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HomeMy WebLinkAbout0122 SALT ROCK ROAD - Health y. B�rii'stu�hlet Ah316R00 l i I I i I 0 TOWN OF BARNSTABLE LOCATION 5AI-T 1Z06t A() SEWAGE# VILLAGE (5�}{L_t Z M ASSESSOR'S MAP&PAR(;EC, .�,G " 4� INSTALLERS NAME&PHONE NO. otq6T &JJOWIl SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 6 gL4&dw C ^oz- (size) 0 orm'd NO.OF BEDROOMS OWNER _PAVL lk aay-*ZA-- PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Z Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feeXofle hing facility) `f�-Feet FURNISHED B 41 `� ,h� �o `- 1 6 !� 1 //��\ 1 _ b ' V p '1 7 s `� SV' � � to _ � � �. n f S - { !�� I 1 Rt��I �I I !Y f t a { I � y I f �� �i—'I - r T T�- I- • , +Tid am: ILL i I 1�-� ��_�;�-_� i t Imo , i f , Li 7i —` I ram`IL- I , , 1 1 -;� 1---� 11 �+ -?- s, I I i ' Owner:Paul Kelleher Address: 122 Salt Rock Road,Barnstable. Date of inspection: 7/3/06 COMMONWEALTH OF MASSACHUSETTS .: EXECUTATIVE OFFICE OF ENVIRONMENTAL AFFAIRS a- DEPARTMENT OF ENVIRONMENTAL PROTECTION 9 ONE WINTER STREET,BOSTON MA 02108(617)292-5500 14IITT ROMNEY TRUDY COXE Governor Secretary DAVID B. STRUHS TITLE 5 Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION d G Property Address:_122 Salt Rock Road Name of Owner:Paul Kelleher Barnstable Address: 1 Old Center St. Pembroke,MA 02359 Date of Inspection: 7/3/06 Name of Inspector: James F.Noone,P.E. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: BSI Mailing Address: 66 Pleasant St.Pembroke,MA. 02359 Telephone Number: (617)839-8666 �a� 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: XPasses Conditionally Passes Needs Further Evaluation By the Local Approving Authority - - yFais Inspector's Signature: Date: cill `' 2006 The System Inspecto/in1spsection. ubmit a copy of this inspection report to the Approving Authority(Board of Heal t or DEP)withinthirty(30) days of completing t If the system is a shared system or has a design flow of 10,000 gpd of greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Proiection. Tl a original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. 3 NOTES AND COMMENTS:, l ® N X d W S APTAA1 All G c� 01 A 1 Lsoutg ultavpl INSPECTION SUMMARY: A) SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310CMR 15.303 or in 310 CMR 15.304 exist. y failure criteria not evaluated are indicated below. COMMENTS: 696 VND W-ATt.JZ4- A&MLJ OV .S©1Gr s-MVU , A,10 V ldi C ®pS�l�lf,�i4Ta6Vr B) SYSTEM CONDITIONALLY PASSES: . One or more 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. 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 complying septic tank as approved by the Board of Health. C:\Documents and Settings\Jim\My Documents\JFNJOBS\Septic Inspections\Pembroke\122 Salt Rock Barnstable.doc BSI,66 Pleasant St.Pembroke,MA 02359 Page 1 of 5 4. Owner:Paul Kelleher Address: 122 Salt Rock Road,Barnstable. Date of inspection: 7/3/06 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) r` _Sewage backup of breakout or 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 the approval of the Board of Health): 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 Q 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 310CMR 15.303(1)(b)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 THE PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 a soil absorption system and the SAS is within a Zone 1 of a public water supply well. _The system has a septic tank and a soil absorption system and the SAS is within 50 feet of a private water supply well. _The system has a septic tank and a 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 3)OTHER > D) SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: Yes No X Backup of sewage into facility or system components due to an overloaded or clogged SAS or cesspool. XDischarge or ponding of effluent to the surface of the ground of surface waters due to an overloaded or clogged SAS or cesspool. kStatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. XLiquid depth in cesspool is less than 6"below invert or available.volume is less than'/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes.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 1 of a public water supply well. 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 50 feet or more from a private water supply well with no acceptable water quality analysis.If the well has been analyzed and determined to be acceptable,attach a copy of the.well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. _ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303 therefore the system fails.The basis for this determination is indicated below.The board of health should be contacted to determine what would be necessary to correct the failure. C:\Documents and Settings\Jim\My DocumentsVFNJOBS\Septic Inspections\Pembroke\122 Salt Rock Barnstable.doc BSI, 66 Pleasant St.Pembroke,MA 02359 Page 2 of 5 Owner:Paul Kelleher Address: 122 Salt Rock Road,Barnstable. Date of inspection: 7/3/06 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Yes No Pumping information was provided by the owner,occupant,or Board of Health. X Were any of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates. Has the system received normal flows in the previous two weeks. _ Large volumes of water have not been introduced into the system recently or as part of this inspection. —J� Were as-built plans have been obtained and examined. Was the facility or dwelling was inspected for signs of sewage backup. _The site was inspected for signs of breakout. _Were all system components,excluding the Soil Absorption System,located on the site. _Locate public water supply where it comes into house _Locate all wells within 100,. _The facility owner and occupants were provided with information on the proper maintenance of Subsurface Disposal Systems. 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 and depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Existing Information.Existing Plan at the Board of Health Determined in the field CX9 PMC- 4'044 Aj lq Vvlke ee-rv .a Pro n C0"-s F01, OVAAACOI J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL: Number of bedrooms(design): Number of bedrooms(actual): Design flow: 100 g.p.d./bedroom. Total DESIGN flow: Number of current residents: Garbage grinder: 0 Laundry(separate system): Laundry system inspected: _kjIff Seasonal use: S. P Water meter reOd gs(last 2 years usage): 100 gpd average Sump Pump:_/V Last date of occupancy:Current_Last date: GENERAL INFORMATION PUMPING RECORDS AND SOURCE OF INFORMATION: Dates pumped: 0 W AA Q Vr0fl.2 Z-04- S` Information Source:Owner Board of Health Other System pumped as part of the inspection: i/fiS Volume Pumped: . Reason for Pumping: TO 0,PC[U-t1' f JVIt rPgTr&v, TYPE OF SYSTEM - ®NPl- ®b5ly _Septic tank/distribution box/soil absorption system _Shared system _Single cesspool _UA Technology Overflow cesspool _Tight Tank Privy APPROXIMATE AGE OF ALL SYSTEM COMPONENTS: DATE INSTALLED/SOURCE: 4!!p—jf4-) SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE: C:\Documents and Settings\Jim\My DocumentsVFNJOBS\Septic Inspections\Pembroke\122 Salt Rock Bamstable.doc BSI,66 Pleasant St.Pembroke,MA 02359 Page 3 of 5 Owner:Paul Kelleher Address: 122 Salt Rock Road,Barnstable. Date of inspection: 7/3/06 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) BUILDING SEWER: i Depth below grade: Material of construction:_cast iron, PVC, other,. Distance from private water supply well or suction line:- Diameter: a" _ Comments: l Az5ac-'T/9N V Y//-e ee-ru 6-W 11 491N40/"�/d6) Sri -tc NW lflA^ SEPTIC TANK: Depth below grade: (A) Material of construction:Concrete Metal ,Fibreglass Polyethylene Other If tank is metal list age: Is age confirmed by a Certificate of Compliance:Yes No Dimensions:L W D (H-B) FIELD MEASUREMEENTS(DEPTH FROM GRADE) Sludge depth: (H-G) A) TOP OF TANK Distance from top of sludge to bottom of outlet tee or baffle: (G-F) B)CEILING OF TANK Scum thickness: (E-D) - C)TOP OF OUTLET TEE Distance from top of scum to top of outlet tee or baffle: (D-C) D)TOP OF SCUM Distance from bottom of scum to bottom of outlet tee or baffle: (F-E) E)BOTTOM OF SCUM How dimensions were determined:Direct measurement F)BOTTOM OF OUTLET TEE Comments: G)TOP OF SLUDGE H)BOTTOM OF SLUDGE/TANK DISTRIBUTION BOX: Depth of liquid level above outlet invert- Distribution equal: Any evidence of solids carryover: Any evidence of leakage: Comments: SOIL ABSORPTION SYSTEM(SAS): Type:Leaching pits,number: Leaching cambers,number: Leaching galleries,number: Leaching trenches,number: length: Leaching fields,number: dimensions: Alternative system: Comments: CESSPOOLS: Number and configuration: w FIELD MEASUREMEENTS(DEPTH FROM GRADE) Distance from top of liquid to inlet invert: (C-B) A).TOP OF CESSPOOL 2�2 Depth of solids layer: (F-E) B)INVERT OF INLET L4.01 _ Depth of scum layer: (D-C) C)TOP OF SCUM .8 Dimensions of cesspool: D)BOTTOM OF SCUM 11. z Materials of construction: 4°rY l eaNc- a kz E)TOP OF SLUDGE Indication of groundwater inflow: 1t30N; F)BOTTOM OF SLUDGE/CESSPOOL Volume pumped: 6-0 Comments: ejU TL2T T/;,P. l l✓ �dc7� 40NiI'/l�t�� N© li✓l ilILWGIi — f�L(9ty 'TOP 6}('FRL 4-61 l P 1! 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' • . ' . Town of Barnstable Regulatory Services Thomas F. Geiler,Director a"""�"B�' ' Public Health Division f67� 1� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Y Office: 508-862-4644 - Fax: 508 790 6304 MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 MAIN STREET HYANNIS,MA 02601 FAX:508-790-6304 SEPTIC SYSTEM INSPECTOR REGISTRATION Date Z 0 Name of DEP Certified Inspector _ TA tl A;S F. mDONr P tZ. ON,P * lWO- Business Address Kj 6 Pcus;;o� 5r. Pr,,1'1 x*,oitc , n-- dzal Business Telephone No. 61,1-7 FAX Number LSO$ — -7J 511 C) Home Address_ PGflaapT .S I, Home Telephone Number The undersigned agrees to comply with PART VIII, SECTION 14.00 of the Board of Health Regulations. `The septic system inspector shall complete every applicable section of the"Title 5 Official Inspection Form-Not For Voluntary Assessments,Subsurface Sewage Disposal System Form," supplied by the Massachusetts Department of Environmental Protection. In addition,at the bottom of the last page of this official inspection form,the septic system inspector shall provide a sketch diagram showing the vertical separation distance between the bottom of the soil absorption system and the groundwater table along with any high groundwater elevation adjustments determined. The Septic System Inspector shall submit a copy of the completed septic system inspection report along with the required processing fee to the Public Health Division Office within 30 days of the inspection date.' Signature of Applicant Q/healtWWpfdes/septin Owner:Paul Kelleher Address: 122 Salt Rock Road,Barnstable. Date of inspection: 7/3/06 .,r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM } PART C F SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: 71 L- 1 ;--�-- 1 �7LLL� — ( � A -; I I -TL�L � - ! r- r 1 Ir---- - - ! ! - -LL _I__i _I-i _' I , �-- , 11 1 I � 11�i , ( TH , s 1 1 1 SITE EXAM Slope: Q N f fi-C)PA % Z `rd /jarl'� rz4 c Surface water: 7-a) .N TL I LpcA-riz- 3a-4jo 6/U6w 5r/5%/"-- Check Cellar: i1 Shallow Wells: N ESTIMATED DEPTH TO GROUNDWATER: 0—(V Feet Methods used to determine High Groundwater Elevation: Obtained from Design Plans on record;Date of Design plans: _X Observation of Site Checked with local board of Health Local excavators/installers USGS Data High Groundwater Elevation was established by S<9 i I- 4'-'4A;-I3 UZ-V Of- t1AT—Af C:\Documents and Settings\Jim\My Documents\fFNJOBS\Septic Inspections\Pembroke\122 Salt Rock Barnstable.doc BSI, 66 Pleasant St.Pembroke,,MA 02359 Page 5 of 5