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HomeMy WebLinkAbout0136 NOBADEER ROAD - Health 136 Nobadeer Road,Hyannis A=251 - 226.E H a' rI l 0 Commonwealth of Massachusetts ' Executive Office;of Enviroranental Affairs ' Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 •John Grad D.E.P. Title V Septic Inspector P.O. Box 2119 Z Z Teaticket,MA 02536 WILLIAM F.WELD (50 - Governor 1 2 ARGEO PAUL CELLUCCI. Lt.Governor et SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM pc cP PART A ROMEO CERTIFICATION OCT6 C Property Address: 138 Nobadeer Rd.6eAWaclle Lot 18 y Address of Owner: TOWN OFBARNSTABLE Date of Inspection;9/29197 (if different) all HEALTHOEPT Name of Inspector:John Graci Robert MacDonald;26 Mary David Rd. uth Port I am a DEP approved system,inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: F G 9 CERTIFICATION STATEMENT 4 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: X Passes �- This inspection is based on criteria defined in Title V _ Conditionally as es code 310 CMR 15.303.My findings are of how the system is Needs FL r aluation By the Locel'Approvin d'Authority performing at the time of the inspection.My inspection does - not Imply any warranty or guarantee of the longevity of the. FeIIS septic system and any of its components useful life. Inspector's Signature: Date 9/29197 The System Inspector shall su mit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 original should be sent to the system owner'and copies sent to the buyer,if applicable and the approving authority. INSPECTIOWSUMMARY: Check A. B,C,or,D: , A] SYSTEM PASSES: 4 �. X I have not found any information which indicates that the system violates any of the failure criteria defined as in 316 CMR 15.303' Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion ., of the replacement or repair,passes inspection: ,.. 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 04127/97) , One Winter Street • Boston,Massachusetts 02108 9 FAX(617)556-1049 a Telephone(617)292-5500 SUBSURFACE.SEWAGE.DISPOSAL SYSTEM INSPECTION FORM "PART A' CERTIFICATION (continued) M _ ' Property Address: 136 Nobadeer Rd.Centerville Lot 18 Owner: Robert MacDonald;26 Mary David Rd.Yarmouth Pod Date of Inspection:9/29/97 1 _ Sewaae backup or.breakout.or hiahstatic water level observed.in.the distribution box is due to a broke.n. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations. broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 ' L C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:f _ 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: ' 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 of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply 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 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 col'Iform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility,and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to`determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"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 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 sewage in facility or system component due fo an'overloaded or,clogged SAS or " cesspool. a Discharge or ondin of effluent_ g p g to the surface of the ground or surface waters due to an Quarto©dad or clogged cesspool. i SAS is in hydraulic failure. (revised 04127/97) 4 SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART A ,CERTIFICATION (continued) Property Address: 136 NobadeerRd.Centerville Lot 18'' ' Owner: Robert MacDonald;26 Mary David Rd.Yarmouth Port Date of Inspection:929/97 D]SYSTEM FAILS(continued) Yes No , Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. g Liquid depth in cesspool is less than 6"below-invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year-NOT due to clogged or obstructed pipe(s). Numbers 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 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. 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: 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 b. 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 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 0427/97) n. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B , . W e •. CHECLIST Property Address: 136 Nobadear Rd.Centerville Lot 19' Owner: Robert MacDonald;26 Mary David Rd.Yarmouth Port Date of Inspectlon:9l29/97 _t Check if the following have been done:You must indicate-either"Yes"or"No"as to each of the following: — Pumping information was requested of the owner,occupant,and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this, inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for.signs of sewage back-up. " X The system does not receive non-sanitary or industrial waste flow. _X_ — The site was inspected for signs of breakout: X All system components,excluding the Soil Absorption System,have been located on the site. X 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. s _ X The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. X Existing information. Ex. Plan'at B.O.H: x Determined in the field(#any failure criteria related to Part C is at issue,approximation of distance is unacceptable)115.302(3)(b)1 . { • (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION Property,Address: 136 Nobadeer Rd.Centerville Lot 18' ' Owner: Robert MacDonald;26 Mary David Rd:Yarmouth Port Date of Inspection:9/29/97 FLOW CONDITIONS RESIDENTIAL Design flow: 330 g•p•d./bedroom for S.A.S.•.r Number of bedrooms: 3 ri Number of current residents: o Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage;(gpd): n/a. Sump Pump(yes or no): No Last date of t occuP ancY o 2 weeks a ` 9 COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:U gallons/day ' Grease trap present:(yes or no) No Ftt Industrial Waste Holding Tank resent: (Yes or no) N Non-sanitarywaste discharged to the Title 5 s stem: es or no No� w 9 Y (Y ) Water meter readings; if available:.n/a Last date of occupancy: n/a I , OTHER:(Describe) n/a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last year. System pumped as part of inspection: (yes or no),Yes If yes,volume pumped: 1300 gallons ` Reason for pumping: Maintenance _ TYPE OF SYSTEM " X Septic tank/distribution,box/soil absorptions system - Single cesspool Overflow cesspool, Privy Shared system(yes or no) (if yes,attach 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 information: 13 years Sewage odors detected when arriving at the site: (yes or no):No (revised D 27197) .: ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a.,. PART C SYSTEM INFORMATION(continued) Property Address: 136 Nobadeer Rd.Centerville Lot 18 Owner: Robert MacDonald;26 Mary David Rd;Yarmouth Port Date of Inspection:9/29/97 „•. <. SEPTIC TANK: x (locate on site plan) Depth below grade: 16• ` Material of construction:x concreate metal FRP, Polyethylene—Other(explain) If tank is metal, list age. o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L B'6'H 5'7'W 4'8' Sludge depth:1' Distance from top of sludge to bottom of outlet teeor baffle:•15" Scum Distantce from top of scum to to of outlet tee = „ P P or baffle 6 Distance form bottom of scum to bottom of outlet tee or.baffle: f 1'. How dimensions were determined: Measured rt 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.) Septic tank and all components are structurally sound.Recommend pumping septic system every two years for maintenance. GREASE TRAP' (locate on site plan) Material of construction: concrete metal FRP p Poly Depthg ethylene=other(explain) . • •' Dimensions:.n/a ;.• Scum thickness:n/a Distance from top of scum to top of outlet tee or baffle:n/a f Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping,'ta _ Comments: , N (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.) - F nla BUILDING SEWER: (Locate on site plan) Depth below grade:'22• Material of construction: cast iron x 40 PVC other(explain) Distance from private water supply well or suction lin0own Diameter: . 4, rvamments:(conditions of joints,venting,evidence'of leakage,etc,) (revised 04127/97) h,, :d LOCATION SEWAGE PERMIT NO. �3-7 3 VILLAGE � S uiSs�Y 1 t (�.0 o�J✓���G - /Ga INSTA LLER'S NAME 8 ADDRESS GUILDER OR OWNER DATE PERMMIT ISSUED 9�. j;7 DATE COMPLIANCE ISSUED 1 1 W n __J // TOWN OF BAR�NnSTABLE LOCATION �3C� �IO./�? �=}' SEWAGE# VILLAGE ASSESSOR'S MAP&PARCELpZs INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 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 SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 136 Nobadeer Rd.Centerville Lot 18 Owner: Robert MacDonald;26 Mary David Rd.Yarmouth Port r Date of Inspection:9129/97 TIGHT OR HOLDING TANK: ,n, (locate on site plan) Depth below grade: n/e Material of construction-concrete_metal_FRP_Polyethylene other(explain) Dimensions: rda x , Capacity: n/a gallons a Design flow: We n gallons/day , Alarm level:_n/a Alarm in working order? Yes No Date of previous pumping: Comments: " (condition of inlet tee,condition of alarm and float switches,`etc.) We DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: Liquid leveI With bottom of pipe + ' Comments: (note if level and distribution is equal,evidence of solids carryoverr,'evidence of leakage into or out of box etc.) Distribution box is structurally sound. PUMP CHAMBER: >' (locate on site plan) Pumps in working order:(yes or no)No ` Alarms in working order(yes orno),Yes' Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n/a (revised 04/27197)' , SUBSURFACE SEWAGE DISPOSAL`SYSTEM INSPECTION FORM PART C' SYSTEM INFORMATION(continued) Property Address: 136 Nobadeer Rd.Centerville Lot 18 ' Owner: Robert MacDonald;26 Mary David Rd Yarmouth Port' Date of Inspection:9/29/97 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible; excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: We { Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:n/a leaching galleries;number: n/a leaching trenches,number,length: n/a leaching fields,number, dimensions:n1a ` overflow cesspool,number:n/a Alternate system: n/a • Name of Technology:_n/a Comments:(note condition of soil, signs of hydraulic failure, level of ponding,'condition of vegetation,etc.) The leach pit is structurally sound and functioning properly.It had 3' of water in it.Shows signs of having 4'6"in R. CESSPOOLS (locate on site plan) I Number and configuration: We , Depth-top of liquid to inlet invert: n1a _ Depth of solids layer: n1a '• Depth of scum layer: n/a �. Dimensions of cesspool: n1a i Materials of construction: We ` Indication of groundwater: n1a .inflow(cesspool must.be pumped as part of inspection) n/a Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) n1a PRIVY: ` (locate on site plan) = 3 Materials of construction: n/a, Dimensions: n1a Depth of solids: n1a Comments:(note condition of soil,signs of hydraulic failure,level of:ponding,condition of vegetation, etc.) We , (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 136 Nobadeer Rd.Centerville Lot 16 Robert MacDonald;26 Mary David Rd:Yarmouth Port 929197 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) A �154C �l c oI � � . a o • 4g �e Ar ` 3 he 33 q3 y gape ! of _10 (revised 04/27/97) ill' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 136 Nobadeer Rd.Centerville Lot 18 Robert MacDonald;26 Mary David Rd.Yarmouth Port 9/29/97 Depth of groundwater 12+ Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established.the High Groundwater Elevation.(MUST be completed) LISGS Maps and Charts (revised 04/27/97) Pago 10 of 10