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Home My WebLink About0969 MAIN STREET (OST.) - Health 969 MAIN STREET, OSTERVILLE A= 0 II. • �: ,oQTE: .4/26/00---- t � V PROPERTY ADDRESS:969_ Main Street --9stezYi.LLe,.Mass-------- REC:EJED MAY On the above date, I Inspected the septlo ,system at the aThis system consists of the following: HEAL 1 . 1 -6 'X10" Leaching pit. 2. 1 -7 'X 6 ' 'Leaching pit. Based on my Inspectlon, I certify the followlrig condltlona: 3 . This is not a title five septic system. �� -- 4 . This is a sewage system. ( No septic tank ) The sewage system- is improper working order--' - at the present time-. SIGNATURE: ./ Name: Company; Joae.2h_P: Macomber_& Son , Inc Box 66 Address:-_____________ Centerville Ma ._02632-0066 Phone;___508 775_3338_______ THIS CERTIFICATION DOES NOT CONSTITUTE A OVARANTY OR WARRANTY J6SEPH R MACOMBER & SON, INC., Tinks•Cesspools•l.esch(telds Pumped Instilled Town sewer Conneatlons P.O. Box 66 75•J33 tery Ill. M 102632.0066 I t � COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretary ARCEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION P„pertyAd&.: 969 Main Street NameofownerWilliam Mackey Os t r v i l l a,Mass. 02655 Address of Owner: D:<e Name of�'on' (�::e Inspector: prrao Joseph. P.Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Comparry Name: J_P_M a r c)m h P r R g n n T M C Maaing Address: BOX 0 2 6 3 2 Talephone Numbs.: —7 7 5-3 3 3 8 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 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: Z/Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspectors Signature. Date: The System Inspect alltubmita copy othi, spection report to the Approving Authority(Board of Health or DEP)withln 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 shall submit the report to the appropriate regional office of the Department offnvironmertatProtection. The original should be senttovw system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 page iorn iJ Printed on Recycled Paper SUBSVRFA(9 SEWAGE DISPOSAL SYSTUA INSPECTION FORM PART AA CERTV%CATION (oorhdnued) P►op..rtyAaar.aa: 969 Main Street Osterville,Mass. Ow►+w: William Mackey D""of kupecdon:4/2 6/0 0 INSPECTION SVMMAAY: ch-r-k A. B, C, of D. A�r SYSTEM PASSES:J—✓f �� I have not found any Information wNch indicates that any of the fallurs conMoru described In 310 CMR 14.303 exist. Any tali+ ciftsda not evaluated wo Ind sated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: ` A On@ a more system somponenu as described In the 'Condt)onal►u#'soodon need to be replaced w ropalred. The &ystam• w; complkdon of the repl&earnent or repair,as approved by the Board of Health, will pees. tndcete-yes;no; or not determined(Y, N. or NO). Desulbo b&a)a of detwn-Jowdon In all Instances. If'not determined', expl&Ln why not. 1 ,(/ The septic tank Is metal, uniese the owner or operates h"provided the system Mapector with a dopy of a Certlflcate o `CompU&nce (etuched)Indicating that the Will wu Inatalled wlWn twenty 120)years prior to the data of the Nupacvor the septic tank, whether or not metal.Is crooked,struawrally unsound, show#sub#tmtlal Infiltration a eafavedon, w (allure Is Imminent. The system will pass Inspection If the existing septa tank Is replaced with a complying septic tint a roved b Y the Board of Health. DP . b&cku Sewage or breakout or high static water level observed In the dsulbud or on box Is due to broken obstrucud plc� g P or due to • broken. •etdad or uneven dstrlbution box. The system will pane Inspection If(with approval of the Board of Ha&Ith)• broken pips(s) we replaced obswodon la removed distribution box Is levelled or replaced • The eystsm reclulred pumpirtg-mon than-four-Ema v"ardue to brokrnw obmatod pipe(&). the let*.,+ w*-Pc -'� Inspection If(with approval of the Board of 1496M): broken plpe(s) we repi&cid obstruction Is removed revised 9/2/98 Page I or it 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddress:969 Main Street Osterville,Mass. Owner: William Mackey Date of hapec6on;4/2 6/0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ 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 WU.L PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.WILLPF103ECT THE PUBLIC HEALTH AND SAFIETTAND THE ENMONMEili( ' Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a ssit 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 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. IVj The system has a septic tank and soil absorption system and the SAS is within 60 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 50 feet or more from a private water supply well, 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-ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid).- 3) OTHER I/ This is`a sewacreAsystem The system censist-s of J - L-6 ' x t n r leach------i=3—c i t . &1-6'X 7 '—i•ea a h!Rg pit as �.. ?oVPrflnu�_ ! p if¢ are in Corioc 1 / M revised 9/2/98 Page 3orii SUBSURFACE SEWAGE DISPOSAL SYSTEIN,INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddress:969 Main Street Osterville,Mass. Owner: William Mackey Date of Inspection: 4/2 6/0 0 D. SYSTEM FAILS: ,You must indicate either "Yes" or "No" to each of the following: I have 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.sewage intofecility-orayatem component due go an overloaded ormbggad-SAS•or^ceaspod. -y--°- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid leveLin th ibu ' n box above outlet Invert due to an overloaded or clogged SAS or cesspool. Liquid depth in,aesspccl.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 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-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" to each of the following: The following criteria apply to large systems in addition to the criteria above: 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 J _ !// the system is within 400 feet of a surface drinking water supply the system is-within 200 feetof-*-tritiut8f-ytoesurfao*4Ankiwg�water•supplY the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone It 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 infognation. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B CHECKLIST Property Address: 969 Main Street Osterville,Mass. Owrw: William Mackey Date of Inspectlon:4/2 6/0 0 Check if the following have been done:You must Indicate either "Yes" or "No" as to each of the following: Yes Now Pumping Information was provided by the owner, occupant, or Board of Health. j� None of the systemsonVownLs iwwbwn pusnped4opaRJaest twoaweeka sn"lia'trystem 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 with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. 4Z The system does not receive non-sanitary or industrial waste flow. _ The she was Inspected for'signs of breakout. All system components,'iiicluding the Soil Absorption Systemihave been located on the site. �frtJ�` The septic tank manholes were uncovered, opened, and the interior of the septic tank was Inspected for condition of baffles - P or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orr 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) (15.302(3)(b)) The facilityowner d.acc,inaats tha n ar mai„tar, (e+r --.--,.---.jf dittereai frnoto�scner),�car�rcyidadawith Jcfarmasioaan pLp o o} SubSurface Disposal Systems. revised 9/2/98 page sorti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION Property Address: 969 Main Street Osterville,Mass. Owns: William Mackey D.ft of k►spec8on: 4/2 6/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: dD _g.p.d./bedroom. Number of bedrooms(design):_ Number of bedrooms(actual):_ Total DESIGN flow Number of current residents:_ Garbage grinder(yes or no): - , Laundry(separate system) (yes or no):_; If yes, separatelnspaction.required — Laundry system Inspected (yes or no) Seasonal use(yes or no):_ -. — Water meter readings,if available(last two year usage(gpol: 1 9 9 8-1 2 3, 0 0 qa 1 lore=3 3 6 . 9 9 "GPD Sump Pump(yes or no):_ 11 999=1 61 , 000gallons=441 1 0 GPD. Last date of occupancy: /y COMMERCUILMIDUSTRIAL: i Type of establishm t: 0 f i ce Btt i 1 d i ng , Design flow: 6 edd ort 1 b.20 , Basis of design flow : - Grosse trap present.. (yes or 1_ Industrial Waste Holding Tank present:(yes or no)NO _ Non-sanitary waste discharged to the Title b system: (yes or no]UQ� _ -Water motor.rosdings,iif available: Lest date of occupancy"4" 2 6' 0 0------ _� _ --�— - OTHER:(Describe) NONE Last date of occupancy:_ GENERAL INFORMATION PUMPING RECORDS and source of Information: System pumped as part of inspection: (yes or n •_ If yes, volume pumped: U gallons Reason for pumping: NA TYPE OF SYSTEM .4)11 Septic tank/distribution box/soil absorption system 41A Single cesspool _V& Overflow cesspool AIL Privy Shared system(yes or no) (if yes, attach previous Inspection records,It any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank _Copy of DEP Approval 1 -6 'X10 '• Leaching pit, 1 -6 ' X7 ' leaching pit as an overflow. APPROXIMATE AGE of all components, dot*InstaNediif known)-and source of.iwforrnation: Sewage odors detected when arriving at the site: (Yes or no)l revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contlnued) PropertyAdd►e":969 Main Street Osterville,Mass. Owner: William Mackey Data of kupection;4/2 6/0 0 BUILDING SEWER: (Locate on site plan) Depth below grade: �r Material of construction:_cast iron 240 PVC g other(explain) Distance fromprivate water supply well or suction line Diameter Comments: (condition of joints, venting,evidence of hak c-etc.) Joints mar t; qht Nn Alz, dencp of leakage. yst-tzm is -zePted through the heuse vent. sdrnC TANK: (locate on site plan) Depth below grade: Material of construction:iLconcretq.�metaU_4FlberglassAP4 Polyethylene 4�4other(expiain) If tank is rnetal, list age V.4 Js.age.confirmed by Certificate of Compliance A'' (Yes/No) Dimensions: All Sludge depth: Distance from top of sludge to bottom of outlet tee or treffie: .60 Scum thickness:_ Y Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: to How dimensions were determined: Afif Comments: (recommendation for pumping,• ondition of nlet and outlet to s or•ba jes,.depth of liquid level in relation to outlet invert, structural-integrity, evidence of leakage,etc.) A �P � ` ep is an is not OrPSPnt GREASE TRAP: (locate on site plan) Depth below grade:AM Material of construction.tkconcretoAAmetal4$Fibergla3sOVA Polyethylene4!lother(explain) 44 Dimensions: .419 Scum thickness: 4 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:AA Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level In relation to outlet invert, structural integrity, evidence of leakage, etc.) Grease trap is not nrPsPnt _ revised 9/2/98 Page 7orII I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Prop"Aydre"069 Main Street Osterville,Mass. Owner: William Mackey Dee of In�: 4/2 6/0 0 TIGHT OR HOLDING TANK:,(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grade: 444 Material of construction:,Y$concrety(metal.&berglasa&Po)yothylene,�/Aother(explaln) Dimenslons: JA Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm In working order:Yes/,&4 Nglf Date of previous pumping: 4W_ Comments: (condition of Wet tee, condition of alarm and float switches,etc.) lQ or-hc)lcling tanks are nn+- p-w @rOgn DISTRIBUTION BOX-xiot Ilocats on site plan) Depth of liquid level above outlet Invert:_ Comments: (note If level and distribution is equal, evidence of sollds carryover, evidence of leakage Into or out of fox, etc.) — - D PUMP CHAMBER (locate on site plan) Pumps in working order:(Yes of No) N Alarms In working order(Yes or No)-" Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) U revised 9/2/98 Page Iof11 r 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 969 Main Street Osterville,Mass. Owner: William Mackey Date of Irwp.cdort:4/2 6/0 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, number: —44 leaching chambers, number: leaching galleries,number:_ D leaching trenches,number, length: —�— leaching fields, number, dimensions:[) overflow cesspool,number: Alternative system: Name of Technology: �i Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, con iti n of veget tign, etc.) Lomm bone No signs of h drauTic failure or pon ing. of s are ry.Vege a ion n e waster is 1 1 4 b 1 ow the i nvprt _pi pa 'I' a over ow pi is dry. CESSPOOLS Q (locate on site plan) Number and configuration: ID Depth-top of liquid to inlet invert: dA Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: IVA inflow (cesspool must be.pumped as part of Inspection) QP;-,tnc)1 S arP not Present Comments: (note condition of soil, signs of hydraulic failure,level of pending,condition of•vegetation, etc.) ess o3 s are not present. PRIVY:GAV& (locate on site plan) : Materials of construction: Dimensions: /L Depth of solids:_ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition,of vegetation;etc.) Privy is not present, revised 9/2/98 page 9orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM { PART C SYSTEM INFORJAAT10N(oondrw*4 PropwtyAd&—: 969 Main Street O.stervillerMass. Owrw: William Mackey Date of 4►+p�"tw"4/26/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to at least two permanent reference landmarks or benchmarks locate all well,wlWn 100' (Locate when publlo water supply comas Into house) q ; / � 1 revised 9/2/96 Page 10ofII SUBSURFACE SEWAGE DISPQSAI SYSTEM INSPECTION FORM PART C SYSTEM Y1FORMATION(,,,d.+edl Prop,rtyAddraas: 969 Main Street Osterville,Mass. own«: William Mackey Darts of►nsp« 4/2 6/0 0 NRCS Report name Soil Type_ Typical depth to groundwater uSOS Date wobsite visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Collar Shallow wells I EsBmstod Depth to Groundwater&Feet Plsese Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Slte IAbutting property, bsorvation hole. basement sump sic.) Determined from local conditlons Chocked with local Board of health Chocked FEMA Maps hocked pumping records —.4z/checked local excavators. Installers Used USGS Data Describe how you established the High Groundwater Elevation. (MW be completed) Used water contours Map. Gahrety & Miller Model 1 2/1 6/94 revised 9/2/98 Palioitorit +•nrnT+. —ntre*-TT 1i'.r:Jeff•rttnlr'nrtr.nrnitr.T-rerR►!T1*�+'rtn'InRn7rl�n�nwT T7rrrr-r...+�...-•,r ` TOWN OF Barnstable BOARD OF HEALTH Sll[iSURFACR 9EWAGE DISPOSAL SYSTEM INSPECTION .FORM - PART D •- CERTIFICATION I•.•rr�•T••.•.•1—�...I,".�1T1lT1 r1..'.I.Tn TI1rRT1/7f"RTI'r—.5'T�7T1y 71'R1�rTww�wIw/�+nnr�nw�Rs inn .r.�trrr•r.-fir�.•A -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 969 Main Street Osterville,Mass. ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME William Mackey PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber. & SoArInc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street To►m or City - State IIP COMPANY TELEPHONE ( 508 1 775 - 3338 FAX ( 508 ) 790 - 1578 A 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 . Check 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 15 . 303 . Any faililre criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* \ The inspection which I' have con tcted has found that the system fails to Protect the iiublic health and the environment in accordance with Title 6 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this. inspection form . Inspector Signature - Date ^ ecopy of this certification must be provided. to the OWNER, the BUYER On Where applicable ) and the 130ARD OF HEALTH. * 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 CMR 16 . 305 . partd..doc THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / � LI DATA f w i m Mackey j 9t in Street Os =11e,Mass. • 026 5 �.....�...` Sewage, system consists of. 1 -6 'x10 ' leaching pit 1 -7 'x6 ' leaching pit. 1 y I I r r