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Home My WebLink About0081 BLACKTHORN ROAD - Health 81 Blackthorn Road, Marstons Mills i DATE: 12f 1,2/95 _ PROPERTY AiDDRESS:_61 Blackthorn jig Marstons Mills . Marstons Mills 'Ma s,s . On the above date, 1 Inspected the septic system at the above address. This system consists of the following: 1 : '.1 -1000 gallon septic tank. l0. 2. -I -Distribution box. {d '3 . 1 -1000 gallon leaching pit packed in stone . Based bn my lnsrwctlon, I certify the followingconditions: �(9 1 . -This is a title five septic sys.t:em.• ( 78 Code ) 19 The♦sep.ti•c system is ' in proper working or'der.. at the present time . ti 5IGNATUR!7— � �( Name J P .M-acomber Jr_ C/ - i - ------- Com.pany:3- P_Macomber & Son- 'Inc .. Address:__B.0, __Centelrvilhe LMass__0.2.632 Phone:---508�J7-5�3338-----__ , I THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY &ME99 JOSEPH P. MACOMBER & SON, INC. Tank"esapools Le"Mlelds Pumpod 6 InsUlled Town Sewer Connections P.O. Box 66i' Centerville, MA 02632-0066 775-3338 775-6412 Commonweotih of mcssociiusetls Executive Office of Environmeniol Affoifs Department of Environmental Protection Wlillam F.Wold pphrrwr . . Trudy Coxe S+u.tary,EOEA David B. Struhs CorrurJutonu SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 81 Blackthorn Lane Address of Owner: Property Address: (if different) Date of Inspection:) 2/1 2/95 Name of Inspector: Joseph. P.Macomber Jr. Company Name, Address and Telephone Number: J.P.Macomber & Son Inc. Box 66 Centervi116 ,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected te sewhe age d onsa was spertorn>ed[ein at sbaed on ai nylUaining and experience fnd the ep roper tfunctaonuand and complete as of the time oinspection. maintenance of on-site sewage disposal systems, The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Date: Inspector's Signaturer� `L f / The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a -jesign flow of 10,000 gpd or greater, rite inspector and the system owner shall submit the iepon 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. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: have not found any information which ;ndic::tes that the system violates any of the failure criteria as defined in 310 CMR 15.303. —�/— 1 Any failure criteria not evaluated are indicated below. Bj SYSTEM CONDITIONALLY PASSES: One or more system components need to iX replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Oescribe basis or determination in all instances. If"not determined", explain why not) The septic tank is metal, 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. 1 trevlacd 6/15/95) Ono 1Nlntor SUoot 0 Boclon, Ma:sachutottt 02108 • FAX(517) ,s. -1049 • T•lophons (617)292.5500 U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 81 Blackthorn Lane Marstons Mills Owner: Edward O ' Sullivan Date of Inspection: 12/1 2/9 5 B) SYSTEM CONDITIONALLY PASSES (continued) A,T Sewage backup or breakout o- high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced A,Jp 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 o•'the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: &0 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 wstem nd> d seuU(. Wlin anU >Un cU�Ulpliun )y)lenl ul'i1� i� 100 fee. to a surfacc v.-ate. SUpr7,)' Gr u,uu.a.—j lC a surface water supply. The system hay a septic tank and soil absorption system and is within a Zone I of a public water supply 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 is less than 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. D) SYSTEM FAILS: _ 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 shuuld be contacted to determine what will be necessary to correct the failure. Backup of sewage into faciliy or system component due to an overloaded or clogged SAS or cesspool. (� Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/ls/55) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CEain.CATION (continue;d) +" Property Address: 81 Blackthorn Lane Mar`stons Mills ,Mass . Owner: Edward O ' Sullivan Date of Inspection: 1 2/12/9 5 D) SYSTEM FAILS (continued): • " Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in p"l is less;than 6" below invert or available volume is less than 1/2 day flow. 89 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($). Number of times pumped ',ny portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. LV-14 Any portion of a cesspool or pr vy is within 100 feet of a surface water supply or tributary to a surface water supply. AIR Any portion of a cesspool or privy is within a Zone I of a public well. 82# Any portion of a cesspool or privy is within 50 feet of a private water supply well. dZA 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: A_ The design flow of system is 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: the system is within 400 feet of a surface drinking water supply NO 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. trevised 6/15/95) 3 is SUBSURFACE: SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 81 Blackthorn Lane Marstons Mills ,Mass . Owner: Edward O' Sullivan Date of Inspection: 1 2/1 2/9 5 Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped fur at least two weeks 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. _.V/As built plans have been obtained and examined. Note if they are not available with N/A. 2The facility or dwelling was inspected for signs of sewage back-up. —/The system does not receive non-sanitary or industrial waste flow 4/The site was inspected for signs of breakout. All system components, 4Kluding the Soil Absorption System, have been located on the site. YThe 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. iThe size and location of the Soil Absorption System on the site has been determined based on existing information or a proximated by non-intrusive meftcls. The (acilit) uv.n� different from ov,ner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95; 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 81 Blackthorn Lane Marstons Mills ,Mass . Owner: Edward O ' Sullivan Date of Inspection: 1 2/1 2/9 5 FLOW CONDITIONS RESIDENTIAL: Design flow:_ e_.gallons 042 r d.� Number of bedrooms: Number of current residents:Z Garbage grinder (yes or no): Laundry connected to system (yes or no):A-Li Seasonal use (yes or no):_ aila Water meter readings, if avble: �c�'�-��9�` � Dt�C_ �` iy " 'C"I e;, Last date of occupancy) 4`-�5 COMMERCIAUINDUSTRIAL: Type of establishment: A,, Design flow:�l�allons/day Grease trap present: (yes or no)" Industrial Waste Holding Tank present: (yes or no)" n-sanitary waste discharged to the Title 5 system: (yes or no)AM ater meter readings, if available:_ A>h Last date of occupancy: OTHER: (Describe) AM Last date of occupancy: n?& GENERAL INFORMATION PUMPING RECORDS and source of information: myayr,L. 9 q Qa l?Arrcl 190, MY�" 7,4A l k a/v y /k 04"V ek System pumped as pan of inspection: (yes (,r no) If yes, volume pumped gallon: Reason for pumping: TYPE OF STEM 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) Other (explain) APPROXIMATE AGE of all components, date ins:alied (if known) and source of information: gage odors detected when arriving at the site: (;e. or no) ' (revised 8/15/95) 5 C7) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 81 Blackthorn Lane Marstons Mills ,Mass . Owner: Edward o ' Sullivan Date of Inspection: 12/12/95 SEPTIC TANK: b—IdO c 'L gNx (locate on site plan) Depth below grade: Material of construction: Zoncrete _metal _FRP __other(expljm) Dimensions:_ ` g le 11iA ) •, _ Sludge depth: v7' Distance from top o. sludge to bosom of outlet tee or uafilr Scum thickness:_ Distance from top of scum to top of outlet tee or baffle:_�"� Distance from bottom of scum to bottom of outlet tee or baffle:_ Comments: f -ommendatlon for pumping, condition of inlet and outlet tees or baffles, depth ul liquid level in relation to outlet invert, structural ;rity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) Depth below grade.4 Material of,constructlo"YVAconcrete _metal _FRP _othertexpia!n) Dimensions' 104 Scum thickness. lam/ _ Distance from top of scum to top of outlet tee or baifl,: All D!5:ancC, from botion, w,!,mm of O'JII�•i Ire;' :)r (?d l!I. _ [[_ Comments. oecommendahon for purnping cond�tlon of nici ;Ind outlel tc•e� ul baffles, dtaptil ul hquld level in relation to outlet invert, structural u llrgl lly, rvl�len�.• of Ir,ll..l�o (revised 8,':5/55) 6 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C )YSTEM INFORMATION (continued) Property Address: 81 Blackthorn Lane Marstons Mills ,Mass . Owner: Edward O ' Sullivan Date of Inspection: 1 2/1 2/9 5 TIGHT OR HOLDING TANK:AD (locate on site plan) ` Depth below grade:, Material of constructiowat concrete _metal _'FRP —other(explain) Dimensions:�A A Capacity: gallons Design flow: gallons/day Alarm level: k11 Pt Comments: (condition of inlet tee, condition of alarm and float switches, e(c.) Mt A) _ DISTRIBUTION BOX:-&.5 (locate on site plan) Depth of liquid level above outlet invert Comments. lnoie it level anU U,�UiLu;�,.:. c:,_.,:', e•::1Cf'Ci OE SGIIC), " 0'•'e':. C., dense of leaka'e into of out of box, etc.) Distribution box is level ;No evidence of solids carry over;No evidence o leakage in or out of the box. No repairs needed at this time . PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)A119 Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 81 Blackthorn Lane Marstons Mills ,Mass . Owner: Edward O ' Sullivan Date of Inspection:12/12/9 5 SOIL ABSORPTION SYSTEM (SAS):_00 approximated by non-intrusive methods) (locate on site plan, if possible; excavation not required, but0-y be If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:( leaching gall,:ries, number:, leaching trenches,,number,length: leaching fields, number, dimensions: overflow cesspool, number: 0 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) fall Soile of and 'normal . No repqlrq CL. DOLS: AD (locate on site plan) Number and configuration: A1►� Depth-top of liquid to inlet invert: A�1 Depth of solids layer: Depth of scum layer: Dimensions of cesspool:— materials of construction: Indication of groundwater._________ — inflow (cesspool must be pumped as part o' inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: /A/1 (locate on site plan) Dimensions: Materials of construction: Depth of solids:_ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 8 (revised 8/15/95) . 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 81 Blackthorn Lane Marstons Mills ,Mass . Owner: Edward 0 ( Osullivan Date of Inspection: 1 2/1 2/9 5 SKETCH OF SEWAGE DISPOSAL SYSTEM: • include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' f l• IJ ,,, � DEPTH TO GROUNDWATER Depth to groundwater: 16 t + feet method of dgtermiriZiion or approximation: p1-a rr— ri i 1 e Barns �ghle Bo Of H a lth No water encountered-- at 1- (revised 8/15/95) 9 if >•tmnrn -Ri•rs.-.•+••rtrrr-.�•rtrs+'(—e-r..n-.—r.:•:sr.�=rr:rrr:.--.r...t*:ctncr..r....- . . .. _. .. . . -.. _ ss�-r..«rs•a.r•rrrs,.•t�-.'tr.•sr-.rr r-• TOWN OF Barnstable IlOARD OF HEALTH j SUBSURFACE SFHAGF DISPOSAL SYSTEM INSPECTION FORM - PART U - CERTIFICATION I�.i h•••rt•f-r••.-:: --.fir.^.--•nmr.T•r.:rr::�-c.-*crrr-rnor-•r-t:.r.—i-:r�rn�m.Tcrr-rs-cr rrm t;�+aTrt+•rtiv+*mr -TYPE OR PRINT CI.EARLI•- PROPERTY INSPECTED STREET ADDRESS 81 Blackthorn Lane Marat.nn Mi 11 S Maas ASSESSORS MAP , BLOCK ANY` PARCEL # 19 i OWNER' s NAME Edward 04Sullivan PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J. P.Macomber & Son Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( ) .� 508- =_ .5338 FAX ( 508 720 - 1 578 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 complete as of the ti.rne 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 . % �la Check one : • XXX System PASSED Tile 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 failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which "I have conducted has found that the system fails to Protect the publiche-alth and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature �•� Date 12/14/95 One copy of this certification must be( where applicable ) and the BOARD OFF EALzovided to the OWNER, the BUYER * If the inspection FAILED, th'e owner or"` erator shall u within one year of tl)Provided date of the inspection , unless allowed or the system otherwise as rovided in 310 Ch1FZ 16 . 305 , required V THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTI[Or ICE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the - ion of Water Pollution Contrc