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HomeMy WebLinkAboutInspection Report 1995 May 08 • TOWN OF YARMOUTH c 0, _!� r y 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 MATTACMEE5 "'0•Aw t"toc*'0,; Telephone(508)398-2231,Ext. 241 — Fax(508)398-2365 BOARD OF HEALTH July 10, 1995 Brad Graham Tiger Home Inspection, Inc. 969 Washington Street Braintree, MA 02184 Re: 10 Kerry Court, West Yarmouth Dear Mr. Graham: This department is in receipt of a subsurface sewage disposal inspection report on the above property conducted May 8, 1995 by your company, and received on May 22, 1995 by this department. The report was not completed in regard tothe state requirements in that: 1.) The depth to groundwater must be determined, and if applicable, the high groundwater must be included. The report also does not comply with the town's policy for septic system inspection reports due to the following reason(s): 1.) There was no additional as-built submitted, on town approved format, with the report.. The missing information must be completed before this office will accept the aforementioned report. Please revise the report appropriately and forward such copies to this department within 2 weeks upon receipt of this letter. Enclosed for your information is this departments request form for septic system information. Sncerely, bruce G. Murphy, MPH Health Agent BGM/cg cc: file Brian Dudley, D.E.P. 111\i Printed on Recycled LPaper r GER HOME INSPECTION 1 3ll wEo r -,-_,., HIRE THE EYE OF THE TIGER MAY 2 219 95 I "5' i 969 WASHINGTON STREET A/' BRAINTREE, MA 02184 .2 < 617-849-0988 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PORN TITLE 5 INSPECTION FORM Address of property * a.: .� ,I.. Lor 3 Owner' s name '(v it`i-;t Cruvw "' W1.T{°1.0..(A, bate of inspection `'j".r. 5°-(? t> 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. le As built plans have been obtained and examined. Note if they are not available with N/A. ZThe facility or dwelling was inspected for signs of sewage back-up. site s.sin to ei --cakput,..- Pill system components, excluding the SAS, have been located on the "" site. I l' The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, materialof 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 aprL oximated by non-intrusive methods. V The facility owner (and occupants, if different from owner) were i provided with information on the proper maintenance of SSDS. : ' 71-1. �h 0 ►# f .E,-e 7 i TIG HOME IN E TION INC ©. , 0 ': �-ri , ; . '' ,,,� _ HIRE THE EYE bF THE TIGER ,. f ''�a '„ ' 969 WASHINGTON STREET ''' - k.‘;',, ,1 BRAINTREE, MA 02184 i- I 617-849-0088 8 ` ""`'' ' SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION. 'ORM , PART B , I SYSTEM INFORMATION I FLOW' CONDITIONS -r 51- If residential �~ 'c. . ► ) =, , 42 numr of bedrooms - - -4, •-... -t 7 r *. ".4.. 'sem. . „* a <w m a�. s„fs. '...ref- ` - © / s " -.'' .'-r .. -.,..,y`+--�v£. yr.-:'-`- •<,=,:. t+., lit, laundry connected to system, yes or no ,a seasonal use, yes or no .If nonresidential, calculated flow: q3- .Sept cr ' -. 13164C> Water meter readings, if available: , , .ct 0�4, Sear r( - soL f41'2 - 6'%csioo A cApplocller'covo Last date of occupancy Z GENERAL INFORMATION X41 "I Pumping records and source of information: 4" Sysei' umped as part of inspection, yes or no if yes, volume pumped Reason for pumping: i rtm Type o system _ j * eptid*tank/distribution box/soil absorption system Single cesspool Overflow cesspool � Privyii Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) ,a Approximate age of all' components. Date installed, if known. Source of '< t information: f V.-- 1 Si-go °' 4. 4 • i, Quiff•-- I 11 1 (...."/ -;.. i NO Sewage odors detected when arriv'nc at th .si`t , eyes o no 1 , ,:,.. i 4.0.4 I x ion TIGER HOME INSPECTION INC.© f HIRE THE EYE OF THE TIGER r cr-„r; 969 WASHINGTON STREET r '.”( ,„+O+ :gds���► BRAINTREE, MA 02184 9 y „,/4` f " . --rte' 617-849-0088 s'' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 PART B 3I. SYSTEM INFORMATION continued 4 SEPTIC TANK: 4 ' (locate on` site plan) , , depth below grade: 45 material of construction* loncrete metal PRPE,othe, (exp ►in) r t` dimensions.,.. 2f 4 + r 4,.. L� .i c t y" distance from top of sludge to bot om of outlet tee or baffle eV' scum thickness laii distance from top of scum to top of outlet tee or baffle ; , 40 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 invertig.iist -4•e.24.... el..lev3. 4,-...14-teak-- kihtzlicT ire_ 1.1 irCk 115...<4.44 6 -„i 4 , structural integrity, evidence of leakage, recommendations for repairs, etc. ) t ea � 1`I { , DISTRIBUTION BOX: 2.---* (locate on site plan) 14.'e o , - elle ;depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, E PUMP CHAMBER: I (locate on site plan) tsi/�, 1 4' Ji pumps in working order, yes or no . Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) f. ! ct A il„,6*„._0( re. 6.,,,L 1411 ) ti �, . TIGER HOME INSPECTION INC .i HIRE THE EYE OF THE TIGER �y„c- ..:411*.,.., 969 WASHINGTON STREET 10 ti BRAINTREE, MA 02184 r.T. It ' `J, 617-849-0088 r' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART E SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : ) (locate on site plan, if possible; excavation not required, but may be ' approximated by non-intrusive methods)' If notYdetermained to be present, explain: 1 $ y .."0, 'f. Ar. '.`A ,ie.e-.t ,.. �- T �, �fi + '-. y , a _ 4 ', 7 leaching chambers and number (Faen- c a i x�.ti- c ci.wlet05 leaching galleries and number leaching trenches, number, length 4 leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, I condition of vegetation, recommendations for maintenance or repairsetc. ) III ?•tncl iCQrtANM. 1. r I to zSl _ '�.‘t.I.cue... ... CESSPOOLS (locate on site plans /� a number and configuration #" 1 depth-top of liquid to inlet invert ' depth of solids layer v dept of scum layer j mensiortr4it cesspool materials of construction indication of groundwater'' I i infloct (cesspool must be 3pumplal�,,as Comments: (note condition of soil, signs of hydraulic failure, level of ponding, 1 conditiorf of*vegetation, recommendations for maintenance or repairs,etc. ) ; PRIVY: (locate on site plan) r ,. z >• materials of construction dimensions depth of solids Comments: -11 (note condition of soil, signs of hydraulic# fa:lure, levelr ponding, F ' condition of vegetation, recom>a�er> at na fry nt noes., epa�.r , 6 ) I ') 4 .,.,a r c ,J-e- „, ''' -,' R �' ! TIGER HOME INSPECTIONS INC. 1`, i HIRE THE EYE OF THE TIGER ,��' • u 11 p. .� ,., , « .4 ,, 8•69 WASHINGTON STREET . = BRAINTREE, MA 02184 =� -817-849-0088 SUBSURPACE SEWAGE DISPOS*II SYSTEM INSPECTION FORM .1 PAST a I SYSTEM INI'O TON continued c SKETCH OF SEWAGE DISPOSAL SYSTEM: i include ties to at least two permanent references landmarks or benchmarks "''-"locate 'ill wells within .00' f . (*I' • . °‘'.'4141Cc't .t 14 \ ' — .1 J i . t • e i • ilk v _ t ;,t- '$= b"1.7 ti'7�tr" 4.741:,_:4.,:-:,,,,-:'*,7,1:,,,t. ,,, • I' DEPTH TO GROUNDWATER i t • erg depth, to groundwater ' j metod of determination or approximation: _ - mac- -14 issi3 r;,-- J 1 is i #.r 4'i is j 4 z16$*"# y. '' * TIGER HOME INSPECTION INC. 11«'" 1 x ;:lei HIRE THE EYE OF THE TIGER 12 n'-* ` ,. , ,, 969 WASHINGTON STREET te, :fff. . ... ,, » . BRAINTREE, MA 02184 4` 1 617-849-0088 t„, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORE ., 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) :lies BackuP of sews a into facility? o1t. 4•�t 6e,,3 5 We. , Discharge or ponding of effluent to the surface of the ground orh ` 1' 41/, ' „NtAZ hfoN Static liquid level in the distribution box above outlet invert? Ort t ev.5p ve.(.are,t/‘ Ma Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? vta♦ -„E, .�.�b4 q 14n ,: Required pumping 4 times or more' in,the last year? number oftimes pumped o v'+cie i mw .*4'vtet. •,'' r_ o► Septic tank is metal? cracked? structurally unsound? substantial )1 infiltration? substantial exfiltration? tank failure imminent? ;-, Is any portion of the SAS, cesspool or privy: hid below the high groundwater elevation? a t trwirvem-Asv‘ 1,4%44t, 'N, t4 within 50 feet of a surface water? nom riN L x` wt in,, 100 , : .i;k-t.iskriefatet. tom' is 4or tr t water supply? Yeti,, , +sn 0./ .• ND. within a Zone I of a public well? i` r ..,b”‘ y' 4. 0v0c,46.146 W . within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS)? rya+ o. (lt4-c.c24ok4; o within 50 feet of a private water supply well? ,4 Lol rta.4 t,. t(., ti'v-N, r .c44 `' less than 100 feet but greater than 50 feet from a private water , . supply well with no acceptable water quality analysis? If the well ',A( has been analyzed to be accetable, attach copy� of wel water analysi for coliform bacteria, volatile organic.compounds, ama-ia nitrogen -- and nitrate 'nitrogen. I 4 s. ' 9µ f j: ,,,, ', ,, `4,4#- ii?^ a te" x'A. P,t;;:, '7'. 4'''''Y'''''"'' } "v y"t:+' ':#s,Yv+r, `I. !' „Zi5":r4'7 At 3�s 32'---1--- ` TIGER HOME INSPECTION 1NC.© f ` t HIRE THE EYE OF THE TIGER � G b. u f ,, j 969 WASHINGTON STREET i°j F 10,-4_..- BRAINTREE, MA 02184 `\ r :il; -,s 617-849-0088 ' tt�r,`'.. s ✓$''' , 4 � q, - F ,I 13 ,, , . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM }} PART D I _{., 4.. ' -r' ERTIFI ION :if,t�, '''''''.,,'C.-;, fP e ; r. �� �'• 'd` 7 �t A p S ' ti - .;;,..t,- s d„ ,,,":2".:"--.-..gt,==*„. 1, r,�.' , ` ' SiIYa'Gt'. ,'",,,,-. 1 W.i. §t' 4 A ...1 ��-az., Name -Of Inspector �°w► ;.-. .` 9t wv Company Name ""A►t vaC`- 41®tAne .. "3. •S 'ec -i`etA Company Address ►ti►V..1`�*cikcsliN. i ` Cbv 4'�t'`e'�22. < I Certificat'on Statement. 4 I certify that I have personally inspected the sewage disposal system at . �` this address; and that the information reported is true, accurate and 41 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 functionand manitenance of on-site sewage disposal systems. `- ' Chec. •ne: I have not found any information which indicates that the system fails to triffeeimately protect public health or the environment as defined in 310 CMR 15.303 . A,ny ., ailure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. r.� _, t h e det . _ ; , ?► tea akl "-: c ,p oto Ip! b1 ° 1 h ,a0d _.. 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..t.itztot..(1 Date .y'....y..c ,---' Original to system owner Copies .to: Buyer (if applicable) Approving authority n ,w '; ) 11) • TOWN OF YARMOU 0H 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 0266411_1 1 i " MAT TACMEES � :_ Telephone (508) 398-2231, Ext. 241 — Fax (508) 398-2365 MAY 0 8 1995 BOARD OF HEALTH REQUEST FOR Slsir1C SYSTEM INFORMATION L. (FORM MUST BE FULLY COMPLETED) c(4-4.1•- -3e , 1. LOCATION OF INSPECTION: a9 a ) 2. TOWN ASSESSOR'S MAP # cj® ► r LOT # S 3. DATE HOUSE WAS BUILT: 4. WELL ON PROPERTY, INCLUDING IRRIGATION WELLS? YES NO (SHOW LOCATION ON SEPTIC INSPECTION FORM. ) 5. OWNER'S NAME AND ADDRESS: C.c • V ke & C- d1 _ - 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 DEPARTMENT To PROVIDE INFORMATION REQUESTED. ON COMPLETED SEPTIC INSPECTION FORM, ATTACH "AS-BUILT" LOCATION CARD SUPPLIED BY THE HEALTH DEPARTMENT. MAP AND LOT NUMBER MUST ALSO BE PLACED ON THE FRONT PAGE OF THE INSPECTION FORM. NAME OF STATE CERTIFIED SEPTIC INSPECTOR: gfra,e_a ��� � n /r1, , • ADDRESS: c7 Ria % t vv,J , r TELPHONE NUMBER: Lo(`2_. 'f(c )• - FILING FEE OF $30.00 PAID ON: I � Printed on 04/06/95 Recycled Z Paper TOWN o OF YARMOU ot,„ . 9 .:11 l 'jJ 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 026 lni L L> •4, oar Telephone(508)398-2231, Ext. 241 — Fax(508)398-2365 l BOARD OF HEALTH MAY 081995 REQUEST FOR SEPTIC SYSTEM INFORMATIOLJ --- (FORM MUST BE FULLY COMPLETED) C � � 3c , 1. LOCATION OF INSPECTION: d 1 ac!) i�r,( ,c�,,�d.. , ��v \1/4A 2. TOWN ASSESSOR'S MAP # jO S , LOT # 3. DATE HOUSE WAS BUILT: 3 A,'"?_4;3 4. WELL ON PROPERTY, INCLUDING IRRIGATION WELLS? YES NO [� (SHOW LOCATION ON SEPTIC INSPECTION FORM.) 5. OWNER'S NAME AND ADDRESS: 'lll et 1 a 4z C.c• w,!ii .- sizA - oCIQ?o 6. BUYER'S NAME AND ADDRESS: 7. OTHER INFORMATION REQUESTED: The Health Department will provide: 1. Last four (4) years of septic pumping history; fl O(1€. 2. Septic system location "AS-BUILT" card, if on file; 3. Septic system description; 4. Copy of Septic Disposal Application; Ai? M- t 5. Percolation card, if on file (New houses since 1980); 6. Review of engineered septic plan, if on file. MoN - ON FILE ALLOW TEN (10) BUSINESS DAYS FROM DATE OF SUBMITTAL FOR THE HEALTH DEPARTMENT TO PROVIDE INFORMATION REQUESTED. ON COMPLETED SEPTIC INSPECTION FORM, ATTACH "AS-BUILT" LOCATION CARD SUPPLIED BY THE HEALTH DEPARTMENT. MAP AND LOT NUMBER MUST ALSO BE PLACED ON THE FRONT PAGE OF THE INSPECTION FORM. NAME OF STATE CERTIFIED SEPTIC INSPECTOR: gir.ArQ (,m, l / r.k\C ` ,1 ADDRESS: cy 4e1 t SA. • 'i�•=g3,,\e, .r-t s 's4A , .:;,9t F-5/ TELPHONE NUMBER: FILING FEE OF $30.00 PAID ON: � RePrintedcycled on Paper 04/06/95 � d.1 : � w - ��p2 r . LOT NO. . ADDRESS:fol i ' OWNERS NAME: V 1 l 19 �'5 yu. f ' SEWAGE PERMIT N , 0---O'J _________________ �NEW:_REPAIR: s -7 DATE ISSUED:_. 6 10 DATE INSTALLED:.._ INSTALLERS NAME: �0 ` • �1"c o INSTALLATION OF; Gird #,4<, + WATER TABLE: FINAL INSPECTION BY:..W3'VJ DRAWING OF INSTALLATION ON REVERSE SIDE : r.- *- - --t 2 . S4e.. (1:7 l /3 f d 1410.- 2-.s Fizz/ ✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF 1---/AW ititOCITH l4lpftratu n fur Disposal Earful dun tructiun ferntit Application is hereby made for a Permit to Construct ( ) or Repair (i. Individual Sewage Disposal System at:Act /0crw" 2, Z( av2'T" tub tion ddress or Lot Na -- gZi 7177 0 (../fl �ner I: .101C � G Address --_... Installer Address Type of Building Size Lot ......Sq. feet aDwelling—No. of Bedroom Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Buildin: No. of persons Showers ( ) — Cafeteria ( ) a Other fixtures Design Flow �_ gallons per person per day. Total daily flow .gallons. M Septic Tank—Liquid ca'',«ty . ...., lons Length Width Diameter Depth x Disposal Trench—No.. Wi., Total Length Total leaching area....................sq. ft. Seepage Pit No D .. ,eter Depth below inlet Total leaching area. -sq- ft. z Other Distribution box k ) II osing tank ( ) Percolation Test Results 'erformed ,y Date. Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water f=. Test Pit No. 2 minutes per inch Depth of Test Pit. Depth to ground water P4 O Description of Soil W ... UNature of Repairs or Alt tions—A swer when applicable/ 1._.,, 1 Al ,r2. F. --�e u.r..sw `X c.✓ _2,` Agreement: � The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued 1 y the and of health. Sign? -�� " -2 -/3 - C. e Application Approved By 41f. ----'� .......3//4-7 1 _d......... u Application Disapproved for the fol , 'ng reasons: Permit No 9°—5 5 ---. �� GN'C /6�... Issued.... 1 144k Date THE COMMONWEALTH OF MASSACHUSETTS t OARD OF HEALTH V a,Xi 1 OF ' /(Z-/lc v ri/ jx elrrtif tratr uf OIuntp1tana .- THIS IS TO C R FY, That the Individual Sewage Disposal System constructed ( ) or Repaired (j7( at....l.0....1rtlCiZy! CGL'2.7l.1/4.h71 1 has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as describ in the application for Disposal Works Construction Permit No ?'O"52.5 dated 3 ./(z;)-(-40 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL.FUNCTION SATISFACTORY. DATE Inspector