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Inspection Report 1995 Aug 07
/(11 a L - 75C : 1 TROY WILLIAMS �\2 SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 760-1819 40 Old Bass River Road South Dennis,MA 02660 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property 3 3 Mvat RcA , &3 s /t; • Owner's name& "4; �a I Sts 45 Mailing address 3 >o , U; C..w C; Date of Inspection S�'"v0., AUG 0 9 1995 F/2 (9S PART A CHECKLIST Check if the following have been done: ,/ Pumping information was requested of the owner, occupant and Board of Health. / None of the system components have been pumped for at least two weeks 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. N/'9 As built plans have been obtained and examined. Note if they are not available with N/A. 1/ The facility or dwelling was inspected for signs of sewage back-up. V The site was inspected for signs of breakout. 1/ All system components, excluding the SAS, have been located on the site. N/4 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 SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SSDS. Page 1 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential 3 number of bedrooms D number of current residents A/0 garbage grinder, yes or no No laundry connected to system, yes or no YES seasonal use,yes or no If nonresidential, calculated flow: Water meter readings, if available: Al/f' Va c.03, 4- .2yrs . Last date of occupancy GENERAL INFORMATION Pumping records and source of information: 1 v AA? 0.+"Lip ivl /hA✓ Nn6_4s01., 0.JQ% i lab. N0 System pumped as part of inspection,yes or no If yes,volume pumped Reason for pumping: Type of system / Septic tank/distribution box/soil absorption system V Single cesspool Overflow cesspool Privy Shared system(yes or no) (If yes, attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed, if known. Source of information: Vr1 4, h6v ; IA- .3 `� �rs . os," o Mb Sewage odors detected when arriving at the site, yes or no Page 2 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: fv'//9 (locate on site plan) depth below grade: material of construction: concrete metal FRP other(explain) dimensions: sludge depth distance from top of sludge to bottom of outlet tee or baffle scum thickness distance from top of scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle 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,recommendations for repairs,etc.) DISTRIBUTION BOX:/\//q (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, recommendation for repairs,etc) PUMP CHAMBER: "//.q (locate on site plan) pumps in working order,yes or no Comments: (note condition of pump chamber,condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) Page 3 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM(SAS): N/i9 (locate on site plan,if poss.;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,etc.) CESSPOOLS (locate on site plan) : V number and configuration p ti inieA ic.e y o 0 depth-top of liquid to inlet invert 4.) depth of solids layer Nd NE depth of scum layer NONE dimensions of cesspool 5 ' X o? 'at c,aM, materials of construction S; .pt e r- 6/o ma k Go N c ,-c c . indication of groundwater inflow (cesspool must be pumped as part of inspection) Eva u r,d w w�-c ,v r s e r f ; c-e s sp t d /. Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,etc.) i S pros : ,., bo ore" Gas"de„ PRIVY: N M (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,etc.) Page 4 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 3 dfr- aa ' 17' .S,hy/4 crosspeo I . DEPTH TO GROUNDWATER Q • .5 depth to groundwater • 02 adjusted high groundwater level method of determination or approximation: • von. .A G. . a., ( I ,rode i✓ _ A It 4 il c rin GJ��'S', p .' r <:. �-,:"- i __� "'�_, ,f*e_ s--4044,40 _i <�C y>e� 1�Q Y�6 0 l'r C �-S SQ o / ; s 71. Page 5 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no or not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) I\/ Backup of sewage into facility? A/ Discharge or ponding of effluent to the surface of the ground or surface waters? N/A Static liquid level in the distribution box above outlet invert? N Liquid depth in cesspool<6"below invert or available volume< 1/2 day flow? A) Required pumping 4 times or more in the last year? Number of times pumped N/T Septic tank is metal?cracked? structurally unsound? substantial infiltration? substantial exfiltration?tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? C4 SS po o I ��� w; 7 K"' ^`� pr.s,hct i s G.?.5 be 46a ad:),ci-e b4, G/cwa.7-o; N within 50 feet of a surface water? /U within 100 feet of a surface water supply or tributary to a surface water supply? A/ within a Zone I of a public well? N within 50 feet of a bordering vegetated wetland or salt marsh(cesspools and privies only, not the SAS)? /V within 50 feet of a private water supply well? Ai 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. Page 6 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector: Troy Williams Company Name: TROY WILLIAMS SEPTIC INSPECTIONS Company Address: 40 Old Bass River Road, South Dennis, MA 02660 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. the inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check one: I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. 1,7I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature S ," Date 8/7 /j S- Original to system owner Copies to : Buyer(if applicable) Approving authority PROPERTY ADDRESS: 3 3 / p.tt Rol 4-1" Nilo J / Page 7 of 7 • Permit Number: Date: e/7/9,$'' Completed by: w'! l;c.-.t HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 3 3 Pape- Rd Lot No. Owner: .5•a„ A Address: Contractor: Address: Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. Date 8/7 nSI a.51 month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OA Appropriate index well (/�Ign1Rgl .......................................... © Water-level range zone A — STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to 7/qs I q,oZ water level for index well month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment .. (a 3 STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) .oZ TOWN OF YARMOUTH r 11 to 1201'Tli _'S SOITH YARMOUTH MASSACHUSETTS 0266,+-4451 MQTACIi[�js i ro..uo '(rlrl)hunc(SUh) 398-2211, Ext. 241 — Fax (508)398-2365 BOARD OF HEALTH REQUEST FOR SEPTIC SYSTEM INFORMATION (FORM MUST BE FULLY COMPLETED) 1. LOCATION OF INSPECTION: 33 2. TOWN ASSESSOR'S MAP # o? / , LOT # U S6 3. DATE HOUSE WAS BUILT: ' • 4• WELL ON PROPERTY, INCLUDING IRRIGATIION WELLS? YES NO (SHOW LOCATION ON SEPTIC INSPECTION FORM. ) 5. OWNER'S NAME AND ADDRESS: 1 -(,to C�✓// u; {-f..J Civ . S 4 ®` e-D h /4. Gam.. 6. BUYER'S NAME AND ADDRESS: 7. OTHER INFORMATION REQUESTED: The Health Department will provide: 1. Last four (4) years of septic pumping history; 2. Septic system location "AS—BUILT" card, if on file; 3. Septic system description; 4. Copy of Septic Disposal Application; 5. Percolation card, if on file (New houses since 1980); 6. Review of engineered septic plan, if on file. ALLOW TEN (10) BUSINESS DAYS FROM DATE OF SUBMITTAL FOR THE HEALTH DEPARNT TO PROVIDE INFORMATION REQUESTED. ON COMPLETED SEPTIC INSPECTION FORM, ATTACH "AS--BUILT" LOCATION CARD SUPPLIED BY THE HEALTH DEPARTMENT, MAP AND LOT NUMBER MUST AL90 BE PLACED ON THE FRONT PAGE OF THE INSPECTION FORM. NAME OF STATE CERTIFIED SEPTIC INSPECTOR: Troy Williams ADDRESS: Septic Inspections 40 Old Bass River Road SouthDennis,MA 02660-2701 TELPHONE NUMBER: FILING FEE OF $30.00 PAID ON: 04/06/95 rip Printed on Recycled ?anPr JF.Yq�r a TOWN OF YARMOUTH ' / 1146 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 MATTAC MEES ' * oothnTtu�� j Telephone(508) 398-2231, Ext. 241 — Fax(508) 398-2365 BOARD OF HEALTH August 11, 1995 Michael Sonfist 23 Pond View Circle Sharon, MA 02067 Re: Subsurface Sewage Disposal Inspection To Whom It May Concern: This office is in receipt of a subsurface sewage disposal inspection report, on your property at 33 Hope Road, conducted on August 7, 1995 by Troy Williams Inspections, and received by this department on August 8, 1995. The report identifies your property as having failed the inspection for the following reason(s) : 1.) The cesspool was found with ground water present and it is 2.5 feet below adjusted high ground water elevation. You have one year to get engineered plans and upgrade your system to meet the state Title V requirements. If you should have any questions or comments relative to this matter, please contact me at the Health Office. I can be reached by calling (508)398-2231, ext. 241, Monday through Friday, from 9:00 a.m. to 11:00 a.m. Sincerely ;,�� ruce G. Murphy lth Agent BGM/cg cc: file iPrinted on t Recycled L Paper