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Home My WebLink About0139 POPONESSETT ROAD - Health 139 PO P p Ile esoT V..kt COTUIT A= i J i J FDCDu- Ln cm - • Ln I i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292•6600 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVM B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION P►wtyAdd,.,s: 139 Popponesett Road Name of0�w�er Chris Minervino C o t u i t,Mass. 02635 Address of Ownw: Mae Lane Dort,of hspection: Dover,Mass. Name of kupectar: (PieasePrirt)Joseph P. Macomber Jr. I am a DEP approved system bupector pursuarrt to Section 15.340 of TMe 5(310 CMR 15.000) c,, „ N,f11e: Joseph P. Macomber & Son, Inc. Making Address: SOX 66, Centerville, M 6 3 2-0 0 6 6 Telephone Number: CERTIFICATION STATEMENT 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 se age disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails 54' Inspector's Signature: D.:The System Inspecto all submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)wttNn 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 "ll submit the report to the appropriate regional office of the Department of-Envlronmentai Protection. The original should be.sent toVw system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS r �4�� UN �® _ pB 2 g of `O0 r z revised 9/2/98 page Iorli �,Printed on R"kd Paper SUB3URfAC9 SEWAGE 013POSAL SYSTDA tN3►ECT$0N FORM • PART A ,. .• t ti CFRTU•iCJ1TtON (oondrx+e� Pr*pw y Ada o-a&: 139 Popponesett Road Cotuit,Mass. Owr*: Chris Minervino °°'a Of tr,ap.KZS«+' 5/2 4/0 0 paPECTION SVIA tAAY: Check A. e, C, " a. A., SYSTEM PASSES: Fi I have not found any Information wNeh Ind)eates that any of the hours ooridhltuts deaer(bod In 310 CMR 14,303 oxlet. Any W" crherta not ova)usted uo Indicated below. t70 hl1tFNT5: B. SYSTEM CONCITtONAUY PASSES; ` One of more system oompononu u do+ortbod In the 'Cor►dltlo"/aaa'seodon need to be replaced w rsp&Uod. Tho eystom. w;x compJadon of the replacement w repair,"approved by the Board of Health, will pa.as, u:ndca .yes..no..or,not determined(Y. N, w NO). 0e+crib•baal+of dotarnJnadon In all WUnoes. If 'not detorn*wd', expi&Ln why not. 1 Ajg)f- The septic tank Is meal,uNo#s the ownw w opwotor has provided the system 4upootor whh a copY of a C.rd•ncote of t_ CompUance (onschod)IndJcadnp that the ur►k was IrAullod wlWn twenty 120)Years prior to the Claw of the 4tapecVon: the septic tank, whether or not motel,I+orookod,+VvoturaAy unsound, show+subetandal InWodon Or exftrvsdon, a t- fallure Is InuNnent. The system wW pa+s Inspection If the ox)stinp septic tank Is replaced with a cornpllMO +epdc uru approved by the Board of HoWth. 1 Q $*wage backup or breakout or Nph sudo water level observed In the dl+vlbudon box Is due to broken w obswcud p+P or due to a broken, settled or unovon dlstrUtIon box. The system wW pass Irupootlon 1t(w)th approval of VW Board of Healthl. broken pipes)we replaced. obswcdon Is removed distribution box Is levelled w replaced The sy*tsm required pwnptrtg ff*m V%anlourdmos s"ardus to broK*nw obst, cted plpe(ol. The iyet*.. wvygxr Inspection 11(wlth approval of the Board of Health): broken plpe(s).uo repiacid obstruction Is removed r revised 9/2/98 page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION (con*wed) Prope,ty Addreu:1 39 Popponesett Road Cotuit,Mass. Ottew: Chris Minervino Doti'G4k-P- 0n:5/24/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ,sA — Conditions exist which require further evaluation by the Board of Health In order to determine if the system Is falling to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CWt 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH ya LMOJECT THE PUBLIC HEALT11AND SAFETY AKD THE EN1080NMEI>IiL• Cesspool or privy Is within 60 fast of surface water Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPUFR,IF ANY)DETFRlM993 THAT THE SYSTEM IS FUNCTIONING W A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic 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 soil absorption system and the SAS Is within a Zone I of a public water supply wall. 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 then 100 feet but 60 feet or more from a private water supply wall, 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 tammonla nitrogen and nitrate nhrogen Is equal to or less than 5 ppm. Method used to determine distance_(approximation not valid).- 3) OTHER This is 'a-sewa e- �' vR ' "" e o r have c can san ' ms. is s s em as ears The- cesspools are structurally- sound. revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM „ ` PART A CERTIFICATION (continued) 139 Po onesett Road Cotuit Propwty Address. PP Mass.► Ownw: Chris Minervino Date of Inspection:5/2 4/0 0 D. SYSTEM FAILS: You.must indicate either "Yes" or "No" to each of the following: AV I hews determined that one or more of the following failure conditions exist as described 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 correct the failure. Yes No Backup of**Wage irrtofaciR"•Vyetent coRtponent•dne%to an overloaded orclegged•SfIS-or-ceaspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. __A/044_/ 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(a). 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 less-then 100 feet but greater than 60 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" to each of the following: The following criteria apply to large systems In addition to the criteria above: 4 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-isrwii44n 200 feet of•+•t+irsuterV_to-a eurfao"Ank4PV water•eurply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforination. revised 9/2/98 Page 4or11 I 1 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �. ., PART B CHECKLIST propartyAddfei,:139 Popponesett Road Cotuit,Mass. own«: Chris Minervino Dart*of Inspects°': 5/2 4/0 0 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. None of the system•compoaants hawl»an paatped4opat•Jeaat vwo•weaks an&tbe'*ystom hasbaeavecolaiwges omw 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 she was Inspected for signs of breakout. _ All system components.,-onluding 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 baffler or teas, 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:- Existing information. For example, 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) 115.302(3)(b)1 _ The facility ownar(and.^^ mmuAf diflar&u froauoAww).w&r&4ma triad wllh)atarmatiomon*t-fur walaz ^-^r ^f SubSurface Disposal Systems. revised 9/2/98 Page 5ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM > PART C SYSTEM INFORMATION Property Address: 139 Popponesett Road Cotuit,Mass. owrwr: Chris Minervino Data 04 Inspection: 5/2 4/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow:_aV g.p.d./bedr m. Number of bedrooms,(�dosslg,�);� Number of bedrooms(actuaq:� Total DESIGN flow' Number of current residents:, Garbage grinder(yea or no):_0 Laundry(separate system) ( es or(96 ,_, If yes, sepacatslnspection.required Laundry system Inspected (0s)or no) Seasonal use eyes or no): Water meter readings,If available (last two year's usage lgpdL: �c/9,/,��'/��.rJS — •7 6 Sump Pump(yes or no):AAD R 41,0 4!6 /e• Last date of occupancy: A . COMMERCtAVW DUSTRIAL: Type of establishment: Design flow: and ( Based on 15.203) Basis of design flow Grease trap present: (Yes or no) Industrial Waste Holding Tank present:(yes or no)A& Non•sanitary waste discharged to the Title 6 system: (yes or no)A?d Water meter readings,If available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: 4)19 GENERAL INFORMATION PUMPING RECORDS&ng sou ce of information: 4 &Z!ti A,f��O System pumped as part of Inspection: eyes or no)� if yes, volume pumped: d gallons Reason for pumping: �— TYPE OF SYSTEM Septic tank ldistributlon box/soil absorption system / Single cesspool Overflow cesspool X0 Privy Shared system(yes or no) (if yes, attach previous Inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract AAA Tight Tank 44 Copy of DEP Approval Other �!) APPROXIMATE AGE of all components, date Inetagediif known)-and sources o(•iwfom►ation: Sewage odors detected when arriving at the site: (yes or no) revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PmpamrtyAdd,eu: 139 Popponesett Road Cotuit,Mass. owns: Chris Minervino Date of inspection: 5/2 4/0 0 BUILDING SEWER: (Locate on site plan) 11 Depth below grade: Material of con truction: cat iron hJ1 0 PVC Pother(explain) r ' ,,6 Distance from private water supply well or suction line f�r Diameter Y Comments: (condition of joints, venting, evidence of foakage,-etc.) Joint SEPTIC TANK:4 le (locate on site plan) Depth below grade: '(11f Material of construction ifconcreteNRmetaI4 Fiberglass.W—W Polyethylene W40ther(explain) If tank is metal, list age A14 Js.age.confirmed by Certificate of Compliance yjj(Yes/No) Dimensions: AW Sludge depth: ,t 99 _ Distance from top of sludge to bottom of outlet tee or baf er: A14 Scum thickness: 414 Distance from top of scum to top of outlet tee or baffle: 4, _ Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: AIIO Comments: (recommendation for pumping, condition of Inlet and outlet toes or-baffles, depth of liquid level in relation to outlet invert, structuraHntegrity, evidence of leakage,etc.) Septic tank is GREASE TRAP: 'c (locate on site plan) Depth below grade:4L Material of constructi on:4�4concreto4 metaljyjFiberglassA&Polyethylone4other(explain) Dimensions: lR Scum thickness: A-44 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Dete of last pumping: _ 1 Comments: (recommendation for pumping, condition of inlet and outlet toes or baffles, depth of liquid level In relation to outlet Invert, structural Intogrity, evidence of leakage, etc.) rease ra is revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART C SYSTEM WFORMAMN(contUxHd) Property Ada*": 1 39 Popponesett Road Cotuit,Mass. Ow^w: Chris Minervino Dew of h%',)o d n:5/2 4/0 0 TIGHT OR HOLDING TANK: LVj—(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grade:—ALA Material of construction:Vdconcrete(�s metal 4�.aFlberolm&Polyethylene jother(explaln) AX Olmenslons: NR Capacity:,_gallons Design flow: gallons/day Alarm present Alarm level: Alum In working order:Y@#AH No&V Date of previous pumping: 4A Comments: (condition of Inlet tee, condition of*farm and float switches,etc.) 1 Di.STRIBUTION BOX:d"-Ne, (locate on site plan) Depth of liquid level above outlet Inven: Ar,4 Comments: Ina*If level and distribution Is equal, evidence of"Ids carryover, evidence of leakage Into or out of box, etc.! is ri u i PUMP CHAMBER: /Ib4 Notate on site plan) Pumps In working order:(Yes or No) K-* Alarms In working order(Yes or No)_�1 Comments: inote condition of pump chamber,condition of pumps and appurtenances, etc.) camp C n1iamhpr 1 c *+ revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C ' SYSTEM INFORMATiON(contlrKbed) Property Address: 139 POpponesett Road Cotuit,Mass. Ownw: Chris Minervino Date of�`"p"ti°r':5/2 4/0 0 SOIL ABSORPTION SYSTEM(SAS); (locate on site plan,If possible;excavation not required,location may be approximated by non-Intrusive methods) If not located, explain: Type: leaching pits, numben-a leaching chambers, number:Q leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions overflow cesspool, number. Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Loamy sand e a ion s norm are. ver ow is c e n CESSPOOLS: (locate on site plan) Number and configuration: Depth top of liquid to Inlet Invert; Depth of solids layer: Depth of scum layer: Dimensiohs of cesspool Materials of construction: Cmx.4,1, Indication of groundwater: 4 inflow (cesspool must be pumped as part of Inspection) Cesspools are- dry. Commenu: Inote condition of soil, signs of hydraulic failure, level of pending,condition of,vogetatlon, etc.) Cesspools are dry, PRIVY:1t* (locate on site plan) Mater*s of construction: Dimensions: 111/� Depth of solids: 44 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) Privy is not oresent revised 9/2/98 Page 9of 11 I SU93URFACC SEWAGE 04POSAL SYSTEM WSPICTION FOR1d FART C SYSTEM WFORMAT10N(eon VAA0 1 r,opwsyAdaw: Chris Minervino owr«: 139 Popponesett Road Cotuit,Mass. ().a at Inap.cdon: 5/2 4/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include dss to at least two permensnt reference landmarks or benchmarks lots%# all wells wiWn 100' (Locate where publlo water supply comas Into house) reYised 9/2/98 Pa�elootll SUBSURFACE SEWAGE OtSPQSAL SYSTEM WSPECTION FORM PART C SYSTEM INFORMATION (corr k..d) Ptop*MAddraaa: 139 Popponesett Road Cotuit,Mass. own«: Chris Minervino Dou of tnapocdort:5/2 4/0 0 NRCS Report name Soil Typo_ Typical depth to groundwater USOS Date wobsite visited Observation Wells chocked Oroundweisr depth: Shallow Moderato Deep SITE EXAM Slope Surface water Check Collar Shallow wells Estimated Depth to Oroundwstorv%6rFeet Plosse Indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record bservod Si�(AbutWdng propert observation hole. basomoot sump etc.) etermined al conditions Chocked with local Board of health Checked FEMA Maps Chocked pumping records 1//Chocked local oxcovstors, Instollors Used USGS Date Describe how you established the High Groundwater Elevation. ftLd be completed) Used water contours Map. Gahrety & Miller Model 12/16/9 w revised 9/2/98 PogsltofIt 1, J n r.. n4, ,0..y�.•rp.. 11'OHN OF Barnstable WARD OF HEALTH SUIISUNFACF SEWAGE DISPOSAL ,SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I •.•T^1•T••.••.'. —T.I I T.�.�TT'ItA T',I1'R.91,'1 PIIr JI�RI11!pl'T.r—l1�10R1�1R1'�1T�A��t�9Rt Vw11 .+rrT•►�'�. .�..I -TYPO OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 139 Popponesett Road Cotuit,Mass. ' ASSESSORS MAP , BLOCK AND PARCEL lY7T OWNER' s NAME Chris Minervino PART D - CERTIFICATION NAME OF INSPECTOR _ Joseph P. Macomber Jr, COMPANY NAME Joseph P. Macomber &"`Son, Inc. COMPANY ADDRESS Box 66 Centerville MA. 02632-0066 Street Town or Clty State EIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790- 1578 w 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 omplete 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 , ' 11 % tlli�lt Check one; _ v System PASSED The inspection which 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 vo ted has found that the system fails to- Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date ne copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the DOARD OF HEALZ'11, * If the inspection FAILED, the owner or operator shall upgrade - the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CHR 16 . 306 . partd ,doc