HomeMy WebLinkAbout0634 BUMPS RIVER ROAD - Health 634 BuMns River'Road
Osterville
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SEWAGE INSPECTIONS
LOCATION 634 Bumps River Road DATE 11 /13/02
VILLAGE Osterville,Mass. ASSESSOR'S MAP & LOT I 008
-INS,PECTOR Joseph P.Macomber Jr.
SEPTIC TANK CAPACITY 1 n n n ga 1 1 on
LEACHING FACILITY: (type) 1 -LP-1 000 6 'X1 0 ' (sizc)1 500 gallons
NO. OF BEDROOMS 3
BUILDER OR OWNER Richard Smith
OWNER MAILING ADDRESS
'Same
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REVISED 1st FLOOR LAYOUT M P ACOCK KITCHEN REMODEL
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Pearorce Evpeow,Tor; ALL DIMENSIONS AND SIZE O ' O SCALE: DATE:
DESIGN PLANS ARE PROVIDED PORTHE CerUReE Member DESIGNATIONS GIV ARE
John Peacock PAIR USE STTHECLIENTORMMAGENT. SUSSI,TOVERIFICATIONON
RT[SAN ITCHENS INC. FIRM
DCANNOTBEUSE OR
A-1
634 BUnIPS River Rd. FILNSREMAI NOT
DRO EROR REUSED JOB SUBJECT
TTO VERIFICATION
IFICATMENT
937A Main Street Osterville,MA 02655 508-428-8828 Ostervllle,MA 02655 WITHOUT PERMISSION. TO FIT SITE CONDITIONS.
m NEW FRAMING PLAN
---- - SHOWING EXISTING
(dotted)
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LL____._�______ _________J .
nry
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DuiB�eE 6petleuy for: DESIGN PLAN.ARE PROVIDED FOR WE CerUFlAE MrmEer ALL DIMENSIONS AND 512E SCALE: DATE:
�. John Peacock PAIR USE BY THE CLIENT OR HIS AGENT. DEB...ATIONSGIVENARE
(RRTI SAN (3 ITC H E N S INC. PLANS REIMIN THE PROPERTY OF THJ3 SUBJECT TO VERIFICATION ON A��
634 Bumps River Rd. FIRM AND CAN NOT BE USED OR REUSED JOB SITE AND ADJUSTMENT
937A Main Street Osterville,MA 02655 508-428-8828 Ostervllle MA 02655 WITHOUT PERMISSION. TO FIT SITE CONDITIONS.
RECEIVED
: DEC 1 0 2002
DATE: 11 /13/02
.TOWN OF BAhNSTABLE
PROPERTY ADDRESS'S -C-13- I7tp,5-Riyer,Road HEALTH DEPT.
____
_ Osterv_i11e,Mass______---
02655------------------------
On the above date, I inspected the septic system, at the above address.
This system consists of the following:
1 . 1 -1 000 gallon septic tank. '
2. 1 -1000 gallon precast leaching pit. - 6 'X10 ' ,
Based on my inspection, I certify the following conditions:
3. This is a title five septic system. ( 78 Code)
4 . The septic system is in proper working'orde'r '
at the present time.
5 . The leaching pit is presently dry.The stain line on the, pit .
is 54" below the inert pipe. r
6. House has had very little use. in the pa`s.t twoiyears,
R
NATU SIG /. :
Name :- J ._ P . Macomber Jr .
COrrlpany : Josgeh Pam_ Macomber & ,Son , I.nc .
Add Fes s :__BQx -��------------
--G.kn-t-e _M�� _22-632=0066
Phone : 50_8- 775- 3338
--- -- --- --------
THIS CERTIFICATION DOES NOT CONSTITUTE 'A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON; INC. .,
Tanks-Cesspool's-Leachflelds.. `'-•- .
Pumped & Installed'
Town Sewer Connectlons °
P.O. Box 66 Centerville. MA 02632-0066
775.3338 775.6412
�-\ COMMONWEALTH OF MA,SSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
196;-
TITLE-5 r
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS'
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 634 Bumps River Road l
Osterville,Mass.
Owner's Name: Rid-bar .T Rmi th
Owner's Addresc.ha_rles G_ Smith
228 Hollis Ave North Quicy,Mass. 02171
Date of Inspection: 1 1 /1 3 02
Name of Inspector: (please print)Joseph P.Maeombdr Jr.
Company Name: jT P MaenmhP & Son Inc.
Mailing Address: BOX 66
Centerville,Mass. 02632
Telephone Number:5R_77r,_133R
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 the inspection. The inspection was performed based on my
graining and experience in the proper function and maintenance of on site sewage disposal systems. I am a DE,P
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
t��Passes -
_ Conditionally Passes r
_ Needs'Funher Evaluation by the Local Approving Authority '
_ Fails
Inspector's Signature: Date:
The system inspector sha bmit 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
auihoriry.
'rotes and Comments
•'• 7-
This report only describes conditions at the time of inspection and under the conditions of use at tha`t�•
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use. `
Title 5 Inspection Form 6/15/2000 page I
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Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
t CERTIFICATION (continued)
Property Address: 634 Bumps River Road
QSi-Prvi 1 1 c�i
Owner: Richard J. Smith "
Date of Inspection: 11 13 0 2
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section 1)
S s m Passes t
}
d aye not found any information hich indicates that any of the failure criteria described in 310 CMR R
15.301 or in T�C1CifI�I3 �4 exist.Any failure criteria not evaluated are indicated below.
Comments:
_The septic system is in proper working order at the present time.
B. System Conditionally Passes:
106 1
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.
eo The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existLAg 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: p
r�bservation of sewage backup or break out or high static water level in the di ibution box ue 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: +
/LE) 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 pipes)are replaced .
obstruction is removed
ND explain:
2
4.
Page 3 of I }
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 634 Rump-, Ri vpPr RnaA
n 4 t-P r%7 i 1.10,-M•a•S•s-�
Owner: Richard T_ smi th
Date of Inspection: •a /! Z /n-)
•r
C• Further Evaluation is Required by the Board of•Health:
Conditions exist'which require funherevaluation by the Board of Health in order to determine if the.sys-tem'
is !ailing to protect public health,safety or the cnvironment.A ,.
.F i
1. System will pass unless Board of Health det'ermines'in'accordance with 310 CMR I5.303(1)(b) thatthe
system is not functioning in a manner wbich will protect public bealtb, safety and the environment:
Cesspool or privy is within 50 feet of,a`surface water
Cesspool or privy is within 50 feeCof a'bordering vegetated wetland or a`salt marsh''
2. System will fail unless the Board of Health (and Public.Water Supplier, if any) determines tharthie
System is functioning in a manner that protects the public health, safety and environment.
4 P The system has a septic tank and soil absorption system (SAS)and'the'SAS is within 100,(eel of a
surface water supply or tributary to a surface water supply.
,UD The system has a septic tank and,SAS and the SAS is within a Zone l of a'public water supply
.�b The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well Y {
,Ud The system has a septic tank and SAS and:the SAS`is less than.100 feet t 50'feet or more from a'
private eater supply,wel1" Method'used to determine distance
This system passes if the well water analysis, performed at DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free,from.pollution from that factliN znd
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that,no o her .t
failure criteria are triggered: A copy of the analysis must'b.e anached to-this form.
3. Other: „
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Page 4 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 634 Bumps River Road
nGtarvillP aGG. � . .
Owner: Richard J. Smith i
Date of Inspection: 1 1 /1 3/0 2 F ;
•
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections::
Yes ;�eDis
r ,
ckup of sewage into facility or system component due to overloaded or clogged SAS or cesspool .
charge or ponding of effluent to the'surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
.(Jd .Static liquid level,in th distribution box bove•outlet invert due to an overloaded or clogged SAS or
esspool ;1_/ r1Q � - Ay
t��-iquid depth inccsspeol 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
_2of 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
�cvater supply.
/Arty portion of a cesspool or privy is within a Zone 1 of a public well.
_ y portion of a cesspool or privy is within 50 feet of a private water supply well:
�I//�
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. [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.]
_(Yes/No)The system fails. I have determined'that one or more'of the above failure criteria exist as
described in 310 CMR 15.103. 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: 5
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: b "
(The following criteria apply to large systems in addition to the criteria above)
yes now
;/ the system is within 400 feet of a surface drinking water supply
'1the system is within 200 feet of tributary
_ y to a surface drinking water supply
_ �' 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
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.
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OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B '
d, .CHECKLIST
Properry Address:634 'BUMPS River Road
OWner:Ra, - Smith
Date of lospectioo: 11T14_3 /92
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
YCS -
pumpusg information was provided by the owner, occupant, or Board of Health _
ere anv of the system componenis pumped out 0 the previous two weeks "
Has the system received norrnai�nQws.tn-the previous nvo week,period ?
H sc large volumes of water been introduced to the system recently,or as,pai of this inspection '
P
4 Werc.as built plans of the system obtained and cxam0cd?'(l(they were not:.available note &s N/A),
Was the facility or dwelling inspected for.signs of sewage back up,^.
Was the site tnspccied (or'signs of break out '
��'crc all system romponents; luding the SAS, Located on site"''
were the septic tank manholes uncovered,opened, and thrinterior of the tank inspected for the,coriCi:!o
^e bzf(les or tees material''o(consweuon; dimensions, depth of liquid, depth of sludge and depth of scum '
was the fmlin, owner (and occupants if different from owner) provided'with information on the prCCr
;maintenance of subsurface_seµ age zdisposal systems
" The size and location of the Soil'Absorption System (SA-S) on the site has been determined baseC`ror
Yes' no�
/ Existing in(ormation, For axample, a plan at the Board;or`Health-` e"
Determined 0-the;field'(if any of the failure criteriYa related to,Pan C is at.issue approximation of d,stan;c
;s unacceptable) I3'l0 CMR 15 102(3)(b)) g `
T
s
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Page 6 of I I 4 x '
OFFICIAL INSPECTION FORM ""NOT FOR VOLUNTARY ASSESSMEN_TS
SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM
PART C f "a
SYSTEM INFORMATION '
Property Add ress:(34 Bumps :River Road. t`
Osterville,Mass.
. .
Owner:Ri rha rd T_ Smith
Date or Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): ✓ 'Number,of bedrooms(actual): -
DESIGN flow based on 310 CUR 15.203,(for example: 110 gpd x #.of bedrooms)# XfR) ^
Number of current residents:
Does residence have a garbage grinder(yes orIs laundry on a separate sewage system es or no): ,w[if yes.separate inspection requtredJ',_
Laundry system inspected(yes or no):/ �y
Seasonaf use: (yes or no): ti6 a
Water meter readings, if available (last 2 years usage(gpd)):rc2000"1 4, 000 gallons-38.36 G?D
Sump pump(yes or no): 41V 2001 -1 3, 000 gallons=35. 62 G?D
r -
Last datepanty:� U -
of occu
COMMERCIAL/I DUSTRIAL '
Type of establishment:
Design flow(based on 310 CMR 15J03): 7 44,7
Basis of design flow(seats/persons/sgft;etc.) a5� '
Grease trap present(yes or no): c'
Industrial waste holding tank present (yes or no):,t/
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe): �!3`
GENERAL INFORMATION - -4
Pumping Records
Source of information: el
Was system pumped as part of the inspection (yes or no):
If yes, volume pumped: O gallons - How was quantity puri ped determined
Reason for pumping: .I
TYP .OF SYSTEM IY
Septic:tank, soil absorption system .
Single cesspool _ .
/a ,
verflow cesspool
Shared system(yes or no)(if yes, attach previous inspection records, if any)R
nnovanve/Alternative technology. Attach a co of the current operation and maintenance
copy p contract (to be
obtained from system owner)
Vight tank Attach a copy of the DEP approval
;_
her(describe):. }
Ap�9 a e,of II compougnts, date installed(if known)and source of information: 4
Were sewage odors'detected when arriving at the.site{yes or-no):�' :t
Page 7 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 634 Bumps River Road
Osterville,Mass.
Owner: Richard Smith
Date of Inspection: 1 1 /1 3/0 2
BUILDING SEWER(locate on site plan)
Depth below grade:_ JI /other
Liteweigth PVC 4"pipe.
Materials of construction���t iron �1�30 PVC (explain):Sch. 35 .
Distance from private water supply well or suction line: 0�-
Comments(on condition of joints,venting, evidence of leakage,etc.):
Jointa appear tight -No eviden .e of 1 akagP-The system is
vented through the house vents.
SEPTIC TANK:Zlocate on,site plan) IA'b P
Depth below grade:
Material of construction: t/concrete±�Lmetal tLfiberglass4 polyethylene
,1/�other(explain) AOF
If tank is metal list age: X11 is age confirmed by a Certificate of Compliance(yes or no)2P(attach a copy of ..
certificate) 1 1
Dimensions: J,6, ��lt�a� ✓�' r• �°'r f,
Sludge depthQ,
Distance from top of Judge to bottom of outlet tee or baffle:
Scum thickness:L
Distance from top of scum to top of outlet tee or baffle: .4e2,e�--
Distanee from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined: AAaarl d
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 septic tank annually Ga. rbage disposal is present.
T n I of- & niitl af- f-epc nrp_ i n i lava Thy'' J-ank 1S strum-11ra1 1_
sound and shows no "evidence of leakage.Liquid level at the
SAPS TAW ocate on s te�Ian�ne inches.
Depth below grade:
Material of construction A$concrete.114 meta lAlJi fiberglasstA�po lye thy]enclAother
(explain): AM
Dimensions: fl
Scum thickness: 4119
Distance from top of scum to top.of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
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 tgan i c nnf- prosent
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Page 8 of 1 1
OFFICIAL INSPECTION FORM' NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C f
SYSTEM INFORMATION(continued)
Property Add ress:634 Bumps River. Road
(�Gt-Prvi 1 1 e f Mass
Owner: Richard Smith
Date of Inspection: 1 1 /13 0 2 }
TIGHT or HOLDING TANKrYperG(tank must be pumped at time of inspect ion)(locate on site plan),
Depth below grade: ,yR
Material of constructio concrete 4,1,4 metal tM fiberglas's fIlA polyethylene A)0 other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: ( 44 Alarm in working order(yes or no):z �
Date of last pumping:
Comments(condition of alarm and float switches; etc.):
Ti;ht- nr hal tli nQ flanks --are not present '
DISTRIBUTION BO?4�"(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
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.): ,
Ili -, -ri hiii-inn hnx is not present
PUMP CHAMBER4f_,(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber;condition of pumps and appurtenances,etc.):
Pump chamber is not -present.
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Page 9 of 1 I
e �
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 634 Bumps River Road
Osterville,Mass.
Owner gi r-hard Smith
Date of Inspection: I-1,L1,3 f p 2 0 :
SOIL ABSORPTION SYSTEM (SAS): e
( ) (locate on site.plan, excav�jio4 not required)
allon recast leachin it. 6 'X10
_ 7 1000 a p g p
If SAS not located explain why:
T.O a d• SPe page 1 0
Type
aching pits, number: 1
leaching chambers, number: 0
leaching galleries, number: D '
leaching trenches,number, length: 0
leaching fields, number, dimensions: -
�!I overflow cesspool, number:
innovative/alternative system Type/name of technology
Comments (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
sand to medium fine sand.No signs of hydraulic failure
ng. Soils are car .Vege a ion 1
is presently dry.The stain line on the pi
invert '
CESSPOOL (cesspool must be pumped as part of inspection)(locate on siteplan)
Number and configuration: -
Depth.—* top of liquid to inlet invert:_
Depth of solids layer:
Depth of scum layer.
Dimensions of cesspool "
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
ss ools .are not regent.
PRIVY/t,/*g(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.);
-Priuy J s nest _present
9
PW 100(11
OFFICL. INSPECTION F0RXf _ NOT FOR VOL;(JNTtiRY ASSESSME, —:
5UasVRF.,CC' SewACE DISPOS,,,L SYSTEIri INSPEC-TION FpR,.�n
PART C
SYSTEM INPORJYLA T1ON (conilnvto)
➢`cv,ry) ^00111.634 Bumps River Road
e, ass. r
Smith
13 02
t
5KrTCH Or SCwnCC DISPO.AL SYST'CM '
Ao"of I I1(1(h ot(nI I1r I I( O;IpoIll IXIIIm inclv4lnf 11i! IO !I)till two
'(!i++vt� to<I I Iu ..iui 100II(I OD(lTTltntnl ftt(lcAc( I4AC1nIr,, ;
w(Itr Iv➢PIY (filcil In(
3 y . zv~xI,P s Z 111c c. Zc 2 A psi,-�4l A\.e
Z � 1
watt
Page 11 of 1 I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 634 Bumps River Road
Osterville,Mass.
Owner:- Richard Smith
Date of Inspection: 11 13 0 2
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:
N_tZ Obtained from system design plans on record-If checked,date of design plan reviewed: NA'
YES Observed site(abutting property/observation hole within 150 feet of SAS) .
N_Q_Checked with local Board of Health-explain: NA
yEa Checked with local excavators, installers-(attach documentation)
yFS Accessed USGS database-explain:http: //town.barnstale.us.ma. -,
You must describe how you established the high ground water elevation: ,
Ised: Gahrety & Miller Model. 12/16/94 Ground water elevations above sea level.
Ised: USGS; Observation well .data, June 1992
Ised: USGS* Technical bulletin 92-000-1 Plate #2 January 1992 Annual ran es of
un
ground wa r 1 va ions
y
Leaching !,
Pit / . .eet' .
Groundwater`Feet Below Bottom of Pit High Groundwater,Adjustment, ft per Frim to. .. p p r Method
Therefore, the vertical separation distance between the bottom
of the leaching pit and the adjusted groundwater table is 4,,,
feet.
4
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TOWN OF Barnstable LvJARU OF HEALTH i
SONSIMFACR SF.HAGF I)I SPOSAL SYS'rEM INSPECTION FORM PART D •-. CEIiTI F'.CATION I
.•••T11�T". •.:t—�.IIS..—.�.T.T.."n.•.f:>T.TIa•.TTTt T.TT.TI'.�—•.•1.'- ^�t.•"ITT.rI••••9••RTT.T.Ti1ii'T1�TiTTIiT 1R11f•tR}�1S1rt7T1T—Rr.:—•I•I'T'1' •�. —. A
-TYPt OR PRINT CLEARLY—
PROPERTY INSPECTED i
STREET ADDRESS 634 Bumps River Road `Ostbrville,Mass.l
ASSESSORS MAP , . BLOCK AND PARCEL #
OWNER ' s NAMERichard Smith
PAI?T V CERTIFICATION
NAME OF INSPECTOR Joseph P. Macomber Jr '.'
COMPANY NAME Joseph P. Macomber Vion° Inc 3
COMPANY ADDRESS Box 66 Centerville Mass 02632 . 5`
5 t r e 9 t Town or Clty Sty:• iIP
COMPANY TELEPHONE ( 508 ) 775-33-38 FAX ( 508 ) 790-1.578
CERTIFICATION STATEMENT ' q
I certify that ° I have personally inspected the sewage `dis.posa`1 system at
this address and that. Lae ilaformaLion reported is true , .accurate , urd
omplete as • of the time of . inspectionl The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are cons'i.steht
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems . !.(
Chec one :
System PASSED
The inspection which I have conducted has ..not found. any. information
which indicates that the system fails to adequately protect pubic
health or the environment,as defined in -3.10 CMR 15'.. 3.03 , Any fai :ure
criteria. not .evalua.ted, are as stated in .the FAILURE CRITERIA section of
this form .
System FAILEU*.
The inspection which I hftve cord 'cted - has found that
. the system fails to
Protect the llublic health and, the environment in accordance with. Title
5 ,, 3.10 CMR 15 • 303 , and .as specifically no;ted .on PART C FAILURE
CRITERIA of this` -inspection for
. Inspector Signature ` . Date
copy -of this c t.ification must be One
Where applicable a.nd the DOA[ZO OF II�nP�ovided to the OWNER, the BUYER
* If the inspection FAILED , thti owner or operator °ehall u '
pgrade ' tho a}'stem
within one year of the date of the inspection , unless allowed or required
otherwise as provided - in 3.10 CFjR ' _5 . 305 .
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