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HomeMy WebLinkAbout0094 FLEETWOOD PATH - Health 94 Fleetwood Path,Marstons Mills �f Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection . kip One winter Street,Boston,Ma. 02108 John GradD.E.P. Title M19 tic t ] oT P. a�B'� ' Te, �kke M 025 6 WILLIAM F.WELD (5o'8) 564 �b Governor ARGEO PAUL CELLUCCI � 1 Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM T� 'OFg,� 1991 PART A �pf CERTIFICATION Property Address: 94 Fleetwood Path Marstons Mills Lot 101 Address of Owner: Date of Inspection:8/12/97 (if different) Name of Inspector:John Graci Domenic Peluso:30 Cranberry Rd.Buzzards Bay Ma.02532 1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: 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 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: X Passes This inspection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Furt f'r Evaluation B the Local Approving Authority performing at the time of the inspection.My inspection does Y PP 9 tY not imply any warranty or guarantee of the longevity of the Fails septic system and any of its components useful life. Inspector's Signature; Date: 8/13/97 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 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: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: p One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is 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. (revised 04127/97) One Winter Street 9 Boston,Massachusetts 02108 9 FAX(617)556-1049 0 Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 Fleetwood Path Marston Mills Lot 101 Owner: Domenic Peluso:30 Cranberry Rd.Bu—rds Bay Ma.02532 Date of Inspection:8112/97 — 5ewaae backup or.breakout.or hiah.static water level observed.in.the distrihution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced 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 of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 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 system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply 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 the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for col'Iform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: 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 should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility 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 cesspool. SAS is in hydraulic failure. (revised 04/27/97) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 94 Fleetwood Path Marstons Mills Lot 101 Owner: Domenic Peluso:30 Cranberry Rd.Buzzards Bay Mo.02532 Date of Inspection:8/12/97 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _y_ — 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 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 system does not receive non-sanitary or industrial waste flow. -x- — The site was inspected for signs of breakout. x _ All system components,excluding the Soil Absorption System,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 Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)115.302(3)(b)j (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 94 Fleetwood Path Marston Mills Lot 101 Owner: Domenic Peluso:30 Cranberry Rd.Buzzards Bay Me.02532 Date of Inspection:8/12/97 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): n/a Sump Pump(yes or no): No Last date of occupancy: 1986 COMMERCIAL/INDUSTRIAL: Type of establishment: rJa Design flow:0 gallons/day 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: n/a Last date of occupancy: n/a OTHER: (Describe) n/a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last year. System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Copy of up to date contract? Other: APPROXIMATE AGE of all components,date installed(if known)and source information: 1979 Sewage odors detected when arriving at the site: (yes or no) No (revised 0427/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 Fleetwood Path Marston Mills Lot 101 Owner: Domenic Peluso:30 Cranberry Rd.Buzzards Bay Me.02532 Date of Inspection:0112/97 SEPTIC TANK: X (locate on site plan) Depth below grade: 2' Material of construction:X concreate_meta l_FRP_Polyethylene_other(explain) If tank is metal, list age 19 . Is age confirmed by Certificate of Compliance Yes (Yes/No) Dimensions: L 8'6'H 5'7'W 4'10' Sludge depth:4" Distance from top of sludge to bottom of outlet tee or baffle: 23" Scum thickness:0 Distance from top of scum to top of outlet tee or baffle:2" Distance form bottom of scum to bottom of outlet tee or baffle: 0 How dimensions were determined. Measured 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.) Septic tank and all components are structurally sound.Recommend pumping system every one to two years for maintenance. GREASE TRAP:_ (locate on site plan) Depth below grade: We Material of construction: concrete metal FRP Polyethylene_other(explain) 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,1, 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.) n/a BUILDING SEWER: (Locate on site plan) Depth below grade: 2'6" Material of construction:_cast iron X 40 PVC_other(explain) Distance from private water supply well or suction linelown Diameter: 4' Cn,vamments:(conditions of joints,venting, evidence of leakage,etc.) (revised 04/27/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 Fleetwood Path Marstons Mills Lot 101 Owner: Domenic Peluso:30 Cranberry Rd.Buzzards Bay Me.02532 Date of Inspection:8/12/97 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n/a Material of construction: concrete_metal_FRP_Polyethylene_other(explain) Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm level:_n/a Alarm in working order?_Yes No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) n/a DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) We PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Yes Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc) n/a (revised 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 Fleetwood Path Marstons Mills Lot 101 Owner: Domenic Peluso:30 Cranberry Rd.Buzzards Bay Me.02532 Date of Inspection:8112197 SOIL ABSORPTION SYSTEM (SAS):X (locate on site plan,if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: n/a Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:n/a leaching galleries,number: n/a leaching trenches,number, length: n/a leaching fields,number, dimensions:n/a overflow cesspool,number:n/a Alternate system: n/a Name of Technology:_n/a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) The overflow is structurally sound and functioning propedy.lt was empty at the time of the inspection.Shows signs of being 39 full. CESSPOOLS:_ (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: n/a inflow(cesspool must be pumped as part of inspection) n/a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) n/a PRIVY:_ (locate on site plan) 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.) n/a (revised 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 94 Fleetwood Path Marstons Mills Lot 101 Domenic Peluso:30 Cranberry Rd.Buaards Bay Me.02532 8H 2/97 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 10Y(Locate where public water supply comes into house) I n 0 0 GX Ql� lit A,c 47 to y�6 B (revised 04/27/97) page ! of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 94 Fleetwood Path Marstons Mills Lot 101 Domenic Peluso:30 Cranberry Rd.Buzzards Bay Ma.02532 8/12/97 Depth of groundwater 12, Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data: Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts I (revised 04/27197) page 10 of 10 L0CATV20-16 �� SWAGE PERMI NO. LLN, 7 - G6 VILLAGE INSTA LLER'S NAME ADDRESS BUILDER OR OWNER )jo- �V� .0 1 4 ao��? r A) rS DATE PERMIT ISSUED T-3- 0 DATE COMPLIANCE ISSUED 1 -I - -17 t CA _ 1 � Fim..............................No... 7.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town. ................OF....Barnstable...----------------------------------••--------------- ApplirFa#iun for Iliupuiial Vorkfi Tunitrnrtiun .an it Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: • Flee wood Path _Lot .101 Locati n-Ad ss or Lot No. .tip...... ®.4-� --------------------- k�. ...........................-------......._...-----.........__...._ a Owner - Address - v? �------------------------------------------------ ........ ------------1�. - �' � :........... Install r Address Type of Building S p'Lj'��x Size Lot...20_T 300____._._Sq. feet U _3.________._______.___ _ExPansion Attic (Dwelling—No. of Bedrooms_______________ Garbage Grinder (a ) a, Other—Type of Building ____________________________ No. of persons............6.............. Showers ( ) — Cafeteria ( ) aOther fixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- d W Design Flow................55.......................gallons per perso per day. Total dailyy, flow-.___.33P___--___........._...........gallons. WSeptic Tank—Liquid capacitytQQQ-gallons Length.__-6_.._ Width.�t__._-10 Diameter................ DepthS___'�!.__-. Disposal Trench—No--------------------- Width.................... Total Length______._______.._._ Total leaching area_______.____.......sq. ft. Seepage Pit No..____.1---------- Diameter___10.... __._. Depth below inlet........F?-T........ Total leaching area_.____z67___sq. ft. Z Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed byCape Cod survey ConsultantsDate__.•7AV7$-----•_-_•--___ ,tea Test Pit No. 1......2-------minutes per inch Depth of Test Pit_12 t______..._. Depth to ground water..T10T1G____._._-. Test Pit No. 2................minutes per inch Depth of Test.Pit.................... Depth to ground water........................ a •---------------••-----------•------•-•---••-------- ------------------------------• ---•--- Description of Soi10.0-0.5 wood loam_? 0.5-2._0 rocker su�_so . ,., 2.6_ x clean med. sand. 9 U ---------•---------•-•--•-•------------- --•----- - o� .. •----- Phy R�NVJIG� ----•-----------------------•-----------------------•----------••--•----------- o--•--•-----R: ------•• ---- U Nature of Repairs or Alterations—Answer when applicable.............................. 7----- -----------------------------.............................................................................................................. ----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage isposal Syst F � � with the provisions of TI!HE 5 of the State Sanitary Code— The undersigned further agrees not to system in operation until a Certificate of Compliance has been issued by the board of health. Q ate -Application Approved BY •••••��._.... . / -----a. - Date Application Disapproved for the following reasons----------------------------•---------------------------------------------------•--------------------------•--•- ......-•-•---------------•-----------•---....-------------------•--------...------------•--••---------•----------------..-----------------------•------------------------.............................. Date Permit No......................................................... Issued ... . .................................. Date r T - No... ..... FIns..............••-•••......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....Town ...............OF...Barnstable....................................................... Appliration for Uhip i al Works Towitriartion Prrutit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: --------- Fleecfwood Path ......................... ot 101 Location-Address or Lot No. •-K k ,fia bra •' ..f�/•PY l�y+�[ r _ Owner t Address a ......................... .:.:. ?.!!#!�J...................-•---._._.....-•-----•----..... ........................ ---.._...---•--.--.-----------------------........ Installer Address U Type of Building Size Lot._2.QG..,.3. ........Sq. feet Dwelling—No. of Bedrooms...............3._........._.......__..__.Expansion Attic ( ) Garbage Grinder ( ) '_ Other—Type of Building No. of ersons...._._....�______________ Showers ( ) — Cafeteria ( )\ , a YP g ----•-••••••------•. P aOther fixtures .....-......................... -------------------------------------------------_ --•-----------•-----------•----•-.._.•- d W Design Flow............... 5._..______._...........gallons per person tper day. Total dailyflow......3.30........ ____.__.._...___.._.._�allons. � WSeptic Tank—Liquid capacit}�OOO-•gallons Length$____ 6..._. Width►._._"_l0._.Diameter________________ Depth5....... �. x Disposal Trench—No. .0.0................ Width_....-.............. Total Length.. Total Total leaching area.....•..............sq. ft. 1 10 6 . Total leachin area.. 26 ....s � Seepage Pit No..................... Diameter......._..._._.._.._ Depth below_inlet.•_...._..__.._..._ g .........._7 q. ft. Z Other Distribution box (X ) Dosing tank ( ) '-' Percolation Test Results Performed baPe...COd SuTV�y_-COriSLlltd»tS Date...7..1 �$ .. Test Pit No. 1.....Z._.._..minutes per inch Depth of Test Pith._............ Depth to ground water. 9AA........._. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.................. ----•-• ----...........•......•••.....0........................•.....................................................•••••---••-•--......_.........•--- D Description of SoiAO-P-0 .5_..wood loam, 0.5-2.0 r'oek .3ubsoil a 2.0-12.0 x clean meek. sand �N o U ••-•----•--.._.. ----•••. �Pt F�Ags W ---------------------------------------•.......................................••••••. .............................••-•................ ... �' .......••••• . q UNature of Repairs or Alterations—Answer when applicable------------------------------------------- -_......_. .--.R ,•B ICK ---•-•----•.................................:........ .......----............................................................. ........ n. Agreement: / The undersigned agrees to install the aforedescribed Individual Sewage D° osal Syst i�; r i the provisions of TITLi, y g 5 of the State Sanitary Code—The undersigned furtl er agrees not t L, in operation until a Certificate of Compliance ha'-.been issued by the board of health. ned• ' " " A >,f-1 ' ----- ..... v g t ,� A. k ' irate Application Approved BY----•- X.! ..-- ---=-_._. ..-- .... --- Date Application .............. Application Disapproved for the following.:reasons______________________ ....-•--••...................•----••------•-------•---------•---.............................................................--............................ ------•----------------•- Date PermitNo-----------...........-.................................. Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 8y . ► ..........oF....., .:.: ........................................................... ............ TertifirFa#r of TompliFaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ") or Repaired Q " a� `by.................. - - --a= ....................................•- / Installer at). Sb .•-•'',.f 6 cr.........t f— .• c- ' 1 f f = ---------- has been installed in accordance with the provisions of h__.JF_7 j of The State Sanitary Code as described in the application for Disposal Works Construction Permit N .._ ___________________ da.ted_.P._=.r__:?_�__--_-__-_-_.--_._.-_- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................................•-•..........------••---• Inspector----•--....... .................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ?t�.. ...........OF......... .L �. ..:............................ No........................ ,, . FEE. ................... �i��az�ttl� �ark� ��aa�#raimrn rr�ti# Permission is hereby granted............ "_�.__.:_. ?k/_.�f.................................... to Construct (%r ) or Repair ( ) an Individual Sewage Disposal System at ------ '°=C � a..a ... u I) ....... ............................ . Street as shown on the application for Disposal.Works Construction Per No.._ __ _._ ated__ __,,5'_.� � Board of Health + DATE . --------- ,. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS .3- s j.-' 4 _`af-^!t *-`r rya&.-p'tt -i ✓ .. "x f. T ,i,., "ljl f .✓'`< '.t- , - .�:. ' + v, ,, r`" t r -'. 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