth below grade:—Ai! Material of eo n• !/concrete_meW._FRP_other(explain) Dimensions: •, G pp 8 , - Shwp depth: ;R o' Distance f vin top of shulge to bottom of outlet tee or baffle: Scum thielmesa: B 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 Is-',age, etc.) TEES Gar�iY<p G':::tP,D 4/44--ia T nA ,4ixy,o� / /LG,e�2 A.riD L,�f1A.�.tO /X/i TU 1L/J/9/Alzi AGL ui✓/I� c✓i9S •L?cu/if /3'1 /9/ GREASE TRAP._ (locate on site plan) Depth below grade: Material of constn&ction:_oonerete__metal_FRP_other(explain) Dimensions: Scum thickness: Distance ftm top of aaim 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 bailles, depth of liquid level in relation to outlet invert, itructurslfiategrity, evidence of he><age,etc.) (revised 11/03/95) . 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Piwperty Address. Owner. h ," Date of Inspection: TIGHT OR BOLDING TANK:_ (locate an site plan) Depth below pmde: Material of c wWaction:_concrete_metal_F"_other(e:plam) Capacity: Qallons Design flow: sallons/day Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert:-- Comments: (note if kval and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) LAX- LW��fl Goo i T 4iAs [,/14,X L U Z T W !��'/� /d/,�,4 ,S�/Jf�'.Cf�T.t� '4� 6 G PUMP CHAMBER;_ r (locate an site plan) Peeps in working ordsr:(yes or no) Comn�ata: '. (note condition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Iaspeotiooe *Aa BOLL AMORPTION SYSTEM (SAS):_/c--'" (loods on site plan,if possible;sscavation not required,but may be approximated by non-intrusive methods) If not determined to be present,aplain: T'Pe: bachtng pits, number: leaching eAamber•, number: inching galleries,number: s leaching trenches,number,length: bathing fields, number,dimensions: ovardow cesspool, number: Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.)_ 17�y CBBSPOOLS:_ (locate an site plea) Number and configuration: Depth-top of liquid to islet invert: Depth of solids layer Depth of scum layer: Dimensions of cesspool: UstaAals of construction: Indication of groundwater: hd1ow(eses;-I must be pumped as part of inspections Cammsnts:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) Il•B1VY:_ (bests an site plan) Materials of conmuetion Dimensions: Depth of solids: Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued; P.operty Addre.e yG f04,&4 4g-,�C c•s�.v,�' cc� Owner. iy�.ry •E'!�/f h GiGRQ�.v.� Date of Iaspeotion: SE MB OF SEWAGE DISPOSAL SYSTEM: brim a tir to at Last two permanent references landmarks or benchmarks I="an walk within 100' .. Q DEPTH TO GROUNDWATER Depth to s?y� mstbod of detwmiaation or approsima ' i314ulsrl-; .6e r= 6/5 T&/. Si/�c .ro /9 T 72 T HB c r/v� l5 3 , s Ow P -3 2vfy, 6.- (revised 11/03/95) 9 TOWN OF BARNSTABLE LOCATION V6 /Zk6,0/i Cc�% L/�,ci/' SEWAGE # 91- VILLAGE Zo!n,;r y l? ASSESSOR'S MAP&LOT �Oy LTy /ivs�✓/'c �.s NAME&PHONE NO. f{, �-`/LG,E'i[ SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) G.TG (size) NO.OF BEDROOMS .3 OR OWNERSQ,�f/ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Id 4— 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 � o o o a Ci, b � t SEWAGE W A E PERMIT NO. A� Ioa c i LOC T 6"7-e VILLAGE � Cps INSTALLER'S NAME i ADDRESS AHN A. AALTO .BACKHOE SERVICE Street ,West Barnstable, Mass. 02668 GUILDER OR OWNER DA T E P ERMIT ISSU E D �� DATE COMPLIANCE ISSUED / �4 i _i at .M1 h