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HomeMy WebLinkAboutInspection Report 2006 Apr 19 TOWN F YARMOUTH ® 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 MATTACHEES .44 �oRaORATEO 6�9 Telephone (508) 398-2231, Ext. 241 — Fax (508) 760-3472 .i� �, BOARD OF HEALTH April 19, 2006 Mr. and Mrs. John Sage 3185 Woodland Lane Alexandria VA 22309 RE: Subsurface Sewage Disposal System Inspection Report, 48 Shaker House Road, Yarmouth Port Dear Mr. and Mrs. Sage: This department is in receipt of a subsurface sewage disposal system inspection report conducted by Troy M. Williams of Troy Williams Septic Inspections on March 21, 2006 and received in this office on March 23, 2006. The report notes that the septic system conditionally passed the septic inspection. However, in order for the report to be considered a passed report and used for purposes of real estate transfer, the repairs identified in the report must be made. It may be necessary for you to obtain permits from the building department for the plumbing repairs and this department for any septic system repairs. If you should have any questions, please contact me at the Health Department. I can be reached at the telephone number printed above on Monday through Friday between 9:30 to 11:00 AM during regularly scheduled office hours. Sincerely, Bruce G. Murphy, MPH Health Director BGM/mar cc: Peter DeFreitas, Plumbing Inspector File i� Printed on L. A Recycled aper A - 11 5 TROY WILLIAMS ! M `" 51 -4- SEPTIC INSPECTIONS MAR 2 3 2006 Certified by MA Department of Environmental Protection HEALTH DEPT. (508) 3&5-1300 19 Hummel Drive C� i��;�J/ /7�/L 9j____ South Dennis, MA 02660 COMMONWEALTH OF MASSACHUSETTS 1� *;vim _ /, EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS t/tt11 = DEPARTMENT OF ENVIRONMENTAL PROTECTION s =`=t1i.= ''i:., TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 48 Shaker House Road CERTIFICATION Yarmouth Port,MA Property Address: John&Mary Lou Sage 3185 Woodland Lane Owner's Name: Alexandria,VA 22309 Owner's Address: March 21,2006 Date of Inspection: Troy M. Williams Troy Williams Septic Inspections Name of Inspector: 19 Hummel Drive Company Name: South Dennis,MA 02660 Mailing Address: (508)385-1300 Telephone Number: CERTIFICATION STATEMENT I certify that 1 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 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: '/,J,ce. ....r.,� Date: 3 / ! /o The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth 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 Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This Inspection represents the conditions of the system on the Date of Inspection noted above. ****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. Title 5 Inspection Form 6/15/2000 page 1 of II Page 2 of 11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A C..ERTIFICATJON (continued) • Properly Address: 48 Shaker House Road Yarmouth Port,MA Owner: John&Mary Lou Sage Bate of Inspection: March 21,2006 Inspection Summary: Check A,13,C,1)or E/ALWAYS complete all of Section 1) A. System Passes: I have not found any information which indicates that v of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.301 exist Any failure criteria nt evaluated are indicated below. Comments: • B. System Conditionally Passes: • V 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. Answer des. no of not determined(Y,N,N1))in the 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 not)is structurally unsound,exhibits substantial infiltration or exfiltratiou or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it Is structurally sottgd, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. NI)explain: Ste 4 to Observation of sewage backup or break out or high water static levekilts l � idue to broken or obstructed pipe(s)of due to a broken,settled or uneven .' '1+ . System will pass inspection if(with approval of Board ofllealth): to„,0`'+ t (;H; ✓ broken pipa(s}-oto repl4ccd L L �i uct o t-if-fet eve11...T4 ' > h.r,a....l o•, i 1. r I'ht. To 7`►•,k �iow k:f�in�4, p• t _ dilttiltttfiett-bex is leveled or replaced i (13041Ll✓ire...:..:�) OV 4I s4- (..�� 0A +S.,*1{ f oWore A c. LA �e J� (<.(r 7 d—"5° "1'i7 Layr "4" NO explain: SJ +.p . /V The system required pumping more than 4 bines 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)ora rcplaccd obstntction is removed „o��� L BoIk. ��a o 14, 5-1., a5 t..t .- f-A—(;)•.•;v S 0., a of u w.e CA ...,A jUW NO explain: ay.al i4'-o } pµy. / - d //Lc rtp'r'+1 _v.3p t (:"- PA SS ePASS D ' Page 3ofiI OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART A CERTIFICATION(continued) Property Address: 48 Shaker House Road Owner: Yarmouth Port,MA Date of fuspectinn: John&Mary Lou Sage March 21,2006 C. Further Evaluation is Required by the Boarrl of Health: Conditions exist which require thither evaluation by the Board of tlealth in order to determine if the system is failing to protect public health. safety or the environment. • 1. System sill pass unless Board of Health determines in accordance with 310 CMR 1530 )(b) that the system is not functioning in a manner which will protect public health,safety and the nv'ironment Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a botderi»g vegetated wetland or a salt arsh • 2. System will fail unless the Board of Health(and Public Wale upplier,Rimy)determines that the system is functioning In a manner that protects the public hea t,safety and environment: The system has a septic tank and soil absorption sy em(SAS)and the SAS is within 100 feet of a surface %%ater supply or tributary to a surface water s ply. The system has a septic tank and SAS ant it. SAS is within a Zone I of a public water supply. The ss stein has a septic tank and S anti the SAS is within 50 feet of a private water supply well. The system has a septic tanl: • d SAS and Ute: SAS is less than 100 feet but 50 feet or more from a private water supply well•'. M mod used to determine distance "This system passes if tl • well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile or_anic compounds indicates that the well is free from pollution from that facility and the presence of nm .nia nitrogen and nitrate nitrogen is equal to Of less than S ppm,provided that no other failure criteria ; triggered. A copy of the analysis must be attached to this form. 3. Other: •3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA RT CERTIFICATION (continued) Property Address: 48 Shaker House Road Yarmouth Port,MA Owner: John&Mary Lou Sage March 21,2006 Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: Yes No flachui,of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface ol.the ground or surface waters due to an overloaded or clogged SAS Or cesspool __ V 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 %day flow 7 Required pumping more than 4 times in the last year jO1'due to clogged or obstructed pipe(s). Number of times pumped—_.—. • Any portion of the SAS,cesspool or privy is below high ground water elevation. _az_ Any portion of 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 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 titan 50 feet from a private water supply well with no acceptable %%aterquality analysis. ('Phis system passes if the well water analysis, performed at a DEP certified laboratory, 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, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) No_ (Yes/No)The system ,ails. I have determined that one or triune of the above failure criteria exist as dccrii ed in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of dealt!,to determine what will be necessary to correct the failure. E. large Systems: To he considered a large system the system must serve a facility with it test. flow of 10,000 gpd to 15,000 gPd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteri• ove) yes no — the system is within 400 feet of a surface drjnkin titer supply the system is within 200 feet of a tribur. • a surface drinking water supply _ the system is located in a nitroge • nsitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water sup r ' well if you have answered"yes"to a question in Section h the system is considered a significant threat,or answered "yes"in Section P above the .rge system hits failed•The oyvnpr Of operator of any large system considered a swot-Kant threat under s ton it or failed under Section P shall upgrade the system in accordance with 1I13 CMR 15.304.The system o er should comae{the Ppprapr!Otc rcgi°nal office of the Department. • 1 • Page 5 of 11 OFFIC_iAL INSPECTION FARM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE AISI'C)SAI,SYSTEM INSPECTION FORM PART I3 CHECKLIST Property Address: 48 Shaker House Road Yarmouth Port,MA Owner: John&Mary Lou Sage Date of Inspection: March 21,2006 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No .,/ _.__. i' ;: �nti information was provided by the owner, occupant, or lioal.l of I kali!, Were any of the system components pumped out in the previous two weeks !las the system received normal flows in the previous two week period? ./_ I lave large volumes of water been introduced to the system recently or as pari of this inspection ? ✓ _ ____ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling 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 tlhe septic tank manholes uncovered,opened. and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? _✓_ Was the facility owner(and occupants if different frim►owner)provided with information on the proper maintenance of subsurface sewage disposal systems ". The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no 7 Existing information. For example,a plan at the (Board of Health. y _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR IS.302(3)(b)J 5 Page 6 of I • OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART SYSTEM INFORMATION Property Address: 48 Shaker House Road Owner: Yarmouth Port,MA Date ofulspectiu,►c John&Mary Lou Sage March 21,2006 FLOW CONDITIONS RESIDENTIAL Number ofbedroo►ns(design): 3 Number of beclroo0 (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: It()gpd x 11 of bedrooms): 3 30 Number of Cliff cat residents: Dues residence have a garbage grinder(yes or no): G_ 0�4 1.741e- Is Igor} laundry on a s palate sewage system(yes(it ttol ,./o if yes separate inspection required] Laundry system inspected(yes or no): AIA Seasonal use: (yes or 110): _No Water meter readings, if available(last 2 yearstlsage(gpd)): b 5= 3 S' sov ((,h o y: 4 5 riot y //mow S Sump pump(yes or no):Ain Last date of occupancy: Or c.� COMM ERC IAIJINOUSTRIAI. Type of establishment' Design flow(based on 310 CMR 15.203): gpd Oasis of design now(scats/persons/sgti.etc.): - — Grease trap Isresenr(yes or no): -.-- Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title S systei yes ur►w): Water n►etcr reaEiwgs, if available: • Last date of occupancy/use: - -- O1111E1.(describe): (.ENEILA I. INFORMATION ION Pumping Itccords Sotoce of information ✓�. -t ..3/2i_/QJ p AOW._ Was system pumped as pan of the inspection(yes or nu):A/tz If yes, volume pumped: _ gallons -- !low was quantity pumped determined'.' Reason for pumping: TYPE OF SYSTEM • /Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool • -privy Shared system(yes or no)(if yes,attach previous inspection records, If any) innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be ubtalned from system owner) —Tight tank Attach a copy of the DEP approval —Other(describe): Approximate age of all components. dale installed(if 1cnown)and source of information: n s-1-1k-WJ I /r 7 /00 p�,e a s- bail}/ 1 /o o {-'-f_„e___-B-o-t; Com, 1'��1�i.h I-- pr•r»,t;.,� ,.,y�,. �fi�, d,.(4,-.) I /3t /a6 Were sewage odors detected when arriving at the site(yes or tin): A/o • • 6 • ' Page 7 of 1 I OFFICIAL. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA RT C SYSTEM INFoitmA`HON(continued) Property Address: 48 Shaker House Road Owner: Yarmouth Port,MA Date of Inspection: &Mary Lou Sage March 21,2006 BUILDING SEWl:lt (locate on site plan) Depth belo%% grade: o1 ' r Materials of construction: __cast iron V 90 PVC _other(explain): Distance fiort. larvate water supply well or suction line: __...U41 Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: / (locate on site plan) Depth below grade: _ ( krs ri seyS -{,> I ' Material of construction: _t/concrete__metal fiberglass polyethylene _other(explain) titan!: is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of cenificate) Dimensions: (. />' /O,s'X fq ' /500 1Kr4.>.-. Sludge depth: y'— Distance from top of sludge to bottom of outlet tee or baffle: 42 'B" Scum thickness: _ 111 1,, Distance from top of scum to top of outlet tee or baffle: Distance lion bottom of scum to bottom of outlet tee or baffle: /v, blow were dimensions determined: _ P,-a� ��lk�►_._ _ - Comments(on pumping recommendations, inlet anti outlet tee or baffle condition, strucurat integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): W.A}�✓ t c.I I w �, a a o�� �, Ih �(,f , rs✓} 0� /< +.. �.,..-.'jN4- G+N✓� .i" .4 V�dc. ,N✓L✓+..c:1 .0 n,)<fv.+.:_-fv.-._�.ay.r_.._l�"hp in fu-,K Gw�s .t y 1� II L r--- ...'--' �L.... S.1._sl_Y._-_..�1.�lr� tkiz_._G sr r(G� I;67.4- c.—A-0 ; c ci.A 0 ;h, 0,i+I A4 �N�/i✓r 4c, p{ "t'�+U �• p I S V 77 k.��f'z, I; s tr�.e h0 i ' 5,11+4 ^-t ds 6z or-A-A 6 ows;ma47,y LA., ( l l � el. GREASE TRAP:y(locateon site plan) o k ° Jo✓c yr w I 5u-e Lip ;ti _o 1..141 I, v14. Acv Icy f /�✓+ s. b fel 7C0 Depth below grade: lc;♦ '-'.-r ,s ht<d -4 p--- 1?o if. A/O `„;,1 Material of construction: concrete metal__fiberglass olyethylene_ other a y. dL (explain): Dimensions: ---- — �.. 7uo.,111 Scum thickness: _ -- Out-N t f i1NS �1,�. F •,.w ..,.. .t Distance from top of scum to top of outlet tee or ' c: 9 c s' ti w) t*,A ; Distance from bottom of scum to bottom of out tee or baffle: Date of lest pumping: Comments(on pumping rccommcndatio ., inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of akage,etc.): ------------ • • 7 _ • Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE I)ISI'OSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Shaker House Road Owner: Yarmouth Port,MA Date of inspection:John&Mary Lou Sage March 21,2006 1 IGIIT or 1101.DING TANK: __(tank must he pumped at time of insp tion)(locate on site plan) Depth below grade: Material of construction: ___concrete metal __.f iberOlass polyethylene other(explain): Dimensions: Capacity: __gallons Design Flo%+ ^ gallons/day Alarm present(yes or no): _.. Alarm level: Alarm in working order es or no): Date of last pumping: Comments(condition of alarm and float ' itches, etc.): DISTRIBUTION BOX: 'V (if present most be opened)(locate on site plan) Depth of liquid level above outlet invert: — Comments(note if box is level and distribution to outlets equal, any evidence of solids cartyaver, any evidence of leakage into or out of box, etc.): Wµms.-�-u�,s� ( . _...9-.13_1;,1, c✓ t�/o. a tsir� k�; _ c� .,,,yt v�4F t_�..#p-- �. r�Pta��:c PUMP CHAMBER: (locale on site plait) Pumps in working order(yes or no): __ Alarms in working order(yes or no): Comments(note condition of pump chamber,condition pumps and appurtenances,etc.): • • $ . Page 9 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 48 Shaker House Road Owner: Yarmouth Port,MA • Date of inspection: John&Mary Lou Sage March 21,2006 SOIL ABSORPTION ION SYSTk.M (SAS): v/. on site plan,excavation not required) if SAS not located explain wit) Type — leaching pits. number: leaching chambers,number: 3- 500 5 ri. c S fo.-) (3 3, s 'X' 9' k X' leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: • overflow cesspool,number: _ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic (ailuro, level of ponding, damp soil,condition of vegetation, etc.): � ,r �cif l U� S 1 ya .._. _✓ /.tP_'=L^ L GJ:CJ!] d V�O...L� .,tJ_�_ 17 6l..ry / 5 / Ps 111 4_ n Ir S l\ 1.6 5 -I^I N'1 t., u�i 1J L'.1 G✓ L•✓►�� CESSPOOLS: _ (cesspool must be pumped as part of inspection)(locat ►n site plan) Number and configuration: Depth–lop of liquid to inlet invert: Depth of solids layer: —____-- Depth of sewn la%er Dimensions of cesspool: -- – Materials of construction: Indication of groundwater inflow(yes or no): _ Comments(note condition of soil,signs of h • aulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: — -- Depth of solids: Comments(note condition of soil,signs of hydraul ilure, level of ponding, condition of vegetation,etc.): • • • 9 • Page 10 of 1 Iwp l � OFFICIAL, INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 48 Shaker House Road Property Address: Yarmouth Port,MA John&Mary Lou Sage Owner: March 21,2006 • Date of Inspection: SKETCH OF SFWACE DISPOSAL SYSTEM Provide a sketch of the Sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. — - — — rvo,t. _v 2V o 22'6 0 0 3b ' . 23 ' 39 32 yr 32 �— N Z 26 , t4 N • • Pagc11ofII OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMA'T'ION (continued) • Property Address: 48 Shaker House Road Owner: Yarmouth Port,MA Hatt of Inspection: John&Mary Lou Sage March 21,2006 SITE EXAM Slope Surface water Check cellar ✓ Shallow wells Estimated depth to ground water /Z'4- feet Adjusted high ground water elevation — feet Please indicate (check)all methods used to detennune the high gloom! eater elesatiun Obtained how system design plans on record - If checked,date of design plan reviewed: 1_1/.2 / ✓ Observed site(abutting property/observation bole within 150 feet of SAS) — t/ - Checked with local Hoard of l Icalth-explain; Checked with local excavators, installers- (attach documentation) — — Accessed US(;S database-explain: r9 .s.-1ti1 .._Zorvrr a x-2.0' /, 3 ' You must describe how you established the high ground water elevation: Ca IN 'MOrs oh � )u.y SLtnwc ------A ' ''s �-��c1. ,..� r `( !nom w c....kcr �' n‘.( .. cr._ f_. I/.or. /.3 u kF9K. off' --Q l-c-a��L,., � s:rt._--.,5`. B. _.w -S ram This repoti has been prepared and the system inspected as of the date of inspection. This report is not a warranty or guarantee that the system wlq function properly In!hafnium. There have peen no warranties or guarantees, either expressed,written er implied, relating to the eyelet% the inspectia0 and/or this report. II