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HomeMy WebLinkAbout0456 EEL RIVER ROAD - Health 456`EerRiver Road Osterville P t , A = 14 4, 037 a a : T a e a . r r F , Y w 0 r: PIZJ - 037 MAP PARCEL LOT 6117104 DATE------ ---- PROPERTY ADDRESS:_456 6ei R ive2 Rd_._ 0,3t e�zv.i_Le. lea. 02655 On the above date, the septic system at the above address was Inspected. This system consists of the following: RECEIVED 1. 1- 1500 gageon 6el2t.ic tank 2. 7-d.i,3taigut.ion Sox JUN 18 2004 3. 4-,1.e o wd.i 11 u's o 2.s Based on inspection, I certify the following conditions: TOWN OF BARNSTASLE HEALTH DEPT. 4. 7h.iz ins a t.itUe Live �3e/2t.ic .6y�tem. �5. The �e�t is �syztem .iz .in p2opea woaking oade2 at the pe/zzent time. — - 6:- Tiowdillu-oaz whe2'e d2y at time o� inZ/2eCt.iOn. SIGNATURE ? Ag /h Name: B2uce /lacaze.izte./z Company: -Tn�h $— rpm &_Son, Inc. Add ress:__p__._Bnx_6.6_--------=- C en tt n-r14 116, MA n26-32, 066 Phone:___1.5.Qa)__u_9_-333$--------_. THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775.6412 • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFiCE OF ENVIRONMENTAL AFFAIRS A o DEPARTMENT OF ENVIRRONMENTALEROTECTIM y V, > V. TITLE 5 OFFICIAL INSPECTION FORM—NOT.:FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: fe-e Rivet Rd, 0bt eAyii ee, 8 . 02055 Owner's Name: BiLe 12chipo"Pd r Owner's Address: 488 Fv 2 1?,„o,7 i?d Q'A10 a J)J.P.P +7n Date of Inspection: 6/1 7/0 4 Name of Inspector: (please print)4132 Company Name: 1_ P, 8acomE~eit 9 Son Inc. Mailing'Address: C e n te2vi e, 7a66. 02632 Telephone Number: 5 0 8-7 7 5=3 3 3 8 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 . training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340.of'Tit'le 5(310 C'MR 15 000). The system: Passes Conditionally Passes Needs Further Evaluation.by the Local Approving Authority Fails Inspector's Signature: �U Date: w I 1 " _0 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 7-time.This inspection does not address how the system will perform in the future under the same or different conditions of use. r J Title 5.Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM: PART A CERTIFICATION (continued) Property Address: 4 B4 fee /U v e 2 Rd.- Owner: /3.J-.P.P 4a rh.i f.n.Pd Date of Inspection: 17/n Inspection Summary: Check~Aj%C,D or.E/ALWAYS complete:all of Section.:D r A. System Passei: I have not found any information.which 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: . 7 h o A o pi ;C A/, f = ea a OP a a w E3 77.5r 61-1b��g1b GG t 4 6-996 49 Ir B. System Conditionally Passes: 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. The septic tank is metal and over 20 years old*or the septic tank(whether metal:ornot)is:structurally unsound,exhibits 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: .v Observation of sewage backup or break out or high static water level in the distribution box 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::. 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 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION(continued) Property Address: 496 Ee.12 Rivelt I?d. 0.6 ayiZ.PP, 1rri. 02655 Owner:. /3.i,0// An r h i 0.n Dr/ Date of Inspection: /1 Z/n 4 C. Further Evaluation is Required by the Board of Health: Conditions exist whichsequire further evaluation by.the 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: Q 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 any)determines:that the system is functioning in a manner that protects the public health,safety and 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 asurface water supply. The system has a.septic tank and SAS and the::SAS is'within a Zone 1 of a-public water supply. The system has a septic tank and.SAS'and the SAS is within50 feet of a private water supply well. The system has aseptic tank and SAS and the SAS is less than 100 fe t_but 50 feet or.more from a private water supply well". Method used to determine distance thsuod "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: ,n 3 Page.4 of I l OFFICLA L INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM:.INSFECTION FORM �^ PART:A CERTIFICATION(continued) Property Address: 4156 6e e R.ive2 Rd. 0-6.te2v.iQQe. Na, 02655 Owner: /3iQQ Tzch.iPcL.P_d Date of Inspection: h/1 7/r)4•" D. System Failure.Criteria applicable to all systems:. You must indicate"yes":or"no''to.each of the followingforiall inspections: Yes No Backup of sewage.into facility or system,component due.to overloaded,or clogged SAS.or cesspool Discharge.or,ponding.of effluent-to the surface•ofthe'.ground or:.surfacematers 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 1/2 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 vis within a Zone 1 of a:public wyell... _ ✓ Any portion of a cesspool or privy is within.50 feet of 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.-[This system pasies:if the well water:analysis, 1 performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates:.thatthe.well is free from pollution<.from:,that:facility;and.the presence of:ammenia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are triggered:A copy ofthe 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 15.303,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: To be considered a large system the.system:must serve,ataeility with a design flow of 1•.0;00.0 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 V the system is within 400 feet pfa surface drinking water supply the system is within 200 feet of a utary,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 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 finder 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 r Page 5 of 11 a OFFICIAL INSPECTION FORM—NOT'FOR VOLUNTARY ASSESSMENTS SUBSURFACE:SEWAGE RISPOSAL,'SYSTWIN'5PECTION FORM PART B CHECICLIST Property Address: 46b Ee i R ive/z Rd. e2v i�Le m_a. Owner: B-ei 42ch.iga ed Date of Inspection: 6/ 7/0 4 Check if the following have been done You must indicate"yes or"no°"as to each-of the.. lowing: . 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 th[sinspection? J _ Were as built plans of the system obtained and examined?(If they were not available' Coto 48 N/A) 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,gcluding the SAS,located on site? J _ Were the septic tank manholes 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•©f scum? 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 es no ✓ Existing information.For example,a plan at the Board of Health. _ Determined 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)] 4 ' S Page 6 of 1 I OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DIS-POSALSYSTEMINSPECTION FORM PART C SYSTEM INFORMATION Property Address: 4.56 Ee:Q /Uve2 Rd. 0,3t e zv�i eiP-, 1?a. Owner: 13,Le i A zch-L* aid Date of Inspection: 6177104 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): .3 Number of bedrooms.(actual): DESIGN flow based on'310 ClvfR 15.203 (for example:110 gpd x#of bedrooms):3 K Up'33 Q ( , Number of current residents: . ] �� Does residence have a garbage grinder(yes or no):_�2s Is laundry on a separate sewage:system.(yes or-no):fW [if yes separate inspection required] Laundry system inspected(yes or no): Q 9-5 Seasonal.use;(yes or no): YM �opa - 1 a o0 0 Water meter readings,if available(last 2 years usage(gpd)): aoo 3 - I S(,000 Sump pump(yes or no):r O Last date of occupancy: COMMERCIAL/INbUSTRIAL Type of estabjjsbment: Qd� . Design flow(bl don 310 CMR 15.203): I/l..o, gpd Basis.of degio"flow(seats/persons/sgR,etc.): q1, Grease trap present(yes or no):1 Industrial waste holding tank present(yes or no):(19x Non-sanitary waste discharged to the Title 5 system(yes or no)/L- Water.meter readings,if available: „ Last date of occupancy/use:ftq, OTHER(describe): (J� GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):►lp If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ,ZSeptic tank,distribution box,soil absorption system o Single cesspool. Imo Overflow cesspool 0 Privy YIA Shared system(yes or no)(if yes,attach previous inspection records,if any) ,to Innovative/Alternative.technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) {�D Tight tank _Attach a.copy of the DEP approval OA Other(describe): Approxi aatte age of al]components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):A 6 - r Ptgc.7 of 11 OFFICIAL INSFIECTIQN-FORM-NOT FOR VOLUNTARY ASSESSMENTS S'(JB:S f31~LFACE $BWAG'E IDISPOSAL SY$TEMi INSPECTION FORM PART C SYSTEM. INFORMATION(continued) Property A.ddrO 45.6.Ee�,r,.�,a.._Rd. Owner: �3 l 4 p n ;,4,9d Dste of_}nspcc.t1ots: �/�?i n.l,�.,., �,.•. f BUILDING s wER(locate on site plan) Depth bclgw.grade: Materials:of 6on.itruatiARc ,rc4st Iron 40 PVC.,,,..other(citpl4ln): ' Distance&M priv:tc water iopply well or suction.line: 4 Comments(on conClon of jgkht3,Ventirtg,,cvldence of Ic 4ge,cac.)i o cnt� a' en.ted thzough houze ventz. SEPTIC TANK, ✓(Locate on site plan) 159© �ai�n D4 th .below grade: Mitcrisd of consove0on: /concrctc meta..f„_,frbcrgFass_,_,polyethylene. othcr(cxp{ain) , If txNc is mc4a1 list age: is&�s conr c.d by a CcRc n-c itc of CompUance(yes or no):T(attach a copy of certificate) � .� r ri Sg y ~ Sludge depth Dis.txncc fiom top of sludge to bottom of outict tee or baffle: Scurn thickness:. n I . Q Distance f om top of$cum to.top of outict tee or baffle: Distance r om.bonom of setun to bottom of outlet tee or baffle_ How w.cre dimensions determined: Comments.(on.pumpin.g re.cornmcnditfq�$,Wet and out ci:ice or baffle.condition, structural integrity,liquid levels as related:tfl outic.t invert,cvi:dcnce o.f.Leak4gc.,cte;), P m z , n cl .3how.6 no '6.tgnI3 o� leakage.,-,:, i .•.. GREASE TRAP: (locate on site plan Depth below grmdc: Mmcrial of conswvction: Lconcrete L metal JA,flberglas olycthylcn&other (explain 1. Dimcn;ions: Scum thickness: Distance tro.m top-of scum to top of outlet fee yr baffle: �'A-W, Distance Uom bottom of scum to bottom of outlet;cc or baffle; Date of Iast P=. PIng: Commenu(on pumping recom,mendations, inlet and outlet tee or baffle condition, structural intcVity;liquid lcveLs as related to-outlet invert, evidence of:Ieaka:ge.,cto: 7 . Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS "SM ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) Property Address: 456 (Ee e R ive2 Rd. Owner;• 13i00 AnrhiOnOr/ Date of Inspection; 1/1 7/0 4 TIGHT or HOLDING TANK:IID&IL(tank must be pumped at time of inspection)(locate on site plan) Depth below.grade:_AA_ . Material of construction: concrete metal fiberglass&Solyethylene `,Q- other(explain) Dimensions: Capacity: gallons Design FloW.II gallons/day Alarm present(yes or no):41 Alarm level:I& _ Alarm in working order(yes or no):A Date of last pumping: _ Comments(condition of alarm and float switches,etc.): 7 �r44 e ¢ hA 4 fnnkA nnv_ not' 22e.6ent DISTRIBUTION BOX: / (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: I'W 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.): l7 ' 9 ox has one La.t e2cL e. /Il Aage tn.to 02 011 O OZ. O e [ ca22y oveIt, PUMP CHAMBER: 1121. (locate on site plan) Pumps in working order(yes or.no):N\ Alarms in working order(yes or no): i Comments(note condition of pump chamb r, condition of pumps and appurtenances,etc.): Puml? chamge2 not 12ae-sent'. 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTIONYORM PART C SYSTEM INFORMATION(continued); Property Address: 456 Ee-P R ive2 I?d. 0.61 e2v.i-P_.P_v, N0 Owner: L3.i P-P An rh,i.P,nor/ Date of Inspection: / SOIL ABSORPTION SYSTEM(SAS): � (locate on site plan,excavation not required) 41) P wrl i 4-oii At)n A If SAS not located explain why: [nrnfnrl .Soo Pngp 10 Type fVP leaching pits,number: 14 leaching chambers,number: Io�d 4Eugor AD leaching galleries,number: (\J6 leaching trenches,number,length: leaching fields,number,dimensions: 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.): /onm(4(_Arinr/ L) 4inp roa2ze zancl No 3.icin>3 oe hi/d zau-P.ic �a-i-Pu ze on Ronr/i n-a. L ael at.ioa L6 no zma P . CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: VkA 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.): rPAAPooP noP PRIVY: 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.): 9 L 1 Page 10 of 11 OFFICIAL INSPECTION FORM.: NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE% SYSTEM INSPECTION;FORM PART C SYSTEM INFORMATION(continued) Property Address: 4 5 6 Ee-i Rivea Rd. Cl�ste2v� QQe. Na.- Owner: BU A�zch.L&a.ecl Date of Inspection: 0117104 -SKETCH OF SEWAGE-DISPOSAL SYSTEM Prbvjde 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. I Y i ' 4$' 10 :. i Page I I of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued). Property Address: 456. fed Rivet Rd. OztelzviiXg, a., Owoer. /U PP Anrh ;PnPd Date of Inspection: 6/9 7/04 SITE EXAM Slope . Surface water Check cellar Shallow wells - Estimated depth to ground water�� feet Please indicate (check)all methods used to determine the hfgh.ground water elevation: Obtained from system design plans on record - If checked, We of design plan reviewed: Observed site (abutting property/observation hole within 150 feet.of SAS) Checked with local Board of Health-explain: _ Checked with local excavators, installers- (arch documentation) _Accessed USGS database-explain: You must describe how you established the high ground water elevation: uzed:Gah?etu X Niieea Nodee 12116194 gzouad wa.te2 move Sea ieve-p. tine 1992 11Aor] Z orhnirn0 P Ili Oofin 92-000—. 1 ea #2 4nnucL-e zangez O �I.Irr f�o n o P 0>>n f i n n.c 1 VU UI ll'VVIIU ...... J A Leaching Pit :eet Groundwater: Feet Bclow,Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimptcr Method nerefore, the vertical•separation distance between the bonom Of the leaching pit and the adjusted groundwater table is 11 TOWN OF BARNSTABLE LOCATION lC SEWAGE A PA VILLAGE ASSESSOR'S MAP & LOT I INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY ��� ws eke LEACHING FACILITY:(type)r �;® (size) c';: i NO. OF BEDROOMS 4- PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: �. DATE COMPLIANCE ISSUED: �q- VARIANCE GRANTED: Yes . No s \,up