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Home My WebLink About0069 COUNTRY CLUB DRIVE - Health 69 COUNTRY CLUB.DR., BARNSTABLE A= f 6 3 0 F e ° 6 r S N .; .. a .. r� J /( CO.-%I--%i N«EE.�,LTH OF MaSACHt;SETTS c c _ EXEC :TRrt j OFFICE OF E:�'VIR0�;1iE\T. I. AFFAIRS DEPAR , OF ENVIRONMENTAL PROTECTION " O\M RZ.\'TERiSTRrE=.BOS.O\11A 0210i t61.i 292-55Uv 1 TRl DY COX: Secre.a-Y . ARGEO PALL CELLtCCI 3- DAVID B STP._-uc Govern: Cotn.Russ:o:►er SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPEC'TWX FORM PART•A CERTBFICATION Property Address 69 CountryClub Dr NcnwofOwnw Al Morrisey .Addnass of owrwr: Date of Inspection: Cummagguid Name of aspector:IPlaase Print)Wm. E. Robinson Sr. 1 am a DEP approved s arspector to Seeoon 15—W of Tide 5 I310 CUR 15.000) CornpenyName: Wm. E. Robinson Septic Service MaiLngAdd►ess: PO Box 10 9. Centerville MA Toleplwne Number: 775 CERTIRCATION 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-sit:;P/e.W__.*.1. a disposal systems. The system: _ s Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority - Fails , Inspector's Signawre: Date: �J The System inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty I30)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 of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS 1a .o�t o � r } c7 �� ... retiised 9/2/9E Pa�rlorl) �� -^-tad o-Recvc:rd Paw, - - . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icondnuod) NopertyAddress: 69 Cbuntry Club Drive, Cummaquid Jwner: Al Morrisey Date of 4aspection: 1 a, INSPECTION SUMMARY: Check B, C, Or D: 'A. tPASSES: e not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One'or more system components as described 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.. Indic a yes,no. or not determined(Y.N,or ND). Describe basis of date. Onsdon 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 lattached)indicating that the tank was installed within twenty 120)years prior to the date of the inspection:or the septic tank,whether or not metal,is cracked,structurally unsound.shows substantial infiltration or exfiltrption. or'tank failure is imminent. The system will pass.inspeetion It the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if Iwith approval of the Board of Health). broken pipets)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass inspection if twith approval of the Board of Health): broken pipets)are replaced obstruction is removed rev1S2Q 9/2/96 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontinued) ` P►op"Address: 69 Country Club Drive, .Cummaquid Owner: n Date of InsPeb LAorrlSey 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 IN ACCORDANCE WITH 310 CMIR 15.303(1)(b)THAT THE SYSTEM NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT�THE SYSTEM IS NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 1 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 well. The system has a septic tank and soil absorption system and the,SAS 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 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) THER re% se.. P2Rc3of17 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (contirwed) Property Address: 80 Country Club Drive, Cummaquid Owner: .�1 Date of Inspectilc>rf: Mo r r i s e y D. SYSTEM FAILS: You lNo 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 Backup of sewage into 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 SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 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. GE SYSTEM FAILS: You mu t indicate either "Yes' or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: he 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 ealth and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply 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 own r 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 a Department for further information. rev-Se Pagc4ofII ,w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST ` e'roperty Address:owner: 69 Coun try, Club, Drive, : Cummaquid L Date of InspAJ-onMorrisey V Check if the following have been done: You must indicate either "Yes" or -No** as to each of the following: Yes i No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks an&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. _ 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.' _ The system does not receive non-sanitary or industrial'waste flows The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been locatedon the site. 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. The size and.location of the Soil Absorption System on the site has been determined based on: �• - _ Existing information. For example, Plan at B.O.N. _ Determined in the field(if.any of the.:failure criteria related to Part Cis at issue,approximation of distance is unacceptable) 115.302(3)(b)1 r The facility owner land occupants,if differeru from owner) were provided with information on the yropermaintenanc."f SubSurface Disposal Systems. re,_s-c 9/2/98 Pser 5 or n .0 C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 'roperty Address: 80 "Country Club Drive, Cummaquid Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 4V60 g.p.d.fbedroom. Number of bedrooms(design): Number of bedrooms (actual)-_ Total DESIGN flow �,<-4) Number of current residents::- Garbage grinder(yes or no):-X--14 Laundry(separate system) lyes or no):A:&? If yes,separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no): A,v Water meter readings, if available (last two year's usage(gpd): 1 999-2000 93,000 gal. Sump Pump(yes or no):d"® 1 998-1 999 100,000 gal.- Last date of occupanc9j,12 -4 CO! ERCIAL11NDUSTRIAL: Type f establishment: Design flow: Qpd ( Based on 15.203) Basis o design flow Grease trap present: (yes or no)_ Indust al Waste Holding Tank present: (yes or no)_ Non-s nitary waste discharged to the Title 5 system: (yes or no)_ Wate meter readings. if available: Last ate of occupancy: 01(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS/� sou of inform�tio `!! System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons /Reason for pumping: TYPE y SYSTEM ttLo Septic tank idistribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records:if any) VA Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other v APPROXIMATE AGE of all components, date installed(if known)and source of information: rY bo i,+e•, q Or Sewage odors detected when arriving at the site: (yes or no) C) rev seG �%[,�5c Page 6(if II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Ico Wnued) 'ropeny Address: 69 -Country Club Drive, Cummaquid Owrw.- Al Morrisey Date of Irtspectiory, !a-0-0 P 77 BUIL G SEWER: (Locate on site plan) Depth elow grade:_ Materi 1 of construction:_cast iron_40 PVC_ other(explain) Dist" ce from private water supply well or suction line. , Diam er Com ents: tcondition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:' (locate on site plan) Depth below grade: 1 Material of construction: ✓concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: l ) Scum thickness: /`� �\ \ Distance from top of scum to top of outlet tee or baffle: r 7� f � . Distance from bottom of scum to bottom o outlet tee'or baffle: How dimensions were determined: 'omments: „ (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, stru turd integri , evidence of leaks e. etc.) o -o Q G T" r 1� T, J f/y ��!G a� �b r 6)'- r GR E TRAP: (locate n site plan) Depth b low grade:_ Material f construction:_concrete metal_Fiberglass _Polyethylene_otherlexplainl " Dimensi ns: , Scum th ckness: - Distanc from top of scum to top of outlet tee or baffle: , Distant from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comme tS: (recom endation for pumping, condition of inlet and'outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evident of leakage, etc.) . , � Y. - - r C / _EZ _�_" � 2�•So ,. Page 7oflf . - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ►roperty Address: 69 Country Club Drive, Cummaquid Owner: Date of Ins Morrisey T19HT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (lo to on site plan) Dep h below grade:_ Mat rial of construction:_concrete_metal_Fiberglass_Polyethylene_otherlexplain) Dime sions: Co pa ity: gallons Desi n flow: gallons/day Ala present Ala- level: Alarm in working order: Yes_ No_ Dot of previous pumping: Co ments: (co dition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:I/ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal. evid nce of solids carryover, evidence of leakage into or out of box, etc.) - PUMP HAMBER: (locate n site plan) Pumps in working order: (Yes or No) Alarms i working order (Yes or No) Common s: (note co dition of pump chamber, condition of pumps and appurtenances,etc.) revise" 5/2/98 Page 8ofII f ,� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'ropenyAddress: 69- Country Club Drive,, Cummaquid Owner: Ap I Date of Inspecb . Morrisey 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:_ leaching chambers, number: leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: { overflow cesspool, number:_ Alternative system: Name of Technology: Comments: » (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) ),o A r:4; L. C� of/o)c K•r c; G o gw!t CES P OLS: at (loce site plan) Number d configuration: Depth-top of liquid to inlet invert: Depth of olids layer: )epth of cum layer: « , Dimensio s of cesspool Materials f construction: Indication of groundwater: nflow (cesspool must be pumped as.part of inspections Commen s: I (note cond lion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)- PRIVY: (locate on to plan) Materials o construction Depth of s lids: Dimensions Commen t a. Inote co dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) .-.'f ai ♦ w pagc9of'II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION fcorttinuW) 'rop"Address: 69 Country Club Drive, Cummaquid lwrw: Al Morrisey Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) e a e.. - ;'2i -_ Pap-IOol11 r f 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) , ropeRy Address: _ u Owner: ' �1' 69 Country Club. Drive, Cummaquid Date of u�spec.� Mo r r i s e y NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited - Observation Wells checked Deep Groundwater depth: Shallow Moderate SITE EXAM Slope Surface water w . Check Cellar Shallow wells ' Estimated Depth to Groundwater -l7 Feet ' Please indicate all the methods used to determine High Groundwater Elevation: r Obtained from Design Plans on record _Observed.Site(Abutting propeny:observation hole. basement sump etc.) _ Determined from local conditions r- V Checked with local Board of health t y Checked FEMA Maps . r Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) . 4 4 : 4 rev=sec 9/2/9E PaRcIIofI1 H