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Home My WebLink AboutInspection Report 2014 Oct 05 - SideOwner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ISI Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Route 6A C5%X)6 Property Address HUGHESJOANN Owner's Name Yarmouthport MA 02675 City/Town State Zip Code 10/05/14 Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Trevor Kellett loon P Name of Inspector TK Septic Inspections Company Name -H 38 Vacation Lane Company Address West Yarmouth Cityrrown 508-579-5502 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address ana mai me 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: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/16/14 Inspector's Signature Date The system inspector shall submit 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 to the buyer, if applicable, and the approving authority. ****This report only describes conditions 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 the same or different conditions of use. Mrs - 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 1 of 17 � Commonweakh of Massachusetts � Title 5 Official Inspection Form Subsurtace Sewage Disposal System Form-Not for Voluntary AssessmeMs 56 Route 6A Pmperty Address HUGHESJOANN �^e� ovmer's Hame ��o"na6onis Yarmouthport MA 0�75 10/05/14 required for avery Pa9e. CM1YfTown State Lp Code Date of Inspection B. Certification �cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) Systern Passes: ❑ I have not tound any information which indicates that any of the failure criteria described in 310 CMR '15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Gomments: 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 Heatth,will pass. Check the box for°yes',°no' or°not determined'(Y, N, ND)for the following statements. If°not determined,° please explain. The septic tank is metal and over 20 years old' or the septic tank(whether metal or rrot) is strudurally unsound, exhibits substantial infiltration or e�cfittration or tank failure is imminent. System will pass irupection 'rf the existing tank is replaced with a complying septic tank as approved by fhe Board of HeaRh. "A metal septic tank will pass inspection if it is structurally sound, not leakirg and if a Certficate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15h�s.Y13 TiYe 501AWI�n�emm Fam'SL�rtece San9a OisposY`Y�^'�'+9e 2 d 1] � � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurtace Sewage Disposal System Form-Not for Voluntary Assessments 56 Route 6A ProParty Address HUGHESJOANN �"�^8� Oarr�er's Name ��O�tiO°R Yarmouth rt MA 02675 �0/05/�4 requiredforevery � Pa9e. CilylToxn Sfate Zip Code �ate M I�spection B. Certification (cont.� ❑ Pump Chamber pumps/alarms not operationaL System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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 broke�, settled or uneven distribution box. System will pass inspection if(with approval of Board of HeaRh): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or repiaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumpirg 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Furdier Evaluation is Required by the Board of Health: ❑ Conddioru exist which require further evaluation by the Board of Heatth in order to determine if the system is failing to protect public heatth, safety or the environmerrt. 1. System will pass unless Board of Heatth determi�es in accordance with 310 CMR 15.303(1)�b)that the syst�n is not functioning In a manner which will protect public h�lth, safety and the environrt�errt: ❑ Cesspool or privy is within 50 feet of a surFace water ❑ Cesspool or privy is within 50 feet of a borderirx,�vegetated wetland or a salt marsh tJns•3n3 Title 5011�tr�aqclan Fam:9ibealae Se�e OiM��'Po9e 3 0117 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurtace Sewage Disposal System Form-Not for Voluntary AssessmeMs 56 Route 6A r�o�ny naaro� HUGHESJOANN �� Oymer's Name °1fO11�hon�s YarmouthpoR MA 02675 10/05/14 required for avery �9e. Cily/Tovm Stare Zip Code Date of Inspection B. Certification �cont.� 2. System will fail �less tlie Board of H�Itli(and Public Wat�Supplier,H any) determines that the system is functioning in a manner that protects U�e public health, saFety and�vironmeM: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surtace water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private v�ater 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 vrater supply well`•. Method used to determine distance: "This system pass� if the well water analysis, pertormed at a DEP certified laboratory, for fecal col'rform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure crRena are higgered. A copy of the analysis must be attached to this form. 3. OMer D) Syste�n Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to exh of dre following for all inspections: Yes No � � Backup of sewage into facility or system canponent due to overloaded or clogged SAS or cesspool � � Discharge or ponding of effluer�t 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 overioaded or clogged SAS or cesspool � � Liquid depRh in cesspool is less than 6° below invert or available volume is less than 'F day flow t5ins.3/13 TAe 5 ORtlel Mspe�m Fotm SAsefe¢Se�veye Oi�S/5en'iepe�ot 1] � � Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurtace Sewage D)sposal Sysbem Form-Not for Voluntary Assessments 56 Route 6A �or�m naare:: HUGHESJOANN Owner p�¢Ys Name re uredforava YaRi�outhport MA 02675 10/OSl14 Pa9e� ry Cily/Town SYate Zip Code Date W Inspection B. Certification (cont.) Yes No � � Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:_ ❑ � My portion of the SAS, cesspool or privy is below high ground water elevation. � � Any portion of cesspool or privy is within �00 feet of a surtace water supply or trilwtary to a surface vrater supply. ❑ � Any portion of a cesspool or Fxivy is within a Zone 1 of a public well. ❑ � My portion of a cesspool or privy s 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. [fhis system passes'rf tFre well water analysis, pertwmed at a DEP certified laboratory,fa fecal cdifwm bacteria indicates absent and ihe presence of ammonia rtitrogen and nitrate nitrogen is equal to or less U�an 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this fwm.] � � The system is a cesspool serving a facildy with a design flow of 2000gpd- 10,OOOgpd. � � The system fails. I have determi�ed that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefwe the system fails.The system owner should contact the Board of Heallh to determine what will be necessary to corcect the failure. E) Large Systems: To be considered a large system the syst�n must serve a fxility witli a design flow of 10,000 gpd to 15,�00 gpd. For large systems, you must indicate either°yes° or°no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surtace drinking water supply ❑ ❑ the system is vvithin 2�feet of a tributary to a surtace drinking water supply � � the system is located in a nKrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered°yes"to any questlon in Section E the system is considered a significant threat, or answered'yes' in Section D above the large system has tailed. The owner or operator of any large system considered a significaM threat urber Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner shouki contact the apExopriate regional office of the Department r.u^%•�+3 rne s ondr Myedlm Form'SDa,Rem SeYaqe q�S)skm'Pe9a 5 011] � Commonwealth of Massachusetts � Title 5 Official Inspection Form Subsurface Sewage Disp��System Form-Not for Voluntary AssessmeMs 56 Route 6A aroperty addrass HUGHESJOANN �� ouMers Name iMormetbn is YarmoUtliport MA 02675 10/OS/l4 required/or every P89e. Ci[Y/Town State Zip Coda Uaffi of Inspection C. CheCkliSt Check if the folbwing have been done. You must indicate"yes° or'no° as to each of the following: Yes No ❑ � Pumping information was provided by the owner, occupaM, or Board of Health ❑ � Were any of tfie system components pumped out in fhe previous Mro weeks? � ❑ Has the system received normal flows in the previous two week period9 � � Have large volumes of water been introduced to the system recently or as part of this inspection? � � Were as buitt plans of the system o�ained and examined?(if they were not available note as WA) � ❑ Was the facility or dweliing inspected for signs of sewage back up? � ❑ Was the site inspected for signs of break out? � ❑ Were all system components, excluding the SAS, located on site? � ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, mffierial of construction, dimensions, depth of liquid, depth of sludge and depth of scum? � � W�the facility owner(and occupants iF different from owner)provided with information on the proper maintenance of subsurtace sev�rage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been detertnined based on: � ❑ Existing information. For euample, a plan at the Board of Heatth. � � Determined in the field(if any of the failure crderia related to Part C is at issue approximation of distance is unacceptable)[310 CMR '15.302(5)] D. System Information Resid�tl�Flow Conditlons: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15203(for examp�e: 1�0 gpd x#of bedrooms): 440 15ins•3113 ��tle 5011tld kxpxqan Fam:SNanface Sewege q�Syslem'Poge 6 M i7 � � Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal Systern Form-Not for VoluMary AssessmeMs 56 Route 6A PropertyAtldreu � HUGHESJOANN �'^'T1ef OwrtieYs Name �gy°"�'hOO� ,y Yarmouth rt , �,,,a�„a,� po rwA o2s�s �aosna pa9e. cilyrtovn, smte zip code oate or�nspeceon D. System Information Description: Number of current residents: � Dces residence have a garb�qe grinder? ❑ Yes � No Is laundry on a separate sewage system?(Include laundry system inspection � Yes � No information in this report.) Laundry system inspected? ❑ Yes � No Seasonaluse? ❑ Yes � No Water meter readings, if available(last 2 years usage(gpd)): —��-�-(L�– Detail: 3.0 i � i 55.G�� Zo l'-� �'l5 � ��G Sump pump? ❑ Yes � No Last date of occupancy: currerd oata Commercial/lndustrial Flow Conditions; Type of Establ�hment: Design flow(based on 3�0 CMR 15.203): �ibr�s per my�9pd� Basis of design flow(seats/persons/sq.ft,etc.j: Grease trap preseM? ❑ Yes ❑ No Industrial waste holding tank preserd? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, 'rf available: t51ns.31t3 rtle S OIAtld Inspxfm Fam:SDaxfafn^xnge qaponl Sysbn•Page]of 11 � Commonwealth of Massachusetts � Title 5 Official Inspection Form Subsurface Sewage Disposal Sysbem Form-Not for Voluntary AssessmeMs 56 Route 6A Property Add�ess HUGHESJOANN Oaner p�r's Name �Morme+bn is Yarmouthport MA 02675 10/05/14 required Tor every �9g_ CM1y/Town State LP Code Date of Irspection D. System Information (cont.) Lastdate of�cupancy/use: oa� Otlier(describe below): Generallnformadon P�mping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume�mped: 90ia,a Howwas quantity pumped determined? Reason for pumping: Type of Sysbem: ❑ Septic tank,dishibution box,soil absorption system � Single cesspool ❑ Overflowcesspool ❑ Privy ❑ Shared system (yes or no)('rf yes, attach previous inspection records, if any) ❑ InnovativeJAtternative technology. Attach a copy of the current operation and maiMenance contract(to be obtained from system owner)and a copy of latest irupection of the I/A system by system operator under contract ❑ TigM tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ns•3I13 TiBe 501idal�m Fam 9IDsafe¢S�we9e L159��^'�9e 8 of 1"! � � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fwm-Not for Voluntary Assessments 56 Route 6A Propert/A�Jress HUGHESJOANN �� Owner's Name informauonis Ya�mouthpOrt MA 02675 10lOS/14 required for every page. City/Town State Zip Code Data of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of iMormation: 40 years+ Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Buildi�g Sewer(locate on site plan): � Depth befow grede: �� Material of construction: ❑cast iron �40 PVC ❑other(explain): Distance from private water supply well or suction line: f�� Comments(on condition ofjoints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grede: faet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(expiain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certficate) ❑ Yes ❑ No Dimer�ions: Sludge depth: I51ns.Yl3 Tltle S OIRtlY bq�etlan Fam 9�s+h�Serape qsPosel Syybm'Ppe 9 W 1) � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurtace Sewage Disposal System Form-Not for Voluntary AssessmeMs 56 Route 6A Ro�m naareu HUGHESJOANN �� owners Name irrfotmation is Yafmoutllport MA 02675 '10/05/l4 required Por every Pa9e. CRYITown sfate Zip code Date of Inspection D. System information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outiet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Commenis(on pumping recommendatioru, inlet arW outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Gr�se Trap(locate on sde plan): Depth below grade: fe,t Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outiet tee or bafFle Distance from bottom of scum to bottom of outlet tee or bafFle Date of last pumping: p,�, i5ais.Y13 TiAe 501Rtltl„spttEm Form:9Dwrfem Sew�ga d�oml Syuten•Pege 10�1� � Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Fwm-Not for Voluntary Assessments 56 Route 6A PropaM Address HUGHESJOANN �'^'�� Owner's Name Irequ'ired for evary Yarmouthport MA 02675 �0/05114 ps9e. Cilylfown Siate Zip Code �te of Irepection D. System Information (cont.) Comments(on pumping recommendatioru, inlet a�d outlet tee or baftle cond'Rion,structural integrity, liquid levels as related to outlet invert, evidence of leak�e, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: galbm Design Flow y,ib��r�y Alarm present: ❑ Yes ❑ No Alarm level: PJartn in worldng order: ❑ Yes ❑ No Date of I�t pumpirg: �� Comments(corWdion of alarm and float switches, etc,): `Attach copy of current pumping coMract(required). Is copy attached? ❑ Yes ❑ No t5ns.3113 TMa501A� NapecCan Fmm:SiDsurtece Sewage Gsyo�Sy99m•Pege 11011] � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurtace Sewage Daposal System Form-Not for Voluntary Assessmerds 56 Route 6A Propeey nddress HUGHESJOANN �a� ONner's Name "�Of�°0�� Yarmouthport MA 02675 10/OS/14 required for every Pa9e� Cily/Toxn State ZiP Code Date M Irspectbn D. System Information (cont.) 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 solids carryover, any evidence of leakage into or out of box, etc.): No D BOX Pump Chamber(locate on sde plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No' Commenls(note cond'Rion of pump chamber, contlition of pumps and appurtenances, etc.): 'If pumps or alarms are not in working order, system is a conditional pass. Soil Absorpdon System(SAS)(locate on sde plan, eaccavation not required): If SAS not located, explain why: Hins•3113 Tltlo S OIA WI Inspxlan(ortrc 9+Envfeoe Sawa9e dy�o�S@tem'Pege 12 d 1'/ � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurtace Sewage Disposal System Form-Not for Voluntary Assessments 56 Route 6A aropeny naareu HUGHESJOANN a"'�� Owt�er's Name ��q�� ry Yarmouth rt ,a �„��„e,� ao nn,a ozs�s �aos��a page. CitylTovn SYate Zip Code Data of I�xpection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ Ieaching trenches number, length: ❑ leaching fields number, dimensiors: ❑ overfbwcesspool number: ❑ innovative/attemative system Type/name of technology: Commenis(note cond'Rion of soil, sigrr of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration � Depth—top of liqu�to iniet invert even Depth of solids layer 6 Depth of scum layer � Dimensions of cesspool 5k5' Materials of construction drywell block Indication of groundwater inflow ❑ Yes � No t5m.3�13 TIYe 5011tle1 Inspadim From:9Daurfece SeYrege q�o�l S)gpn.Pggp/3 0111 � Commonweaith of Massachusetts Title 5 Official Inspection Form Subsurtace Sewage Disposal Systern Form-Not for Voluntary AssessmeMs 56 Route 6A aro�ny naaress HUGHESJOANN �e� Ovmer's Nama iMommeonis yarmoUtllport MA 02675 10/05/�4 required for avery Pa9e. Ci�'lTow� State Zip Coda Date of Irspection D. System Information (cont.) Comments(note conddion of soil,signs of hydraulic failure, level of ponding, cond'Rion of vegetation, etc.): The 5x5 drywell block pit had staining all the way to the invert as well as up the walls sign of failure Privy(locate on site plan): Materiats of construction: Dimensions Depth of solids Comments(note cond'Rion of soil,signs of hydraulic failure, level of ponding, corWition of vegetation, etc.): t5Yis•Y13 TIOe S OIAdtl C�spedon Fam SLDsufam Sexege dapwN Sy9nin'P4ga 14 of t] . �6 � � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fwm-Not for Voluntary AssessmeMs 56 Route 6A Properry Atldress HUGHESJOANN Owner pomer's Nama irdormaeonis Yarmouthport MA 02675 10/05/14 required for every pe9a, City/Town Stata Zip Coda Date of lnspacdon D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sew�qe disposal system, including ties to at le�t lwo permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below � handsketch in the area below ❑ drawing attached separately r i r f G/a+c''..1� � � v I ; �_._.._.,._.__... __. B �k� � O �o�s� ��o�� A1)29 A B1)27 t5ns.YI3 TIYe 5011de11napecban Fom�9ipaxhte Oi osl Seoage y SyNem.Page 15 ot 1] � Commonwealth of Massachusetts Title 5 Official Inspection Form SubsuMace Sewage Disp�al System Form-Not for Voluntary Assessments 56 Route 6A Propeny ndd�u HUGHESJOANN �� Wmer's Nama ��O�tiO°5 YarmouThport MA 02675 10/05114 requimd for every p�ae, cily/rowa sqee ZiP coae �aee ot trrspectioo D. System Information (cont.) site Exam: � Check Slope ❑ Surface water � Check cellar ❑ Shallow wells Estimated de h to hi h round vrater 20+ Pt 9 9 �� Please indicate all methals used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: oace ❑ Observed site(aLwtting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Heatth-explain: ❑ Checked with local excavators, installers-(attach documeMation) � Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS Maps show GW at over 20 feet Before filing this Inspection Report, please see Repwt Completeness Checklist on next page. i5x�s.3�t3 TAk 5 OIRCY hsP�an Fortn:9Asirfam SewNa Gyoal 9�Stem'Pepe i6 d 1] . � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurtace Sewage Disposal System Form-Not for Voluntary Assessments 56 Route 6A Property Address HUGHESJOANN Ovmer pwr�er's Name iMqrmafionis ry Yarmouth re �;,�,r„e,� Port MA o2s�s 10/05/14 Fe9e. CityRown State Zip Code Date W Irspectlon E. Report Completeness Checklist � Inspection Summary:A, B, C, D, or E checked � Inspection Summary D(System Failure Criteria Applicable to All Systems)completed � System Information—Estimated depth to high groundwater � Sketch of Sewa,ge Disposal System edher drawn on page 15 or attached in separate file t5ns.3113 Tlb 501LtlY Onpxbm Fmm:9�LaeTaoe$vxqgp qy�oal Sy�em•Fpe 17 K 7 i