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HomeMy WebLinkAboutTitle V Inspection Report - 178 STONECLEAVE ROAD 4/26/1996 C rnr onwe offh of Mmsac hus ff Executive Office of Envir nn"ienfal Affairs Implaronmental Protection WHUM�nrorra F.Vft1d 4"F Cpl, 1 'rt,6'l�f Gf' i?`A( 1a4� T y Cosa FFI ��ao U Gavenwr f t°waan SUBSURFACE I!aVVAt"3 L1IlIatlt3.Ala ll 'I1"C jlCdEt`;"1"iCDtV p"0Im PART A y �. CERTIFICATION 61 c v1 P mperty Addr a. N °, ,57-°p rj vi e C:.1'e rt a)e, 0(9, tv✓ w a L e,r 1 � � m 4viroaa of Owner' Date of Aveo on: k/°2&/µ s r/a✓- 3 o�A 0 (if rA am rrt) N arno of Inca for % br o wt rG ("'O l `l l as Cornpan Narne,Address and Telephone Number. t ca r Dee— I k.1 5,"r"err, T a ar 4 'jq Ile w tiarIj/ e, and"1 I,.. t : " $ Xk-`/ ' 1 1 crertify that I have personally inspected the sewage diaaposal system at this addr'eaas and Unit the information reported]view is true, as ttrate and complete rta of the time of iwuap , ion. The inspection wns im fonned Imsed on my training and experience hit the prof r function and maintenance of on-site sewage disposal syst.enis. The eyntprn: °L passes Conditionally Pa,sseaa �� t to L��czt.l AP}'rrovir�a�Authority a ]oeds Further 1,vaaluaation 13y tl I'"atlsr / s! Iru aotor' tas r t" V DAt Tho 8yid'em 11topedor ra it aec 1, p systar:n is ar stern or has a deni n report of]0,0041 or M Authority t 1 in orw it uuj py of tlri t Approving,A ty withirn thirty(30)days od eowarlalaatira th:as rigs .ion. If the � � 'fin � �r~°eatmxr, the iars��a>da.or and the"*,;Win r^saai°elrrall�.rhrait tha report to the appropw to regional oboe of the Department of Environmental I'''rotection. The original should be sent to the system owner and copies sent to the buyer, if anpphcaahle sxrd the approving author°ity. INSPIXTION SUMMARY: Check DAB, C, or 11; A] SYSTEM PASSM: I have newt:found any information which indicates that the aystem violates Any of the failure criteria air define in 310 CMR 16.303, aSray failure criteria Hart avarlitaated aanaa tridicaCard below, 11) SYSTEM CONDITIONALLY PASSFA: One or more s y**m components need to be mplaeod or rapariiwL The system, upon Winpletion of the roplaeamont or repair, I xwes inspection. Indicate yes, no,or not datennined(Y, N, or ND). Describe Immis of determination in all inxtancoa. if"not(kgOr ",explain why rot) Thrr septic tank is tnertal, cracked,structurally unsound, ahows substantial infiltration or oxfiltration,.or tank fair is imminent. The system will pass ineperction if the existing)septic tank is replaced with a P,onfornring;septic tarok as approved by the 11oard of health. (rovi seal 11/03/95) 1 One VAnter Strom a Boston,mossachusefts 021013 a FAX(617)WW1049 0 Tolapkwie(617)292.3 Pr9nled on Rcc),led Papvr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART CERTIFICATION(continued) property Addrem 7 S10tj a G) e(A v e 0j. IVY )4w C'r Owner. V) , G a w fq Date of Inzpeotiom d a l- K� III SYSTEM CONDITIONALLY PASSES (continued) backup Sewage or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken ed or uneven dWxibution box. The system will pass inspection if(with approval of the Board of Health); broken pipe(s)are replaced obstruction is removed distribution box is lied or replaces ® 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ,14 Conditions exist which rsquiro firther evaluation by the Board of Health in order to determine if the system is failing to protect the public hs&W safety and the environment. I) SYSTEM WILL PASS UN1=S BOARD OF HEALTH DETERMINES THAT THE SYSTEM IB NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: C4xspool or privy is within 60 feet of a surface water Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh. 9) SYSTEM WILL FAIL Ulqj,8SS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETORMICNES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC; HEALTH SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zane I of a public water supply well. �. The system has a septic tank and soil absorption system and in within 60 feet of a private water supply well. system The has a septic tank and soil absorption system and is less than 100 feet but 60 feet or mom hvm a private water supply well,unless a well water analysis for coliform bacteria and volatile organk compounds indicates that the weU is fiw hvm pollution that beffity and the presence of ammonia nitrogen and nitrate nitrogen L equal to or less thin 6 ppm. 3) OTHER (revised 11/03/45) 2 SUBSURFACE SEWAGE DISPOSAL SYSTFM INSPECTION FORM PART A CERTIFICATION(continued) Property Addreaw 7 5/n'� v'tv 4 e J�A u e �d dL' � �r,do✓eY O"er. l.A A h j Date of I 'q . 4"9 J( /D, SYSTEM FAIM Ply r I that the systm violates or#or more of the following Wure criteri®am defined in 310 CMR 16.309. The bads for this detarmination is identMed below. The Board of Health should be contacted to determine what will be necessary to correct the failure, p of sewer Into ficcility or system component due to an overloaded or clogged SAS or cesspool. or pending of effluent to the surIkes of the ground or surface water,due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is leas than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(e). Number of times pumped .� Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. ® Any portion of a oesrpool 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 I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply yell. ® Any portion of a osoMml or privy is leas than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, a of well water analysis 1%r coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. F) LARGE SYSTEM FAIL; The following criteria apply to large systems in addition to the criteria above: The system serves a fimfifty with a design flow of 10,000 gpd or greater(Large System)and the system is a aigatficgurt threat to publk health and soft and the envbonment bwAuse one or more of the following conditions . the system is within 400 Awt of a surface drinking water supply ® the system is witbin 300 feet of a tributary to a surface drinking water supply ® the system is located in a nitrogen sensitive am (Interior Wellhead P (IWpA)or a mapped Zone lI of a public water VM*well) The owner or operator of any such system shall bring the systam and facility into full compliance with the SKwndwatar treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for Anther information, (revised 11/03/95) 9 i BUBSU"ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART$ CHECKLIST 179 5,PF®W e Jac,v e �� "V' Daft of Inspecum h — :z '10 Check if the fb have been done: Pumping hulbrination was requested of the owner, occupant, and Board of Health, None of the system oomponants have been pumped for at least two weeks and the system has been receiving normal flow rates during t period. Imv volumes of water have not been introduced into the system recently or as part of this inspection. (�As buM plane have been okind and examined. Note if they are not available with N/A. The ftdltty or dwelling was inspectwl for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow The site was inmpactW for sip,of breakout. All r sum oomponeats, excluding the Sail Absorption System, have been located on the site. )-The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of bafflas or material of oonstruction, dimensions,depth of liquid, depth of sludge, depth of scum. The and location of the Boil Absorption System on the site has been determined based on existing in—formation or approalmated by non-intrusive methods, The Wility owner(and occupants, if different from owner) were provided with information on the proper maintenance of sub- Surface Disposal Syxtem, (revised 11/03/95) 4 SUBSURFACE S AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM I TION Property A 7 �v vt L��co v e Igo(. '^ c"v-1° Date,of Inspection: FLOW CONDITIONS Nsign 11oa:79 Lffluons . Number of Number of current ts:AL G or no):_" Laundry connected to system or no):-g.6 Seasonal use(yes or no):_V Water mater readings,if available: A62 5 a 67 k.)ca Ter 5 t (' �r�uA mfr Vt t Last date of occupancy: y'+ t li i ^N r� l b L h Ouse- C011dlldF-RggALajMUSTR1AL Type of establishment: Design flow: ns/day Grease trap present: (yes or no)_ Industrial Waste Holding Wank present: (yes or no)_ Non-sanitary waste discharged to the Title b system: (yer or no)_ Water meter readings,if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INF'ORMA'TION PUMPING It ORDS and source of Lion; V—, System pumped Is part fins ion: (yes or no))4C6 If yes,volume pumped: long Reason for P►� upp� e l c.il wr F R © CR co-" (Of 7o cr C- Ic .40-pr (n o r Septic tankklistribution box/soil absorption system .� Single cesspool .�.� Privy w -� Shared system or no) (if yes,attach previous inspection records, if any) .® Other(explain) "PROM MATE AGE of all components,date installed(if known)and source of information: yl S�g PeSYSTer�I crQ 9 �` mlel Sewage odors detected when arriving at the site: (yes or no)�U (revised 11/03/95) 6 I SUBSURFACE SEWAGH DISPOSAL SYSTEM INSPECTION FORM PART C c SYSTEM INFORMATION(oontinued) Property Address: Date of InaptmUm 14 C TANW V (locate on site plan) Depth below f v7 Material of :, con — —F'RP—other(explain) Sludge depth: Distance from top of sledge to bottom of outlet tee or baffle: '- i y Beum thicknm:--y—iCL- Distance from top of scum to top of outlet tee or baffle: 61 Distance fiom bottom of scum to bottom of outlet tee or baffle: 7 IH• Comments: (recommendation for pumping ndition of inlet and outlet toes or baffles, d th of liquid level in relation to tlet invert, structural integrity, evidence of leakage,stc.) '4. ;E , C GREASE ® 4 1 � (locate on site plan) Depth below Material of —oonorete_ —F'RP®other(eaplain) Dimensions: Scum Dictance ftew top of scum to top of outlet tee or Dixtaww from bottom of scum to bottom of outlet too or e: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural in evidence of lealtage,aft.) (revised 11/03/95) SUBSURFACE t9 AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Imes Ad l 7�` $To i1)e eAea V e Vd . Owner W` Ca ca w's I Date of I N C/b SEPTIC T -_Y (locate on cube plan) Depth below Material of co _ ®FRP—other(explain) D L , _ � ' W1, .�,',° °. `� /duo Sal -r�.a/r Sludge iv,, Distance 4lvm top of sludge to bottoms of outlet tee or baffle: r r� Scum : y i At r Distance$rom top of scum to top of outlet tee or baffle: '1 Distance ftm bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation ibr pumping ndition of' et and outlet tees or baffles, d th of liquid level in relation too tlet invert,structural integrity, evidence of ,etc.) c� — . Co )r 414Q27 42-1 7 .'a k c° O E� (locate on Nita plan) 1 Depth below Material of —concrete— —FRP—other(axplain) Dimensions: Baum t ' Distance from top of scum to top of outlet tae or baffle:_ D of scum-to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet or baffiet, depth of liquid level in relation to outlet invert,etrudxuvl integrity, evidence of leakage,etc.) (revised 11/03/95) g ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYNTEM INMRMATION(continued) Property Ad v 4e G�C�i ✓e ROY, W. 4�,o/®��� Owner I Date of Inspection: TIGHT OR HOLDING T (locate on plan) � � ' Depth blow Material of construction:__ _ —F'F,P—other(explain) Dimensions: Capacity:---vallons Design flow:----------galloWday Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) 449--re- � PU -e L�1 CY �'D G� Ci��CY 1/D C(.y� CD l.°� T� "�0}� Dt�'d'RIIgU°CION T3OXs� (locate on mite plan) / Depth of liquid level alcove outlet invert: -/._+ ',� � ��be G! ®Ic� 6 0 -H o-4 � � p t�E,s o o r' -7,0 -•0" e-14P Comments: / (note if level and distribution is equal, dance f solids carryover, evidence of le into or out of bol, etc.) S t Y� ^ IV 1 1 Ar PA 1 ry PUMP C { (locate on site plan) pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,W-) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) r Date of Inspectiow t 5 MOIL ABSORPTION ffSTEM(SASZ (locate on site plan.if ; ovation not r0quIred,but WAY be aPPrutimated by non-intrusive ) If not determined to be present, Type: lathing Pits,number: lathing chambers, n lathing gellerise,number: lathing treaches, numberje : -J lathing Uds,number, uxions: overflow campool,number: Comments: (note oo n of ll, of hydraulic failure, 11 o ding, condition of ve do ,etc.) EI Vic' . Cr CESSPOOLS:_ (lute on site plan) �t Number and configuration: Depth-top of liquid to inlet invert: Depth of Aids layer. Depth of scum layer. Dimensions of ll Materials of n: Indication of inflow(ampool must be pumpsd as part of ins ion) Comments: (noto condition of soil,signs of hydraulic faliure, level of ponding,condition of vegetstion,etc.) PRIVY: (locate an rite plan) Materials of Dimensions: Depth of solids• Comments: (note condition of sail,signs of hydraulic fidlure, level of pending,condition of vegetation, (revised 11/03/95) b e SUBSURFACE SEWAGE D'S SAIL SYSTEM INSPECTION FORM PART C nINMR14ATION(continued) Prop,rtyAddrom (% � 7°c�vpfi e (���✓t? I Ica+ t /�C "r c 4 0 v�T Ovmer. NA,> l.Jl.Lt�'vl Cf 1 Date of E OF SEWAGE DISPOSAL SYSTEM: tim to at lftft two panuanent references landmarks or bianchmarks locate all wells within 100' /'Y O 0 0 a tl C7 d O O 0 O O a ® Q p v o o u v n o e) 0 0 0 v 0 l7 G O d.1 fJ p C7 C� 0 tl Cd O 4 c> v o O �s e G G U U G O u c? G b 'C ®� n D TO GROUNDWATER Depth to �wste f tiaa or tion: v v, O G w n 7�e�v° ✓ C' v L, K A /S u z°b(�rsn l.r i 1, 'Y V Ti w �yf Pe wi . (revised 11/03/95) 9 SEPTIC YNSPE "TIO DA'FE"> . ADDRESS: � On the above date and time, I made a visual inspection of the septic system at the above-referenced property. Based upon my visual inspection, I certify that the septic was in proper working order as of the date and time of the inspection. This certification does not constitute a guaranty nor warrant and because of the age and unpredictable characteristics of the septic system, it is not to be interpreted as insuring that the system will continue to be in working order for any future period of time, no matter how brief. Owner further agrees to indemnify and hold harrn.less inspecting company from any liability and costs incurred from the result of any third party reliance 1.1pon information provided, Acknowledged by: � ) /� � Y'S 7 �r A A j R, mond N. Lepore _,._... l~ EE RAY, INC, 5 Allenhurst Way Wilmington, MAC 01887 r f