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HomeMy WebLinkAbout0020 POND MEADOW DRIVE - Health 20 Pond Meadow Drive Marstons Mills P l A = 045 033 \ i i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMEi�I'rAL AFFAIRS z DEPARTMENT OF ENVIRONMENTAL PROTECTION W TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 20 POND MEADOW MARSTONS MILLS, MA 02648 OL—I 5 •� Owner's Name: WILLIAM LAUDER Owner's Address: 20 POND MEADOW MARSTONS MILLS, MA 02648 JUN 14 2002 Date of Inspection: 5/27/02 TOWN OF BARNSTABLE Name of Inspector: (please print) . . JOHN GRACI HEALTH DEPT. Company Name: SEPTIC INSPECTIONS t I v , Mailing Address: -N.O. BOX.2119 TEATICKET,MA. 02536 3 Telephone Number: 508-564-6813 FAX 508-564-7270 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 Title 5(310 CMR 15.000). The system: n ; X Passes _ Conditionall P sses., _ Needs Furt valuation by the Local Approving Authority Fails 3Cii +, Inspector's Signature: x Date: 5/27/02 1, The system inspector shall submi 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 io the buyer, if applicable,and the approving authority. ,.a Notes and Comments SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describe'sFconditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under tho.same or different conditions of use. t `Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20 POND MEADOW MARSTONS MILLS,MA 02648 Owner: WILLIAM LAUDER,,,,, ;,4 Date of Inspection: 5/27/02 Inspection Summary: Check,A.iB,C,D or E,/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CM 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as diescribed 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. n/a 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 ortank 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: n/a n/a 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: n/a n/a 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: n/a k: Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A `CERTIFICATION(continued) Property Address: 20 POND MEADOW MARSTONS MILLS, MA 02648 Owner: WILLIAM LAUDER Date of Inspection: 5/27/02 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 public health,safety or the environment. e, 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: _ 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 I 2. System will fail unless the Board of Health(and Public Water Supplicr, 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 a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tankand SAS 'and the SAS is within 50 feet of a private water supply well. _ The system has a septic'tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well wafer analysis, perfor►ned at a DEP certifies; laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free fi-om 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/a i 3i I i t;r Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE°SEWAGE DISPOSAL SYSTEM INSPECTION FORM i, PART A CERTIFICATION(continued) AT Property Address: 20 POND MEADOW MIARSTONS MILLS, MA 02648 Owner: WILLIAM LAUDER Date of Inspection: 5/27/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to,the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow X Required pumping more.than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NINE YEARS AGO BY OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspoofor privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or-.privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure.. ii. E. Large Systems: 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: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet,of,a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located iWa nitrogeq sensitive area(Interim Wellhead Protection Area—I WPA)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 systeip has lailed.'I'he owner or operator ufany large SyStcui CO Sirlcral a Siguilicnnt difetil 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. Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 20 POND MEADOW MARSTONS MILLS, MA 02648 Owner: WILLIAM LAUDER Date of Inspection: 5/27/02 Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks`' X _ Has the system received no'rinal flows in the previous two week period 9 X Have large volumes of water been introduced to the system recently or as part of this inspection '? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site'? X _ Were the septic tank matholes,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 of scum ? X _ Was the facility owner(and;occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems,,?, `rl is The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no ; X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any ofithie failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J{ sa r ,I a qr.. e, ,t} Page 6 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 20 POND MEADOW MARSTONS MILLS,MA 02648 Owner: WILLIAM LAUDER Date of Inspection: 5/27/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):S" Nuinber of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents:,2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage.system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings, if available(last:2 years.usage(gpd)): n/a Sump pump(yes or no): NO i Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 1-51203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: ri/a, Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NINE YEARS AGO BY OWNER Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons'-How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption lystem _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,°attach previous inspection records, if any) _Innovative/Alternative technology,GAttach a copy of the current operation and maintenance contract(to be obtained from system owner) " 4 _Tight tank Attach a copy of the DEP approval Other(describe): n/a s a Approximate age of all components,'date�'installed(if known)and source of information: 20 YEARS BY OWNER Were sewage odors detected when arriving'at`the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 POND MEADOW MARSTONS MILLS, MA 02648 Owner: WILLIAM LAUDER Date of Inspection: 5/27/02 BUILDING SEWER(locate on site plan) Depth below grade: 10" Materials of construction:_cast iron,'_40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): WELL WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 4" Material of construction: Xconcrete_metal fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7" W;4' 10"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plag) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a rt f 7 i Page 8 of I I A OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 POND MEADOW MARSTONS MILLS,MA 02648 Owner: WILLIAM LAUDER Date of Inspection: 5/27/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/days` Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present'must be'opened)(locate on site plan) Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal,any evidence of so'ids carryover, any evidence of leakage into or out of box,etc.): n/a PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Continents(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R 5 e Page 9 of I 1 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 POND MEADOW MARSTONS MILLS, MA 02648 Owner: WILLIAM LAUDER Date of Inspection: 5/27/02 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' OCTAGON PIT, leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. PIT WAS HALF FULL AT TIME OF INSPECTION. STAIN LINES INDICATE PIT HAS NEVER BEEN MORE THAN HALF FULL. CESSPOOLS: (cesspool mus fbe pumped as'-part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a € Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) ,t Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 POND MEADOW MARSTONS MILLS,MA 02648 .6, Owner: WILLIAM LAUDER Date of Inspection: 5/27/02 ' r• SKETCH OF SEWAGE DISPOSAL SYSTEM Provide 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. 7t <, „fie D uy IL 9 � a �n 'y Page I I of 11 r: OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 POND MEADOW MARSTONS MILLS,MA 02648 Owner: WILLIAM LAUDER Date of Inspection: 5/27/02 SITE EXAM lip _Slope Surface water _Check cellar _Shallow wells Estimated depth to ground water.10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked, date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the`liigh ground water elevation: HAND AUGER- 10+FT.. f ' ,a 1 S U; Y. n. r 9 `4 - 3 Z, �x1ST�w . 177 . - - �y:q„q.•i Iv�v w��Ye lnu�Lt u.�•i , � 777 t1k OF jj{, .ef__i5Y C'F 0!'/ Y '4A i r�p! GIST riOA/ Z.00Ll7 •* �`�°18���� .�Jt .Sr�✓QYl`%! �ti"i�_ LQ F-,5---COA.IFGVAI W1lh' �� A.M. FOR P.M. M 'k/ � PHf1NED RETURNED PJE YOUR CALL A A C NUMB: EXTENSION `"r ME PLEASE CALL. WILL CALL AGAIN CAME TO SEE YOU WANTS TO. SEE YOU SIGNED TOPS FORM 4002 NOTESr - ----- -- - - - -- LO`LA T kON y� \ SEWAGE. PERMIT NO. .VILLAGE INSTA; LLER'S NAME i ADDRESS B U I,L D E R OR OWN ER tft jue,e,%/T L oG DATE PERMIT ISSUED DATE COMPLIANCE ISSUEDgy )o i I d f � 0 37 1 ;f CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 11/15/2002 Report Prepared For: 9l�ey �O Goulet,Margaret& David Order Number: G021803 Margaret L. Goulet �l F P O Box 119 Sagamore Beach, MA 02560 Laboratory ID#: 0218030-01 Description: Water-Drinldng Water Sample#: 18030 Sampline Location: 20 Pond Meadow Drive,Marston Mills Collected: 11/03/2002 Collected by: Margaret Goo 045-033 Received: 11/04/2002 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 2.2 mg/L 10 EPA 300.0 11/06/2002 LAB: Metals Copper 0.5 mg/L 1.3 SM 3111B 11/12/2002 Iron <0.1 mg/L 0.3 SM 3111B 11/12/2002 Sodium 18 mg/L 20 SM 3111B 11/12/2002 LAB: Microbiology Total Coliform Absent P/A Absent 307 11/04/2002 LAB: Physical Chemistry Conductance 131 umohs/em EPA 120.1 11/04/2002 pH 5.8 pH-units EPA 150.1 11/04/2002 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: c.�(Lab Director) Director) -• trcxr.?- i°; 3Z a Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 y December 22, 1977 r , Mr, .John• H. MtecD ack,- Jr, 211 Cain Avenue r Braintree, Massachusetts 02184 y Dear Mr. McCormack: , You are granted ,a variance to ,instal,l' a- well 135{,feet from an ; 'abutter's sewage system on Lot 6 Pond' Meadow �riee Marstons Mills, ,In Lieu of.. the required 150' feet. a The installation 'of the septic system must strictly adhere % to the submitted plan r All other provisions of" 'Tit le V, !Of-..the- State Environmenial hp ; Code, and Towin of Barnstable Head th Reclata tang apply. ,5 r4y. yours, " s kt '11&t I,. Childs,. Chairman , Ann Jane shbaugh • - Xe Wr Mandelstam Mr Dt _ BOARD QF. `HEALTM ti 4 TOWN- €oF• ARNSTABLE John H. McCormack, Jr. 211 Cain Av. Braintree, Mass. 02184 December 12 , 1977 Board of Health Town of Barnstable Hyannis,. Mass. To the Members of the Board; Enclosed you will please find an Application for Disposal Works Construction Permit, as well as the required two (2) plans for Proposed Sewage as drawn by Crowell & Taylor Corp. , signed by Ronald A. Gifford, Registered Sanitarian, and the Fee of $15. 00 for said Application. I have been advised by Mr. Paul Murray that due to the 135 foot distance of the now-completed well to the abbutter' s sewage, a variance is required by the Board for the Application to be approved. Therefore, please consider this letter to be a request for said variance. If there are any questions regarding this matter, I would be most happy to furnish the Board with whatever information you would require. Your anticipated cooperation will be greatly appreciated. Sincerely John H. 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