HomeMy WebLinkAbout0074 RIDGE ROAD - Health 74 RIDGE ROAD,,
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Safe Earth Systems, Inc. 12
P.O. Box 1359 1b �-�
a/ Marstons Mills, MA 02648
051/ 508-477-2999 - 508-420-2803c r
Address of Property: 74 Ridge Road
West Barnstable, MA 02668
Owner's Name: John Hamlet
Date of Inspection: 8125/95 9
PART A CHECKLIST
_x_ Pumping information was requested of the owner, occupant
and Board of Health.
_x_ None of the system components have been pumped for 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
_x_ As built plans have been obtained and examined.
Note if they are not available with N/A.
_x_ The facility or dwelling was inspected for signs of sewage
back-up.
_x_ The site was inspected for signs of breakout.
_x_ All system components, excluding the SAS, have been
located on the site.
_x_ The 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.
x The size and location of the SAS on the site has been
determined based on existing information or approximated
by non-intrusive methods.
_x_ The facility owner (and occupants, if different from owner)
were provided with information on the proper maintenance
of SSDS.
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
If Residential
Number of bedrooms
Number of current residents
_No_ Garbage Grinder (yes/no)
_No_ Laundry connected to system (yes/no)
_Yes_ Seasonal use (yes/no)
If Non-residential
Calculated flow
Water meter readings, if available:
8/25/95 Last date of occupancy
General Information
Pumping records and source of information:
_NO_ System pumped as part of inspection (yes/no)
If yes, volume pumped
Reason for pumping:
Type of system:
Septic tank/distribution box/soil absorption system
_x Single cesspool
Overflow cesspool
Privy
Shared system (yes/no) (if yes, attach previous inspection
records if any.)
Other; Explain
Approximate age of all components. Date installed, if known. Source of
information: 25 Years, Owner
_No_ Sewage odors detected when arriving at the site (yes/no).
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SYSTEM INFORMATION continued
Septic Tank: _n/a
(Locate on site plan)
Depth below grade: n/a
Material of construction : e concrete_ metal FRP_ other(explain)
Dimensions
_0_ Sludge depth
_n/a— Distance from top of sludge to bottom of outlet tee or baffle
_0 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
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,
recommendations for repairs, etc.)
Cesspool is showing no signs of back up. No inlet or outlet tees are present.
No liquids are present inside system. .
Distribution box: _n/a
(locate on site plan) s
_0 Depth of liquid level above outlet invert
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage
into or out of box, recommendation for repairs, etc.)
Pump Chamber: _N/A e
(locate on site plan)
_N/A Pumps in working order (yes/no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs, etc.)
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SYSTEM INFORMATION continued
Soil Absorption System (SAS): _n/a
(locate on site plan, if possible; excavation not required, but may be approximated by
non-intrusive methods)
If not determined to be present, explain:
Type
Leaching pits and number
Leaching chambers and number
Leaching galleries and number
Leaching trenches, number, length
Leaching fields, number, dimensions
Overflow cesspool, number
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of
vegetation, recommendations for maintenance or repairs, etc.)
CESSPOOLS (locate on site plan): X
Number and configuration 1
Depth-top of liquid to inlet invert 6'
Depth of solid layer <1"
Depth of scum layer 0
Dimensions of cesspool 5'diameter 6'deep
Materials of construction concrete block
Indication of groundwater no
Inflow ( cesspool must be pumped as part of inspection)
no liquids present
Comments:
(note condition of soil, signs or hydraulic failure, level ponding, condition of vegetation,
recommendations for maintenance or repairs, etc.)
No signs of failure. Install 18" riser.
PRIVY: N/A
(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, recommendations for maintenance or repairs, etc.
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SYSTEM INFORMATION continued
Sketch of Sewage Disposal System:
Include time to at least two permanent references, landmarks or
benchmarks.
Locate all wells within 100'
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Depth to Groundwater
Depth to groundwater
Method of determination or approximation: Obtained from site well
information
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PART C
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of
determination in all instances. If"not determined", explain why not.
N Backup of sewage into facility?
N Discharge or ponding of effluent to the surface of the ground
or surface waters?
N Static liquid `level in the distribution box above outlet invert?
N Liquid depth in cesspool <6" below invert or available
volume < 1/2 day flow?
N Required pumping 4 times or more in the last year?
Number of times pumped
N Septic tank is metal? cracked? structurally unsound?
substantial infiltration? substantial exfiltration? tank failure
imminent?
N Is any portion of the SAS, cesspool or privy- below the high
groundwater elevation?
N Within 50 feet or a surface water?
N Within 100 feet of a surface water supply or tributary to a
surface water supply?
N Within a Zone I of a public well?
N Within 50 feet of a bordering vegetated wetland or salt
marsh (cesspools and privies only, not the SAS)?
N Within 50 feet of a private water supply well?
N 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.
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INFORMATION FORM
PART D
CERTIFICATION
Name of Inspector: Michael DiMaggio
Company Name: Safe Earth Systems
Company Address: 135 Rte. 130, Mashpee, MA 02649
Mailing Address: P.O. Box 1359, Marstons Mills, MA 02648
Certification Statement
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 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:
_x_ I have 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.
I have determined that the system fails to protect public
health and the environment as defined in 310 CMR 15.303. The basis for
this determination is provided in the Failure Criteria section of this form.
Inspector's Signatur
Date 8/25/95
Original to systems owner
Copies to: Board of Health
Buyer (if applicable)
Approving Authority
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