Loading...
HomeMy WebLinkAbout- Title V Inspection Report - 46 FOSTER STREET 10/3/2018 (3) ° TIGER ENVIRONMENTAL w ;, a„,46 ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: —'IG—E - u t `Y av Owner: f� "" trlmf ---- _ - Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup 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,settled,or uneven distribution 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 devefled-ar replaeed 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 placed obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: I I Cesspool or privy is within 50 feet of a surface water 1 Cesspool'orprivy is wittiin-50'foet of a bordefing'vegetated Wetland�ora salt marsh 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet of 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 Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. n TIGER EN11/16 ONdMEN1TAL ENGINEERING G 41 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: c :t< `..,kt.. a,. f`�..�c;rJBk '=, owner: 11t`�1(; ,. > �trl ...... Date of Inspection: D] SYSTEM FAILS: I have y one or more of the following failure criteria as defined in 310 CMR 15.303. The basis f determined nation sV a� dent f ep below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool Discharge or ponding of effluent 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 overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year LM due to clogged or obstructed pipe(s). Number of times pumped Any portion of the soil absorption system, cesspool or privy is below the high groundwater elevation. Any portion of a 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 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. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater(large system) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: The system is within 406 feet,of a surface drinking water supply. The system is within 200 feet of a tributary toia suface drinking water supply. The system is located in a nitrogen sensitive area (Interim Wellhead Protection Area{IWPA) or a mapped Zone II of a public water supply well). The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment. program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. The intent of 310 CMR 15.302 is to provide reasonable guidelines for the inspection of existing systems in as non-intrusive a manner as is possible to avoid damage to the system and any unnecessary disturbance of the surrounding soil area which is related to the treatment process. The inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be placed upon it by the new owner.The inspection criteria are intended to allow far timely inspection to avoid undue delay in the transfer of property. I understand that this report does not constitute a warranty or guarantee of future operation. Client or Representative ._.-..---_- Date Yi re ENTAL TIGER ENVIRONM ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: r�Jt�1 ' EA Owner: Date of Inspection: " Check If the following have been done: Pumping information was requested of the owner,^(occupant, and Board of Health. Done 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. t As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, 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 baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. The size and location of the soil absorption system on the site has been determined based on existing information or approximated by non-intrusive methods. rr` The facility owner(and occupants, if different';frorrr owner)were provided with information on the proper maintenance of subsurface disposal system.' 0 d l � TIGER ENVIRONMENTAL p wau ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: FLOW CONDITIONS g RESIDENTIAL: flow'Design gallons »� Number of bedrooms: 4,, Number of current residents: o Garbage grinder: (yes or no) 0C __ Laundry connected to system: (yes or no) Seasonal use: Yes or no ° -- -� y ", ..—".� ...". tdJ A'.� & '_,F/ p r meter reading r Water g� Last date of o cupancy: O Rz"� � r C __"1 ���w� ~. 1,� w�f:J COMMERCIAL/INDUSTRIAL: Type of establishment: ..__ __— Design flow: gallons/day Grease trap present: (yes or no) Industrial waste holding tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: -- - - Last date of occupancy: OTHER: (Describe) Last date of occupancy: ,, GENERAL INFORMATION _. _ � ,t''d`"�16.. , PUMPING RECORDS and source of information f ��,�,���,a��.Nw ..� System pumped as part of inspection: (yes or no) t..)e tm�1tro,� tit tjw �,. It yes, volume pumped: gallons Reason for pumping: - TYPE OF SYSTEM: Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool _ Privy tlo Shared system(yes or no) (if yes, attach previous records, if any) Other(explain) - .. p . " � urce of information: tAPPROXIMATEAGEofµal�com components, date installed if known) nds �p gastc, U o YIi F ( Y 4 TIGER ENVIRONMENTAL ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(con tin ued) Property Address: ©caner. j 4411AE .1c r.f _. Date of Inspection: ... -" f ` Sewage odors detected when arriving at the site: (yes or no) m>__ SEPTIC TANK: " (locate on site plan) Depth below grade: Material of construction: ti�concrete _metal _ PRP other(explain) Dimensions: �� � 0 Sludge deptt e or baffle: m tap of.,sa —Mudge to bottom of outlet te ) V j Scum thickne s: f Distance from p 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 inlet and outlet te�e..sry or affles..,e a de...p h of liquid level in relation�toWoutlet invert, structuralintegrity, e of leakage, ) m t t^ _ tµcr�r — tff n4 ., tt ;w q — m GREASE TRAP: _t'"��)�'� (locate on site plan) Dept below grade: Matterlial of construction: _—concrete _m� etal FRP other (explain) Dimensions: .. 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, etc.) - - 6 TIGER ENVIRONMENTAL J." ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ,:: 6 `°- . �.1 �� �1 1 ". Owner: Date of Inspection: TIGHT OR HOLDING TANK. '(locate on site plan) V } -Depth below grade: Material of construction: _.concrete __ _metal FRP ---,-.other (explain) Dimensions: Capacity: __ _gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOA: '"",S (A, (locate on site plan) Depth of liquid level above outlet invert: LqG r; G � u evidence of solids carry over, evidence of leakage into or out of box, etc.) level and distribution is equal evidence Comments: note f t t .� f f._ s 0E G� k � t 1 C.,a r".t � PUMP CHAMBER: 00 (locate on site plan) Pumps in working order: (yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) t 7 TIGER ENVIRONMENTAL ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: V'N " Owner: Date of Inspection: . ~ :�> SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible;excavation not required,but may be appfoximated:by non-intrusive methods) If not determined to be present, explain: Type. Leaching pits, number: Leaching chambers, number: Leaching galleries, number: Leaching trenches, number„ length: Leaching fields, number, dimensions: I .a. Overflow cesspool, number. Comm : (note condition of soil, signs of hydraulic failure level of ponding, condition of vegetation, etc.) < ��•. 0,! � ''> p Comments: 1A I Y, Wa � :rt , CESSPOOLS: IJ 0 (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: _ Depth of solids layer: Depth of scum layer; — Dimensions of cesspool Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part,of inspection);, Comments: (note condition of soil, signs of hydraulic 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 hydraulic failure, level of ponding,condition of vegetation, etc.) i „A 'TIGER ENVIRONMENTAL ENGINEERING 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,PART C SYSTEM INFORMATION(continued) 1 Property Address: Owner: Date of Inspection: ;_° SKETCH OF SEWAGE DISPOSAL,SYSTEM: Include ties to at least two permanent references, landmarks or,benchmarks Locate all wells within 1`00' . . . . . ,. I ..�.., r . . . q . . . . . . . �. . ...,., .,.,.. S � u . . . . . .... . « . . . . . . . . « . . « i . , . . . . . . k .i • r . . . . . . . . . . . . . . NQzA . . . . . . . .....,�,�...�...qw,.�„,.mom DEPTH TO GROUNDWATER: Depth to groundwater: .. - 10 feet Method of�determination or approximation: - --------PI —_ n