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HomeMy WebLinkAbout0721 POPONESSETT ROAD - Health 721 POPQNel�SErr Ke& A = 006 045 0 r I' I I 1 f f h � AO CATIO SEWAGE PERMIT NO. L G I N S T A LLER'S NAME i ADDRESS BUILDER OR WNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED tN a 32 Y l -s ?al BPOnP,�S�? co Ut f.; DATE -9/�/ ----- - PROPERTY AOORESS: 222_$ p©iiesett road-_ -_-Cotuit,Mass_---- ----- 02635 ------------------- On tho above dalo,,l InapWod the oeptlo syite`r� at the aboyo addra53 Thli iyslom conalsli of (he following; 1 . 2-6 ' XV black cesspools. RREIVE® 2. The cesspools are in series Based on my Inspeallon, I cortlfy the following oondlilon t OCT 9 2001 . 3. This is not a title five septic system_ ®�fHEALTHDEPT RNSTABLS 4 . This is a sewage system. The sewage system consists o wo block cesspools. in series.The main cesspool acts as a septic tank.Contains soilds in place.Waste water passes over to the second cesspool.Waste water is 66" below the inv rt pip 5. The sewage system is in proper $1 Q NAT _, working order at the present time. Name yQa�cC �U�_.,__.._ Company; Jo� •�h_P � N• comber—b $on , Inc , Addreaa ; Box 66 --- CenceryilleL He_- 02637-0066 , TM:S CERTIFICATION OOE$ NOT CON9TITVTC A OVARANTY OR WARRANTY JOSEPH P, MACOMBER & SON, INC, Tinki-0vijpooll-l.vichflildl - Pvmped 4 Infl+lled Town S+wor Connevlloni P.O. Box 66 01nteryllli, MA 02637-0066 y7SJJJB 775b<lZ �Y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 721 Popponeett Road Cotuit,Mass. Owner's Name:James Schaadt Owner's Address: 9/,?/01 Same Date of Inspection: 9 01 Name of Inspector: (please print) Joseph P.Macomber Jr.J CompanyName: .P.Macom er I Son Inc. Mailing Address: Box 66 Centerville,Mass. 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that 1 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: �✓ Passes Conditional]\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 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 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 or differentf conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 721 Popponesett Road o ui , ass. Owner: James Sc as t Date of Inspection: 9 01 Inspection Summary: Check A,B,C,D or E/ALWAY complete all of Section D A.� System Passes: Ihave found an information hich 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: The sewage system is in proper working order at the present time. r B. System Conditionally Passes: Vt) 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. Answer yes, no,or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. /IJO e The e tic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhi its substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,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 out or high static water level in the istributi bo due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: Az The system required pumping more than 4 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 ND explain: 2 r Page 3 of I I f OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 721 Popponesett Road Cotuit,Mass. Owner: James Schaadt Date of Inspection: C. Further Evaluation is Required by the Board of Health: AJ6 Conditions exist which require further evaluation by the Board of Health in order to determine 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 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: k)A Cesspool or privy is within 50 feet of a surface water 411) 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 any) determines that the system is functioning in a manner that protects the public health,safety and environment: VO 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. 4)D The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. .W The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ,6 The system has a septic tank and SAS and the SAS is less than 100 feet but feet or more from a private water supply well". Method used to determine distance "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. 3. Other: 3 Page 4 of I l OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 721 .Popponsett Road Cotuit,mass. Owner: James Schaadt Date of Inspection: 9/.9/01 D. System Failure Criteria applicable to all systems: You must indicate"yes or"no"to each of the following for all inspections: Yes No Dackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool .Up',e L Static liquid level in th istribution bo bove 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 '14 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 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. 1�y portion of a cesspool or privy is within 50 feet of a private water supply well. y 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.] Al? (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: r 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 within400 feet of a surface drinking water supply _ —;--/ti,e system is within 200 feet of a tributary,to a surface drinking water supply _ the system is located to a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone I1 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 721 Popponsett Road Cotuit,Mass. Owner: James Sch,aadt Date of Inspection:9 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 ? /Were as built plans of the system obtained and examined? (If they were not available note aj9 _ 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,.�tcluding the SAS, located on site? Were th se tic anholes 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 ? 2_ 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 Soil Absorption System (SAS) on the site has been determined based on: Y/Ex isting information. For example,a plan at the Board of Health. _ _ etermined 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)) 5 Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 721 Popponsett Road o ui , ass. Owner: James Schaadt Date of Inspection: FLOW CONDITIONS RESIDENTIAL 22 Number of bedrooms(design): t% Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms):. /M'= �� Number of current residents:_ , Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system ( es or no):z)O [if yes separate inspection required) Laundry system inspected(yes Seasonal use: (yes or no): 4,V � p� Water meter readings, if available(last 2 years usage(gpd)):f4T/" Sump pump(yes or no): Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): ,{J1A gpd Basis of design flow(seats/persons/sgft,etc.): do Grease trap present(yes or no): I 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: ��¢ Was system pumped as part of the inspection(yes or no): �° 'A If yes, volume pumped: / � gallons -- How was quanQry pumped determined? Koj1.W.,'" Reason for pumping: S000 TYPE OF SYSTEM A)l)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 Zained from system owner) Tight tank •(&Attach a copy of the DEP approval ��Other(describe): Appr i ate age of all com o ents, date installed(if known)and source of information: Were sewage odors detected,when arriving at the site(yes or no): 6 Page 7 of 1 I ;. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:721 popponsett Road o ui , ass. Owner: James Schaadt Date of Inspection: 9 01 BUILDING SEWER(locate on site plan) Cast iron exits house to // orangeberg pipe to the main Depth below grade: I-T cesspool. Cast iron tee Materials of construction: cast iron V60 PVC 1!�4thersexplain): to the overf low cesspool. Distance from private water supply well or suction line: /D ,o Comments(on condition of joints, venting, evidence of leakage,etc.): Joints appear tight.No evidence of leakage.The system is vented through the house vents. SEPTIC TANKKt/bNO(locate on site plan) Depth below grade: 4,0 Material of construction:4,Aoncrete,{/A metal.,e[�berglassA/hpolyethylene Mother(explain) �4 If tank is metal list age:A/h Is age confirmed by a Certificate of Compliance (yes or no)aGI>9 (attach a copy of certificate) Dimensions: Nd Sludge depth: �04 Distance from top of sludge to bottom of outlet tee or baffle:4 Scum thickness: 4A 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 determined: --el'4 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of.leakage, etc.): Pump the main cesspool every 2-3 years.0utlet tee is present. . The cesspools are stucturally sound The covers are to grade. Pumped main cesspool at time of inspection.No signs of water water intr sion.Onl)r 6" of waste water in the overflow cesspool. GREASE TRAPXC(locate on site plan) Depth below grade: Material of construction:,e4 concrete•i/4meta1,09 fiberglass polyethylene tAother (explain): 11614 Dimensions: 10 Scum thickness: .f1 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Ad 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.): Grease - trap is not present. 7 Page 8 of 1 1 t ,•u r :. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 721 Poppon2, Road Owner: James c as Date of Inspection: TIGHT or HOLDING TANK,(�5. /C(tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: elf Material of construction: A concrete Aj&metal VA fiberglass &, polyethylene�i4other(explain): 1 Dimensions: Capacity: gallons Design Flow: tw gallons/day Alarm present (yes or no): � . Alarm level: J,4 Alarm in working order(yes or no):,IAI Date of last um in : P P g a/r2 Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present DISTRIBUTION BO}C4ALe,(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: *e/� 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.): Distribution box is not present PUMP CHAMBERd/��(locate on site plan) Pumps in working order(yes or no): 09 Alarms in working order(yes or no):�ip- Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present. 8 .. Page 9 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 721 Popponesett Road Cotuit,Mass. Owner:James Schaadt Date of Inspection: 9 01 SOIL ABSORPTION SYSTEM (SAS): Zlocate on site plan,excavation not required) If SAS not located explain why: Located Type N�d leaching pits, number:- C� �c� leaching chambers, number: O LUe leaching galleries,number:. ,(JO leaching trenches,number, length: 4,40 leaching fields,number, dimensions: .Cluj overflow cesspool, number: I l innovative/alternative system Type/name of technology: a '1 6 Qe, Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,co vegetation, etc.): Loamy sand to fine sand.No signs of hydraulic failure or ponding.Soi s are ary.vegetation CESSPOOLS: Z(cesspool must b um ed s part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet ingrt: Depth of solids layer: !'0 Depth of scum layer:. Dimensions of cesspools I- L Materials of construction: Indication of groundwater inflow(yes or no): (4P Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Same as above PRIVYA�(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.): Privy is not present. 9 c w Page 10 of I I , OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 721 Popponesett Road Cotuit,Mass_ Owner: James Schaadt Date of Inspection: 9.1 /rl 1 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. 10 t Page 1 1 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 721 Popponesett Road Cotuit,Mass. Owner: James Schaadt Date of Inspection: 9 01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet . • Please indicate (check)all methods used to determine the high,ground water elevation: tip' Obtained from system design Tans on record- if checked,date of design plan reviewed: c fS Observed site(abutting prope bservation hole within 150 feet of SAS) -5, hecked with local Boar of Health-explain:4),f ,� [/S my /�� Checked with local excavators, installers- (attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Top of roun [Leaching Pit :eet Groundwaterk"Feet Below Bottom of pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. . 11 , i mnrw.-n+•ri*-.-rr-:ri►rmr•nmrrnn xsnrr..r:•mr-nnr,�msnm+mrnia +s�rnar+/rs+ Barnstable i TOWN OF BOARD OF HEALTH SUBSURFACE SEHAGF DISPOSAL ,SYSTEM INSPECTION FORM TART.D .- CERTIFICATION •••T!'t^T••.-•. —r.t.T.^.�rnmr+n-R.•nnT+i1't!•lTta+rTrT.r-i rsrs+l'7srn1R�T�T Rs'ItTs esen ..-:rm•t---„ .�..� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED 0 STREET ADDRESS 721 Popponesett Road Cotuit,Mass., ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME James Sch�adt PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inr,.f COMPANY ADDRESS Box 66 Centerville,Mass.02632 Street Town or Clty State LIP COMPANY TELEPHONE ( 508 ). 790 -, 1 578 - FAX (508. ) 790 -1578 R CERTIFICATION STATEMENT A I certify that I have personally inspected the sewage disposal system at this address and that the i►�formation 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 Ch/ecy one : 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 16 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* . The inspection which, I' h.Rve. con Ucted has found that the system fails to Protect the public health and the environment in accordance with Title 6 , 3.10 CMR 15 . 303, an'd as specifically noted on PART C -' FAILURE CRITERIA of .th'is inspection fo m . Inspector Signature Date ne copy of this Ve fication must be prov ded to . the OWNER, the BUYER ( where applicable the BOARD OF HEAL1'1I. * If the inspection FAILED, the owner or operator shall upgrade ' thIa ayetem. within one year of . the date of the inspection, unless allowed or required otherwise as provided' 'in 3.10 CMR 15 . 305 , partd.doc